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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
__________________________________________________________________________________________
Conclusion
With proper case selection reRT can be delivered with
acceptable toxicities and is associated with improved
outcomes.
OC-044 ART DECO (CRUK/10/018): dose escalated vs
standard dose IMRT in locally advanced head and neck
cancer
C. Nutting
1
, J. Morden
2
, D. Bernstein
3
, M. Beasley
4
, V.
Cosgrove
5
, S. Fisher
6
, B. Foran
7
, T. Guerrero-Urbano
8
, D.
Gujral
9
, K. Harrington
1
, E. Junor
10
, H. Mehanna
11
, A.
Miah
12
, N. Palaniappan
13
, S. Ramkumar
14
, P. Sanghera
15
, M.
Sen
16
, A. Sibtain
17
, W. Soe
18
, C. West
19
, D. Piercey
2
, S.
Witts
2
, M. Emson
2
, E. Hall
2
1
The Institute of Cancer Research and The Royal Marsden
NHS Foundation Trust, Head and Neck Unit, Sutton,
United Kingdom
2
The Institute of Cancer Research, ICR-Clinical Trials and
Statistics Unit, Sutton, United Kingdom
3
The Royal Marsden NHS Foundation Trust, Radiotherapy
Physics, Sutton, United Kingdom
4
Bristol Haematology and Oncology Centre, Oncology,
Bristol, United Kingdom
5
St James's University Hospital, Radiotherapy Physics,
Leeds, United Kingdom
6
University of Leeds, LICAP, Leeds, United Kingdom
7
Weston Park Hospital, Oncology, Sheffield, United
Kingdom
8
Guy's and St Thomas' Hospitals NHS Trust, Oncology,
London, United Kingdom
9
Imperial College Healthcare NHS Trust, Oncology,
London, United Kingdom
10
Western General Hospital, Oncology, Edinburgh, United
Kingdom
11
University of Birmingham, INHANSE, Birmingham,
United Kingdom
12
The Royal Marsden NHS Foundation Trust, Sarcoma
Unit, Sutton, United Kingdom
13
Velindre Hospital, Oncology, Cardiff, United Kingdom
14
Southampton General Hospital, Oncology,
Southampton, United Kingdom
15
Queen Elizabeth Hospital, Oncology, Birmingham,
United Kingdom
16
St James's University Hospital, Oncology, Leeds, United
Kingdom
17
St Bartholomew's Hospital, Oncology, London, United
Kingdom
18
Glan Clwyd Hospital, Oncology, Rhyl, United Kingdom
19
University of Manchester, Radiation Biology,
Manchester, United Kingdom
Purpose or Objective
Radical (chemo)radiotherapy offers curative treatment for
patients with locally advanced laryngeal or
hypopharyngeal cancer. IMRT permits safe dose-escalation
and hence potential improved locoregional control given
reduction in volume of normal tissue receiving high dose
radiation.
Material and Methods
Patients with histologically squamous cell laryngeal or
hypopharyngeal cancer (AJCC III-IVa/b) were randomised
to dose-escalated (DE-IMRT) (primary tumour:
67.2Gray(Gy)/28 fractions(f), at risk nodes: 56Gy/28f) or
standard dose (ST-IMRT) (primary tumour: 65Gy/30f, at
risk nodes: 54Gy/30f) IMRT. Patients received 2 cycles
concomitant cisplatin, and up to 3 cycles platinum-based
induction chemotherapy. Treatment allocation (1:1) used
minimisation, balancing for centre, tumour site, nodal
status and planned chemotherapy. Primary endpoint was
locoregional failure- free rate (LRFFR) i.e. time to
locoregional relapse or completion of radiotherapy in
patients with persistent disease 3 months after treatment
(clinical assessment). Target recruitment was 354
patients; 100 events required to detect improvement in 2-
year LRFFR from 60% to 77.5% (two-sided α=0.05, 90%
power). LRFFR was analysed using competing risks
methodology (with death as competing event), compared
between groups by Gray’s test. Secondary endpoints
(α=0.01) included toxicity (CTCAEv4.0, LENT SOMA),
patient-reported quality of life and overall survival.
Results
276 patients (138 ST-IMRT; 138 DE-IMRT) were randomised
(2011-2015) from 32 UK centres. 84% were male, 66% had
laryngeal tumours, 98% were N0-2, mean age was 62 years.
Planned chemotherapy was 40% induction and
concomitant,
48%
concomitant
only,
13%
none. Recruitment stopped early due to planned interim
futility analysis (subhazard ratio (SHR)>1 after 50%
required events). 32/138 (23%) ST-IMRT and 37/138 (27%)
DE-IMRT patients reported LRFFR events, SHR for DE-IMRT
1.22 (95%CI 0.76–1.94), p=0.42. Grade≥2 acute pharyngeal
mucositis and 3 month post-RT pharyngeal dysphagia was
higher with DE-IMRT (p=0.008, p=0.01 respectively).
Conclusion
There was no evidence for a statistically significant
improvement in locoregional control with DE-IMRT
compared with ST-IMRT. DE-IMRT was associated with a
worse toxicity profile.
OC-045 Recurrence patterns after 40 Gy to the elective
treated neck in head and neck cancer.
D. Nevens
1
, F. Duprez
2
, J. Daisne
3
, J. Schatteman
4
, W. De
Neve
2
, S. Nuyts
1
1
University Hospital Gasthuisberg, Radiation Oncology
Department, Leuven, Belgium
2
Ghent University Hospital, Department of Radiation
Oncology, Ghent, Belgium
3
MaternitéUniversité Catholique de Louvain- CHU-UCL-
Namur- site Sainte-Elisabeth, Radiation Oncolgy
Department, Namur, Belgium
4
Ghent University Hospital, Nuclear Medicine, Ghent,
Belgium
Purpose or Objective
To investigate the patterns of regional recurrences with
emphasis on recurrences in the electively irradiated lymph
node regions after dose de-escalation to 40 Gy (EQD2Gy)
in head and neck cancer.
Material and Methods
Two hundred thirty-three patients treated with
radio(chemo)therapy using
40 Gy (EQD2Gy) to the
elective lymph node regions were included. All regional
recurrences were reconstructed and projected on the