6th ICHNO Abstract Book

6th ICHNO 6 th ICHNO Conference International Conference on innovative approaches in Head and Neck Oncology 16 – 18 March 2017 Barcelona, Spain __________________________________________________________________________________________ page 27

and the use of gastrostomy and adjuvant chemotherapy had a positive correlation (p=0.045 and p = 0.047, respectively). Conclusion Both OS and PFS in our population were similar to current literature. We found a significant correlation between treatment features (use of gastrostomy, adjuvant chemotherapy, infectious complications) and patients features (weight loss) with survival outcomes. PO-052 N2 node metastasis in squamous cancers of head and neck: failure patterns and future management S. Giri 1 , M.R. Kanakamedala 1 , S. Vijayakumar 1 , S. Mangana 1 , E.L. Bhanat 1 , M.P. Giri 1 , M. Chhabria 1 1 University of Mississippi, Department of Radiation Oncology, Jackson, USA Purpose or Objective To evaluate outcomes of patients with N2 Neck nodes from Squamous Cell Head and Neck Cancers. Material and Methods Between 2009-2014, 172 patients were treated at our center; 71 white, 98 African American (AA) and 3 other races, with a median age of 55 yrs. The T stages were: Tx 5 (3%), T1 13 (7%), T2 45 (26%), T3 34 (20%), T4 75 (44%). The N2 neck stages were: N2A 13(8%), N2B 67 (39%) and N2C 92 (53%). The primary sites included: oropharynx 73 (42%), Larynx 39 (23%), Hypopharynx 17 (10%), Oral cavity 20 (12%), Nasopharynx 9 ( 5%), other 14 (8%). Treatment consisted of Surgery followed by Radiation therapy (SRT) for 41 (24%). The median radiation dose was 60 Gy in 30 fractions of 2 Gy once daily. All radiation therapy was given by Intensity Modulated Radiation Therapy (IMRT). Another 131 (76%) patients were treated by concurrent chemotherapy and IMRT (CRT). The chemotherapy consisted of either Cisplatin or Cetuximab. The radiation dose was 70 Gy in 35 fractions of 2 Gy each. The minimum follow up was 24 months. Results The overall local control (LC) in the neck for the entire group is 147/171 (85%). The LC was 38/41 (93%) in those who were treated with SRT and 107/131 (81.6%) in the CRT group, which was not statistically significant. There were no statistical differences between location of primary and subsequent neck disease control. 32/172 (25%) developed distant metastasis (DM). In the SRT group it was 6/41 (14%) and CRT 26/131 (19.8%), which was statistically insignificant. There were no differences between the various N2 groups. There was also no correlation with failure at the primary site. The DM rate was significantly worse in African Americans (AA) versus white patients (p = 0.01). Patients who developed metastatic disease did so within 18 months. The disease free survival (DFS) and overall survival (OS) at 3 years were calculated by Grays test and Log Rank Test, respectively. The DFS for the entire group was 49% (95% CI 0.39-0.58). There were no differences between the various N2 stages. The DFS was significantly worse in AA (40%) versus white patients (62%) (p = 0.007). The OS was 71% for the entire group with no difference in OS by N2 stages. Similarly, there was no difference in OS between AA and white patients (p=0.6). Conclusion We report on 172 patients with advanced squamous cell cancer of the head and neck who underwent combined modality treatment, which was tolerated well. Patients with N2 neck disease have an excellent LC rate with combined modality treatment; either surgery followed by CRT or CRT alone. AA patients have a significantly worse DFS compared to the white patients. They also have a significantly increased risk of developing DM.

Nearly a quarter develop DM with the majority having loco regional control. These patients should be considered for neoadjuvant chemotherapy trials. PO-053 Impact of PTV coverage on local recurrences and overall survival after IMRT for head and neck cancers L. Piram (France), T. Frederic-Moreau, J. Miroir, N. Saroul, N. Pham-Dang, L. Berger, J. Biau, M. Lapeyre 1 Centre Jean PERRIN, Radiotherapy, Clermont-Ferrand, France 2 CHU G. MONTPIED, Head and Neck Surgery, Clermont- Ferrand, France 3 CHU ESTAING, Maxillo-facial Surgery, Clermont- Ferrand, France 4 Centre Jean PERRIN, Medical Physics, Clermont-Ferrand, France Purpose or Objective Intensity modulated Radiotherapy (IMRT) is the standard radiotherapy technique for head and neck cancer irradiation. The International Commission on Radiation Units (ICRU) recommends covering 95% of the target volume with 95% isodose. However, this objective is not always achievable due to organs at risk constraints. Objective: To assess the impact on local recurrences and overall survival of high risk PTV (HRPTV) coverage by 95% isodose among patients treated for a head and neck squamous cell carcinoma, with simultaneous-integrated boost-IMRT (SIB-IMRT) and bilateral lymph node irradiation. Material and Methods From May 2011 to January 2014, 119 patients who underwent RapidArc® SIB-IMRT were included in this prospective evaluation (22 oral cavities, 58 oropharynx, 25 hypopharynx, 14 larynx). Sex ratio was 6.4, median age was 61.5 years. Doses, delivered in 33 fractions, were: post-operative HRPTV (38 patients): 66Gy; non-operative HRPTV (81 patients): 70Gy; intermediate risk PTV: 59.4Gy; low risk PTV: 54Gy. Age, sex, clinical stage, tumour location, chemotherapy, overall treatment time and HRPTV coverage (V95HRPTV) at 90 or 95% were studied. Results Among postoperative patients, local control after 2 years of follow-up was 70% vs 100%, p = 0.0083 (V95HRPTV+/- 95%) and 40% vs. 90.7%, p = 0.0000052 (V95HRPTV+/-90%). Two-year overall survival was 75% vs. 88.9%, p = 0.046 (V95HRPTV+/-95%) and 40% vs. 87.9%, p = 0.0030 (V95HRPTV+/-90%). Among non-operative patients, two- year local control was 66.4% vs. 75.9%, p = 0.47 (V95HRPTV+/-95%) and 54.4% vs.74.6%, p = 0.15 (V95HRPTV+/-90%). Two-year overall survival was 57.1% vs. 79.5%, p = 0.015 (V95HRPTV+/-95%) and 40% vs. 74.2%, p =0.0040 (V95HRPTV+/-90%). With multivariate analysis, V95HRPTV ≥ 95% was a prognostic factor of overall survival, V95HRPTV ≥ 90% was a prognostic factor of overall survival and local control. Conclusion High risk PTV coverage by 95% isodose affects local control and overall survival. ICRU guidelines must be followed as often as possible. When impossible, coverage must remain above 90% of the high risk PTV so as not to compromise local control and overall survival. PO-054 Cisplatin use in UK head and neck cancer management: a clinician survey of current practice B. Foran 1 , J. Fenwick 2 , B. Byrne 2 , J. Christian 3 1 Weston Park Hospital, Oncology, Sheffield, United Kingdom 2 Merck Serono Ltd- UK- an affiliate of Merck KGaA- Darmstadt- Germany, Medical Affairs, Feltham, United Kingdom