ESTRO 36 Abstract Book

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S593 ESTRO 36 2017
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Head and Neck (H&N) cancer survivors are an increasingly
population, due to the improvement in diagnosis and
treatment. The aim of this study is to analyse the health
status and physical activity in H&N cancer survivors in a
single institution.
Material and Methods
The population was composed of a series of 50 H&N cancer
patients survivors (>3 years post-diagnosis) treated in our
institution from 2006 to 2013, having no signs of cancer
recurrence to the date. They were reviewed based on
personal interviews and specific questionnaires. The
health status items measured were: nutritional
assessment (with the Body Mass Index (BMI), the
Malnutrition Universal Screening Tool (MUST) and the
Subjective Global Assessment (SGA)), cardiovascular risk
(with the HeartScore® tool), toxic habits (tobacco and
alcohol by the Alcohol Use Disorders Identification Test
(AUDIT)) and physical activity (with the Global Physical
Activity Questionnaire(GPAQ)).
Results
The mean age was 64 years (range, 43-84 years) and 46
patients (92%) were male. The most frequent site of the
primary tumour was larynx (48%) and the main histology
squamous cell carcinoma (76%). 72% of patients had
advanced cancers (stages III and IV), whereas 26% had
stages I and II. All patients received radiotherapy, of which
31 patients (62%) were given 3DRT technique and 19
patients (38%) IMRT technique. Surgery was performed in
17 patients (34%), and 20 patients (40%) underwent neck
dissection. The most part of our population had
overweight (BMI 27 ± 3). The MUST score showed that 7
patients (14%) were at high risk of malnutrition, and
regarding SGA, 12 patients (24%) were suspected of
malnutrition. Cardiovascular risk was high or very high in
12 (24%) and 19 (19%) patients, respectively. Taking into
account toxic habits, 6 patients (12%) were active
smokers, while 38 (76%) were ex-smokers. AUDIT score
showed that 3 (6%) were risk drinkers and 3 (6%) had
problems related with alcohol abused. 86% of the patients
accomplished WHO recommendations of physical exercise.
Conclusion
Our study indicates that head and neck cancer survivors
could have clinical issues regarding health status, and
efforts should be done to identify these patients,
especially those with risk of malnutrition, high
cardiovascular risk or toxic habits, in order to offer the
best clinical care.
EP-1087 Real-world Cetuximab toxicity in curative
and recurrent/metastatic setting in HNSCC patients.
I. Desideri 1, C. Muntoni1, C. Ciabatti1, M. Lo Russo1, P.
Bonomo 1, M. Loi1, D. Greto1, I. Meattini1, L. Livi1
1 University of Florence, Radiotherapy, Firenze, Italy
Purpose or Objective
Observational monocentric study to assess, in patients
affected by head and neck squamous cell carcinomas
(HNSCC), the acute toxicity of Cetuximab (CTX)
administered concurrently with radiotherapy (RT) in the
curative setting, or as a chemotherapy (CT) in patients
with recurrent/metastatic disease.
Material and Methods
A total of 110 HNSCC patients undergoing chemotherapy
with Cetuximab were retrospectively analyzed. Patients
were treated in our Institution between February 2007 and
May 2016. Performance Status (PS) evaluated with the
Eastern Cooperative Oncology Group (ECOG) scale.
Relevant comorbidity were evaluated with the Charlson
Comorbidity Index (CCI). Skin toxicity was evaluated
according to Common Terminology Criteria for Adverse
Events (CTCAE) version 4.03.
Results
The median age was 67 years (range 32-84 years); 83
(75.5%) patients were male. Ninety (82%) were smokers,
most of them had a smoking history > 20 pack/years. PS
was scored ≤ 1 in 100 (90.9%) patients. The median CCI
was 6 (range 1- 13). The most represented head and neck
subsites in the study were the oropharynx (27%) and the
larynx (32%). Fourty-three (39.1%) patients underwent a
curative treatment with a concomitant CTX-RT treatment,
while 67 (60.9%) received a CTX-containing chemotherapy
regimen. In patients undergoing a curative treatment, the
median number of CTX cycles administered amounted to 6
(range 2-8) ; median RT dose was 67Gy (range 66-70).
Acute mucositis G≤2 and G3 was observed in 24
(55,8%) and 18 (41,9%) patients respectively. Actinic
dermatitis G≤2 was observed in 25
(58,1%) patients, while G3 and G4 dermatitis was present
in 17 (39,5%) and in 1 (2.3%) patient, respectively. In the
advanced disease subgroup, CTX was administered as first-
line CT in 39 cases (53.6%) as a triplet
combination (cis/carboplatin, 5-FU, CTX), and in 21
(26.8%) as a 2-drugs regimen (carboplatin / CTX); 7
patients (19.6%) received CTX monotherapy. Incidence of
acneiform rash G1-G2 was 37.3%, while G3 was 3.0%(25
and 2 patients, respectively); incidence of
hypomagnesemia G1-G2 was 4.5% (3 patients), no G3
toxicity was reported. Infusion reactions G2 was reported
in 2 (3.0%) patients.
Conclusion
Cetuximab is a mainstay in the radical and palliative
treatment in HNSCC patients but its toxicity in our serie is
not negligible, though in line with data from literature.
Accurate patients selections and toxicity management
during treatment are mandatory to ensure safety and
clinical benefit.
EP-1088 EGFR as blood biomarker improves prognostic
value of nomogram for survival in laryngeal carcinoma
F.W.R. Wesseling 1, G. Feliciani1, C. Oberije1, M.P. Van de
Waarenburg2, C.G. Schalkwijk2, P. Lambin1, F.J. Hoebers 1
1Maastricht Radiation Oncology MAASTRO clinic- GROW -
School for Oncology and Developmental Biology-
Maastricht University Medical Centre, Department of
Radiation Oncology, Maastricht, The Netherlands
2Laboratory for Metabolism and Vascular Medicine-
Maastricht University, Department of Internal Medicine,
Maastricht, The Netherlands
Purpose or Objective
To improve the prognostic value of a previously validated
nomogram for laryngeal carcinoma derived from clinical
parameters 1 by adding blood biomarker results for
hypoxia, inflammation, tumor load and cell growth.
Material and Methods
For 50 patients treated for laryngeal carcinoma at our
clinic by radiotherapy with curative intent, blood samples
were stored in a blood biobank (ClinicalTrials.gov:
NCT01084785) before start of treatment. Eight
biomarkers representing hypoxia, inflammation, tumor
load and cell growth were selected and measured with
commercially available kits: IL6, IL8, CEA, c-kit, E-cad,
EGFR, MMP-9 and osteopontin. Primary outcome was
overall survival (OS). Blood biomarker results and a
prognostic score, based on our previously developed
nomogram were entered in a Cox regression analysis using
least absolute shrinkage and selection operator (LASSO)
variable selection procedure with 10-fold cross validation.
Significant biomarkers were added to the nomogram score
to investigate whether the prognostic value would be
improved. Concordance index (C-index) was used to
evaluate the performance of the model.
Results
Clinical staging was: St. I: 18%, St. II: 20%, St. III: 34% and
St. IV: 28%. Most patients were treated with accelerated
locoregional radiotherapy (68%) or local radiotherapy
(16%). After a median follow up of 56 months, 2 and 5 year
OS was 75% and 58%. LASSO procedure selected EGFR and
the nomogram score as variables significantly associated
with OS. Spearman ρ coefficient and visual inspection