ESTRO 2020 Abstract Book

S32 ESTRO 2020

PD-0073 Outcomes in patients aged 70 and above treated with radical radiotherapy for head and neck cancer L. Hay 1 , S. Borgaonkar 2 , P. McLoone 3 , A. James 2 , D. Grose 2 , C. Wilson 2 , C. Lamb 2 , S. Schipani 2 , M. Thomson 1 , C. Paterson 2 1 The Beatson West of Scotland Cancer Centre, Radiotherapy, Glasgow, United Kingdom ; 2 The Beatson West of Scotland Cancer Centre, Oncology, Glasgow, United Kingdom ; 3 University of Glasgow, Institute of Health & Wellbeing, Glasgow, United Kingdom Purpose or Objective Radical radiotherapy (RT) for head and neck (H&N) cancer results in significant acute and late toxicity. In our current practice we review performance status and co-morbidities when evaluating patients’ suitability for radical treatment. However, the use of a formal geriatric or frailty assessment tool is increasingly being indicated as a potential method in assessing older patient’s fitness. This review was prompted to assess carefully selected elderly patient’s tolerance to radical RT to the H&N. Material and Methods Patient information was gained from the department’s RT database and the trusts clinical record system. Descriptive statistics were generated using 148 patients were retrospectively reviewed, aged 70 or above. Patients had received radical radiotherapy to the H&N – either as primary or adjuvant treatment between January 2012 and August 2015. Patient characteristics, treatment details and compliance are displayed in table 1. 140 (95%) patients completed their RT course, although 72 (49%) patients were admitted to hospital within 6 months of completing RT. The mean number of days spent in hospital was 12 (SD 24). 108 (73%) patients were able to continue living in their own home at 12 months post RT. 60 (41%) patients experienced a relapse of their H&N disease. The mean number of days to relapse was 373 (SD 369). 29 relapses were loco-regional and 31 were distal. Of the patients with loco-regional relapse 3 underwent salvage surgery. 59 (40%) patients died within 2 years of completing RT. 45 (76%) died as a result of their cancer diagnosis while the remaining 14 (23%) died due to other causes. Median patient survival for all patients was 38 months (95% CI 27.2-45.5 months). Patient survival was stratified by age; median survival of 28.9 months (95%CI 18.8 to 39.3) for the 70 to 75 years group and 45.1 months (95%CI 32.7 to 53.2) for those greater than 75 years. Table 2 displays patient’s median survival by treated sub- site. Patients with hypopharyngeal SCC had a short median survival, in keeping with the recognised poor prognosis in this sub-site. A careful assessment must be made in these patients in particular, balancing the toxicity and general impact of treatment with the small likelihood of long term disease control despite a radical approach. STATA. Results

developed through collaboration between physicians, physicists and RTTs. Our TLP used the following criteria: possible tumour progression, tumour regression, baseline shift, pleural effusion, atelectasis, and pneumonia. For these criteria, frequency and follow-up action (i.e. no action required, new CT or plan adaptation) were scored.

Results ITACs were observed in 43% of treatments and in 47% of patients. Out of all ITACs recorded, the majority (96%) were graded as a yellow action level, and only 4 % were graded as red action level (Table 2). ITACs regarding tumour regression (R3) were most often reported, but never led to plan adaptation due to local policy of not adapting the treatment to tumor response. For the total of graded ITACs (i.e. non green), the majority (86%) did not require any further action after investigation; in 5 cases (10% of the ITACs) a new CT scan was made; in 2 cases (4% of the ITACs) a plan adaptation was required due to possible tumor progression (GTV out of PTV; R2) or baseline shift (GTV out of PTV; R5) (Figure 2).

The results show that our TLP is effective and adequate for identifying patients in need of adaptive re-planning. The data obtained further supports the findings of Hattu et al. regarding the workload decrease as the criteria presented in figure 2 did not led to any false alert, hence no protocol adaptation was needed. A secondary analysis limited to primary lung cancer (i.e. excluding patients treated for lung metastases) would be interesting to determine the potential pattern linking set- up time (time from 1st CBCT to beam delivery) to ITAC grade for SBRT treatments vs non-SBRT treatments. Conclusion Our TLP has been proven effective for identifying patients requiring an adaptive re-planning. The data obtained support that there is no need for a protocol modification because no false alerts were found, and so no changes in workload are proposed.