6th ICHNO Abstract Book

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page 28 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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3Nottingham City Hospital, Oncology, Nottingham, United
Kingdom
Purpose or Objective
In patients with locally advanced squamous cell carcinoma
of the head and neck (LASCCHN), concurrent chemo-
radiation therapy (CRT) is the current standard of care.
Based on published evidence, International and European
guidelines for the management of LASCCHN recommend
single-agent cisplatin given 3-weekly at a dose of
100mg/m2 as the preferred regimen. We conducted a
survey of H&N cancer clinicians from oncology
departments in the UK and Ireland to explore the current
clinical management of LASCCHN, with a particular focus
on the use of cisplatin.
Material and Methods
During March 2016, 55 H&N cancer clinicians from centres
across the UK and Ireland were invited to complete an e-
mail survey about their use of cisplatin in the management
of patients with LASCCHN receiving concurrent CRT. We
present here the responses of 50 oncologists (47
consultant clinical or medical oncologists [n=44 and n=3,
respectively]) and 3 specialist oncology registrars/clinical
fellows).
Results
39% of respondents (19/49 who answered the question)
stated that they use the guideline-recommended cisplatin
dosing schedule (3-weekly high dose cisplatin [100mg/m2])
for patients with LASCCHN receiving concurrent CRT
whereas 61% (30/49) use weekly cisplatin at a dose of 35-
45mg/m2. The estimated percentage of patients with
LASCCHN who are unsuitable for platinum-based therapy
ranged between respondents from 5-60%, with a median
of 30%. Poor performance status (n=33), age (n=6) and
platinum side effects (n=5) were the main reasons given
for patients being unsuitable.
Conclusion
Despite strong clinical trial evidence and International
guidelines recommending high dose 3-weekly cisplatin,
over half of the clinicians surveyed use weekly cisplatin
for patients with LASCCHN who are receiving concurrent
CRT. This may reflect current pressures within the NHS to
reduce inpatient stays, and the burden of inpatient
admission required to administer the 3-weekly regimen
due to the greater need for supportive care than with the
weekly regimen, which can be administered on an
outpatient basis. Also, many clinicians perceive weekly
cisplatin to be a “gentler” way of giving concomitant
chemoradiotherapy. However, further research is required
to confirm the efficacy and reasons for this widespread
non-compliance with International guidelines.
PO-055 Subglottic squamous cell carcinoma in Denmark
from 1971-2016 –a report from the DAHANCA-group
L. Hill-Madsen1, C.A. Kristensen2, E. Andersen3, J.
Johansen 4 , L.J. Andersen5, H. Primdahl6, J. Overgaard7,
N.M. Lyhne1,7
1Aalborg University Hospital, Department of Head and
Neck Surgery, Aalborg, Denmark
2Rigshospitalet, Department of oncology, Copenhagen,
Denmark
3Herlev Hospital, Department of oncology, Copenhagen,
Denmark
4Odense University Hospital, Department of oncology,
Odense, Denmark
5Aalborg University Hospital, Department of oncology,
Aalborg, Denmark
6Aarhus University Hospital, Department of oncology,
Aarhus, Denmark
7Aarhus University Hospital, Experimental Clinical
Oncology, Aarhus, Denmark
Purpose or Objective
The aim of this study was to describe the pattern of failure
in a national consecutive cohort of patients diagnosed
with subglottic squamous cell carcinoma (SCC) over a 45
years period.
Material and Methods
All patients diagnosed with a subglottic SCC in Denmark
between 1971 and 2016 were included and followed from
the first contact with the oncology center to death or May
1 2016. Patients were identified in the Danish Head and
Neck Cancer Database (DAHANCA database) after
combining with the Danish Cancer Registry. Information
regarding patient and tumor characteristics, treatment
and outcome was prospectively registered in the DAHANCA
database. National patient charts were used to identify
missing information.
Results
169 patients were identified of whom 139 (82%) were
male. The stage distribution was I=13 (8%), II=60 (36%),
III=47 (28%), and IV=47 (28%). Two patients had unknown
tumor stage due to death (n=1) and emigration (n=1) prior
to the final staging. The tumor differentiation was well or
moderate in 84 (50%) patients, poor in 36 (21%), and
unknown in 49 (29%). The primary treatment intent was
curative for 145 (86%) patients and palliative for 8 (5%).
143 received primary radiotherapy and six received
primary surgery. Information regarding primary treatment
was missing in four patients. 16 patients (9%) did not
receive any primary treatment at all. The median follow-
up was 5.1 years/1.9 years (patients alive/patients who
died). Only one patient was lost to follow-up. 82 failures
were observed among the 145 patients treated with
curative intent; of these 70%, 18%, and 5% included T site,
N site, and M site, respectively. 18 patients did not
achieve disease control at any time despite definitive
treatment. 85% of failures observed after curatively
intended treatment were observed within the first two
years. Salvage treatment cured 22 of the 82 patients with
failure.
The five-year cumulative incidences of treatment failure
for patients treated with curative intent was 61%. The
five-year cumulative incidence of ultimate treatment
failure (failure despite salvage attempt) was 46%. For all
patients, the five-year disease-specific survival (DSS) and
overall survival (OS) were 50% and 37%, respectively. For
patients treated with curative intent the five-year DSS was
54% and OS was 41%.
Conclusion
This study describes a complete national cohort of
patients diagnosed with a subglottic SCC in Denmark over
a 45 year period. Subglottic SCC is a rare disease with
male predominance and typically diagnosed in advanced
stage. The disease has a poor prognosis and more than half
of patients treated with curative intent experienced
treatment failure. Only few of whom were saved by
salvage.
PO-056 Tolerance and outcomes of radical
hypofractionated radiotherapy for glottic cancer in the
elderly
A. Zeniou1, S. Ramasamy1, L. Murray1, M. Sen 1, K. Cardale1,
K. Dyker 1, R. Prestwich1
1St James' Institute of Oncology, Clinical Oncology, Leeds,
United Kingdom
Purpose or Objective
There is limited data to guide the management of elderly
patients with head and neck cancer with regard to
treatment outcomes and tolerability. The aim of this study
is to review the tolerance and disease outcomes of
patients aged over 70 years treated with definitive