ESTRO 36 Abstract Book

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S585 ESTRO 36 2017
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late toxicities. Treatments were delivered twice a week
for a total of 5 fractions via image-guided volumetric arc
therapy with the OAR as the fusion surrogate. Quality of
life (QOL) data was collected at consultation and follow
up using the MD Anderson Dysphagia Inventory (MDADI),
Symptom Inventory – Head and Neck Module (MDASI-HN),
and Xerostomia Questionnaire. Local control and overall
survival were estimated using the Kaplan-Meier method.
Results
Sixty patients were treated to 69 sites (9 for a second
metachronous failure). Thirty two patients underwent
surgical salvage prior to SBRT. Retreatment sites included
the aerodigestive tract (43%), lateral neck (22%), and skull
base (35%). The median prior radiotherapy dose was 63.6
Gy and the median reirradiation planning target volume
(PTV) was 61.0 cm3 (range 16.8 to 349 cm3). Despite
prioritizing OAR-sparing over PTV coverage, the median
V90 was 98.4% and D90 was 99.0%. The 1- and 2- year rates
of local control were both 54%. Median survival was 18.5
months after SBRT. Late grade 3 toxicities occurred in 3%
of the aerodigestive tract group, 1% of the skull base
group, and none treated to the lateral neck. No grade 4 or
5 toxicities were observed. Compared to baseline,
patients with skull base reirradiation maintained a stable
QOL, while patients treated to the aerodigestive tract
demonstrated decreased QOL associated with worsening
dysphagia. All groups experienced increased xerostomia.
Conclusion
OAR-sparing SBRT is able to achieve excellent tumor
coverage while protecting the organs at highest risk of
reirradiation-related complications. Compared to
conventional fractionation, the potential for lowered
toxicity and maintained QOL makes SBRT a promising
salvage option for recurrent head and neck cancer.
Further, prioritizing OARs preserves a treatment option for
repeat reirradiation in patients who develop a second in-
field tumor recurrence.
EP-1072 Early nutritional support in head and neck:
survey of Italian radiation
oncologists/otolaryngologists.
M. Trignani1, A. Allajbej1 , A. Di Pilla1, M. Nuzzo1, S. Di
Biase1 , M. Di Perna1, A. Croce 2, M. Di Nicola3, I. Porfilio3,
D. Genovesi1
1Ospedale Clinicizzato S.S. Annunziata, Radiotherapy,
Chieti, Italy
2Otolaryngology, Otolaryngology, Chieti, Italy
3Preventive Medicine and Hygiene, Biomedical Science,
Chieti, Italy
Purpose or Objective
The aim of this study was to evaluate the most common
approaches among Italian radiation oncologists (RO) and
otolaryngologists (OL) in early nutritional management of
head and neck (H&N) cancer patients. Type of nutritional
supplements prophylactically used, timing and criteria of
percutaneous endoscopic gastrostomy placement (PEG)
and role of nutritional counseling were investigated.
Material and Methods
A questionnaire, focused on different points of nutritional
management in H&N cancer patients, was created and
approved by a multidisciplinary team (MDT) including RO,
OL and nutritionists. The survey, containing 10 multiple-
choice questions, was prepared on SurveyMonkey online
interface and emailed to 106 Italian centers of radiation
oncology and 100 centers of otolaryngology. Responses
were collected over a 2-month period. Descriptive
analyses in terms of frequencies and percentages was
automatically elaborated by SurveyMonkey. Chi-square
test was performed to establish any significant difference
between interviewed.
Results
A total of 67/106 and 27/100 questionnaires sent to Italian
centers of Radiation Oncology and Otorhinolaryngology
were filled in, corresponding to a response rate of 63.2%
and of 27% respectively. Respondents answered all
questions, so all were included in the analysis. Regarding
nutritional counseling before starting treatment, 53.7% of
RO claimed to make it rarely, while 26.9% always; 33.3%
of OL affirmed to practice a preventive nutritional
counseling rarely, 29.6% always and 22.2% almost always.
53.7% of RO affirmed they did not employ any nutritional
supplement before starting treatment, while 20.9%
declared to use PEG. Among OL, 37.0% affirmed the use of
other nutritional supplements in a prophylactic phase,
while 29.6% did not use any nutritional supplement
(p=0.05). Considering selection criteria for PEG
placement, tumor stage (locally advanced) and tumor site
(oropharynx) were the most important criteria for both RO
(73.1%) and OL (85.2%). To the question 'when you use
PEG?”, 26.9% of RO and 11.1% of OL replied to place PEG
in a prophylactic phase (p=0.166). PEG is positioned in
reactive phase in 73.1% of cases by RO and in 88.9% of case
by OL. RO (82.1%) and OL (92.6%) stated that the
placement of the PEG before starting treatment should
not be a standard procedure (p=0.330); they also
respectively stated (85.2% and 88.1%) that the assessment
of medical nutritionist before starting a treatment should
represent a standard procedure (p=0.971). Finally, 86.6%
of RO and 92.6% of OL stated to evaluate H&N cancer
patients in MTD.
Conclusion
Management of early nutritional supplementation in H&N
cancer is still controversy. It seems necessary to improve
nutritional evaluation among the Italian MDTs of H&N
cancer care, because this appear lacking. Participation to
surveys should be encouraged in order to better use the
information that this precious, fast and cheap tool can
provide.
EP-1073 Volumetric changes in parotid volume during
radiation therapy in head and neck cancer
M.R. Tonse1
1Tata Memorial Centre, Radiation Oncology- Neuro
Oncology, Mumbai, India
Purpose or Objective