6th ICHNO Abstract Book

page 12 6 th ICHNO Conference International Conference on innovative approaches in Head and Neck Oncology 16 – 18 March 2017 Barcelona, Spain __________________________________________________________________________________________ 6th ICHNO

architecture (DWI), perfusion (DCE-MR) and heterogeneity (texture analysis). Researches on DWI showed that a high degree of restriction of water diffusion (low ADC) correlates with increased cellular density and extracellular space, a typical feature of neoplasms. DWI researches points to high pre-treatment mean ADC and a low increment in ADC early intra-treatment being indicators of poor outcome. CT and MR perfusion techniques have been developed to investigate the changes induced by neo-angiogenesis in the microcirculation of tumor. This has been accomplished by analysis of the kinetics of the passage through the tissues of a bolus of contrast agent (DCE-CT, DCE-MR) or of an endogenous bolus (blood, ASL-MR perfusion). Presently, most of the medical literature on perfusion analysis encompasses pilot studies only. Nevertheless, one emerging finding is that neoplasms showing great heterogeneity of a parameter like Ktrans are associated to a poorer prognosis. Probably related to the presence of areas capable of surviving in conditions of hypoxia. Overall, the availability of these imaging techniques has resulted in the growth of multi-modality and multi- parametric imaging. In addition, the analysis of the quantitative data acquired by both standard and functional imaging techniques has inspired the development of novel approaches of analysis leading to the extrapolation of textural, morphologic features with the potential of providing metrics that can be used to optimize the treatment. SP-018 HNC Biomarkers - how do we translate biology into useful assays for clinical care? T. Seiwert 1 1 University of Chicago, Chicago, USA Abstract text With the advent of powerful new profiling technologies (i.e. next generation sequencing, RNA profiling/nanostring, liquid biopsy, multiplex immune stains) our ability to query tumor biology and answer clinically relevant questions in patient samples has increased exponentially. However, understanding clinical usefulness, technical limitations, and logistics of implementing biomarker testing in clinical practice will take significant, collaborative effort of the HNC community. In this talk we will examine three examples pertinent to HNC: 1) Emerging biomarkers for Immunotherapy, 2) the usefulness and technical limitations of liquid biopsy in curative intent and palliative care, and 3) the hidden complexities of HPV testing, and heterogeneity of HPV biology. OC-019 The phase III study INTERCEPTOR: preliminary results N. Denaro 1 , S. Vecchio 2 , A. Bagicalupo 3 , E. Russi 4 , M. Rampino 5 , M. Benasso 6 , G. Numico 7 , L. Licitra 8 , O. Ostellino 9 , M. D'amico 10 , P. Curcio 11 , M. Merlano 12 1 Azienda Ospedaliera S. Croce e Carle, oncology, Cuneo, Italy 2 AOU San Martino IST Genova, Oncology, Genova, Italy 3 AOU S.Martino IST Genova, Radiotherapy, Genova, Italy 4 ASO Santa Croce e Carle, Radiotherapy, Cuneo, Italy 5 IRCCS Candiolo, Radiotherapy, Oncology, Italy 6 AO Savona, Oncology, Savona, Italy Keynote lecture Proffered papers 2

SP-016 the value of proton therapy for head and neck malignancies: reducing side effects and improving outcomes P. Blanchard 1 , S.J. Frank 1 1 The University of Texas MD Anderson Cancer Center, Radiation Oncology, Houston, USA Abstract text Due to the close vicinity between target volumes and several critical organ structures, head and neck cancer radiotherapy is associated with multiple severe acute and late toxicities. The improved survival in contemporary patients has shed light over the potentially devastating chronic complications that affect increasing numbers of patients. Intensity modulated external-beam photon radiation therapy (IMRT) allowed to spare some critical structures, thereby reducing xerostomia and improving patient reported outcomes (PRO) compared to traditional 2D/3D radiotherapy. However dose reduction to specified structures during IMRT was associated with an increased beam path dose to alternate non-target structures, resulting in clinical toxicities that were uncommon with previous approaches. The physical advantage of proton beam therapy is its sharp increase in dose deposited at the end of the particle range, i.e. the Bragg peak, avoiding any exit dose beyond the target and reducing the integral dose delivered. Dosimetric comparisons between intensity-modulated proton therapy (IMPT) and IMRT have consistently shown that IMPT allowed a better sparing of normal tissues while maintaining dose to target volumes. Clinical reports have suggested improved swallowing and taste function, reduced need for acute and long-term feeding tube requirements, decreased rates of severe weight loss and malnutrition or reduced rates of osteoradionecrosis, for example. Some studies have even suggested that the physical and biological properties of proton therapy could result in improved survival in selected tumor types, such as sinonasal malignancies. The magnitude of the expected reduction in toxicity has been estimated using normal tissue complication probability models (NTCP) and the use of these models has been advocated to select the patients that will benefit the most from proton therapy compared to IMRT. The aim of this presentation is to demonstrate how proton therapy could increase the therapeutic ratio in head and neck cancer. We will 1) introduce basic physics and dosimetry data; 2) discuss the clinical data published so far; 3) address the issue of patient selection for IMPT; 4) discuss the current limitations of proton therapy regarding physical and biological uncertainties, as well as cost effectiveness; and 5) discuss how to objectively evaluate the value of proton therapy in the treatment of head and neck cancers.

Keynote lecture

SP-017 New imaging techniques R. Maroldi 1 1 University of Brescia, Radiology, Brescia, Italy

Abstract text As chemo-radiation therapy is increasingly applied to head and neck cancer, there is a growing need to develop non- invasive surrogate-biomarkers to predict and assess the response to a non-surgical treatment. Therefore, imaging techniques exploring tumor properties other from CT density, T2-T1 weighting or the single-phase "static" enhancement pattern - have been devised. These "functional techniques" aim at targeting tumor micro-