ESTRO 36 Abstract Book

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S595 ESTRO 36
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histologically classified as squamous cells carcinoma. At
the time of the diagnosis, 86.8% of the patients had stage
IV disease.
Mean Karnofksy Performance Status (KPS) was 68%.
RT palliative schemes chosen were 50Gy delivered in 20
fractions during 4 weeks (50Gy/20fr/4w) in 35% of our
patients, 30Gy/10fr/2w in 32%, 37.5Gy/15fr/3w in 18.9%
and 40Gy/20fr/4w in 13.2% of our patients.
After the analysis of cervical and chest CT, 61.2% of the
patients had partial response while 10.2% had complete
imagiologic response, 18.4% had imagiologic progression
and 8.2% had stabilised disease.
After a mean follow-up period of 27.2 months (±8,3),
overall survival was 9.55 months (±9,3).
The group with better tumor response on CT was the group
that underwent for the 50Gy/20fr/4w scheme (in which
89.4% had partial/complete response) with no need for
interruption of the treatment due to toxicity. The group
with longer overall survival was the group that underwent
for the 30Gy/10fr/2w (11.8 months) and the shortest
overall survival was verified after the 37.5Gy/15fr/3w
scheme (5.2 months). Despite these results, there were no
statistically significant differences between the four RT
schemes delivered to our patients and overall survival
(p=0.41).
Patients who had better tumor response on CT (partial or
complete response) had longer overall survival comparing
to patients who had stabilised disease or progression (11.6
months vs. 6.65 months; p=0,011).
Conclusion
There is no consensus regarding the choice of the optimal
RT fractionation scheme used in palliative care of H&N
cancer patients and careful patient selection. Patients
with advanced incurable H&N cancer have a poor
prognosis but the addition of palliative RT provides better
local-regional control of the disease with the possibility of
longer survival rates. More studies should be carried out in
order to evaluate predictive factors of tumor response as
a mean of improving patient’s outcomes and quality of
life.
EP-1082 Primary surgery vs. radiotherapy in early-
stage oropharyngeal cancer: a single centre experience
C. Pedro1, B. Mira2 , P. Silva1, E. Netto3, R. Pocinho 1, A.
Mota 1, P. Pereira1, M. Ferreira2, T. Alexandre2, I.
Sargento2, P. Montalvão4, M. Magalhães4, S. Esteves5, F.
Santos 1
1 Instituto Português de Oncologia de Lisboa Francisco
Gentil- EPE, Radiotherapy Department, Lisboa, Portugal
2 Instituto Português de Oncologia de Lisboa Francisco
Gentil- EPE, Oncology Department, Lisboa, Portugal
3 NOVA Medical School UNL, Radiation Oncology, Lisboa,
Portugal
4 Instituto Português de Oncologia de Lisboa Francisco
Gentil- EPE, Otorhinolaryngology Department, Lisboa,
Portugal
5Instituto Português de Oncologia de Lisboa Francisco
Gentil- EPE, Clinical Research Unit, Lisboa, Portugal
Purpose or Objective
To review the outcomes of early-stage oropharyngeal
squamous cell carcinoma (OSCC) submitted to primary
surgery or primary radiotherapy (RT).
Material and Methods
Retrospective study of patients diagnosed with OSCC
between January 2009 and December 2014, clinically
staged cT1 to cT2 cN0/cN1, who underwent primary
surgery or primary RT. Cases surgically upstaged were
excluded. We analyzed patient charts, imaging and
clinical data regarding primary therapy, adjuvant
treatment and side effects. Toxicity was graded according
to Common Terminology Criteria for Adverse Events
(v4.0). Overall survival (OS) and progression-free survival
(PFS) were analyzed using the Kaplan-Meier method and
log-rank test for group comparison. Time-to-event
endpoints were calculated from the date of first
treatment.
Results
We found 61 patients with cT1 to cT2 cN0/cN1 OSCC
treated with primary surgery or primary RT. Ten were
excluded after surgical upstage. From the remaining 51,
45 were male, with a median age of 56 years. The majority
was treated with surgical resection (n=35), followed by RT
(n=30) with or without (n=21) chemotherapy (high-dose
cisplatin), due to positive (n=9), close (<5mm, n=20) or
non-evaluable (n=3) margins. Sixteen were submitted to
primary RT, with or without (n=13) concomitant
chemotherapy. Disease was in stage I in 10 patients, stage
II in 24 and stage III in 17. Patients were treated with IMRT
using simultaneous integrated boost (n=33) or 3D-CRT.
Prescribed dose was 60-70Gy to the high-risk PTV and 50-
54Gy to the low/intermediate-risk PTV.
Median follow-up time in patients alive was 5 years. Three
patients had tumor persistence, 4 had local failure and no
one developed distant metastasis. In both groups, median
OS and PFS were not reached. In the primary surgery
group, 3-year and 5-year OS were 80% and 62%, and 3-year
and 5-year PFS were 74% and 50%, respectively. In the
primary RT group, both 3-year and 5-year OS were 81%,
and 3-year and 5-year PFS were 81% and 70%, respectively.
There was no significant difference in the two groups (OS
p value = 0,4; PFS p value = 0,3). Acute grade 3 toxicity
was reported by 15 patients (mucositis, dysphagia,
dermatitis, xerostomia). Late side effects were grade 1
xerostomia (n=10) and mandibular osteoradionecrosis
(ORN, n=6). ORN occurred in patients submitted to
primary (n=3) or adjuvant RT, who had been given 66-70Gy
with 3D-CRT (n=4) or concomitant cisplatin (n=2).
Fourteen died due to disease progression (n=3), treatment
complications (sepsis, n=1) or other unrelated causes.
Conclusion
In our study, there was no significant difference in the OS
and PFS between primary surgery vs. primary RT. Although
surgery was the most frequent primary approach, almost
all patients required adjuvant treatment due to close
margins. Our toxicity profile reminds us that careful
patient selection is necessary as well as further surgical
margins studies are warranted to identify subgroups where
treatments can be safely avoided.
EP-1083 HPV as an etiological and prognostic factor
for the Polish patients with HNC.
A. Brewczyński1, T. Rutkowski2, A. Mazurek 3, M.
Snietura4, Z. Kołosza5, A. Wygoda2, K. Składowski2, A.
Celejewska1, E. Małusecka3, A. Fiszer-Kierzkowska3, U.
Bojko3, W. Pigłowski4, A. Hajduk2, P. Polanowski2, U.
Dworzecka2, I. Gawron2, M. Kentnowski2, B. Pilecki2, T.
Stępień 2, I. Domińczyk2, E. Nadolska 2, A. Tatar2, P.