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6th ICHNO
6
th
ICHNO Conference
International Conference on innovative approaches in Head and Neck Oncology
16 – 18 March 2017
Barcelona, Spain
__________________________________________________________________________________________
Material and Methods
The study concerned three patients with nasopharyngeal
carcinoma stage N2-3. A first CT dosimetry was performed
for treatment planning using a 3D conformal radiotherapy.
A second CT scan was acquired at 38-40 Gy.
After merging the two scans, we quantified the anatomic
variations in target volumes and organs at risk, and then
we faithfully reproduce the original planned parameters
on the new CT to assess the dosimetric changes and check
constraints to organs at risk.
A new treatment plan was generated based on the new
target volumes and organs at risk. The new dose
distribution and new dose-volume histograms were
calculated and compared to the reference plane.
Results
The average reduction in lymph node and tumor
macroscopic volumes (GTV) after 38-40 Gy was 53% and
40% respectively. Dosimetric coverage of planned target
volume (PTV) and lymph node tumor remained
satisfactory. To organs at risk, we found an increase of the
maximum dose to the spinal cord for the three patients
(1.4 Gy on average) and brainstem (1.5 Gy for a patient).
After adaptation of the treatment plan, The coverage of
PTVs remained satisfactory. For organs at risk, maximum
doses to the spinal cord and brainstem decreased. On
average, the decrease was about 1.15 Gy to the spinal
cord and 6.85 Gy to the brain stem
Conclusion
Ours results demonstrated a dosimetric benefit with the
use of adaptative radiotherapy in nasopharyngeal
patients.
This study should be continued with a greater number of
patients to define a clear procedure especially that the
application of this concept in clinical practice is limited
due to the dependence on human resources.
PO-084 HDR Interstitial Brachytherapy for head and
neck malignancies with Iridium 192 implants
V. Pareek
1
, R. Bhalavat
2
, M. Chandra
2
1
Jupiter Hospital- Thane, Radiation Oncology, Mumbai,
India
2
Jupiter Hospital, Radiation Oncology, Thane, India
Purpose or Objective
To evaluate the treatment outcomes with HDR Interstitial
Brachytherapy in Head and Neck Cancers at our Institute
with use of Angiocatheters as carrier source of Iridium –
192 wire implants.
Material and Methods
58 Patients with Head and Neck malignancies of varying
TNM staging as per AJCC staging criteria were analyzed
retrospectively between 2008 and 2015. 42 patients
(72.41%) received EBRT with HDR – BRT and 26 patients
(27.59%) received BRT alone. The age group ranged from
27 to 81 years (Median age 56 years) with 41 patients
(70.69%) males and 17 patients (29.31%) females. HDR –
BRT was delivered with Iridium – 192 wire implants using
plastic bead techniques with varying dose rates. The
Biological equivalent doses (BED) were calculated for both
BRT and EBRT keeping α/β =10 for tumor and α/β =3 for
normal tissue and subsequently median BED doses were
calculated and similarly 2 Gy equivalent dose (EQD2) were
calculated and loco-regional control and disease free
survival was assessed.
Results
After completion of HDR – BRT, Patients for followed up
one month later and subsequently every 3 months for first
2 years and thereafter every 6 months with median follow
up period of 25 months (Range 2-84 months). The DFS
probability at year 1 was 82.76% and 68.05% at year 7. The
overall survival probability was 91.37% at year 1 and
85.89% at year 5. The local control rate was 67.27% and
the control rates according to the stage of disease and T
size classification are mentioned in
Table 1.
The rate of
local recurrence was 8.62%, Regional Recurrence was
1.72%, Loco-Regional Failure was 3.44% and Distant
metastases following local or regional failure was 17.23%.
The Median BED for α/β =10 was 86.775Gy and DFS was
74.07% in patients receiving more than 86.775Gy and DFS
was 64.82% in patients receiving less than 86.775Gy and
Median BED for α/β =3 was 128.76Gy and DFS was 74.07 in
patients receiving more than 128.76Gy as compared to
64.82% in patients receiving less than 128.76Gy. The
median EQD2 for α/β =10 was 71.6Gy and for α/β =3 was
75.85Gy. The DFS was 75.86% in patients receiving more
than median dose of 71.6Gy compared to 61.53% in those
receiving less than the median dose. The DFS was 78.57%
in patients receiving median dose of 75.85Gy as compared
to 59.26% in those receiving less than the median dose.
Conclusion
The overall outcome in the Patients with oral cavity and
oropharyngeal malignancies was good with implementing
of HDR – Interstitial Brachytherapy and use of
Angiocatheters as carriers of Iridium – 192 wire. The BED10
value of 86.775Gy and BED3 of 128.76Gy showed that the
dose received more than the median showed better
outcomes in the form of DFS. The EQD2 calculated values
suggested the dose received more than 71.6Gy (α/β =10)
and 75.85Gy (α/β =3) showed better outcomes .The role
of HDR Interstitial Brachytherapy in Head and Neck
cancers is a proven, effective and safe treatment method
with excellent long term outcome.
PO-085 Role of L Glutamine in reducing severity of
chemoradiation induced mucositis and improve QoL in
HNC
V. Pareek
1
, R. Bhalavat
2
, M. Chandra
2
1
Jupiter Hospital- Thane, Radiation Oncology, Mumbai,
India
2
Jupiter Hospital, Radiation Oncology, Thane, India
Purpose or Objective
The incidence of mucositis in the oral cavity, pharynx and
larynx is high among patients with head and neck cancer
(HNC) receiving chemo-radiotherapy (CRT), resulting in
significant pain and impairment of quality of life. The
present study investigated whether L-glutamine
(glutamine) decreases the severity of mucositis in the oral
cavity, pharynx and larynx induced by CRT
Material and Methods
Patients were randomized to orally receive either
glutamine or placebo at a dose of 10 g 3 times a day
throughout the CRT course. Mucositis was assessed using
the National Cancer Institute Common Terminology
Criteria for Adverse Events version 3.0. The primary end
point was mucositis severity. Seventy biopsy proven
patients with head and neck cancer receiving primary or
adjuvant radiation therapy were randomized to receive
either oral glutamine suspension daily 2h before radiation
in the study arm (10 g in 1000 ml of water) (
n
= 35) or
placebo before radiation; control arm (
n
= 35)
Results
Total 30 patients in the glutamine arm and total 33
patients in placebo developed mucositis. Grade 3
mucositis and grade 4 mucositis in the study arm (who
received oral glutamine) were significantly less in the
glutamine arm. The mean duration of grade 3 or worse
mucositis (grade 3 and grade 4) was significantly less in
study arm with
P
< 0.001. Mean time of onset of mucositis
was significantly delayed in patients who took glutamine
in comparison to control arm with
P
< 0.001. Overall,
glutamine was associated with a significant reduction of
mucositis, WL, and enteral nutrition.
Conclusion