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 __________________________________________________________________________________________ 2 VA Long Beach Healthcare System, Radiation Oncology, Long Beach, USA 3 VA Greater Los Angeles Healthcare System, Radiation Oncology, Los Angeles, USA PO-062 Retrospective analysis of 72 patients treated with FEP regimen and CCRT for locally advanced NPC. A. Ouhajjou 1 , Z. Fadoukhair 1 , H. Faouzi 1 1 Oncology Center Alazhar, oncology, Rabat, Morocco page 31

Purpose or Objective The role of neoadjuvant chemotherapy (CT) followed by concurrent chemo-radiotherapy is a matter of interest in nasopharyngeal carcinoma. Several clinical phase III trials have proved that induction chemotherapy based on three- drugs, may significantly improve treatment outcomes in patients with squamous cell carcinoma of the head and neck. We conducted this study to evaluate the experience of induction chemotherapy using modified increased doses FEP regimen (mid FEP) (Epirubicin, Cisplatin, 5-FU, and Leucovorin) followed by concurrent chemoradiation for nasopharyngeal carcinoma (NPC). Material and Methods Between August 1994 and December 2009, 72 patients with pathological proven nonmetastatic NPC were enrolled. Ninty five percent of patients were locally advanced (IIB – IVB). Patients were first treated with 3 cycles of induction chemotherapy with increased doses FEP regimen (mid FEP) based on 5-FU 500 mg/m2 d1-4, Leucovorin 200mg/m2 d1-4, Epirubicin 35mg/m2 d1-2, Cisplatin 25mg/m2 d1-4 every 3 weeks, associated to Granulocyte colony-stimulating factor (G-CSF). After induction chemotherapy, weekly cisplatin was administered concurrently with radiation. Radiation consisted of 65-70 Gy to the planning target volumes of the primary tumor and 45 -60 Gy to any positive nodal disease using 1,8 Gy per fraction. Results Median follow-up of 96 months. After completion of induction CT, 46 evaluable patients (35%) achieved complete clinical response in regional nodes and nasopharynx. After completion of the whole treatment, small residual tumors were noted either at the primary site and / or neck in 26 % of patients. The complete response rate of the nodal area and primary location was 72 %. Residual tumors all showed complete regression upon follow-up after 3 months. The estimated 5-year PFS was 78%. The 5-year OS was 80 % and the estimated 8-year PFS was 67%. The 8-year OS was 73 %. The main grade 3 to 4 (G3/G4) adverse events during neoadjuvant chemotherapy were hematological but manageable. Conclusion Induction chemotherapy using modified increased doses FEP regimen (mid FEP) (Epirubicin, Cisplatin, 5-FU, and Leucovorin) followed by concurrent chemoradiation for locoregionally advanced NPC is feasible and effective in regard to locoregional control and distant metastasis with high compliance. A long-term follow-up study is needed to confirm these preliminary findings. PO-063 Waiting time and fast track model for head and neck cancer patients in Finland H. Irjala 1 , E. Halme 2 , A. Makitie 3 , T. Atula 3 , P. Koivunen 4 1 Turku University Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Turku, Finland 2 Tampere University Hospital, Otorhinolaryngology - Head and Neck Surgery, Tampere, Finland 3 Helsinki University Hospital, Otorhinolaryngology - Head and Neck Surgery, Helsinki, Finland 4 Oulu University Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Oulu, Finland Purpose or Objective Waiting time from referral to treatment has an effect on cancer patients’ prognoses and in addition waiting can be

Purpose or Objective Post-laryngectomy stomal recurrence of head & neck cancer may result from underdosage due to the well- known skin-sparing effect of photon irradiation, even via modern Volumetric Modulated Arc Therapy (VMAT) technique. We aim to verify the VMAT dose coverage and evaluate the dose-compensatory effect of bolus placement by (1) using a physics phantom study and (2) comparing the dose distributions of conventional anterior- to-posterior (AP) and VMAT plans in real-case clinical application. Material and Methods (1) Radiation dose distribution for post-laryngectomy stoma was planned using a physics phantom made of tissue-equivalent solid with a cylindrical hole opening emulating the tracheal stoma. A tracheostomy tube obturator was inserted and 5-mm thick bolus material was used as tissue compensator. Small pieces of bolus cuts were custom-made to reduce the air gaps between the mechanical device and skin surface. Thermoluminescent dosimetry (TLD) was used to verify the dose predicted by a commercial treatment planning system (TPS) on the stoma lumen and the peri-stoma skin. Three VMAT plans were generated using 6MV photon beams: no bolus, bolus with and without air gap compensation. (2) A set of CT-simulation images for post-laryngectomy case was used for meticulous contouring of the catheter cuff, stoma lumen, peri-stoma skin and subclinical tumor bed around the primary site. The resulting dosimetry plans were analyzed with or without bolus placement. Wet gauze was used to minimize the effect of any air gap. Four plans were generated: AP superclavicular (SCV) plan with or without bolus, and VMAT plan with or without bolus. A dose of 60Gy in 30 fractions was prescribed at 3 cm depth for AP SCV plan, and to 95% of the PTV volume for VMAT plan. Results (1) The phantom study shows the dose difference between TPS calculations and TLD measurements for VMAT to be within 5%. The TLD result inside the stoma lumen differs by <1% with vs. without bolus placement. The TLD under the bolus on the peri-stoma skin receives full prescription dose, while it is 20% less without bolus. (2) The peri-stoma skin dose is sensitive to bolus placement for the AP SCV plans (V95% of 20.7%, 33.0% and 94.8% for no bolus, bolus without and with air gap compensation, respectively). The dose drops off rapidly in depth for the stoma lumen. The dose distributions of the two VMAT plans are moderately different for peri-stoma skin (V95% of 95.0% with bolus and air gap compensation, and 82.3% without bolus), but nearly identical for stoma lumen (V95% of 91.5% and 92.0%, respectively). Conclusion The TPS dosimetric results are verified to be in agreement with TLD measurements by the physics phantom study. The clinical case analysis shows that the dose coverage around the stoma in the VMAT plan is better than the conventional AP SCV plan. For VMAT, it is still recommended to place physical bolus and reduce the air gaps in order to achieve optimal dose distribution.