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surgery was performed in 51 (66%) and 48 (53%) cases and
definitive radiochemotherapy was performed in 26 (34%)
and 42 (47%) cases among p16 + and p16 - patients
respectively (p=0.05). 99 patients (60%) underwent initial
surgery followed by adjuvant radio (chemo) therapy in 51
cases (91 %). After a 51-month of median follow-up [47-54
months], the 3-year DFS was 82% and 42% among overall
p16 + and p16 - patients respectively (p=0.01). Among p16
– patients, the 3-year DFS after initial surgery or definitive
radiochemotherapy was 62% and 32% respectively
(p=0.003). Among p16 + patients, the 3-year DFS was 85%
and 77% (p=0.16) whereas severe delayed toxicity
occurred in 42% vs. 18% after initial surgery or definitive
radiochemotherapy respectively (p=0.05).
Conclusion
Whereas p16- OSSC are at high risk of loco-regional failure
and highly benefited from aggressive multimodal
treatment
including
surgery
and
adjuvant
radio(chemo)therapy, p16+ OSCC didn’t harbour the same
benefit from the combinative approach that was
associated with a significant increase of delayed severe
toxicity. The benefit of initial surgery or definitive
radio(chemo) therapy seemed not equivalent among OSSC
patients according to p16 status that might be a useful
tool
to
guide
initial
treatment
decision.
EP-1098 Survival predictors in patients with head and
neck cancer treated with surgical resection
R.C.D.O. Franco
1
, L.L. De Matos
2
, G. De Castro Junior
3
,
M.A.V. Kulcsar
2
, G.N. Marta
1,4
1
Instituto do Câncer do Estado de São Paulo ICESP -
Faculdade de Medicina da Universidade de São Paulo,
Radiation Oncology, Sao Paulo, Brazil
2
Instituto do Câncer do Estado de São Paulo ICESP -
Faculdade de Medicina da Universidade de São Paulo,
Division of Head and Neck Surgery, Sao Paulo, Brazil
3
Instituto do Câncer do Estado de São Paulo ICESP -
Faculdade de Medicina da Universidade de São Paulo,
Clinical Oncology, Sao Paulo, Brazil
4
Hospital Sírio-Libanês, Radiation Oncology, São Paulo,
Brazil
Purpose or Objective
This study aims to identify clinical factors that impact on
overall survival of head and neck squamous cell carcinoma
(HNSCC) patients who received surgery and post-operative
radiation therapy (RT), with or without adjuvant
chemotherapy.
Material and Methods
Between 2009 and 2013, patients diagnosed with HNSCC
who underwent surgical resection with curative intent,
followed by post-operative RT, with or without concurrent
cisplatin-based adjuvant chemotherapy were assessed.
Cox regression analyses were performed to evaluate the
clinical and pathological features that could influence
overall survival rates.
Results
170 patients were included (75.3% male). Oral cavity,
larynx and oropharynx cancer were represented by 57.4%,
30.8% and 11.8% of all patients. Most patients (90.6%) had
locally advanced disease (stage III or IV). Perineural and
lymphovascular involvement were found in 70% and 31%,
respectively. Free surgical margins were observed in 84%
of cases and 66% had positive lymph nodes, 57% with
extracapsular extension. 92.0% of patients received at
least 60 Gy to the tumor bed. 45.0% of patients received
concurrent chemotherapy. After a 23-month median
follow-up, the overall survival rate was 60.7%. At
univariate analysis, perineural invasion (p = 0.025),
positive lymph nodes (p = 0.011), extracapsular extension
(p = 0.005), radiation dose less than 60 Gy to tumor bed
(p=0.000) and stage IV (versus stage III) [p= 0.007]
negatively impacted on the overall survival. Multivariate
analysis demonstrated that presence of extracapsular
extension (p=0.005) and stage IV (p=0.01) were
independent predictors of a lower overall survival rate.
Conclusion
The main factors that negatively affected overall survival
rates in HNSCC patients treated with surgery with curative
intent and post-operative radiation therapy with or
without
concurrent
cisplatin-based
adjuvant
chemotherapy were the presence of extracapsular
extension and stage IV disease.
EP-1099 Evaluation of laryngeal preservation &
outcomes following RT for locally advanced laryngeal
SCC
A.M. Glynn
1
, J. O Shea
1
, R. McDermott
1
, S. Brennan
1
1
St Lukes Radiation Oncology Network, Radiation
Oncology, Dublin, Ireland
Purpose or Objective
To assess failure rates and to evaluate functional
outcomes in patients treated with radical radiotherapy for
locally advanced laryngeal cancer based on cartilage
invasion status
Material and Methods
A retrospective analysis of sixty-four patients who
received radiotherapy (70Gy) with or without platinum-
based chemotherapy for locally advanced SCC of the
larynx from January 2010 to December 2015 at St Luke’s
Radiation Oncology Network, Dublin, Ireland. Patients
were categorised according to the degree of cartilage
invasion based on radiological staging as having no
cartilage invasion (T2/T3), minimal cartilage invasion
(T3+) or gross cartilage invasion (T4)
Results
Sixty-four patients all receiving 70Gy using intensity-
modulated radiation therapy techniques (IMRT) were
analysed. Median age was 62.7 years. Eighty percent were
males and 20% females. Thirty eight (59%) were smokers
at the time of diagnosis and 89% (n=34) continued to
smoke during their treatment. Ninety two percent
underwent PET-CT and 52% had MRI staging prior to
commencing radiotherapy. Thirteen percent (n=8) were
staged as T2, 54.7% (n=35) were T3, 20.3% (n=13) were
T3+ and 12.5% (n=8) were T4. Median time from biopsy
date to radiotherapy start date was 7.2 weeks. Two thirds
(n=42) had chemotherapy.
Median follow-up time was 6.5 months. Median survival
was 23.6 months. Forty seven percent (n=30) documented
failures were identified and median time to failure was
4.5 months. Of those who failed 53% (n=16) failed locally,
27 %( n=8) failed regionally, 7%(n=2) failed loco-regionally
and 13 %( n=4) failed distantly. Furthermore seven percent
of those who failed had T2 disease (n=2), 50% had T3
(n=15), 23% had T3+ (n=7) and 20% had T4 (n=6). Thirty
nine percent (n=26) had PEG tubes inserted, of which 20
had them inserted pre-RT. Based on last follow-up
appointment our overall PEG dependence rate was
27%. Thirty-four percent (n=21) had tracheostomy tubes,
of which 15 had them inserted pre-RT. Our overall
tracheostomy dependence rate was 23%
Conclusion
Traditionally cartilage invasion is considered an indication
for surgical management of laryngeal cancer. With the
reclassification of minor thyroid cartilage invasion as T3,
it is more difficult to decide which patients should be
treated with radiotherapy as part of a laryngeal
preservation approach. Our evaluation did not show a
significant difference in failure rates in terms of cartilage
invasion status. Our results show comparable outcomes
with recent up-to-date literature in terms of PEG and
tracheostomy rates
EP-1100 Nodal Response During Radiotherapy for Head
and Neck Cancer Correlates with Outcome