ESTRO 36 Abstract Book

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S577 ESTRO 36 2017
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Purpose or Objective
Postoperative concurrent chemoradiotherapy (CCRT) is
supprior to RT alone for squamous cell carcinoma of the
head and neck (SCCHN) with high-risk factors (such as
extracapsular invasion, positive resection margin) by both
RTOG 9501 and EORTC 22931 trials. We developed a new
protocol of intensive chemotherapy followed by IMRT
(IntCT+RT) and compared the toxicity and efficacy with
CCRT for patients with SCCHN and poor prognostic factors
after surgery.
Material and Methods
Ninety-two SCCHN patients who received curative
resection first and with at least one of the following
characteristics, resection margin involvement or close to
the tumor, extracapsular invasion, perineural invasion,
angiolymphatic invasion, pathological stage T4, and
multiple neck nodes metastasis were eligible for this
study. Postoperative multi-drugs combination
chemotherapy (Methotrexate 30 mg/m2 d1, Epirubicin 30
mg/m2 d1, alternating with Mitomycin-C 4 mg/m2 d8,
Oncovin 1 mg/m2 d8, Cisplatin 25 mg/m2 d8, Leucovorin
120 mg/m2 d8, 5-fluoroUracil 1000 mg/m2 d8, and
Bleomycin 10 mg/m2 d8) for 10-12 weeks were
administered followed by IMRT in the IntCT+RT groups.
Patient in the CCRT group received similar RT and
concurrent chemotherapy of either tri-weekly cisplatin
100mg/m2 alone or tri-weekly cisplatin 50mg/m2 plus oral
tegafur-uracil 2# bid for 7 weeks.
Results
The IntCT+RT group (n=37) had less regional (8.1% vs.
12.7%) and distant (2.7% vs. 7.3%) failures, compared with
the CCRT group (n=55). The Kaplan-Meier survival analyses
revealed that patients treated by IntCT+RT had better
regional failure-free survival (3-year rate, 94.5% vs. 72.4%,
P=0.0294) and overall survival (75.9% vs. 61.8%, P=0.1343)
than those who received CCRT. Grade 3/4 acute toxicity
of IntCT phase included leucopenia (51.4%), anemia
(27.0%), vomiting (5.4%), alopecia (5.4%) and mucositis
(2.7%) but patients could tolerate it well. During RT
period, patients in the CCRT group had significantly higher
grade 3/4 mucositis (76.4% vs. 57.7%, P=0.0356) and
vomiting (27.3% vs. 0%, P<0.0001) than those in the IntCT-
RT group.
Conclusion
IntCT+RT in postoperative setting for high-risk SCCHN
patients is feasible. We observe a significant better
regional control, favorable overall survival and less grade
3 or 4 mucositis and vomiting in the IntCT-RT group
compard with the CCRT. This novel approach deserves to
be studied in a phase III randomized trial.
EP-1056 Radiation and concurrent superselective
intra-arterial cisplatin for maxillary sinus cancer
T. Ebara1, K. Ando1, M. Kawahara1, M. Suzuki2, H.
Horikoshi3, Y. Tamaki4
1 Gunma Prefectural Cancer Center, Division of Radiation
Oncology, Ota, Japan
2 Gunma Prefectural Cancer Center, Division of Head and
Neck Surgery, Ota, Japan
3 Gunma Prefectural Cancer Center, Division of
Radiology, Ota, Japan
4 Tsukuba University Hospital, Department of Radiation
Oncology, Tsukuba, Japan
Purpose or Objective
This study aimed to evaluate the efficacy of radiation and
concomitant superselective high-dose intra-arterial
cisplatin (RADPLAT) for maxillary sinus squamous
carcinoma (MS-SCC).
Material and Methods
We conducted a retrospective chart review of MS-SCC
patients treated with RADPLAT between 2008 and June
2016.
Results
Thirty-four MS-SCC patients were received RADPLAT.
There were 9 patients (26%) diagnosed with T3, 14 (41%)
with T4a, and 11 (32%) with T4b disease. Lymph-node
involvement was present in 6 patients. Cisplatin with
median 150 mg was administered using the superselective
intra-arterial infusion method bi-weekly. Of them, 29, 3,
1 and 1 patients were received 4, 3, 2 and 1 times cisplatin
infusions, respectively. Radiation, ranged with 50–74 Gy
with median 60 Gy was administered by 2 Gy fraction in 5
times a week. The median follow-up was 24.6 months,
ranged with 4.1-92.4 months. Complete responses in the
primary site were obtained in 11 (32%) patients and partial
responses in 19 (56%) patients. The 2 and 5-year overall
survival rates (OS) were 66 and 45%, respectively. The 2
and 5-year primary-site recurrence free survival rates
(PRFS) were 49 and 40%, respectively. The 2 and 5-year
disease-free survival rates (DFS) were 45 and 37%,
respectively. The patients with T3 showed significantly
better OS (p=0.03). The patients with 4 time infusions
showed significantly better OS, PRFS, and DFS (p<0.05).
There was no life-threatening toxicity.
Conclusion
In RADPLAT for MS-SCC, 4 times cisplatin infusions could
improve the prognosis.
EP-1057 Predictive and prognostic value of
pretreatment [18F] FDG-PET parameters in head-and-
neck cancer
L. Deantonio1, M. Paolini 1, E. Puta2, L. Vigna3, R.
Matheoud3, L. Masini1, G. Sacchetti2, M. Brambilla3, M.
Krengli1
1University Hospital Maggiore della Carità,
Radiotherapy, Novara, Italy
2University Hospital Maggiore della Carità, Nuclear
Medicine, Novara, Italy
3University Hospital Maggiore della Carità, Medical
Physics, Novara, Italy
Purpose or Objective
To evaluate the predictive and prognostic value of [F18]
FDG-PET parameters performed prior to radiotherapy in
head-and-neck cancer patients.
Material and Methods
Thirty-eight patients with newly diagnosed head-and-neck
cancer treated with concomitant chemoradiotherapy
underwent [F18] FDG-PET before the treatment course.
The maximum and the mean standardized uptake value
(SUVmax, SUVmean), the metabolic tumor volume (MTV),
and total lesion glycolysis (TLG) were analysed. Multiple
threshold levels were tested in order to define the most
suitable threshold value for the metabolic activity of each
patient's tumour: the fixed threshold of the 41% and 50%
of the maximum uptake value (SUV41%, SUV50%) and an
adaptive threshold algorithm (ATA) implemented on the
iTaRT workstation (Tecnologie Avanzate, Italy). We
evaluated the relationship of mean values of SUVmax,
SUVmean, MTV, and TLG with tumour characteristics,
treatment response, local recurrence, distant metastasis
and disease-related death. Receiver-operating
characteristic (ROC) curve analysis was done to obtain
optimal predictive cut-off values for PET parameters.
Disease-free (DFS) and overall survival (OS) disease-
related were examined according to these cut-offs.
Results
The mean value and range of each parameters were
calculated (Table1).
Higher SUVmeanATA was associated to higher primary
tumour staging (p= 0.04).
Thirty-two/38 patients (84.2%) had a complete response,
4/38 (10.5%) a partial response, and 2/38 (5.2%) a no
response 8 weeks after the completion of treatment. SUV
parameters resulted not predictive of tumour response.
After a median follow-up of 22 months, 6/38 (15.8%)
patients developed local recurrence and 6/38 (15.8%)