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 67

interruption of the procedure. The information supplied is in visual form, which can reduce ambiguity over verbal command, and aid retention in the visual learner group. 3. By saving and archiving the annotated video clips or photographs there is improved re-call of clinical findings, and location of biopsy sites, allowing all of the members of the multi-disciplinary team (MDT) to have access to the clinical information only found during clinical assessment in theatre. This enables improved clinical dialogue between the various MDT members and hopefully improved decision making and outcomes for patients. 4. Acquisition of clear, contemporaneous clinical images, facilitating retrospective analysis of cases such as in audit and even in cases of litigation. 5. In our experience, patients have responded very positively to the telestrated images, with it aiding discussions, understanding and shared decision-making. Conclusion Telestration has a wide range of uses in clinical practice and in our experience benefits patient care. PO-129 Set-up errors in head and neck cancer patients undergoing IGRT. Relationship to BMI and weight loss. A. Allajbej 1 , F. Patani 2 , M. Trignani 2 , A. Di Pilla 2 , P. Bagalà 3 , A. Vinciguerra 2 , A. Augurio 2 , G. Caravaggio 2 , M.D. Falco 2 , D. Genovesi 2 1 SS.Annunziata, Radiotherapy, Chieti, Italy; 2 SS. Annunziata, Radiotherapy, Chieti, Italy; 3 Campus Biomedico, Medical Physics, Rome, Italy Purpose or Objective To assess translational and rotational set-up errors in Head and Neck cancer patients treated with IMRT and VMAT using daily pretreatment CBCT guidance and correlation between set-up errors and patient-specific factors (weight, height, BMI and weight loss). Material and Methods A total of 274 CBCTs referred to 30 patients were investigated. A customized immobilization system was employed during both planning CT and treatment phase. CBCTs were obtained according to an internal protocol consisting of 4 consecutive CBCTs during the 1 st week of treatment and weekly afterward. Mean translation of first 4 CBCTs was calculated; this value was considered as systematic set-up error; displacements >3 mm were corrected, according to literature data and action limit defined in our protocol. Action limit for rotation acceptance was ≤3°. Mean translations for CBCTs weekly performed during the remaining treatment course were calculated, too. For each patient, height, weight and BMI (pre, mid, end of treatment) were recorded. Percentage of weight loss (mid- and at end treatment) was calculated. Statistical analysis was performed to evaluate correlation between translational displacements and body changes.

Results Seventy-five patients (93.7%) had nodal involvement that was bilateral in 69 patients (86,2%). The high risk levels were II (>85%) and III (>50%) (table 1). The low risk levels were Ia (0%) and VIIb (<3%). Level Right (%) Left (%) Ia 0 0 Ib 13 (16.3) 18 (22.5) II 71 (88.8) 74 (92.5) III 42 (52.5) 50 (62.5) IV 19 (23.8) 29 (36.3) Only two patients had level Ib invasion without ipsilateral level II involvment (Right (R) : (1/13) 7.7% ; left (L) : (1/18) 5.5%). One patient had level IV invasion without ipsilateral level II involvement (R : (0/19) ; L : (1/29) 3.4%). No patient had level Vc invasion without ipsilateral level II involvement. Conclusion The results of our study show that levels II and III are the most frequent sites of involvement in NPC far exceeding 50% of cases. Level IV invasion varies between 20 and 35% but only 3% of cases occur outside of a level II involvement. These same findings are valid for Level Vc (Vc invasion in 12-22% of cases and no invasion without ipsilateral level II involvement). These results support the possibility of prophylactic volume reduction (level IV and Vc exclusion) for patients without level II invasion. Moreover, for level Ib, which is not systematically irradiated, its inclusion in the prophylactic volume must be discussed for all patients with level II involvment given the significant risk of invasion (up to 18%). PO-128 Our experience of using telestration in Head and Neck cancer patients R. Jones 1 , S. Bodnaresu 1 , L. Pope 1 1 ABMU Morriston Hospital, Otolaryngology, Swansea, United Kingdom Purpose or Objective To show how telestration has become incorporated into our clinical practice to improve clinical care, learning and development within our Head and Neck department. Material and Methods Telestration allows an individual to digitally annotate a still or moving video image. This can either be with a digital sketch or with preset digital markers. Telestration has been in use since the 1950s and has been used widely by the media to aid audio-visual presentations, especially within the sports commentary organisations. In our practice, the use of telestration is becoming increasingly commonplace and has a far-reaching range of benefits. Results The clinical uses of telestration in our institution are; 1. It permits real-time annotation of clinical photographs, facilitating accurate documentation of clinical findings and biopsy sites during endoscopic examination of the upper aero-digestive tract. These annotations can be saved electronically in the patients record, not only allowing safe storage of the images, but also providing a detailed record for future clinical management. 2.Telestration can also benefit training by allowing supervising trainers to take a more ‘hands off’ approach, whilst guiding the trainee accurately and without Va-b 17 (21.3) 18 (22.5) Vc 10 (12.5) 18 (22.5) VIIb 2 (2.5) 1 (1.3)

Results Oral-oropharyngeal and larynx were the most common sites treated. Mean translational and rotational set-up errors during the first 4 CBCTs were 0.15 cm (LR), 0.1 cm (AP), 0 cm (CC) and 0.7°(LR-axis), 1°(AP-axis), and 0.6°(CC-axis). Mean translations and rotations of subsequent CBCTs were 0.02 cm (LR), 0.03 cm (AP), 0 cm