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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
__________________________________________________________________________________________
staged using cross-sectional imaging. Early laryngeal
cancers (T1N0) were excluded. A retrospective chart
review determined patient demographics, tumour and
treatment factors. Survival analysis was performed using
the Kaplan-Meier method, and comparisons between
groups used the log rank test.
Results
Median age was 82 years (range 80-92). Patient
demographics are shown in Table 1. 42 (68%) had stage III-
IVb disease. Radiotherapy was delivered using volumetric
modulated arc therapy (VMAT), 5-7 field intensity
modulated radiation therapy (IMRT), or conformal
technique. Prescribed doses were: 52.5-55Gray in 20
fractions and 60-66Gray in 30 fractions. Two (3%) patients
received synchronous cetuximab and two (3%) were
treated in the NIMRAD trial (+/-synchronous nimorazole).
Four (6%) had a neck dissection prior to radiotherapy.
Eight (13%) were electively treated as inpatients. Six (10%)
did not complete radiotherapy: four (6%) due to co-
morbidities and two (3%) due to poor tolerability. 43%
patients required acute admissions for nutritional support
and symptom control. Fourteen (44%) required tube
feeding prior to treatment and an additional 17 (27.4%)
commenced enteral feeding during radiotherapy. The
median enteral tube feeding duration was 3 months.
Grade 2-3 mucositis occurred in 28 (60%), and Grade 2-3
skin reactions in 21 (57%) patients.
Median overall survival was 27.3 months (range 0.7-
62.4m); and 2-year overall survival was 57%. There was a
non-significant trend towards improved survival with
performance status (PS) 0-1 compared to PS 2-3, (28.9m v
21.0m, p=0.1372). Patients who initially weighed <60kg at
start of radiotherapy had significantly worse survival than
those ≥60kg (5.7m v 28.9m, p=0.0033).
Conclusion
We show promising survival outcomes in very elderly
patients treated mainly with radiotherapy alone for head
and neck cancer. We note poor survival outcomes
associated with low pre-treatment weight. Optimisation
of nutritional status may be an important factor to
improve outcomes for this patient group.
PO-150 Age ≥70 is not an adverse prognostic factor for
accelerated radiotherapy in head and neck cancer
C. Terhaard
1
, N. Kasperts
1
, H. Dehnad
1
, E. Smid
1
, L.
Janssen
2
, R.G. Wiggenraad
3
, C.P.J. Raaijmakers
1
1
UMC Utrecht, Radiation Oncology Department, Utrecht,
The Netherlands
2
UMC Utrecht, Head and Neck surgical oncology
Department, Utrecht, The Netherlands
3
RCWEST- Medisch Centrum Haaglanden., Radiation
Oncology department, Den Haag, The Netherlands
Purpose or Objective
Based on meta-analysis it is stated that accelerated
fractionation for patients with intermediate staged head
and neck cancer above an age of 70 years has no benefit,
with however an increased risk of complications,
compared to patients younger than 70. In a large dataset
we evaluated the prognostic significance for outcome of
age in a group of patients with a WHO performance status
of 0 to 1 .
Material and Methods
Since 1998 we treat advanced T2 glottis (based on volume
and/or impaired mobility of the vocal cord), T2
supraglottis , T3 glottis/ supraglottis, T2/ T3
hypopharyngeal cancer, including nodes smaller than 3
cm, with accelerated fractionation.
A dose of 47 Gy is
given in 10 fractions of 2 Gy, followed by 15 fractions of
1.8 Gy, week 3-5, on the primary tumor and the elective
neck levels. A boost dose of 22.5 Gy in 15 fractions of 1.5
Gy is given as a first daily fraction in week 3-5, at least 6
hours before the second fraction. Results have been
published previously
1
. Until July 2014, 310 patients were
treated with this schedule with a minimum follow-up of 2
years, median FU 5 years. Eighty-two patients were ≥ 70
years (O) (70-87, median 75), WHO performance 0-1, 228
< 70 years (Y) (32-69, median 59). Distribution of T-stage
was for T2, T3 and T4, 59%, 30%, and 8%, respectively.;
35% was N+. Distribution of prognostic factors was equal
for gender and Stage. Distribution of tumor location was
larynx, hypopharynx, and oropharynx in 77% vs. 79%, 11%
vs. 16%, and 12% vs. 5%, for group O and Y respectively. A
smoking history was positive in 99% and 87 % for Y vs. O
(p=sign.). Continuation of smoking occurred in 39% vs. 11%
respectively (p=sign.)
Results
Five years local recurrence e free survival was 86% vs. 84%
for Y vs. O (p=n.s.). Actuarial 5 years disease free survival