615 / 1096
S599
ESTRO 36
_______________________________________________________________________________________________
2. Ang KK et al. Impact of Epidermal Growth Factor
Receptor Expression on Survival and Pattern of Relapse in
Patients with Advanced Head and Neck Carcinoma.
Canc
Res.
2002;(713):7350.
EP-1089 Prospective study of body composition
changes during IMRT for H&N cancer as assessed
by DXA scans
J. Johansen
1
, A. Hermann
2
, S. Lønbro
3
1
Odense University Hospital, Oncology, Odense, Denmark
2
Odense University Hospital, Dept. of Endocrinology,
Odense, Denmark
3
Aarhus University, Dept. of Public Health- Section for
Sport Science, Aarhus, Denmark
Purpose or Objective
Weight loss is common after radiation treatment of head
and neck cancer (H&N) as assessed by only pre/post
measurements. Thus, only scarce data exists regarding
body changes during overall treatment time. This study
investigated changes in weight and body composition of
H&N patients during radical radiation treatment, and
correlated the findings to individual tests of muscle
strength.
Material and Methods
Prospective study of 30 H&N patients undergoing IMRT (60-
68 Gy) during a 16 month period. Patients were followed
weekly during treatment, and all had individualized
nutritional counseling. At baseline, and with 2-week
intervals during IMRT and 2 weeks after, patients
underwent whole-body dual-energy X-ray absoptiometry
(DXA) scans, as well as weight measurements and pre/post
treatment maximal muscle strength tests (n=21)(one-
repetition maximum chest press, leg press, and knee
extension). Changes over time were analyzed by linear
regression, and pre/post data were compared by Student’s
paired t-tests.
Results
A total of 131 DXA scans were obtained. Mean age was
58.2, and the patients were predominantly stage II-IV
(77%). Two-thirds received concomitant chemotherapy.
Baseline BMI was 27.4 (± 4.8). Significant overall declines
(p<0.001) were observed in weight (-8.2%; range +2.0 to -
18.4), fat mass (10.3%; range +2.4 to -29.1), and lean body
mass (10.7%; range +0.8 to -23.9). All changes were
mutually correlated in regression analysis, e.g., R
2
=0.74
(p<0.001) for weight loss versus lean body mass. The
decline in lean body mass was correlated with loss of
muscle strength as assessed by chest press (R
2
=0.61;
p<0.001) and knee extension (R
2
=0.25; p=0.03), but not
with leg press (p=.08). Concomitant chemoradiation was
associated with a 10% decline in lean body mass in
univariate analysis, however, no independent predictors
were discerned in multivariate regression.
Conclusion
The overall weight loss during IMRT for H&N was 8.2%.
Weight loss correlated proportionally with the percentage
decline in both fat mass and lean body mass. Loss of lean
body mass correlated well with loss of muscle strength
during treatment. The proportional loss of fat and lean
body mass indicates that physical exercise during
radiotherapy may be required to favor muscle/fat
distribution.
EP-1090 Particle therapy and IMRT for patients with
esthesioneuroblastoma: a single-institution experience
J. Liermann
1
, M. Syed
1
, D. Bernhardt
1
, N. Bougatf
2
, S.B.
Harrabi
1
, A. Paul
1
, T. Sprave
1
, S. Rieken
1
, T. Haberer
2
, K.
Herfarth
1
, J. Debus
1
, H. Hauswald
1
, S. Adeberg
1
1
University Hospital of Heidelberg, Department of
Radiation Oncology, Heidelberg, Germany
2
University Hospital of Heidelberg, Heidelberg Ion-Beam
Therapy Center HIT, Heidelberg, Germany
Purpose or Objective
Esthesioneuroblastoma or olfactory neuroblastoma is a
rare tumor entity originating from the olfactory
neuroepithelium. There is only few data about the
efficacy of different treatment strategies so far. Several
approaches have been made and a combination of
radiation and surgery is thought to be effective. Most
tumors are situated in the nasal cavity and thus applied
radiation therapy (RT) should be very precise. Intensity
modulated radiotherapy (IMRT) and carbon ion
radiotherapy (CIRT) are highly precise techniques with
advanced dose conformity and improved sparing of organs
at risk which might translate into improved local control
and moderate radiation induced toxicity.
Material and Methods
The retrospective analysis contained 17 patients with
esthesioneuroblastoma (Kadish stage ≥ C: 88%; n=15). 4
patients initially presented with cervical lymph node
metastasis and 4 patients already underwent a previous
RT. The treatment consisted of either IMRT (n=5) or CIRT
(n=4) or a combination of both techniques (n=8). Applied
median doses were 60 Gy in 30 fractions (IMRT only), 51
Gy (RBE) in 17 fractions (CIRT only) and 52 Gy in 26
fractions as well as 21 Gy (RBE) in 7 fractions (bimodal
RT). Overall survival and local control rates were
determined after a median follow-up of 8 months (range:
2-72 months). Acute toxicity was evaluated up to three
months after completion of the radiotherapy according to
CTCAE criteria (Version 4.03).
Results
Local recurrence-free survival and overall survival rates
were 90% after a follow-up of 6 months (n=9/10) and 86%
after a follow-up of 12 months (n=6/7). One patient died
5 months after the treatment. Local recurrence occurred
in another patient after 36 months who died 26 months
later. Both of these patients belonged to the group who
underwent a previous RT before. 15 of 17 patients (88%)
are still alive and recurrence-free so far. Grade I toxicity
(100%; n=17) and grade II toxicity (65%; n=11) were
frequently observed. The most common toxicities were
nasal and/or oral mucositis (76%; n=13) and radiation
dermatitis (82%; n=14). Only one patient (6%; n=1)
developed a grade III toxicity (hyposmia).
Conclusion
Considering the advanced tumor stage of the cohort the
results showed good local control and overall survival rates
in short term follow-ups. Our results show that IMRT, CIRT
or a combined approach seem to be a feasible and
effective treatment in esthesioneuroblastoma without
leading to severe acute treatment-related side effects.
Further follow-up will be needed to investigate the
benefit of CIRT.
EP-1091 Low dose fractionated RT in association to
TPF as induction therapy in advanced head and neck
cancer
R. Autorino
1
, M. Massaccesi
1
, A. Pesce
1
, M. Balducci
1
, N.
Di Napoli
1
, T. Tartaglione
2
, V. Rufini
3
, F. Bussu
4
, J. Galli
4
,
S. Chiesa
1
, G. Paludetti
4
, V. Valentini
1
, F. Miccichè
1
1
Polyclinic University A. Gemelli- Catholic University,
Institute of Radiotherapy, Rome, Italy
2
Polyclinic University A. Gemelli- Catholic University,
Institute of Radiology, Rome, Italy
3
Polyclinic University A. Gemelli- Catholic University,
Institute of Nuclear Medicine, Rome, Italy
4
Polyclinic University A. Gemelli- Catholic University,
Institute of Otorhinolaryngology, Rome, Italy
Purpose or Objective
To analyze the efficacy and the feasibility of induction
chemotherapy (ICT) with low-dose radiotherapy (LDR)
compared to ICT alone prior to chemoradiation (CRT) in
locally advanced head and neck squamous cell carcinoma.