ESTRO 36 Abstract Book

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S600 ESTRO 36
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Material and Methods
Between September 2008 and May 2012, 59 patients, with
locally advanced stage III and IV squamous cell carcinoma
of head & neck cancer, received three courses of induction
chemotherapy with docetaxel (75 mg/mq), cisplatin (75
mg/mq) and 5-fluoruracil (750 mg/mq/day on days 1-5)
followed by radiotherapy plus two or three cycles of
concurrent cisplatin 100 mg/mq (Group A). Twenty-nine
of this patients received low dose radiotherapy
concomitantly to induction chemotherapy (Group B).
Treatment courses, hematological data and other
parameters were also investigated.
Results
Three cycles of ICT were administered in all patients: only
one (Group B) received two cycle because of high
hematological toxicity. After neoadjuvant therapy
completation, clinical tumor response was observed in 49
patients (83%); patients undergone low dose radiotherapy
showed better complete remission (p=0.08). Grade > 3
toxicity with dose reduction occurred in 5 patients (8%).
Median time from the final cycle of TPF to starting
radiotherapy was 21 days. All patients received radical
radiotherapy; one, two and three cycles of concurrent
cisplatin was delivered in 0 (0.0%), 17 (58.6%), 10 (41.4%)
patients of Group A and 1 (3.5%), 28 (96.5%), 0 (0.0%)
patients of Group B, respectively. With a median follow-
up of 28 months (range 2-58), one-year local control was
66% and 81% for Group A and Group B, respectively
(p=0.05). No difference was observed in terms of overall
survival and disease free-survival between the two groups
(p=0.9 and 0.8). Toxicity during chemo-radiation was
acceptable in both groups without difference, specially,
in terms of hematological toxicity (p=0.76). But we found
a correlation between hematological toxicity > G3 and
local control (p=0.03).
Conclusion
Low dose radiotherapy in association with ICT prior to
CRT, even if it is not the standard, could be considered
tolerable, with encouraging efficacy in terms of response
and local control, in locally advanced head and neck
squamous cell carcinoma. Further investigation is
warrented to confirm these data.
EP-1092 Perioperative high dose rate brachytherapy
in previously irradiated head and neck cancer: Results
M.I. Martinez Fernandez1 , M. Cambeiro1, J. Alcalde 2, R.
Martínez-Monge1
1 Clinica Universitaria de Navarra, Departament of
Oncology, Pamplona, Spain
2 Clinica Universitaria de Navarra, Departament of
Otolaryngology, Pamplona, Spain
Purpose or Objective
This study was undertaken to determine the feasibility of
salvage surgery and perioperative high dose rate
brachytherapy (PHDRB) in patients with previously
irradiated, recurrent head and neck cancer or second
primary tumors arising in a previously irradiated field.
Material and Methods
Sixty-three patients were treated with surgical resection
and perioperative high dose rate brachytherapy (PHDRB).
The PHDRB dose was 4 Gy b.i.d. x 8 (32 Gy) for R0
resections (surgical margins equal to or greater than 10
mm) and 4 Gy b.i.d x 10 (40 Gy) for R1 resections (close or
microscopically positive surgical margins, or the presence
of extra- capsular nodal extension), respectively. Further
external beam radiotherapy or chemotherapy was not
given.
Results
Resections were categorized as R0 in 7 patients (11.1%)
and R1 in 56 patients (88.9%). Thirty-four patients with R1
resections (54.0%) had microscopically positive margins,
and 22 patients (34.9%) had close margins. Thirty-two
patients (50.8%) developed RTOG grade 3 or greater
adverse events including 3 fatal events. After a median
follow-up of 6.8 years, the 5-year locoregional control rate
and 5-year overall survival rates were 55.0% and 35.6%,
respectively.
Conclusion
Surgical resection and PHDRB is a successful treatment
strategy in selected patients with previously irradiated
head and neck cancer. Long-term locoregional control can
be achieved in a substantial number of cases despite a high
rate of inadequate surgical resections although at the
expense of substantial toxicity.
EP-1093 Hypofractioned robotic stereotactic
radiotherapy of Head and neck Paragangliomas
F. Meniai-Merzouki1, B. Coche-Dequeant 1, E. Bogart2, T.
Lacornerie3, X. Mirabel1, E. Lartigau1,4, D. Pasquier1,5
1Centre Oscar Lambret, Radiation oncology, Lille, France
2Centre Oscar Lambret, Biostatistics departement, Lille,
France
3Centre Oscar Lambret, Medical Physics, Lille, France
4Cristal Cnrs, Umr 9181, Villeneuve D'ascq, France
5Cristal Cnrs, UMR 9181, Villeneuve d'Ascq, France
Purpose or Objective
The aim of this study was to evaluate the outcomes of
hypofractionated robotic stereotactic
radiotherapy for paraganglioma (PGL) of the head and
neck region
Material and Methods
We retrospectively studied 10 patients with benign head
and neck PGL(s), treated with robotic hRST using
Cyberknife at Oscar Lambert center between December
2008 and November 2012. Three of these patients were
diagnosed with recurrent tumors after surgery. The
median time to recurrence after surgery was 42 months.
None of them was embolised before radiotherapy. The
median follow-up was 49,2 months (range: 3-80,4
months).
Results
Eight patients presented with jugular-bulb PGL, 1 patient
with jugular-carotid body PGL and 1 patient with cerebral
posterior fossa PGL. The female/male ratio was 4/1. The
median tumor volume was 12,91 cm3 (range: 0,89-
141,51). The median dose was 36 Gy (range: 21-40). The
median number of fractions was 9 (range: 3-10).The tumor
growth and clinical outcome were evaluated every 6
months in the 2 years and then annually. The 1 and 3 year
freedom from disease progression was 100% and 88%
respectively. PGLs were stable in 8 patients, and partial
response was observed in 2 patients. No toxicity was
observed.
Conclusion
According to our early experience, robotic stereotactic
radiotherapy with Cyberknife seems to be successful
treatment option in management of head and neck PGL
EP-1094 Transoral Laser Microsurgery associated to
Radiotherapy in advanced laryngeal carcinomas.
I. Nieto Regueira1, V. Ochagavia2, A. Nuñez2, C. Ponte2, V.
Muñoz2
1Hospital do Meixoeiro. Complejo Hospitalario
Universitario de Vigo, Radiation Oncology, Vigo, Spain
2Hospital do Meixoeiro. CHUVI, Radiation Oncology, Vigo,
Spain
Purpose or Objective
Transoral Laser Microsurgery is a surgical option treatment
that seems to have similar results to radiotherapy with or
without chemotherapy and offers similar outcomes in local
control and survival compared with open surgery,
preserving the larynx and its function.