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6th ICHNO
6
th
ICHNO Conference
International Conference on innovative approaches in Head and Neck Oncology
16 – 18 March 2017
Barcelona, Spain
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SP-016 the value of proton therapy for head and neck
malignancies: reducing side effects and improving
outcomes
P. Blanchard
1
, S.J. Frank
1
1
The University of Texas MD Anderson Cancer Center,
Radiation Oncology, Houston, USA
Abstract text
Due to the close vicinity between target volumes and
several critical organ structures, head and neck cancer
radiotherapy is associated with multiple severe acute and
late toxicities. The improved survival in contemporary
patients has shed light over the potentially devastating
chronic complications that affect increasing numbers of
patients. Intensity modulated external-beam photon
radiation therapy (IMRT) allowed to spare some critical
structures, thereby reducing xerostomia and improving
patient reported outcomes (PRO) compared to traditional
2D/3D radiotherapy. However dose reduction to specified
structures during IMRT was associated with an increased
beam path dose to alternate non-target structures,
resulting in clinical toxicities that were uncommon with
previous approaches.
The physical advantage of proton beam therapy is its sharp
increase in dose deposited at the end of the particle
range, i.e. the Bragg peak, avoiding any exit dose beyond
the target and reducing the integral dose delivered.
Dosimetric comparisons between intensity-modulated
proton therapy (IMPT) and IMRT have consistently shown
that IMPT allowed a better sparing of normal tissues while
maintaining dose to target volumes. Clinical reports have
suggested improved swallowing and taste function,
reduced need for acute and long-term feeding tube
requirements, decreased rates of severe weight loss and
malnutrition or reduced rates of osteoradionecrosis, for
example. Some studies have even suggested that the
physical and biological properties of proton therapy could
result in improved survival in selected tumor types, such
as sinonasal malignancies. The magnitude of the expected
reduction in toxicity has been estimated using normal
tissue complication probability models (NTCP) and the use
of these models has been advocated to select the patients
that will benefit the most from proton therapy compared
to
IMRT.
The aim of this presentation is to demonstrate how proton
therapy could increase the therapeutic ratio in head and
neck cancer. We will 1) introduce basic physics and
dosimetry data; 2) discuss the clinical data published so
far; 3) address the issue of patient selection for IMPT; 4)
discuss the current limitations of proton therapy regarding
physical and biological uncertainties, as well as cost
effectiveness; and 5) discuss how to objectively evaluate
the value of proton therapy in the treatment of head and
neck cancers.
Keynote lecture
SP-017 New imaging techniques
R. Maroldi
1
1
University of Brescia, Radiology, Brescia, Italy
Abstract text
As chemo-radiation therapy is increasingly applied to head
and neck cancer, there is a growing need to develop non-
invasive surrogate-biomarkers to predict and assess the
response to a non-surgical treatment. Therefore, imaging
techniques exploring tumor properties other from CT
density, T2-T1 weighting or the single-phase "static"
enhancement pattern - have been devised. These
"functional techniques" aim at targeting tumor micro-
architecture (DWI), perfusion (DCE-MR) and heterogeneity
(texture analysis). Researches on DWI showed that a high
degree of restriction of water diffusion (low ADC)
correlates with increased cellular density and
extracellular space, a typical feature of neoplasms. DWI
researches points to high pre-treatment mean ADC and a
low increment in ADC early intra-treatment being
indicators of poor outcome. CT and MR perfusion
techniques have been developed to investigate the
changes induced by neo-angiogenesis in the
microcirculation of tumor. This has been accomplished by
analysis of the kinetics of the passage through the tissues
of a bolus of contrast agent (DCE-CT, DCE-MR) or of an
endogenous bolus (blood, ASL-MR perfusion). Presently,
most of the medical literature on perfusion analysis
encompasses pilot studies only. Nevertheless, one
emerging finding is that neoplasms showing great
heterogeneity of a parameter like Ktrans are associated to
a poorer prognosis. Probably related to the presence of
areas capable of surviving in conditions of hypoxia.
Overall, the availability of these imaging techniques has
resulted in the growth of multi-modality and multi-
parametric imaging. In addition, the analysis of the
quantitative data acquired by both standard and
functional imaging techniques has inspired the
development of novel approaches of analysis leading to
the extrapolation of textural, morphologic features with
the potential of providing metrics that can be used to
optimize the treatment.
Keynote lecture
SP-018 HNC Biomarkers - how do we translate biology
into useful assays for clinical care?
T. Seiwert
1
1
University of Chicago, Chicago, USA
Abstract text
With the advent of powerful new profiling technologies
(i.e.
next
generation
sequencing,
RNA
profiling/nanostring, liquid biopsy, multiplex immune
stains) our ability to query tumor biology and answer
clinically relevant questions in patient samples has
increased exponentially. However, understanding clinical
usefulness, technical limitations, and logistics of
implementing biomarker testing in clinical practice will
take significant, collaborative effort of the HNC
community. In this talk we will examine three examples
pertinent to HNC: 1) Emerging biomarkers for
Immunotherapy, 2) the usefulness and technical
limitations of liquid biopsy in curative intent and palliative
care, and 3) the hidden complexities of HPV testing, and
heterogeneity of HPV biology.
Proffered papers 2
OC-019 The phase III study INTERCEPTOR: preliminary
results
N. Denaro
1
, S. Vecchio
2
, A. Bagicalupo
3
, E. Russi
4
, M.
Rampino
5
, M. Benasso
6
, G. Numico
7
, L. Licitra
8
, O.
Ostellino
9
, M. D'amico
10
, P. Curcio
11
, M. Merlano
12
1
Azienda Ospedaliera S. Croce e Carle, oncology, Cuneo,
Italy
2
AOU San Martino IST Genova, Oncology, Genova, Italy
3
AOU S.Martino IST Genova, Radiotherapy, Genova, Italy
4
ASO Santa Croce e Carle, Radiotherapy, Cuneo, Italy
5
IRCCS Candiolo, Radiotherapy, Oncology, Italy
6
AO Savona, Oncology, Savona, Italy