6th ICHNO Abstract Book

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6th ICHNO page 27
6th ICHNO Conference
International Conference on innovative approaches in Head and Neck Oncology
16 – 18 March 2017
Barcelona, Spain
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and the use of gastrostomy and adjuvant chemotherapy
had a positive correlation (p=0.045 and p = 0.047,
respectively).
Conclusion
Both OS and PFS in our population were similar to current
literature. We found a significant correlation between
treatment features (use of gastrostomy, adjuvant
chemotherapy, infectious complications) and patients
features (weight loss) with survival outcomes.
PO-052 N2 node metastasis in squamous cancers of head
and neck: failure patterns and future management
S. Giri1, M.R. Kanakamedala1, S. Vijayakumar1, S.
Mangana1, E.L. Bhanat1, M.P. Giri 1, M. Chhabria1
1University of Mississippi, Department of Radiation
Oncology, Jackson, USA
Purpose or Objective
To evaluate outcomes of patients with N2 Neck nodes from
Squamous Cell Head and Neck Cancers.
Material and Methods
Between 2009-2014, 172 patients were treated at our
center; 71 white, 98 African American (AA) and 3 other
races, with a median age of 55 yrs. The T stages were: Tx
5 (3%), T1 13 (7%), T2 45 (26%), T3 34 (20%), T4 75 (44%).
The N2 neck stages were: N2A 13(8%), N2B 67 (39%) and
N2C 92 (53%). The primary sites included: oropharynx 73
(42%), Larynx 39 (23%), Hypopharynx 17 (10%), Oral cavity
20 (12%), Nasopharynx 9 ( 5%), other 14 (8%). Treatment
consisted of Surgery followed by Radiation therapy (SRT)
for 41 (24%). The median radiation dose was 60 Gy in 30
fractions of 2 Gy once daily. All radiation therapy was
given by Intensity Modulated Radiation Therapy (IMRT).
Another 131 (76%) patients were treated by concurrent
chemotherapy and IMRT (CRT). The chemotherapy
consisted of either Cisplatin or Cetuximab. The radiation
dose was 70 Gy in 35 fractions of 2 Gy each. The minimum
follow up was 24 months.
Results
The overall local control (LC) in the neck for the entire
group is 147/171 (85%). The LC was 38/41 (93%) in those
who were treated with SRT and 107/131 (81.6%) in the CRT
group, which was not statistically significant. There were
no statistical differences between location of primary and
subsequent neck disease control.
32/172 (25%) developed distant metastasis (DM). In the
SRT group it was 6/41 (14%) and CRT 26/131 (19.8%),
which was statistically insignificant. There were no
differences between the various N2 groups. There was
also no correlation with failure at the primary site. The
DM rate was significantly worse in African Americans
(AA) versus white patients (p = 0.01). Patients who
developed metastatic disease did so within 18 months.
The disease free survival (DFS) and overall survival (OS) at
3 years were calculated by Grays test and Log Rank Test,
respectively. The DFS for the entire group was 49% (95% CI
0.39-0.58). There were no differences between the
various N2 stages. The DFS was significantly worse in AA
(40%) versus white patients (62%) (p = 0.007). The OS was
71% for the entire group with no difference in OS by N2
stages. Similarly, there was no difference in OS between
AA and white patients (p=0.6).Conclusion
We report on 172 patients with advanced squamous cell
cancer of the head and neck who underwent combined
modality treatment, which was tolerated well.
Patients with N2 neck disease have an excellent LC rate
with combined modality treatment; either surgery
followed by CRT or CRT alone.
AA patients have a significantly worse DFS compared to
the white patients. They also have a significantly
increased risk of developing DM.
Nearly a quarter develop DM with the majority having loco
regional control. These patients should be considered for
neoadjuvant chemotherapy trials.
PO-053 Impact of PTV coverage on local recurrences
and overall survival after IMRT for head and neck
cancers
L. Piram (France), T. Frederic-Moreau, J. Miroir, N.
Saroul, N. Pham-Dang, L. Berger, J. Biau, M. Lapeyre
1Centre Jean PERRIN, Radiotherapy, Clermont-Ferrand,
France
2CHU G. MONTPIED, Head and Neck Surgery, Clermont-
Ferrand, France
3CHU ESTAING, Maxillo-facial Surgery, Clermont-
Ferrand, France
4Centre Jean PERRIN, Medical Physics, Clermont-Ferrand,
France
Purpose or Objective
Intensity modulated Radiotherapy (IMRT) is the standard
radiotherapy technique for head and neck cancer
irradiation. The International Commission on Radiation
Units (ICRU) recommends covering 95% of the target
volume with 95% isodose. However, this objective is not
always achievable due to organs at risk constraints.
Objective: To assess the impact on local recurrences and
overall survival of high risk PTV (HRPTV) coverage by 95%
isodose among patients treated for a head and neck
squamous cell carcinoma, with simultaneous-integrated
boost-IMRT (SIB-IMRT) and bilateral lymph node
irradiation.
Material and Methods
From May 2011 to January 2014, 119 patients who
underwent RapidArc® SIB-IMRT were included in this
prospective evaluation (22 oral cavities, 58 oropharynx, 25
hypopharynx, 14 larynx). Sex ratio was 6.4, median age
was 61.5 years. Doses, delivered in 33 fractions, were:
post-operative HRPTV (38 patients): 66Gy; non-operative
HRPTV (81 patients): 70Gy; intermediate risk PTV: 59.4Gy;
low risk PTV: 54Gy. Age, sex, clinical stage, tumour
location, chemotherapy, overall treatment time and
HRPTV coverage (V95HRPTV) at 90 or 95% were studied.
Results
Among postoperative patients, local control after 2 years
of follow-up was 70% vs 100%, p = 0.0083 (V95HRPTV+/-
95%) and 40% vs. 90.7%, p = 0.0000052 (V95HRPTV+/-90%).
Two-year overall survival was 75% vs. 88.9%, p = 0.046
(V95HRPTV+/-95%) and 40% vs. 87.9%, p = 0.0030
(V95HRPTV+/-90%). Among non-operative patients, two-
year local control was 66.4% vs. 75.9%, p = 0.47
(V95HRPTV+/-95%) and 54.4% vs.74.6%, p = 0.15
(V95HRPTV+/-90%). Two-year overall survival was 57.1%
vs. 79.5%, p = 0.015 (V95HRPTV+/-95%) and 40% vs. 74.2%,
p =0.0040 (V95HRPTV+/-90%). With multivariate analysis,
V95HRPTV ≥ 95% was a prognostic factor of overall
survival, V95HRPTV ≥ 90% was a prognostic factor of
overall survival and local control.
Conclusion
High risk PTV coverage by 95% isodose affects local control
and overall survival. ICRU guidelines must be followed as
often as possible. When impossible, coverage must remain
above 90% of the high risk PTV so as not to compromise
local control and overall survival.
PO-054 Cisplatin use in UK head and neck cancer
management: a clinician survey of current practice
B. Foran1, J. Fenwick2, B. Byrne2, J. Christian3
1Weston Park Hospital, Oncology, Sheffield, United
Kingdom
2Merck Serono Ltd- UK- an affiliate of Merck KGaA-
Darmstadt- Germany, Medical Affairs, Feltham, United
Kingdom