7th ICHNO Abstract book

7th ICHNO 7 th ICHNO Conference International Conference on innovative approaches in Head and Neck Oncology 14 – 16 March 2019 Barcelona, Spain __________________________________________________________________________________________ page 47

moved tissues in anatomical structure, thickness and turgor makes this method more physiological in comparison with myocutanous and fasciocutaneous flaps. The complete epithelialization of the flap is shown in 2 month. The absence of a skin layer increases myofascial pectoralis major flap resistance to hypoxia and reduces the risk of necrosis. PO-091 Metronomic chemotherapy in borderline operable oral cavity squamous cell carcinoma - a pilot study B. Bansal 1 , M. Sultania 1 , S. Deo 1 , N. Shukla 1 , A. Sharma 2 , R. Sahoo 2 , S. Bhaskar 3 1 All India Institute of Medical Sciences, Department of Surgical Oncology, New Delhi, India; 2 All India Institute of Medical Sciences, Department of Medical Oncology, New Delhi, India; 3 All India Institute of Medical Sciences, Department of Radiation Oncology, New Delhi, India Purpose or Objective In developing countries, a large proportion of patients with oral squamous cell carcinoma present to tertiary centers at an advanced stage and are borderline resectable with long waiting periods for surgery. The treatment options available to these patients are conventional neoadjuvant chemotherapy, resources of which are constrained and also are associated with issues like cost, toxicity, and compliance. The present study was conducted to assess the feasibility of a neo-adjuvant low- cost, home based chemotherapy option. Material and Methods A single arm feasibility study was conducted in the out- patient department of our institute. After obtaining a written informed consent from the patients diagnosed to have a squamous cell carcinoma of the oral cavity and deemed borderline resectable by a surgeon with experience of more than 25 years – with features viz. Minimal infratemporal fossa involvement, bulky neck nodes, more than 1/3rd edema of the face, oro-cutaneous fistula, multiple satellite nodules over skin and tumor involving multiple critical subsites in oral cavity. They were prescribed a home based ‘metronomic therapy’ comprising of oral methotrexate (15mg/m 2 once a week) and oral celecoxib (200mg twice a day) for eight weeks. RECIST criteria 1.1 was used to assess the response to therapy. The data collected was subjected to appropriate statistical test to evaluate its compliance, toxicity, tolerance and response rate using SPSS software v2015. Results 60 patients were included in the study. Mean age was 51.98 years with male predominance (80%). 55 patients (91.6%) complied with the treatment. Tolerance to the therapy was 100% with no grade III or IV toxicity. The therapy was affordable – 700 INR or 9.5 USD per month. Overall, 33 patients had a clinical response (60%) and disease progressed in 22 patients (40%). By the end of 8 weeks, 26 patients (43.3%) could undergo surgery with wide local margins. Conclusion Neoadjuvant low cost, home based metronomic chemotherapy using oral once weekly methotrexate and twice daily celecoxib seems to be a viable option in managing locally advanced oral cancer in resource constrained setups. PO-092 Can Brachytherapy help reduce the dose to DARS in Head and Neck cancer? A Clinical experience V. Pareek 1 , R. Bhalavat 2 , M. Chandra 2

D30<68Gy, D40<52.5Gy and D50<28.3Gy for prevention of development of hypothyroidism. Conclusion In head and neck squamous cell carcinoma patients treated with radiation therapy, thyroid minimum dose, V30, V40 and V50 and use of chemotherapy and initial nodal burden and tobacco addiction are risk factors for development of subclinical or clinical hypothyroidism and can be used as predictors for such outcomes. These dosimetric parameters can be used as dose constraints for planning in head and neck malignancies. PO-090 The advantages of a pectoralis major myofascial flap in reconstruction of the oropharyngeal defects N. Trizna 1 , I. Belatserkouski 1 , J. Kaliadzich 1 1 National Cancer Centre of Belarus, Head and Neck Department, Minsk, Belarus Purpose or Objective Surgical treatment of head and neck cancer often requires a radical resection of the tumor. This severely impairs important functions such as swallowing, speech, respiration and causes aesthetic mutilation. Therefore the efficient rehabilitation is an essential part of the treatment in addition to the resection of a tumor. Material and Methods Pectoralis major myocutaneus flap (PMMC) is one of the most commonly used and the most universal flap for reconstructive head and neck surgery. We used pectoralis major flap without skin layer. Robertson and Shindo described this flap in 1985 and 1992 as a pectoralis major myofascial flap (PMMF) in head and neck reconstruction. The PMMF appeared to overcome some of the disadvantages of PMMC. Firstly, an arcuate skin incision on the anterior chest wall in an inferolateral edge of the pectoralis major muscle is produced after performing the necessary volume of the cervical lymph node dissection and the removal of a primary tumor The part of the pectoralis major muscle covered with fascia on the vascular pedicle which in the shape and the size corresponds to the postoperative oropharyngeal area defect is mobilizied Secondly, a mobilized flap is moved to the postoperative defect and fixed to the tissue layer-by-layer. Sutures are placed so that the oropharyngeal mucosa and the fascia of the flap are in layer Next, a postoperative wound of the neck and the chest is drained with a tube and is sutured layer-by-layer. Results We have applied the described above method to perform the reconstruction of the oropharyngeal area defects after resection for cancer with the PMMF has successfully been completed in 60 patients in the N.N. Alexandrov NCCB.The reconstruction of the hypopharynx defect with the PMMF was conducted in 15 patients after pharyngolaryngectomy, 5 of them were treated with cetuximab before surgery. 17 patients were performed reconstruction of the tongue defect with PMMF and 28 patients were reconstructed oral cavity defect after resection for cancer. The function of swallowing and speaking, as well as the volume of voice and rate of speech consistent with those before surgery. All patients returned to their professional activity. Conclusion The advantages of using myofascial pectoralis major flap for reconstruction of oropharyngeal area defects are the following: the absence of an aesthetic defect in the donor area and in the area of the moved flap; the absence of hair growth in the moved flap; the correspondence of the