6th ICHNO Abstract Book

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6th ICHNO page 35
6th ICHNO Conference
International Conference on innovative approaches in Head and Neck Oncology
16 – 18 March 2017
Barcelona, Spain
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1Hospital Habib Bourguiba, Radiotherapy oncology, Sfax,
Tunisia
2hospital Habib Bourguiba, medical oncology, sfax,
Tunisia
3hospital Habib Bourguiba, oto-laryngology, sfax, Tunisia
Purpose or Objective
Standard treatment of nasopharyngeal carcinoma (NPC) is
radiotherapy frequently associated with chemotherapy in
advanced disease. However, after conventional
radiotherapy results remain poor with a high rate of both
local relapse and distant metastasis. The aim of our study
was to evaluate the impact of a split course bifractionated
radiotherapy regimen. Here, we present the 10-year
follow-up results.
Material and Methods
From January 1997 to September 2003, 154 patients with
M0 histologically proven NPC were treated in the Habib
Bourguiba hospital, Sfax Tunisia. Patients with locally
advanced nodal disease (N2–N3) received induction
chemotherapy. All patients were randomized to receive
either conventional radiotherapy at 2 Gy/fraction/day, 5
days/week to 70 Gy/7 weeks or split course bifractionated
radiotherapy at 1.6 Gy/fraction, twice daily, 5 days/week
to 70.4 Gy/ 6 weeks.
Results
Update of survival data was done in 2016. With a median
follow-up of 13, 6 years, 10-year overall survival (OS) did
not differ between the two treatment arms: 52% for the
conventional radiotherapy versus 49, 7% for the split
course regimen (p= 0, 3). Loco regional and distant free
survival rates were, respectively (55% and 55, 4%), in
conventional arm and (51, 1% and 51, 5%) in bifractionated
arm, the difference was not statistically significant. There
was more grade II–III skin fibrosis (68, 9% vs. 64, 9%) and
more grade II-III xerostomia (49, 3% vs. 48%) in
experimental arm, but the difference being statistically
non significant.
Conclusion
Compared with conventional radiotherapy, split course
bifractionated radiation therapy failed to demonstrate
significant improvement in locoregional control or overall
survival even after 10-year follow-up.
PO-071 Dose to the thyroid gland during irradiation of
nasopharyngeal carcinoma
W. Siala1 , N. Sellami1, H. Daoud1, M. Kallel1, W. Mnejja1,
L. Farhat2, J. Daoud 1
1Habib Bourguiba hospital, Radiotherapy oncology, Sfax,
Tunisia
2Habib Bourguiba hospital, radiotherapy hospital, sfax,
Tunisia
Purpose or Objective
The thyroid dysfunction is a frequent late toxicity
observed after radiotherapy of nasopharyngeal carcinoma
(NPC).The aim of this study is to evaluate the dose
received by the thyroid gland during irradiation of NPC.
Material and Methods
This is a retrospective study including 87 patients treated
for nasopharyngeal carcinoma between 2011 and 2016 at
the department of radiotherapy; Habib Bourguiba hospital
at Sfax Tunisia. Radiation therapy was performed
according to a conformational technique. The prescribed
dose was 68-70Gy to the nasopharynx and the initially
involved nodes. A dose of 50Gy was deliverated to the rest
of cervical lymph nodes. We delineated the thyroid gland
and we studied the dose received: the minimum dose
(Dmin), the maximum dose (Dmax), the mean dose
(Dmean) and the dose to 50% of the thyroid (D50%). Then,
we compared the different parameters according to the
node stage (TNM 2009).
Results
The average Dmin was 6Gy vs. 7,9Gy respectively for N0-
N1 and N2-N3 (p = 0.3). The average Dmean was
41,2Gy vs. 43,5Gy respectively for N0-N1 and N2-N3 (p =
0.3). The average Dmax was 59,6Gy vs. 65,4Gy
respectively for N0-N1 and N2-N3 (p = 0.07). The average
D50% was 48Gy vs. 48,7Gy respectively for N0-N1 and N2-
N3 (p = 0.7).
Conclusion
The Irradiation of the thyroid gland cannot be avoided
during radiotherapy for nasopharyngeal carcinoma. There
is no consensus about the dose constraints. It seems
preferable to not irradiate more than 50% of thyroid
volume with a dose superior to 50Gy. These constraints
were sometimes exceeded in our study especially for
patients with N2-N3 nodal involvement.
PO-072 Compliance and acute toxicity of
chemoradiotherapy for undifferentiated
nasopharyngeal cancer
N. Jovanovic Korda1, T. Ursulovic2, S. Vucicevic3, V.
Vujanac1, M. Kreacic4
1Institute for Oncology and Radiology of Serbia,
Radiotherapy department for head and neck cancer,
Belgrade, Serbia
2Institute for Oncology and radiology of Serbia, Clinic of
medical Oncology, Belgrade, Serbia
3Institute for Oncology and radiology of Serbia,
Radiotherapy Department, Belgrade, Serbia
4Institute for Oncology and Radiology of Serbia, Clinic
for Medical Oncology, Belgrade, Serbia
Purpose or Objective
To evaluate treatment compliance and acute toxicity for
patients with locally advanced undifferentiated
nasopharyngeal cancer treated with induction Cisplatin-
based chemotherapy followed with concurrent chemo
radiation and adjuvant chemotherapy.
Material and Methods
A total of 73 patients with locally advanced, non
metastaticundifferentiated nasopharyngeal cancer were
included. 42 patients (57.5%) were diagnosed in clinical
stage IV and 31 (42,11%) stage III.
Two cycles of chemotherapy with Epirubicin ( dose of 90
mg /m2 ) and Cisplatin (60mg/m2 ) were administrated
in induction and adjuvant approaches, and two cycles
Epirubicin and Cisplatin with dose 60mg/m2, were given
concurrently with radiotherapy on day 1 and 21 .
Three dimensional radiotherapy was delivered with total
dose 70Gy , using conventional regimen of fractionation.
Results
All patients received induction chemotherapy.
Three patients developed progression of disease after
induction chemotherapy 69 patients (94%) were treated
with 3D conformal radiotherapy and received total dose
of 70Gy using conventional regimen of fractionation . 67
patients received II cycles chemotherapy concurrently
with radiation. After concurrent chemo radiation , 57
patients were treated with adjuvant chemotherapy.
56 patients (77%)completed treatment according to
protocol and protocol modifications were observed in 23%
(17 patients).
Most common acute toxicities were mucositis,
dysphagia and skin toxicity. Severe mucositis grade 3/4
was observed in 47patients (64, 4 %) Most common
hematological toxicities grade 3/4 was neutropenia , seen
in 17 patients (23, 3%) . Two patients developed febrile
neutropenia in concomitant chemoradiation and two in
adjuvant treatment. No treatment related death was
observed.
After 5years, there were no relapses of disease in 65, 3%
patients.