ESTRO 36 Abstract Book

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S591 ESTRO 36 2017
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To review the outcomes of early-stage oropharyngeal
squamous cell carcinoma (OSCC) submitted to primary
surgery or primary radiotherapy (RT).
Material and Methods
Retrospective study of patients diagnosed with OSCC
between January 2009 and December 2014, clinically
staged cT1 to cT2 cN0/cN1, who underwent primary
surgery or primary RT. Cases surgically upstaged were
excluded. We analyzed patient charts, imaging and
clinical data regarding primary therapy, adjuvant
treatment and side effects. Toxicity was graded according
to Common Terminology Criteria for Adverse Events
(v4.0). Overall survival (OS) and progression-free survival
(PFS) were analyzed using the Kaplan-Meier method and
log-rank test for group comparison. Time-to-event
endpoints were calculated from the date of first
treatment.
Results
We found 61 patients with cT1 to cT2 cN0/cN1 OSCC
treated with primary surgery or primary RT. Ten were
excluded after surgical upstage. From the remaining 51,
45 were male, with a median age of 56 years. The majority
was treated with surgical resection (n=35), followed by RT
(n=30) with or without (n=21) chemotherapy (high-dose
cisplatin), due to positive (n=9), close (<5mm, n=20) or
non-evaluable (n=3) margins. Sixteen were submitted to
primary RT, with or without (n=13) concomitant
chemotherapy. Disease was in stage I in 10 patients, stage
II in 24 and stage III in 17. Patients were treated with IMRT
using simultaneous integrated boost (n=33) or 3D-CRT.
Prescribed dose was 60-70Gy to the high-risk PTV and 50-
54Gy to the low/intermediate-risk PTV.
Median follow-up time in patients alive was 5 years. Three
patients had tumor persistence, 4 had local failure and no
one developed distant metastasis. In both groups, median
OS and PFS were not reached. In the primary surgery
group, 3-year and 5-year OS were 80% and 62%, and 3-year
and 5-year PFS were 74% and 50%, respectively. In the
primary RT group, both 3-year and 5-year OS were 81%,
and 3-year and 5-year PFS were 81% and 70%, respectively.
There was no significant difference in the two groups (OS
p value = 0,4; PFS p value = 0,3). Acute grade 3 toxicity
was reported by 15 patients (mucositis, dysphagia,
dermatitis, xerostomia). Late side effects were grade 1
xerostomia (n=10) and mandibular osteoradionecrosis
(ORN, n=6). ORN occurred in patients submitted to
primary (n=3) or adjuvant RT, who had been given 66-70Gy
with 3D-CRT (n=4) or concomitant cisplatin (n=2).
Fourteen died due to disease progression (n=3), treatment
complications (sepsis, n=1) or other unrelated causes.
Conclusion
In our study, there was no significant difference in the OS
and PFS between primary surgery vs. primary RT. Although
surgery was the most frequent primary approach, almost
all patients required adjuvant treatment due to close
margins. Our toxicity profile reminds us that careful
patient selection is necessary as well as further surgical
margins studies are warranted to identify subgroups where
treatments can be safely avoided.
EP-1083 HPV as an etiological and prognostic factor
for the Polish patients with HNC.
A. Brewczyński1, T. Rutkowski2, A. Mazurek 3, M.
Snietura4 , Z. Kołosza5, A. Wygoda2, K. Składowski2, A.
Celejewska1, E. Małusecka3, A. Fiszer-Kierzkowska3, U.
Bojko3, W. Pigłowski4, A. Hajduk 2, P. Polanowski 2, U.
Dworzecka2, I. Gawron2, M. Kentnowski2, B. Pilecki2, T.
Stępień2, I. Domińczyk2, E. Nadolska2, A. Tatar2, P.
Widłak 3
1 Maria Sklodowska-Curie Memorial Cancer Center and
Institute of Oncology III Dept., Department of
Radiotherapy, Gliwice, Poland
2 Maria Sklodowska-Curie Memorial Cancer Center and
Institute of oncology iii dept., i radiation and clinical
oncology department, gliwice, polan
3maria sklodowska-curie memorial cancer center and
institute of oncology iii dept., center for translational
research and molecular biology of cancer, gliwice,
poland
4maria sklodowska-curie memorial cancer center and
institute of oncology iii dept., tumor pathology
department, gliwice, poland
5maria sklodowska-curie memorial cancer center and
institute of oncology iii dept., department of
epidemiology and silesia cancer registry, gliwice, poland
Purpose or Objective
Despite of confirmed prognostic importance of human
papilloma virus (HPV) for patients with head and neck
cancer (HNC) such data based on Polish population is
scarce. The aim of the study was to estimate the ratio of
HPV related tumors in patients with HNC and to evaluate
the prognostic role of HPV in patients with pharynx or
larynx cancer treated with radiotherapy alone (RT) or in
combination with chemotherapy (CHRT) in the Cancer
Center-Institute in Gliwice, Poland between 2012 and
2014.
Material and Methods
322 consecutive patients with HNC (nasopharyngeal
cancer (NPC) 25 (7.8%), oropharyngeal cancer (OPC) 125
(38.8%), hypopharyngeal cancer (HPC) 36 (11,2%),
laryngeal cancer (LXC) 132 (41%), cancer of unknown
primary (FPI) 4 (1,2%)) treated radically with RT (121/38%)
or CHRT (201/62%) have been included. HPV etiology has
been confirmed basing on tissue material and/or
circulating-free DNA HPV. The ratio of HPV-related tumor
has been estimated in all group and in OPC patients.
Patients with OPC HPV-related (HPV+) and HPV-not
related (HPV-) were compared acc. to other prognostic
factors. Three-years local (LC), nodal (NC) control survival
rates and disease-free (DFS), distant metastases-free
(DMFS) and overall survival (OS) rates were compared for
patients with OPC (HPV+) and OPC (HPV-).
Results
Median follow up was 36 months. HPV-related tumors have
been confirmed in 72 (23%) patients, in 3 (4.2%), 58
(80,5%), 1 (1,4%), 9 (12,5%), 1 (1,4%) of patients with NPC,
OPC, HPC, LXC and FPI respectively. In OPC patients these
with HPV+ and HPV- did not differ by sex and the age. OPC
(HPV-) were smokers more often (p=0,0007). T stage in
both groups was similar, but N stage was significantly
higher in (HPV+) (p=0.03). Patients with OPC (HPV+) had
significantly higher 3-year LC (91% v 72%, p=0,006), NC
(90% v 70%, p=0,008), DFS (85% v 63%, p=0,008) and OS
(78% vs 66%, p=0,17). 3-year DMFS was the same in both
groups (93% v 94%, p=0.6). In multivariate analysis HPV
appeared to be an independent factor influencing
OS ratio.
Conclusion
HPV-related tumors in Polish patients with HNC could be
found in a similar percentage like in other countries,
reaching almost half of patients with OPC. Polish patients
with OPC (HPV+) are not so young but do not smoke and
present higher advanced nodal stage. Our findings
confirm that HPV is a strong, independent and beneficial
prognostic factor in Polish patients with OPC.
EP-1084 Laryngeal preservation using chemo-
radiotherapy, single institution experience from Egypt.
A. Al Nagmy1, T. Shouman1, A. Hassouna1, M. Gaber2
1Cairo University- National Cancer Institute, Radiation
Oncology Department, Cairo, Egypt
2Cairo University- Faculty of medicine, Clinical Oncology
Department, Cairo, Egypt
Purpose or Objective
to evaluate organ preservation by radical radiotherapy ±
chemotherapy (CT) in locally advanced laryngeal cancer
Material and Methods