6th ICHNO Abstract Book

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6th ICHNO page 69
6th ICHNO Conference
International Conference on innovative approaches in Head and Neck Oncology
16 – 18 March 2017
Barcelona, Spain
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PT to treat salivary gland tumors showed to be feasible
and safe; initial outcomes are encouraging. Longer follow-
up is required to better evaluate the durability of local
control and the possible development of late toxicities.
Poster: Special requirements for elderly patients
PO-144 Chronic radiation-associated dysphagia after
curative reirradiation. Does age affect?
L. Gutierrez Bayard1, M. Salas Buzón1, E. Porras Alonso 2,
S. Garduño Sánchez1 , M. Macias1, L. De Ingunza Barón 1, E.
González Calvo1, I. Villanego Beltrán1, L. Díaz Gómez 1, V.
Díaz Díaz1
1Hospital Universitario Puerta del Mar, Radiation
Oncology, Cadiz, Spain
2Hospital Universitario Puerto Real, Otorrinolaringology,
Puerto Real, Spain
Purpose or Objective
Chronic radiation-associated dysphagia (RAD) is a complex
toxicity. The Total Dysphagia Risk Score (TDRS) was
developed to predict which patients are most at risk to
develop grade ≥ 2 dysphagia at 6 months following
radiotherapy (RT). The mylo/geniohyoid complex (MHM)
V69 ( the volume receiving ≥69 Gy), , and superior
constrictor muscle (SPC V70), especially in older patients
(>62-years), were associated with chronic-RAD.Acute
during the course of RT are strong prognostic factors for
late
dysphagia. There is no effective treatment to reverse
chronic-RAD in longterm survivors; and intensive and
costly therapies are required for incremental gains in
functionality.
We have the objective to study the incidence of chronic
RAD in these head and neck recurrent tumors, previously
irradiated, including patients (p) over 70 years old (y).
Material and Methods
We evaluated 57 p with recurrent disease, between 2005
to 2014. 27 larynx, 6 nasopharynx,12 oropharynx, 6
hypopharynx and 6 oral cavity. The initial dose received
50- 70 Gy(2-2.2Gy/fraction), 25/57 received radical
radiotherapy,17 /57 radical chemoradiation; other
adjuvant radiotherapy, of which 8 / 57 was combined with
chemotherapy. In 24 / 57 nodal recurrence (N1-N2), local
18/57 (T2-T4),6/57 local+nodal recurrence, 9/57 seconds
tumor, median age 58 year (range 42–79) . Reirradiation
with external 3D conformal/IMRT techniques/ and dose:
50-70 Gy.
Results
The acute grade 2–4 RTOG dysphagia in week 6 (RTOG G2–
4) was 75.4% (G2: 26/57, G3: 17/57). Of 57 p, 17 (29.8%)
had chronic-RAD at 12 months (G2: 14/57, G3: 2/57 G4:
1/57). All of these patients had acute toxicity G3. After
calculation of the TDRS, 7 patients( 2 p <62 years old/ 5p
≥ 62 y (2p ≥ 70 y)), were classified in low-risk group
(TDRS 0–9); 12 patients ( 4 p <62 years old/ 8 p ≥ 62 y (4p
≥ 70 y)),in intermediate-risk group (TDRS10–18) and 38
patients ( 13 p <62 years old/ 25p ≥ 62 y (12p ≥ 70
y)),in high-risk group (TDRS > 18). MHM V69 was ≥ 79.5%
in all patients with chronic-RAD at 12 months, with median
age 58 y, 68% ≥ 62 years (31.5% ≥ 70 years).
Conclusion
Aggressive treatment of this disease , allowing long
survival, even in extensive disease is superior to best
supportive care.
We have not seen a high incidence of severe damage in
healthy tissues. TDRS can be used to predict chronic-RAD
at 12 months (Grade ≥2), but also other relevant endpoints
such as acute dysphagia during RT and MHM V69. In our
series patients older ≥ 70 y, did not suffer more chronic
toxicity dysphagia type.
PO-145 Definitive sequential radiotherapy in elderly
patients with locally advanced oropharyngeal cancer
F. De Felice1, A. Galdieri1, G. Abate 1, N. Bulzonetti1, D.
Musio1, V. Tombolini1
1Sapienza University of Rome- Policlinico Umberto I,
Radiotherapy, Rome, Italy
Purpose or Objective
To evaluate the treatment tolerance and long term follow-
up data in patients aged 70 years and older with locally
advanced oropharyngeal cancer treated by definitive
sequential intensity modulated radiotherapy (IMRT).
Material and Methods
We retrospectively analysed 15 consecutive elderly
patients, with histologically proven squamous cell
carcinoma of the oropharynx, staged T3-4 with or without
involved lymph nodes at diagnosis, who received definitive
sequential IMRT (70 Gy; 2 Gy/fraction). Performance
status (PS) and Adult Comorbidity Evaluation-27 (ACE-27)
scores were calculated, and their influence on treatment
tolerance and clinical outcomes was analysed. Overall
survival (OS) and disease-free survival (DFS)were
estimated according to Kaplan-Meier method and survival
curves were compared using the log-rank test.
Results
A total of 15 patients were included with a median age of
77 years (range 70-88 years). At baseline, all patients had
a PS score of 0, whereas 8 patients (53.3%) had an ACE-27
score of 1, and the remainders (n= 7, 46.7%) had a
comorbidity index of 0.
All patients received the IMRT prescribed total dose. Two
patients had a temporary RT interruption for a mean
period of 5 days, due to severe toxicity. Globally, severe
toxicity was recorded in 9 cases. Mucositis and oral pain
were the most common acute side effects, classified as
Grade 3 in 6 patients (40%) only. Xerostomia was reported
in 13 patients (86.7%), without severe manifestation.
There was no haematological toxicity. ACE-27 score was
not related to higher severe acute toxicity. No patients
experienced grade ≥ 3 late toxicity.
Two and 5-year OS were estimated at 72.7% (95%
confidence interval [CI] 0.425 - 0.888) and 63.6% (95% CI
0.327 - 0.833), respectively. Two and 5-year DFS rates
were66% (95% CI 0.365 - 0.843) and 55% (95% CI 0.244 -
0.776), respectively. Figure 1 showed Kaplan Meier curves
of OS and DFS. Comorbidity score did not influence
survival outcomes, both OS (p = 0.46) and DFS (p = 0.55).
Conclusion
Treatment tolerance, as well as survival outcomes were
good in elderly oropharyngeal cancer patients treated
with definitive sequential IMRT. Due to age and
comorbidity, no dose or volume reduction for IMRT should
be considered in this setting of patients. A prospective