ESTRO 36 Abstract Book

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S569 ESTRO 36 2017
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We have the objective to study the incidence of chronic
RAD in these head and neck recurrent tumors, previously
irradiated, including patients over 70 years old (y)
Material and Methods
We evaluated 69 patients with recurrent disease, between
2005 to 2015. 33 larynx, 7 nasopharynx, 15 oropharynx, 6
hypopharynx and 8 oral cavity. The initial dose received
50- 70 Gy(2-2.2Gy/fraction), 30/69 received radical
radiotherapy,21/69 radical chemoradiation; other
adjuvant radiotherapy, of which 10/ 69 was combined
with chemotherapy. In 29/69 nodal recurrence (N1-N2),
local 22/69 (T2-T4), 7/69 local+nodal recurrence, 11/69
seconds tumor, median age 59 year (range 42–79) .
Reirradiation with external 3D conformal/IMRT
techniques/ and dose: 50-70 Gy bjective to study the
incidence of chronic RAD in these head and neck recurrent
tumors, previously irradiated, including patients over 70
years old (y)
Results
The acute grade 2–4 RTOG dysphagia in week 6 (RTOG G2–
4) was 75.4% (G2: 32/69, G3: 20/69). Of 69 patients, 21
(29.8%) had chronic-RAD at 12 months (G2: 17/69, G3:
3/69 G4: 1/69). All of these patients had acute toxicity
G2-G3. After calculation of the TDRS, nine patients ( 3
patients <62 years old/ 6p ≥ 62 y (3p ≥ 70 y)), were
classified in the low-risk group (TDRS 0–9); 15 patients ( 5
patients <62 years old/ 10 p ≥ 62 y (4p ≥ 70 y)),in the
intermediate-risk group (TDRS10–18) and 45 patients ( 16
patients <62 years old/ 29p ≥ 62 y (14p ≥ 70 y)),in the
high-risk group (TDRS > 18). MHM V69 was ≥ 79.5% in all
patients with chronic-RAD at 12 months, with median age
59, 68% ≥ 62 years (31.5% ≥ 70 years old)
Conclusion
Aggressive treatment of this disease recurring, 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 than 70 years did not suffer more
chronic toxicity dysphagia type
EP-1038 Intraoperative electron beam radiotherapy
for locoregionally recurrent head and neck cancer
P. Wald1, J. Grecula1, A. Bhatt1, V. Diavolitsis1, T.
Teknos 2, M. Old2, J. Rocco 2, A. Agarwal2, E. Ozer2, R.
Carrau 2, D. Blakaj1
1 OSU Medical Center -James Cancer Hospital, Radiation
Oncology, Columbus, USA
2 OSU Medical Center -James Cancer Hospital,
Otolaryngology, Columbus, USA
Purpose or Objective
When feasible, standard of care for locoregionally
recurrent head and neck cancer is salv age surgery.
However, locoregional control (LRC) is unacceptably low
with surgery alone. Adjuvant chemoradiation was shown
to improve LRC and progression free survival (PFS) in a
randomized controlled trial, but LRC at one year was still
only about 60%. The role for intraoperative radiotherapy
(IORT) in the salvage setting remains unclear due to
limited data and variable patient selection criteria
between institutions. We report our institutional
outcomes using IORT for recurrent head and neck cancer.
Material and Methods
Between 2004 and 2015, 61 patients underwent salvage
surgery and IORT for recurrent head and neck cancer at
our institution. IORT was delivered using a mobile electron
unit. A single fraction was delivered to a median dose of
12.5 Gy (range, 10 – 17.5 Gy). We retrospectively
evaluated LRC, PFS, and overall survival (OS) for the entire
group. We then evaluated the squamous cell carcinoma
patients alone. Univariate analysis was performed using
log-rank tests to correlate clinical outcomes with histology
(squamous cell carcinoma vs. others), surgical margin
status (positive vs. negative), and adjuvant therapy
received. LRC, PFS, and OS curves were generated using
the Kaplan-Meier method.
Results
Median follow up for surviving patients was 15.9 months
(range, 4.9 - 74.4). Forty-one patients (67%) were treated
to the primary site and 20 (33%) to a neck recurrence.
Forty-five patients (74%) had squamous cell histology
(SCC). Fifty-seven patients (93%) had previously received
external beam radiotherapy (EBRT) as a component of
their definitive therapy (median dose 66 Gy). The median
time interval between prior EBRT and IORT was 16.4
months (range, 1 – 227 months). Final surgical margins
were positive in 28 patients (46%), negative in 27 patients
(44%), and unknown in 6 patients (10%). Twenty-three
patients (38%) received a course of post-operative EBRT
(median dose 45 Gy, range 25 – 66 Gy) with a median time
interval between IORT and completion of post-operative
EBRT of 78 days (range, 52 – 131). Nine patients (15%)
received post-operative chemotherapy. There was one
grade 5 toxicity which resulted from carotid rupture 18
days after surgery/IORT.
Conclusion
The use of IORT for recurrent head and neck cancer at our
institution has shown effective locoregional control and
overall survival, despite only 38% of our patients receiving
post-operative EBRT. OS was significantly better for non-
SCC histologies compared to SCC. For SCC patients, there
is a trend toward improved PFS (p = 0.09) and OS (p = 0.06)
associated with negative surgical margins. IORT in the re-
irradiation setting has shown acceptably low rates of
severe toxicity. We plan to initiate a prospective trial to
investigate the safety and efficacy of IORT in combination
with post-operative chemoradiation for recurrent head
and neck cancer in the near future.
EP-1039 CTV growth evaluation for involved site neck
lymphoma RT if pre-chemo RT position PET-CT is
absent
D. Bird1, C. Patel2, A. Scarsbrook2, V. Cosgrove1, E.
Thomas3, D. Gilson3, R. Prestwich3
1Leeds Teaching Hospitals Trust, Medical Physics and
Engineering, Leeds, United Kingdom
2Leeds Teaching Hospitals Trust, Radiology and Nuclear
Medicine, Leeds, United Kingdom
3Leeds Teaching Hospitals Trust, Clinical Oncology,
Leeds, United Kingdom
Purpose or Objective
A pre-chemotherapy PET-CT acquired in the radiotherapy
treatment position has not been widely implemented in
the management of lymphoma. An involved site
radiotherapy (ISRT) CTV requires an expansion to account
for the absence of optimal pre-chemotherapy
imaging. The aim of this prospective imaging study is to
determine the size of the expansion required for neck
radiotherapy.
Material and Methods
10 patients with Hodgkin lymphoma and diffuse large B
cell lymphoma were identified from a prospective single
centre imaging study who had undergone a pre-
chemotherapy PET-CT in both the diagnostic and