6th ICHNO Abstract Book

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page 34 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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months; 1-year locoregional control was 35% and freedom
from distant metastases was 30%. Surgery was statistically
significant to locoregional control. None of the remaining
analysed variables had influence on survival and
locoregional control.
Conclusion
Our results have a lower than expected local control.
Despite the small number of patients, surgery was the
only factor with positive impact on locoregional control.
New strategies are warranted to improve the outcome of
this disease.
PO-068 Head and neck cancer of unknown primary
origin: a single institution experience
N. Ferreira1, J. Silva2 , E. Netto3, G. Marau1, M. Ferreira2,
F. Santos 1
1Instituto Português de Oncologia de Lisboa Francisco
Gentil- EPE, Radiation Oncology, Lisboa, Portugal
2Instituto Português de Oncologia de Lisboa Francisco
Gentil- EPE, Medical Oncology, Lisboa, Portugal
3NOVA Medical School UNL, Radiation Oncology, Lisboa,
Portugal
Purpose or Objective
To analyse the outcomes, patterns of failure and toxicity
in patients with head and neck cancer of unknown primary
origin (HNCUP).
Material and Methods
A retrospective database was used to identify patients
with HNCUP for which they received curative-intent
radiotherapy in our institution between 2009 and 2014.
The patient characteristics, treatment plans and late
toxicity profiles were reviewed, and the survival rates
were calculated using the Kaplan-Meier method.
Results
We found 28 patients, 23 men and 5 women, with a median
age of 57.5 years (range 41-82), and a KPS of 70 or higher
in 64% of these patients. All patients were staged as T0
after comprehensive workup evaluation. Two (7%)
presented with stage N2a, 10 (36%) with stage N2b, 3 (7%)
with stage N2c, and 13 (46%) with stage N3 disease. A total
of 15 (54%) patients underwent up-front neck dissection.
23 (82%) patients received systemic chemotherapy in a
combined-modality setting. All patients underwent RT, 6
3D-CRT and 22 IMRT. Generally, patients were treated
with comprehensive nodal irradiation to the bilateral neck
and mucosal axis (nasopharynx, oropharynx, hypopharynx
and larynx). No patient received oral cavity mucosal
irradiation. Median doses to gross disease were 69.96 Gy,
66 Gy to high-risk or postoperative areas, 60 Gy to the
mucosal axis and 50-54 Gy to the lower risk node levels.
With a median follow-up of 3.6 years for the surviving
patients, the overall survival, disease-free survival,
distant metastasis-free survival and locoregional control
rates were 64%, 47%, 69% and 54% at 3 years, respectively.
Only 3 patients developed distant metastasis with
locoregional control. Nine (32%) patients had persistent
neck disease from which two were N2b and seven, N3.
Only two nodal recurrences occurred within the RT
volume: one in a 54 Gy level and the other in a 60 Gy level.
There was one probable mucosal failure (larynx) in the 8
patients in which the larynx was spared from radiation. 8
(29%) patients reported Grade 1 late xerostomia, 7 (25%)
Grade 2, with no Grade 3 late xerostomia reported.
Conclusion
Our study showed lower than expected locoregional
control and survival rates. The large proportion of patients
presenting with N3 disease may explain the suboptimal
results. There were no failures in the spared oral mucosa.
RT with or without chemotherapy for HNCUP produced
reasonable toxicity profile.
PO-069 Radiation Dose and Distribution Following
Transoral Robotic Surgery of the Palatine Tonsil
S. Naqvi1, J.Ferrell2, A. Blanco3, J.Bigcas1, K. Jain1, R.
Karni 1
1The University of Texas Health Science Center- Houston,
Otorhinolaryngology- Head and Neck Surgery, Houston,
USA
2Oregon Health & Science University,
Otorhinolaryngology- Head and Neck Surgery, Portland,
USA
3The University of Texas Health Science Center- Houston,
Radiation Oncology, Houston, USA
Purpose or Objective
The improved survival of HPV-associated oropharynx
cancer has stimulated an interest in new approaches
which de-escalate radiotherapy and in turn decrease
treatment-related morbidity while maintaining a high rate
of disease control. New technologies for transoral surgery
of the oropharynx have emerged as an opportunity for
reducing traditional radiotherapy dose applied to the
mucosal site. Unilateral radiotherapy has been described
as a unique opportunity for decreasing radiotherapy dose
delivered to the contralateral neck in early palatine tonsil
cancer.
Material and Methods
Since 2010, our Tumor Board has embraced transoral
surgery with selective neck dissection for tonsil cancer
with the objective of decreasing radiotherapy dose and
distribution. Herein we present our experience with
twenty-seven consecutive tonsil cancer patients
undergoing transoral robotic surgery, including
demographics, TNM stage, p16 status, margin
control, extracapsular spread, perineural and
lymphovascular invasion, locoregional control and disease-
free survival. Radiation dose and distribution are reported
in light of changes in the treatment plan that result from
successful surgical treatment of the tonsil and
neck. Patients recommended for unilateral post-
operative radiotherapy included those with 1.) Pathologic
T1-2 staging 2.) No extension beyond the glossotonsillar
sulcus or within 1 centimeter of the uvula 3.) Clear
pathologic margins and 4.) Pathologic neck stage ≤ N2b.
Results
In this series, there was 100% disease-free survival with a
median follow up of 30 months. The radiation records of
12 patients were available through a questionnaire to the
radiation oncologists and review of radiotherapy
treatment records. In two patients, no radiotherapy was
given due to early stage disease with clear margins (T1-2,
N0). De-escalation of 10Gy to the tonsil primary site was
observed in 10/12 patients. 7/12 patients received
unilateral radiotherapy to the cervical nodes. 3/12
patients received therapeutic-dose radiation to both sides
of the neck.
Conclusion
The role of transoral surgery and neck dissection in the de-
escalation of adjuvant therapy is highlighted. Transoral
surgery may also help guide which patients are candidates
for unilateral radiotherapy by providing pathologic staging
of the neck and histologically-confirmed tumor mapping in
the oropharynx. Our series, in aggregate with others,
strongly supports a treatment paradigm which
distinguishes early stage tonsil cancer from other cancers
of the oropharynx and endorses unilateral radiotherapy in
selected cases.
PO-070 Conventional vs bifractionated radiotherapy
innasopharyngeal cancer 10years followup of phase3
trial
W. Siala1, N. Sellami1, N. Toumi2, M. Drira3, A. Ghorbel 3,
M. Frikha2, J. Daoud1