ESTRO 36 Abstract Book

329 / 1082

S314 ESTRO 36 2017
_______________________________________________________________________________________________
than men (p< 0.001) and patients presenting nasal cavity
tumors scored higher that all other tumoral sites (p=0.08).
Conclusion
HNC patients undergoing radiation therapy have high
levels of emotional distress, anxiety and claustrophobia.
Given the high percentage of psychological distress,
awareness and management of these issues are primordial
as they may have significant impact on treatment
acceptance and tolerability as well QOL during and after
treatment.
PO-0609 18F-FDG-PET in Guiding Dose-painting with
IMRT in Oropharyngeal Tumours (FiGaRO) – Early Results
A. Michaelidou1, L. Pike2, C. Thomas3, L. Penketh4, Y.
Suh5, S. Barrington2, M. Evans4, M. Lei1, T. Guerrero
Urbano1
1 Guy's and St Thomas' NHS Foundation Trust, Clinical
Oncology, London, United Kingdom
2 The PET Centre at St Thomas' Hospital, Nuclear
Medicine, London, United Kingdom
3 Guy's and St Thomas' NHS Foundation Trust,
Radiotherapy Physics, London, United Kingdom
4 Velindre Cancer Centre, Clinical Oncology, Cardiff,
United Kingdom
5 Royal Marsden NHS Foundation Trust, Clinical Oncology,
London, United Kingdom
Purpose or Objective
IMRT ± chemotherapy is an effective treatment for stage
III/IVa oropharyngeal squamous cell carcinoma (SCC).
Treatment failures occur mostly at the primary site and
are difficult to salvage. Dose escalation strategies are
being explored, with target volume definition and toxicity
considered the main challenges. IMRT can boost doses to
selected areas (dose painting) without exceeding normal
tissue tolerances. 18F-FDG-PET/CT can mediate this, by
defining areas of metabolic activity for dose escalation.
This Phase 1 multicentre study aims to test the feasibility
and safety of 18F-FDG-PET/CT dose-painted IMRT in locally
advanced oropharyngeal SCC. We present toxicity results
in the first 15 patients.
Material and Methods
Patients with ≥T2, HPV-negative or high-risk HPV-positive
disease, suitable for radical treatment with neo-adjuvant
chemotherapy and chemo-IMRT, are eligible.
PET/CT is acquired after one chemotherapy cycle, in the
radiotherapy position, in the immobilization shell. The
FDG-avid gross tumour volume (GTV-T18F-FDG-PET) is
manually delineated by a nuclear medicine physician then
copied onto the fused CT for direct planning. Thirty daily
fractions are delivered in 6 weeks, at 3 dose levels. The
radical volume (PTV1) receives 65Gy, the prophylactic
volume (PTV2) 54Gy and the GTV-T18F-FDG-PET receives
71.5Gy.
Results
Fifteen patients (14 male, 1 female; mean age-61, range
49-71) were treated April’14-March’16, at two centres
(median follow-up 10 months, range 4-26 months. Eight
(53.3%) are HPV-negative, 7(46.7%) are HPV-positive.
Average GTV-T18F-FDG-PET volume was 11.9cc (range 1.6-
67.7cc). Target volume objectives were met in all (median
D95 98.1%, range 96.1-98.9%; Median D5102.9%, range
101.1-103.6%), whilst respecting normal tissue tolerances
and PTV1 hotspot constraints.
On the CTCAEv.4.0 scale, end of treatment toxicities
were: Grade 4–none; Grade 3 - dysphagia-46.7%(n=7),
mucositis-26.7%(n=4), pain-13.3%(n=2), salivary gland-
6.7% (n=1); Grade 2- dysphagia-53.3%(n=8), mucositis-
73.3%(n=11), pain-73.3%(n=11), salivary gland-
86.7%(n=13), dermatitis-73.3%(n=11), xerostomia-
66.7%(n=10), fatigue-46.7%(n=7). Three month post-
treatment toxicities were: Grade 4–none; Grade 3 -
dysphagia-20.0%(n=3); Grade 2- dysphagia-20.0%(n=3),
mucositis-13.3%(n=2), pain-20.0%(n=3), xerostomia-
53.3%(n=8).
On the RTOG/EORTC scale 3-month post treatment
toxicities were: Grade 4-none; Grade 3-salivary gland-
6.7%(n=1), oesophagus-6.7%(n=1); Grade 2–salivary gland-
46.7%(n=7), oesophagus-13.3%(n=2), mucosa-13.3%(n=2),
joint(TMJ)-6.7%(n=1). On LENTSOMA categories one
patient had a grade 4 toxicity - oropharyngeal dysphagia
(gastrostomy dependent). Six (40.0%) had grade 3
toxicities and 13 (86.7%) had grade 2 toxicities.
There were 2 local recurrences within 1 year, both
underwent salvage surgery with clear margins.
Conclusion
18F-FDG-PET-guided selective dose escalation is feasible,
with acceptable acute toxicity. Late toxicity assessment
(3, 6 and 12-months post-treatment) is ongoing.
PO-0610 Effects of an oral health promotion program
in head and neck cancer patients receiving radiotherapy
E. Kim1, H.G. Wu1, J.H. Kim1, K.S. Kim1, T. Yu1, C.W.
Wee1, N. Choi1, B.S. Jang1, S.H. Jeon1, H.J. Lee2, D.H.
Han 2
1Seoul National University College of Medicine, Radiation
Oncology, Seoul, Korea Republic of
2Seoul National University College of Dentistry,
Preventive and Social Dentistry, Seoul, Korea Republic of
Purpose or Objective
To develop oral health promotion program and evaluate
its effectiveness in head and neck cancer (HNC) patients
receiving radiotherapy (RT).
Material and Methods
This was an open-label, non-randomized, prospective
study in 84 HNC patients treated with RT. Dental health
promotion program consisted of oral exam, oral health
education, fluoride varnish and mouthwash. Forty-seven
patients were assigned to an experimental group with the
dental health care program and 37 to a control group.
Clinical benefit was measured by the European
Organization for Research and Treatment of Cancer
(EORTC) Quality of Life Questionnaire head and neck
module (QLQ-H&N35) and the oral examination before and
up to 6 months after RT.
Results
Compared with the control group, the experimental group
showed significant improvement in sexuality, use of pain
killers, and worried about future (p = 0.045, p = 0.049, and
p < 0.001, respectively). Oral health promotion program
did not affect the development of xerostomia. Subgroups
of patients with old age (≥ 60 years), stage IV HNC, and
radical RT reported significant improvement in quality of
life by oral health promotion protocol. Although caries
experience significantly increased in a control group (p =
0.002), there was no significant change in an experimental
group. The experimental group showed significantly
decreased plaque score and bleeding on probe (p < 0.001
and p = 0.004).
Conclusion
Administration of our oral health promotion program
decreased dental problems and slightly improved patients’
quality of life. We recommend the dental care program
for HNC patients receiving RT to reduce treatment related
oral toxicities.
PO-0611 Long-term prognostic impacts of pretreatment
plasma EBV DNA status in nasopharyngeal carcinoma
J.C. Lin1, W.Y. Wang2, J.W. Huang1
1Taichung Veterans General Hospital, Department of
Radiation Oncology, Taichung, Taiwan
2Hung Kuang University, Department of Nursing,
Taichung, Taiwan
Purpose or Objective
To investigate the prognostic impacts of pretreatment
plasma EBV (pEBV) DNA in patients with nasopharyngeal
carcinoma.
Material and Methods