ESTRO 36 Abstract Book

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S595 ESTRO 36 2017
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patients initially presented with cervical lymph node
metastasis and 4 patients already underwent a previous
RT. The treatment consisted of either IMRT (n=5) or CIRT
(n=4) or a combination of both techniques (n=8). Applied
median doses were 60 Gy in 30 fractions (IMRT only), 51
Gy (RBE) in 17 fractions (CIRT only) and 52 Gy in 26
fractions as well as 21 Gy (RBE) in 7 fractions (bimodal
RT). Overall survival and local control rates were
determined after a median follow-up of 8 months (range:
2-72 months). Acute toxicity was evaluated up to three
months after completion of the radiotherapy according to
CTCAE criteria (Version 4.03).
Results
Local recurrence-free survival and overall survival rates
were 90% after a follow-up of 6 months (n=9/10) and 86%
after a follow-up of 12 months (n=6/7). One patient died
5 months after the treatment. Local recurrence occurred
in another patient after 36 months who died 26 months
later. Both of these patients belonged to the group who
underwent a previous RT before. 15 of 17 patients (88%)
are still alive and recurrence-free so far. Grade I toxicity
(100%; n=17) and grade II toxicity (65%; n=11) were
frequently observed. The most common toxicities were
nasal and/or oral mucositis (76%; n=13) and radiation
dermatitis (82%; n=14). Only one patient (6%; n=1)
developed a grade III toxicity (hyposmia).
Conclusion
Considering the advanced tumor stage of the cohort the
results showed good local control and overall survival rates
in short term follow-ups. Our results show that IMRT, CIRT
or a combined approach seem to be a feasible and
effective treatment in esthesioneuroblastoma without
leading to severe acute treatment-related side effects.
Further follow-up will be needed to investigate the
benefit of CIRT.
EP-1091 Low dose fractionated RT in association to
TPF as induction therapy in advanced head and neck
cancer
R. Autorino1, M. Massaccesi1, A. Pesce1, M. Balducci1, N.
Di Napoli 1, T. Tartaglione2, V. Rufini 3, F. Bussu4, J. Galli4,
S. Chiesa 1, G. Paludetti4, V. Valentini1, F. Miccichè 1
1 Polyclinic University A. Gemelli- Catholic University,
Institute of Radiotherapy, Rome, Italy
2 Polyclinic University A. Gemelli- Catholic University,
Institute of Radiology, Rome, Italy
3 Polyclinic University A. Gemelli- Catholic University,
Institute of Nuclear Medicine, Rome, Italy
4 Polyclinic University A. Gemelli- Catholic University,
Institute of Otorhinolaryngology, Rome, Italy
Purpose or Objective
To analyze the efficacy and the feasibility of induction
chemotherapy (ICT) with low-dose radiotherapy (LDR)
compared to ICT alone prior to chemoradiation (CRT) in
locally advanced head and neck squamous cell carcinoma.
Material and Methods
Between September 2008 and May 2012, 59 patients, with
locally advanced stage III and IV squamous cell carcinoma
of head & neck cancer, received three courses of induction
chemotherapy with docetaxel (75 mg/mq), cisplatin (75
mg/mq) and 5-fluoruracil (750 mg/mq/day on days 1-5)
followed by radiotherapy plus two or three cycles of
concurrent cisplatin 100 mg/mq (Group A). Twenty-nine
of this patients received low dose radiotherapy
concomitantly to induction chemotherapy (Group B).
Treatment courses, hematological data and other
parameters were also investigated.
Results
Three cycles of ICT were administered in all patients: only
one (Group B) received two cycle because of high
hematological toxicity. After neoadjuvant therapy
completation, clinical tumor response was observed in 49
patients (83%); patients undergone low dose radiotherapy
showed better complete remission (p=0.08). Grade > 3
toxicity with dose reduction occurred in 5 patients (8%).
Median time from the final cycle of TPF to starting
radiotherapy was 21 days. All patients received radical
radiotherapy; one, two and three cycles of concurrent
cisplatin was delivered in 0 (0.0%), 17 (58.6%), 10 (41.4%)
patients of Group A and 1 (3.5%), 28 (96.5%), 0 (0.0%)
patients of Group B, respectively. With a median follow-
up of 28 months (range 2-58), one-year local control was
66% and 81% for Group A and Group B, respectively
(p=0.05). No difference was observed in terms of overall
survival and disease free-survival between the two groups
(p=0.9 and 0.8). Toxicity during chemo-radiation was
acceptable in both groups without difference, specially,
in terms of hematological toxicity (p=0.76). But we found
a correlation between hematological toxicity > G3 and
local control (p=0.03).
Conclusion
Low dose radiotherapy in association with ICT prior to
CRT, even if it is not the standard, could be considered
tolerable, with encouraging efficacy in terms of response
and local control, in locally advanced head and neck
squamous cell carcinoma. Further investigation is
warrented to confirm these data.
EP-1092 Perioperative high dose rate brachytherapy
in previously irradiated head and neck cancer: Results
M.I. Martinez Fernandez1, M. Cambeiro1, J. Alcalde2, R.
Martínez-Monge1
1Clinica Universitaria de Navarra, Departament of
Oncology, Pamplona, Spain
2Clinica Universitaria de Navarra, Departament of
Otolaryngology, Pamplona, Spain
Purpose or Objective
This study was undertaken to determine the feasibility of
salvage surgery and perioperative high dose rate
brachytherapy (PHDRB) in patients with previously
irradiated, recurrent head and neck cancer or second
primary tumors arising in a previously irradiated field.
Material and Methods
Sixty-three patients were treated with surgical resection
and perioperative high dose rate brachytherapy (PHDRB).
The PHDRB dose was 4 Gy b.i.d. x 8 (32 Gy) for R0
resections (surgical margins equal to or greater than 10
mm) and 4 Gy b.i.d x 10 (40 Gy) for R1 resections (close or
microscopically positive surgical margins, or the presence
of extra- capsular nodal extension), respectively. Further
external beam radiotherapy or chemotherapy was not
given.
Results
Resections were categorized as R0 in 7 patients (11.1%)
and R1 in 56 patients (88.9%). Thirty-four patients with R1
resections (54.0%) had microscopically positive margins,
and 22 patients (34.9%) had close margins. Thirty-two
patients (50.8%) developed RTOG grade 3 or greater
adverse events including 3 fatal events. After a median
follow-up of 6.8 years, the 5-year locoregional control rate
and 5-year overall survival rates were 55.0% and 35.6%,
respectively.
Conclusion
Surgical resection and PHDRB is a successful treatment
strategy in selected patients with previously irradiated
head and neck cancer. Long-term locoregional control can
be achieved in a substantial number of cases despite a high
rate of inadequate surgical resections although at the
expense of substantial toxicity.
EP-1093 Hypofractioned robotic stereotactic
radiotherapy of Head and neck Paragangliomas
F. Meniai-Merzouki1, B. Coche-Dequeant 1, E. Bogart2, T.
Lacornerie3, X. Mirabel1, E. Lartigau1,4, D. Pasquier1,5
1Centre Oscar Lambret, Radiation oncology, Lille, France
2Centre Oscar Lambret, Biostatistics departement, Lille,
France
3Centre Oscar Lambret, Medical Physics, Lille, France