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S589
ESTRO 36 2017
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Dosimetric information, medical records and tumor
characteristics of 49 patients were collected. CT,
structure set and dose files were available for 32 patients,
making it possible to perform deformable image and dose
registration to allow plan summation and extract precise
cumulative dose statistics for the CA. For the remaining
17 patients a reliable approximation of the cumulative
dose to the CAs was made by comparing printed CT-slices
with isodose curves from the previous RT courses with the
dose distribution from the reirradiation. Corresponding
EQD2 was calculated with an α/β-ratio=3.
Results
Forty-four patients had received 1 prior RT course, while
5 had received 2 prior RT courses. Ten patients received
reirradiation with proton RT and 39 with carbon ion RT
(CIRT). In the 49 patients a total of 74 CAs had been
reirradiated to a median cumulative Dmax
EQD2
of 106 Gy
(RBE) (range: 25-167 Gy (RBE)). Details are presented in
TABLE 1
and
FIGURE 1
. Median time between 1
st
and final
RT was 29 months (range: 3-205 months). Median time of
follow-up was 10 months (range: 1-41 months). Two
patients (4%) experienced profuse oronasal bleeding at 6
and 8 months after reirradiation, both fatal. Cumulative
Dmax
EQD2
for these patients CAs were 130 and 107 Gy
(RBE), respectively. Both had recurrent tumors completely
surrounding the CA. The first patient had undergone
surgery close to the CA prior to the reirradiation. At the
time of bleeding he performed a CT-angiogra phy
revealing a pseudoaneurysm on the CA, making the
diagnosis of CBS highly probable. The second patient had
a recurrent tumor at the site of bleeding. Autopsy was
refused, making it impossible to ascertain if the bleeding
was due to CBS or from pathological tumor vessels. If we
attribute both cases to CBS, the CBS-rate for reirradiated
CAs was 2.7% (95% CI 1.0-6.4%).
Conclusion
Reirradiation in the H&N region with particle therapy gives
CBS-rates comparable to normo- or hyperfractionated
photon RT, and does not seem to increase in
hypofractionated schedules typically used in CIRT, in
contrast to what is reported in hypofractionated SBRT with
photons. The low number of events does not make it
possible to define significant risk factors or tolerance
doses for the CA.
EP-1080 Psychological distress in patients with head
and neck cancer during radiotherapy
M. Massaccesi
1
, L. Dinapoli
1
, A. Pesce
1
, R. Autorino
1
, A.
Tenore
1
, M. Balducci
1
, D. Smaniotto
1
, G. Chiloiro
1
, M.
Rigante
2
, G. Cadoni
2
, G. Paludetti
2
, V. Valentini
1
, F.
Miccichè
1
1
Università Cattolica del Sacro Cuore -Fondazione
Policlinico A. Gemelli, Radiation Oncology Department-
Gemelli ART, Rome, Italy
2
Università Cattolica del Sacro Cuore -Fondazione
Policlinico A. Gemelli, Institute of Otorhinolaryngology,
Rome, Italy
Purpose or Objective
The treatment of patients with head and neck (H&N)
cancer is usually complex and burdensome. Radical
radiotherapy (RT), which may follow surgery and be
combined with chemotherapy, usually lasts 6 to 7 weeks
and more than half patients can experience relevant acute
toxicity. Therefore the experience of receiving RT can be
both stressful and anxiety provoking. Aim of this study was
to evaluate the psychological distress of patients with H&N
cancer during RT.
Material and Methods
Consecutive patients with H&N cancer who underwent RT
with radical intent between January and September 2016
were included in this analysis. Psychological support was
available for all patients and Distress Thermometer (DT)
and Hospital Anxiety and Depression Scale (HADS) were
administered to evaluate emotional distress and mood,
respectively at the beginning (T0), after three-four weeks
(T1), and at the end (T2) of the RT course. Toxicity was
evaluated weekly by CTCAE version 4.0 criteria.