6th ICHNO Abstract Book

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6th ICHNO page 33
6th ICHNO Conference
International Conference on innovative approaches in Head and Neck Oncology
16 – 18 March 2017
Barcelona, Spain
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and associated acute and late toxicities with the disease
associated with radiation therapy
Material and Methods
Retrospective medical data presented 25 patients and
were followed up for the survival outcomes. The patients
were assessed for local and regional failures and the
median follow up duration was assessed along with the
survival and local control rates and disease free survival.
The patients were also assessed for the acute and late
toxicities and the outcomes were evaluated with
appropriate statistical tests. The Radiation therapy were
uniformly delivered using either 3DCRT or IMRT with
standard dose of 60Gy in 30 fractions (2Gy per fraction)
and multivariate analysis done for factors such as sex, age,
site and extent, grade of tumor and staging of disease and
the treatment modality used.
Results
The median follow up of the patients were found to 25
months and overall survival was found to be 80%. The
disease free survival was found to 70 % and progression
free survival was 65 %. The toxicities were analyzed using
EORTC Toxicity scales and analyzed using appropriate
statistical analysis. The outcomes were more in the form
of dermatitis, dysphagia and decreased salivation which
were found to be statistically significant in these cases.
Conclusion
Radiation therapy forms an important role in the
treatment armamentarium for the unknown primaries
with nodal metastases in the cervical region. The
treatment modality is associated with better survival
outcomes and also better tolerance to acute and late
toxicities.
PO-066 Early-stage tonsil cancer submitted to primary
surgery and adjuvant therapy: retrospective study
C. Pedro1, E. Netto2, R. Pocinho 1, A. Mota1, P. Pereira1, M.
Magalhães3, P. Montalvão3, F. Santos1
1Instituto Português de Oncologia de Lisboa Francisco
Gentil- EPE, Radiotherapy Department, Lisboa, Portugal
2NOVA Medical School UNL, Radiation Oncoly, Lisboa,
Portugal
3Instituto Português de Oncologia de Lisboa Francisco
Gentil- EPE, Otorhinolaryngology Department, Lisboa,
Portugal
Purpose or Objective
To review the outcomes of early-stage squamous cell
carcinoma of the tonsil submitted to primary surgery and
adjuvant treatment.
Material and Methods
We did a retrospective study of patients diagnosed with
squamous cell carcinoma of the tonsil between January
2009 and December 2014, who underwent primary surgery
followed by adjuvant therapy and were staged pT1 to T2
pN0. We analyzed patient charts, imaging and clinical data
regarding primary therapy, adjuvant treatment and side
effects. Toxicity was graded according to Common
Terminology Criteria for Adverse Events (CTCAE v4.0).
Survival was estimated with Kaplan-Meier survival
analysis.
Results
Between January 2009 and December 2014, 15 patients
with pT1 to T2 pN0 squamous cell carcinoma of the tonsil
were treated with primary surgery and adjuvant therapy.
Most patients were male (n=13), with a median age of 58
years, current moderate to heavy-smokers (more than 10
pack-years, n=11) and/or moderate to heavy-drinkers
(more than 14 units of alcohol per week, n=11). All of them
underwent surgical resection with ipsilateral (n=13) or
bilateral neck dissection, followed by radiotherapy with
(n=3) or without (n=12) systemic therapy (high-dose
cisplatin), due to positive (n=4), close (less than 5 mm,
n=9) or non-evaluable (n=2) surgical margins. The disease
was stage I in 5 patients and stage II in 10. They were all
treated with intensity modulated radiotherapy (IMRT)
using simultaneously integrated boost (SIB-IMRT). The
prescribed dose was 60 to 70 Gy (2 Gy/fraction) to the
high-risk planning target volume (PTV) and 50 to 54 Gy
(1,64 to 2 Gy/fraction) to the low to intermediate-risk
PTV. There was no contralateral nodal irradiation.
After a median follow-up of 3 years, one patient had local
failure and no one developed distant metastasis. Both the
median overall and progression-free survival were
approximately 3 years. The 3-year and 5-year overall
survival were 86% and 71%, and the 3-year and 5-year
progression-free survival were 100% and 80%, respectively.
Three patients died due to complications related to
mandibular osteonecrosis, pulmonary infection and
second tumor (lung cancer). Only three patients reported
acute grade 3 toxicity (mucositis, dysphagia and/or
dermatitis). All other patients had acute grade 1 or 2
dysphagia, xerostomia and dysgeusia. One patient
required nasogastric tube insertion before the beginning
of radiotherapy and another needed one placed during the
treatment. One year after the end of radiotherapy, 2
patients still had grade 1 xerostomia and one patient had
osteoradionecrosis of the mandible.
Conclusion
In our study, close margins were the main reason to
indicate adjuvant therapy in early-stage tonsil carcinoma.
Despite good progression-free survival, the toxicity profile
of combined modality requires caution. Further margin
analysis may identify subgroups in which adjuvant
radiotherapy could be avoided.
PO-067 Mucosal Melanoma of the head and neck: single
institution experience
C. Viveiros1, E. Netto2, A. Mota2, R. Pocinho1, M.
Fortunato1, P. Montalvão3, M. Magalhães3, F. Santos1
1Instituto Português de Oncologia de Lisboa Francisco
Gentil- EPE, Radiotherapy, Lisboa, Portugal
2NOVA Medical School UNL, Radiation Oncology, Lisbon,
Portugal
3Instituto Português de Oncologia de Lisboa Francisco
Gentil- EPE, Otorhinolaryngology, Lisboa, Portugal
Purpose or Objective
Report our clinical results of treatment for Mucosal
Melanoma of the Head and Neck (MMHN).
Material and Methods
Retrospective study of patients with pathologic proven
MMHN treated with curative intent between April/05 and
Jun/15. Demographic data, tumor characteristics,
imaging, and treatment factors were recorded. Survival
and disease-control outcomes were analyzed with Kaplan-
Meier. Toxicity was scored with the CTCAE v4.0.
Results
34 patients with a median age of 71 years were included;
62% female; 38% male. Tumor was located at the nasal
cavity (62%), 24% in oral cavity; 9% in oropharynx; 3% in
maxillary sinus; 62% were Stage III and 38% Stage IVA; 6%
had c-KIT mutation. Only 21% of cases were evaluated
regarding BRAF expression, none was positive. 94% were
treated with surgery in which 25% involved
lymphadenectomy. Pathologically 63% had R2 margins,
16% R1 margins and 16% R0 margins. 65% did adjuvant
radiation therapy (RT) while only 6% definitive RT. 54%
were treated with IMRT and 25% with 3DCRT. 38% did
elective node irradiation. Overall treatment time of RT
was below to 49 days in 63% of cases. A total of 10 patients
did systemic therapy. Most of the patients had anorexia
and nausea and 1 patient had platelet count decreased
grade I. No grade 3 toxicity was reported. After a median
follow up of 20 months, median overall survival was 13