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ESTRO 36
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EP-1071 Organ-sparing SBRT in reirradiation of head
and neck cancer: efficacy, toxicity, and quality of life
I. Zhang
1
, G. Gill
1
, M. Marrero
1
, A. Sharma
1
, A. Riegel
1
, D.
Paul
2
, J. Knisely
1
, S. Teckie
1
, M. Ghaly
1
1
North Shore LIJ Health System, Radiation Medicine, New
Hyde Park, USA
2
North Shore LIJ Health System, Medical Oncology, New
Hyde Park, USA
Purpose or Objective
To present a retrospective analysis of the efficacy,
toxicity, and quality of life (QOL) of patients treated with
organ-at-risk (OAR)-sparing salvage stereotactic body
radiotherapy (SBRT) in previously-irradiated head and
neck cancer.
Material and Methods
From November 2012 to July 2015, 60 patients with in-
field recurrence of head and neck cancer underwent
reirradiation with OAR-sparing SBRT at our institution.
OARs were defined as critical structures that had
approached their radiation tolerances after prior
irradiation and had a high potential to impair QOL if
damaged with re-irradiation. Intact tumors were
prescribed 40 Gy while 35 Gy was prescribed for post-
operative treatments. Doses previously received by the
OARs were estimated by deformably registering the prior
treatment plan onto the new simulation CT to more
accurately delineate dose distributions (Figure 1: Prior
plan overlying the new planning CT without (top) and with
(bottom) deformable registration). Dose constraints for
SBRT were calculated with a biological equivalent dose
(BED) using an alpha/beta ratio of 3 to reduce the risk of
late toxicities. Treatments were delivered twice a week
for a total of 5 fractions via image-guided volumetric arc
therapy with the OAR as the fusion surrogate. Quality of
life (QOL) data was collected at consultation and follow
up using the MD Anderson Dysphagia Inventory (MDADI),
Symptom Inventory – Head and Neck Module (MDASI-HN),
and Xerostomia Questionnaire. Local control and overall
survival were estimated using the Kaplan-Meier method.
Results
Sixty patients were treated to 69 sites (9 for a second
metachronous failure). Thirty two patients underwent
surgical salvage prior to SBRT. Retreatment sites included
the aerodigestive tract (43%), lateral neck (22%), and skull
base (35%). The median prior radiotherapy dose was 63.6
Gy and the median reirradiation planning target volume
(PTV) was 61.0 cm
3
(range 16.8 to 349 cm
3
). Despite
prioritizing OAR-sparing over PTV coverage, the median
V90 was 98.4% and D90 was 99.0%. The 1- and 2- year rates
of local control were both 54%. Median survival was 18.5
months after SBRT. Late grade 3 toxicities occurred in 3%
of the aerodigestive tract group, 1% of the skull base
group, and none treated to the lateral neck. No grade 4 or
5 toxicities were observed. Compared to baseline,
patients with skull base reirradiation maintained a stable
QOL, while patients treated to the aerodigestive tract
demonstrated decreased QOL associated with worsening
dysphagia. All groups experienced increased xerostomia.
Conclusion
OAR-sparing SBRT is able to achieve excellent tumor
coverage while protecting the organs at highest risk of
reirradiation-related complications. Compared to
conventional fractionation, the potential for lowered
toxicity and maintained QOL makes SBRT a promising
salvage option for recurrent head and neck cancer.
Further, prioritizing OARs preserves a treatment option for
repeat reirradiation in patients who develop a second in-
field
tumor recurrence.
EP-1072 Early nutritional support in head and neck:
survey of Italian radiation
oncologists/otolaryngologists.
M. Trignani
1
, A. Allajbej
1
, A. Di Pilla
1
, M. Nuzzo
1
, S. Di
Biase
1
, M. Di Perna
1
, A. Croce
2
, M. Di Nicola
3
, I. Porfilio
3
,
D. Genovesi
1
1
Ospedale Clinicizzato S.S. Annunziata, Radiotherapy,
Chieti, Italy
2
Otolaryngology, Otolaryngology, Chieti, Italy
3
Preventive Medicine and Hygiene, Biomedical Science,
Chieti, Italy
Purpose or Objective
The aim of this study was to evaluate the most common
approaches among Italian radiation oncologists (RO) and
otolaryngologists (OL) in early nutritional management of
head and neck (H&N) cancer patients. Type of nutritional
supplements prophylactically used, timing and criteria of
percutaneous endoscopic gastrostomy placement (PEG)
and role of nutritional counseling were investigated.
Material and Methods
A questionnaire, focused on different points of nutritional
management in H&N cancer patients, was created and
approved by a multidisciplinary team (MDT) including RO,
OL and nutritionists. The survey, containing 10 multiple-
choice questions, was prepared on SurveyMonkey online
interface and emailed to 106 Italian centers of radiation
oncology and 100 centers of otolaryngology. Responses
were collected over a 2-month period. Descriptive
analyses in terms of frequencies and percentages was
automatically elaborated by SurveyMonkey. Chi-square
test was performed to establish any significant difference
between interviewed.
Results
A total of 67/106 and 27/100 questionnaires sent to Italian
centers of Radiation Oncology and Otorhinolaryngology
were filled in, corresponding to a response rate of 63.2%
and of 27% respectively. Respondents answered all
questions, so all were included in the analysis. Regarding
nutritional counseling before starting treatment, 53.7% of
RO claimed to make it rarely, while 26.9% always; 33.3%
of OL affirmed to practice a preventive nutritional
counseling rarely, 29.6% always and 22.2% almost always.