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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
__________________________________________________________________________________________
Purpose or Objective
Several clinical questions have been shown to be difficult
to answer with conventional imaging in patients with head
and neck squamous cell carcinoma (HNSCC). This
presentation focuses on three of these questions.
1. The differentiation between malign and benign lymph
nodes.
2. The detection of cartilage and bone invasion
3. The differentiation between post-radiation effects and
tumor recurrence.
Due to improvements in scanning equipment spectral CT
imaging has recently become commercially available in
daily clinical practice. Spectral CT utilizes different x-ray
energies in order to obtain tissue characteristics. This
additional information might be able to answer some of
the above
questions.
Purpose: To investigate the potential of spectral CT in the
detection of lymph node metastases, cartilage and bone
invasion and tumor recurrence in patients with HNSCC.
Material and Methods
In this analysis we describe the basic principles of spectral
CT including concepts such as iodine and calcium density
and effective atomic number (effective Z). Furthermore
the role of spectral CT in answering the above mentioned
questions will be discussed using clinical cases.
Results
Preliminary data of spectral CT for the detection of lymph
node metastases, cartilage and bone invasion and tumor
recurrence from patients scanned and treated in our head
and neck center.
Conclusion
Spectral CT is a new technique potentially able to answer
clinical questions in patients with HNSCC which currently
are inadequately able to be assessed by conventional
imaging.
Poster: Supportive care, quality of life, rehabilitation
PO-117 Swallowing exercises: Will it really help head
and neck cancer patients?
W. Hashem
1
, R. Abdelkader
2
, L. Abdelkader
2
, S.
Elhadary
2
, K. Mashhour
1
1
Kasr el ainy school of medicine, clinical oncology, Cairo,
Egypt
2
Faculty of Nursing- Cairo University, Medical –Surgical
Nursing, Cairo, Egypt
Purpose or Objective
Dysphagia has been reported in 30-50% of head & neck
cancer patients (HNCPs). It is defined as the difficulty or
impossibility to swallow liquids, food, or medication;
which can occur during the oropharyngeal or esophageal
phase. Factors that predict dysphagia include: T & N
stage, primary site, type of treatment, extension of
treated region, patient characteristics (baseline
swallowing function, PS, smoking & alcohol abuse, age,
lean mass, gender). All treatment options, including
surgery & CRT result in swallowing problems along with
aspiration. The work was a comparative study, the aim of
which is to evaluate the impact of swallowing exercises on
swallowing problems among HNCPs after CRT.
Material and Methods
A sample of 60 HNCPs was equally divided into 2 groups,
control and study groups. The investigators met all
patients 3 times (before, during & after CRT); swallowing
ability was assessed using Sydney Swallowing
Questionnaire (SSQ). The University of Texas, MD Anderson
Cancer Center Swallowing Exercise Protocol was explained
and demonstrated by the investigators to the study group.
Patients in the study group were encouraged to adhere to
the swallowing exercises regularly. All tools used were
translated into Arabic language. Data analyses were
carried out using statistical package for social sciences
(SPSS), program version 20.
Results
Most of the patients from both groups experienced mild
dysphagia during the 1
st
visit. By the 3
rd
visit, severe
dysphagia (to thin & thick liquids, and soft & hard food)
was higher in the control group (73.3%) compared to the
study group (26.7%). During the 1
st
visit, there was no
statistical significant difference between control and
study groups regarding cough or choking during swallowing
hard food (p =1.00) and swallowing thin liquids (p = 0.42);
yet the difference reached a significant level by the 3rd
visit. By the third visit there was statistically significant
difference between both groups in swallowing thin liquids
(p = 0.00), as well as thick liquids (p = 0.00). At the 1
st
visit, there was no significant difference regarding
swallowing soft food (p = 0.24), hard food (p = 0.12), dry
food (p = 0.89) and swallowing Saliva
(p = 0.28). While by
the 3
rd
visit, there was significant difference between
control & study groups in all parameters
.
Conclusion
Dysphagia has been under-estimated & improperly treated
in HNCPs. Adequate prevention & treatment of dysphagia
is essential to plan a complete therapeutic programme, by
reducing the side effects that may have negative impact
on QoL and might affect the overall survival.
PO-118 Acute and late toxicities in patients with oral
cancer treated with intensity-modulated radiotherapy
A. Cristaudo
1
, S. Ursino
1
, D. Delishaj
1
, F. Matteucci
1
, A.
Molinari
1
, F. Paiar
1
1
Ospedale Santa Chiara, Radiation Oncology, Pisa, Italy
Purpose or Objective
to analyze acute and late toxicities in patients (pts) with
oral cancer treated with IMRT.
Material and Methods
From January 2011 to January 2016, 58 pts (mean age 62.9
yrs; range 42-87) with oral cancer who underwent
adjuvant RT or exclusive RT-CT were analyzed. RT was
performed with IMRT technique and LINAC DHX (Varian
Medical Systems). The prescribed dose was 66 Gy (2.2
Gy/ff) for PTVs high risk; 60 Gy (2.0 Gy/ff) for PTVs
intermediate risk and 54 Gy (1.8 Gy/ff) for PTVs low risk.
Acute and late toxicity was evaluated according to CTCAE
scale vs. 4.0 by weekly examination during RT treatment
and every 3 months after RT.
Results
At analysis 41 pts (70%) were male and 17 (30%) female.
The median follow-up was 23.3 months (range 3-
63months). Overall, 36 pts (62%) underwent surgically
treatment and 22 (38%) exclusive RTCT treatment. RTCT
or RT plus molecular-target therapy was prescribed in 27
pts (47%); in addition to RT, 22 pts (81%) received CDDP
40 mg/mq q7 and 5 pts (19%) received Cetuximab 250
mg/mq q7. Acute toxicity: G1/G2 mucositis occurred in 52
pts (89%) and G3 in 2 pts (3.5%); G1/G2 dysphagia in 35 pts
(60%) and G3 in 3 (5%) pts; G1/G2 odynophagia was
observed in 40 (69%) pts and G3 in 4 pts (8%); G1/G2
dysgeusia in 49 pts (84%) and G3 in 2 (3.5%) pts. Finally,
G1/G2 weight loss was observed in 29 pts (50%) and G3 in
3 pts (5%). Patients with G3 dysphagia or weight loss
underwent parenteral nutrition and those with G2 weight
loss required nutritional support. Only 1 pts required the
placement of PEG because of significant weight loss (10
kg). Late toxicity: G1/G2 mucositis occurred in 5 pts (9%);
G1/G2 dysphagia in 24 pts (41%) and G3 in 3 (5%) pts;
G1/G2 odynophagia in 26 pts (45%) and G3 in 1 (1.7%) pts;
G1 dysgeusia occurred in 23 pts (40%) and G3 in 2 (3.5%);
G1/G2 xerostomia was observed in 15 pts (26%) and G3 in