6th ICHNO Abstract Book

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page 60 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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Purpose or Objective
Melatonin (N-acetyl-5-methoxytryptamine) is a potent
free radical scavenger with anti-oxidative and anti-
inflammatory properties. It reportedly maintains
mitochondrial homeostasis under various
pathophysiological conditions, including radiation injury.
We recently found that a melatonin oral gel at 3% restored
melatonin levels in the tongue and prevented mucosal
disruption and ulcer formation caused by irradiation due
to its anti-inflammatory properties. Melatonin oral gel
protected the mitochondria from radiation damage and
blunts inflammasome signal activation in the tongue. The
objective of this study was to analyse several melatonin
formulations to prevent oral mucositis and gastrointestinal
damage in radiation-induced mucositis model in rat.
Material and Methods
Male Wistar rats were subjected to irradiation. The
radiation was administered using a Ray-X YXLON 320-
D03 irradiator, and the rats received a dose of 7.5 Gy/day
for 5 days in their oral cavity. Irradiated rats were treated
during 19 days T.I.D. with different melatonin
formulations. During the study, local effects were
controlled, tongue and duodenum were analysed and
melatonin levels were also evaluated in tongue and
plasma.
Results
We demonstrated that treatment with 3% melatonin
selected gel protected rats from oral mucositis after
irradiation, also protected duodenum against
inflammation and necrosis, and restored endogenous local
melatonin levels in irradiated animals.
Conclusion
The formulation of melatonin oral gel, chosen for
preclinical and clinical development, showed the highest
efficacy preventing oral mucositis and gut damage in
irradiated rats. The selected melatonin gel formulation
also showed the highest local absorption, restoring
endogenous melatonin levels, and the lowest systemic
absorption after repeated oral administration.
These results have led to a clinical trial (Nº EudraCT: 2015-
001534-13)
PO-126 Consenting patients for late-effects of head and
neck radiotherapy: an audit of UK oncology practice
J.A. Christian1, J. Fenwick2, B. Foran3
1Nottingham University Hospital- Nottingham,
Department of Clinical Oncology- City Campus,
Nottingham, United Kingdom
2Merck Serono an affiliate of Merck KGaA- Darmstadt-
Germany, an affiliate of Merck KGaA- Darmstadt-
Germany, Feltham-, United Kingdom
3Weston Park Hospital, Department of Oncology,
Sheffield, United Kingdom
Purpose or Objective
Long-term morbidity after the curative treatment of head
and neck cancer is well-recognised as a significant issue,
but for many patients and clinical staff it can be seen as a
‘secondary problem’ to face only once they have got over
the major hurdle of their cancer being cured. Because late
complications of treatment may occur many years after
curative cancer treatment, it can be a neglected area at
the time of primary consent especially when patients are
faced with the often over-whelming package of immediate
cancer treatment that is facing them. It can then remain
a neglected area during follow-up. This survey investigates
the extent to which Radiotherapy Late Effects (RTLE) are
routinely discussed during the consent process, prior to
commencing curative treatment for Head and Neck
cancer.
Material and Methods
During March 2016, clinical staff from radiotherapy
centres across the UK and Ireland, involved in the consent
process for Head and Neck Radiotherapy (HNRT),
completed an e-mail survey about their current consent
practice for HNRT. They were asked to tick, from a list of
14, which RTLE they would routinely discuss with a patient
who had a T3N2bM0 squamous cell carcinoma of the
oropharynx, and who was due to undergo curative
radiotherapy. They were also asked to list any other RTLE
for which they would routinely consent, which were not
on the list. They were also asked about their process for
monitoring and support of RTLE during follow-up.
Results
Responses were received from 53 clinical staff. The
median number of RTLE discussed with patients was 9. The
range was between 2 and 14.
Table 1 shows the RTLE and the frequency with which they
are discussed at consent.
16.6% of clinical staff prospectively score RTLE in clinic
during follow-up ; 61.1% only document if there is a RTLE-
related problem mentioned in clinic. 81.5% of clinical staff
measure thyroid function only if symptoms of
hypothyroidism are mentioned. 42% of clinical staff did
not know if their patients are still feeding tube dependent
at one year. 18.2% of clinical staff have access to a
dedicated RTLE clinic service.
Conclusion
There is a wide variation across UK radiotherapy centres
in what is discussed with patients concerning RTLE prior
to curative treatment with radiotherapy. With increasing
emphasis on survivorship, RTLE must have a higher priority
not only in our pre-treatment discussions but more
intentional follow-up processes are needed where RTLE
are easily identified and support given.