ESTRO 36 Abstract Book

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S573 ESTRO 36 2017
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Patients were randomized to orally receive either
glutamine or placebo at a dose of 10 g 3 times a day
throughout the CRT course. Mucositis was assessed using
the National Cancer Institute Common Terminology
Criteria for Adverse Events version 3.0. The primary end
point was mucositis severity. Seventy biopsy proven
patients with head and neck cancer receiving primary or
adjuvant radiation therapy were randomized to receive
either oral glutamine suspension daily 2h before radiation
in the study arm (10 g in 1000 ml of water) (n = 35) or
placebo before radiation; control arm (n = 35)
Results
Total 30 patients in the glutamine arm and total 33
patients in placebo developed mucositis. Grade 3
mucositis and grade 4 mucositis in the study arm (who
received oral glutamine) were significantly less in the
glutamine arm. The mean duration of grade 3 or worse
mucositis (grade 3 and grade 4) was significantly less in
study arm with P < 0.001. Mean time of onset of mucositis
was significantly delayed in patients who took glutamine
in comparison to control arm with P < 0.001. Overall,
glutamine was associated with a significant reduction of
mucositis, WL, and enteral nutrition.
Conclusion
Glutamine delays oral mucositis in the head neck cancer
patients. Moreover, it reduces the frequency and duration
of grade 3 and grade 4 mucositis. More of the patients not
receiving glutamine developed severe malnutrition when
compared with those receiving this supplement, but there
were no differences in other outcomes such as
interruption of RT, hospitalization, use of opioid
analgesics, or death during RT. Glutamine may have a
protective effect during RT, reducing the risk and severity
of OM, preventing weight loss, and reducing the need for
nutritional support.
EP-1046 Hypofractionated palliative radiotherapy in
head and neck cancer
P. Vargas Arrabal1, I. Tovar Martin1, C. Prieto Prieto1, M.
Zurita Herrera1, R. Guerrero Tejada1, J. Exposito
Hernandez1, R. Del Moral Avila1, A. Ruiz Martinez1, S.
Rodriguez Pavon1 , R. Ching1
1 Complejo Hospitalario de Granada, Radiation Oncology,
Granada, Spain
Purpose or Objective
There are few published studies on the choice of the best
palliative treatment option for head and neck cancer, as
well as high toxicity and its impact on symptom control
and quality of life, once ruled treatment with curative
intent .
The objective is to evaluate the role of radiotherapy (RT)
in the palliation of tumors advanced head and neck:
identifying patients optimal candidates, appropriate dose,
outcome and duration of palliation and secondary toxicity.
Material and Methods
We retrospectively reviewed 31 patients treated between
2006-2015 histological diagnosis of epidermoid head and
neck cancer stage IV, not candidates for radical treatment
under perfomance status with advanced locoregional
recurrent disease or metastatic. All patients are treated
with three-dimensional conformal external beam
radiotherapy (3D) with different schemes
hypofractionation: dose 30 Gy fractions of 6 Gy (2 x week):
52.4% (16), 30 Gy fractions of 3 Gy (5 x week): 14.3% (5),
20 Gy to 4 Gy fractions (5 x week): 9.5% (3) 23.8% other
(7).
Results
With a mean follow up of 20 months, 90% of patients
completed RT scheme originally planned. The median time
to progression of symptoms is 5 months. The objective
tumor response is complete response: 23.8% (7), Partial /
stabilization: 57.1% (18). The median time to tumor
progression 3 months. The median overall survival is 9
months (2-57).
The acute toxicity is recorded after RT oromucositis G2
9.5% (3), G3 57% (18), radiodermitis G2 9.5% (3), dysphagia
G2 71.4% (22).
Conclusion
In patients with advanced head and neck cancer and no
subsidiary of radical treatment, palliative RT
Hypofractionated, provides a satisfactory rate of disease
control and symptom control with a secondary tolerable
toxicity and better life quality.
EP-1047 Comparison of TPF and CF induction
chemoradiotherapy for radical treatment of head and
neck cancer.
C. Adkin1, D. Adjogatse 1, T. Guerrero Urbano1, M. Lei1
1Guy's and St.Thomas' Hospital NHS Foundation Trust,
Clinical Oncology, London, United Kingdom
Purpose or Objective
To compare the impact of induction chemotherapy using
the TPF (Docetaxel, Cisplatin and 5-fluorouracil) and
standard CF (Cisplatin and 5-fluorouracil) regimens on
toxicity and hospital admissions for radical treatment of
locally advanced head and neck cancer. The aim was to
assess if the TPF regimen increases toxicity during
induction and concomitant chemoradiotherapy and if this
results in increased burden of hospital admissions and
clinic attendance.
Material and Methods
Patients undergoing radical chemoradiotherapy for locally
advanced head and neck cancer at Guy’s hospital during
2015 were selected. Timing, dose and duration of
chemoradiotherapy were recorded. All admissions were
included up to 3 months after completion of radiotherapy.
These admissions were attributed to radical treatment.
The number and duration of hospital admissions, both
elective and acute were assessed, as well as the number
of acute outpatient clinic attendances. The number of
episodes of neutropenia was recorded, as well and the
need for nasogastic/jejunal or gastrostomy feeding tubes.
The cohort was followed up to assess clinical and
radiological response to treatment as well as recurrence
and survival at 3 and 12 months.
Results
44 patients were included (10 TPF, 34 CF). Per patient,
the TPF regime was shown to increase the number of acute
clinic attendances (4.5 vs 2.7), acute admissions (2.4 vs
1.0), length of stay per admission (4.9 days vs 3.8 days)
and total length of stay (13.4 days vs 8.6 days). There was
a considerable increase in the number of episodes of
neutropenia per patient with TPF (1.2 vs 0.4). There was
only a modest increase in elective admissions (0.5 vs 0.4)
and the need for feeding tubes (0.7 vs 0.6). There were 4
deaths during the observed period, all amongst the CF
group.
Conclusion
Within the group of patients selected, the use of TPF
induction chemotherapy appears to increase toxicities,
including neutropenia, the need for clinic attendance and
inpatient admission. The length of stay also appears to be
longer, which may act as a surrogate for severity of
admission. Overall, the TPF induction regimen carries an
increased cost, in terms of morbidity, patient quality of
life and a financial burden of hospital admission and clinic
attendance. This will need to be weighed up against the
potential added benefit over standard CF induction
chemotherapy, in terms of efficacy of response, extended
time to progression and survival.
EP-1048 Phantom Tumour Phenomenon in
Nasopharyngeal Carcinoma Patients after Radiotherapy
Y.M. Jen 1, S. Shi2
1Yee-Ren Hospital, Department of Radiation Oncology,
Nei Hu- Taipei, Taiwan
2Chenzhou NO.1 People's Hospital, Radiation Therapy
Center, chenzhou, China