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6th ICHNO
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6
th
ICHNO Conference
International Conference on innovative approaches in Head and Neck Oncology
16 – 18 March 2017
Barcelona, Spain
__________________________________________________________________________________________
medical oncologists, otolaryngologists, pathologists,
radiation therapists and radiologists.
Poster: Epidemiology and prevention
PO-135 Head and neck squamous cell carcinoma of
unknown primary treated in the era of FDG-PET and
IMRT
M. De Ridder
1
, W.M.C. Klop
2
, O. Hamming-Vrieze
1
, J.P.
De Boer
3
, W. Vogel
4
, M.W.M. Van den Brekel
2
, A. Al-
Mamgani
1
1
Netherlands Cancer Institute, Radiotherapy,
Amsterdam, The Netherlands
2
Netherlands Cancer Institute, Head and Neck surgery,
Amsterdam, The Netherlands
3
Netherlands Cancer Institute, Medical Oncology,
Amsterdam, The Netherlands
4
Netherlands Cancer Institute, Nuclear medicine,
Amsterdam, The Netherlands
Purpose or Objective
Head and neck carcinoma of unknown primary (HNCUP) is
a diagnosis of exclusion after an extensive workup. Since
the introduction of PET-CT in the diagnostic arsenal the
area of true unknown primaries narrowed. Most literature
available nowadays describes cohorts of patients before
the era of PET-CT and IMRT. This cohort thus represents a
more applicable patient selection for current medical
practice.
Material and Methods
Retrospective analyses of 80 PET-staged patients that
were curatively treated with intensity-modulated
radiotherapy (IMRT) between 2006 and 2016. Patient,
tumor and treatment demographics were recorded and
oncologic outcomes were analyzed.
Results
Half of the patients underwent upfront neck dissection,
mostly (super)selective. Of all, 97% received mucosal
irradiation. Unilateral irradiation of the neck was done in
18%
of
the
patients.
Overall survival at 5 year was 62% and disease specific
survival 78%. Extracapsular extension (ECE), N3 neck,
multiple levels of positive lymph nodes (PLN) and PLN in
the lower neck were associated with worse prognosis.
Local control was 100% in the mucosal irradiated patients.
Neck control was 90%. In total 10 patients developed
distant metastases, N3, ECE and lower neck PLN were
associated with DM. Patients treated unilaterally had
significantly less acute dysphagia grade III (0% vs. 33%).
Conclusion
This series gives a current overview of the HNCUP patients
treated over the last 10 years in the Netherlands Cancer
Institute by IMRT in the era of FDG-PET. Five-year disease
specific survival is fairly good with 78%, however ECE, N3
and lower neck PLN are factors associated with a worse
prognosis. These patients are prone for distant metastasis
and future research need to focus on identification of
these patients and development of new strategies to
improve the outcome of this group of patients.
PO-136 Hospital costs associated with head and neck
cancer by phase-of-care in France (EPICORL study)
M. Schwarzinger
1
, F. Huguet
2
, L. Sagaon Teyssier
1
, S.
Témam
3
, Y. Pointreau
4
, M. Bec
5
, C. Even
3
, L. Lévy-
Bachelot
5
, L. Geoffrois
6
1
THEN Translational Health Economics Network, Public
health, Paris, France
2
Tenon Hospital, Radiation Oncology, Paris, France
3
Institut Gustave Roussy, Head & Neck Surgical & Medical
Oncology, Villejuif, France
4
Centre Jean Bernard, Oncology, Le Mans, France
5
MSD France, Market access, Courbevoie, France
6
Institut de Cancérologie de Lorraine - Alexis Vautrin,
Medical oncology, Vandoeuvre Les Nancy, France
Purpose or Objective
Costing studies of head and neck (H&N) cancer care are
scarce.
The study objective was to estimate monthly hospital
costs associated with H&N cancer by phase-of-care in
France.
Material and Methods
We completed a retrospective cohort study using the
French National Hospital Discharge (PMSI) database that
contains all public and private claims for acute care (MCO)
and post-acute care (SSR and HAD) in 2008-2013. Of all
adult patients identified with squamous cell carcinoma at
hospital (ICD-10: C00-C06; C09-C14; C30.0; C31; C32), we
selected all 53,257 incident cases in 2010-2012 without a
personal
history
of
cancer.
Hospital stays were valued from a societal perspective
using national public tariffs and out-of-pocket expenses at
hospital. Hospital stays attributable to cancer care were
identified using French guidelines (INCA 2013) and
summed
over
3
phases-of-care:
1) initial care (first 6 months after diagnosis), by cancer
stage (early I/II; locally advanced III/IVb; distant
metastatic
IVc);
2) continuing care without relapse (6 months after
diagnosis);
3) relapse care in patients without distant metastasis at
diagnosis.
Mean monthly costs were computed by phase-of-care with
use of two-part models taking into account the probability
of hospitalization during continuing care and a log-normal
distribution of costs.
Results
Patients were 78.2% male with a median (IQR) age of 61
(54-71) at diagnosis and 20,582 (38.6%) patients died in
the
follow-up.
During initial care (first 6 months), mean (std) monthly
hospital costs attributable to cancer care increased with a
worse cancer stage at diagnosis: 1,878 (3,277) euros in
15,747 (29.6%) patients with early cancer; 5,199 (3,434)
euros in 32,723 (61.4%) patients with locally advanced
cancer; 6,999 (2,626) euros in 4,785 (9.0%) patients with
distant metastasis. In the follow-up (6 months after
diagnosis), continuing care was associated with hospital
costs of 423 (1,259) euros per month, while relapse care
increased monthly hospital costs to 5,069 (3,353) euros.
In multivariate analyses by phase-of-care, mean monthly
hospital costs significantly varied by cancer site (min: lip
cancer ; max: laryngeal cancer). The presence of primary
cancers other than H&N or Charlson comorbidities other
than cancer almost all significantly increased monthly
costs at all phases-of-care. Death at any phase-of-care
doubled mean hospital costs per month.
Conclusion
Monthly hospital costs were maximum in patients
diagnosed with distant metastasis, and still very high in
patients with locally advanced stage at diagnosis or
relapsing in
he
follow-up.
Less than one third patients with H&N cancer were
diagnosed at early stage during the study period in France.
Increasing early diagnosis would substantially decrease
hospital costs associated with H&N cancer care.