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 69

Poster: Supportive care, quality of life, rehabilitation

Purpose or Objective Oropharyngeal cancers associated with the human papillomavirus (HPV) comprise a disease entity with a generally favorable prognosis. Patients with stage I HPV positive oropharyngeal cancers have reported overall survival rates between 85‐90%. Given these excellent outcomes, recent studies have investigated the role of de‐ intensification of treatment. Although this approach may be appropriate for the majority of patients, there may be a subgroup of patients with a higher risk of recurrence. In order to identify which patients more likely to have a worse progression free survival (PFS), we examined pre‐ treatment radiological features. Material and Methods After institutional review board approval, records of patients with HPV associated oropharyngeal cancer were retrospectively reviewed. We identified 261 patients with biopsy‐proven stage I HPV positive oropharyngeal cancer treated with definitive radiotherapy. CT scans performed as part of the radiation therapy planning process were reviewed and radiological features were analyzed. PFS was assessed via Kaplan‐Meier analysis. Potential radiological predictors of improved PFS were compared via log rank test. Results The median follow up time was 36 months. The 3 year PFS for the entire cohort was 85%. Patients with T1 primary tumors had significantly better PFS than patients with T2 tumors, 95% vs 76.9%, (p=0.004). There was no significant difference in PFS between N0 and N1 disease. Patients with 1‐4 pathologically enlarged lymph nodes had improved PFS as compared to those with 5 or more positive lymph nodes, 88% vs 74.1% (p=0.005). There was no difference in PFS when patients were stratified by size of the largest node, retropharyngeal node positivity, or lowest nodal station.

PO-132 HNC patients´ experience of symptoms during radiotherapy compared to Patient-Reported Outcome tools C. Hollaender‐Mieritz 1 , J. Johansen 2 , C. Johansen 1 , I.R. Vogelius 1 , C.A. Kristensen 1 , H. Pappot 1 1 Rigshospitalet- University of Copenhagen, Department of Oncology, Copenhagen, Denmark; 2 Odense University Hospital, Department of Oncology, Odense, Denmark Purpose or Objective The combination of high dose radiotherapy and chemotherapy is a recommended treatment option for squamous cell carcinoma of the head and neck (HNSCC). The intense treatment regimens result in severe side effects and affected quality of life. Observer‐based scoring systems are the standard approach for assessing treatment induced side effects. The systematic use of a Patient‐Reported Outcome (PRO) questionnaire during cancer treatment and follow‐up has the potential to increase symptom awareness, secure timely management of side effects, improve quality of life and improve data quality. In the present study, qualitative interviews were performed to identify the patients’ experience of symptoms during high dose radiotherapy for HNSCC. Furthermore, it was investigated how these symptoms correspond with validated site‐specific PRO questionnaires identified through the literature. Material and Methods Semi‐structured interviews on side effects were performed until saturation with HNSCC patients of mixed socioeconomic background treated with high dose radiotherapy +/‐ concomitant chemotherapy. The symptoms were thematically grouped in organ classes in accordance with Medical Dictionary for Regulatory Activities (MedDRA). Questions in the most frequently used and validated site‐specific PRO questionnaires, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Head and Neck Cancer (EORTC QLQ‐H&N35), the Functional Assessment of Cancer Therapy General and Head and Neck (FACT‐HN), the M.D. Anderson Symptom Inventory Head and Neck questionnaire (MDASI‐HN) and selected items from the Patient‐Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO‐CTCAE), were compared to the patients’ symptoms identified by interviews. Results Thirteen patients were interviewed. The most frequently mentioned symptoms were oral pain, decreased appetite, dysphagia, dry mouth, fatigue and hoarseness, in order of frequency. A comparison between EORTC QLQ‐H&N35, FACT‐HN, MDASI‐HN, recommended PRO‐CTCAE items and the symptoms described by the patients showed that the PRO questionnaires do not cover the same symptoms, and no specific questionnaire covers all patients’ experiences. Conclusion PRO questionnaires aiming at improved patient care during radiotherapy should be manageable for the patients’ and yet cover the range of symptoms experienced. This study shows that although the available site‐specific questionnaires have been tested, they cover different symptoms and may not fully comprise the patients’ experience of side effects. It appears that there is no gold standard for repeated patient‐reported symptoms during radiotherapy for HNSSC.

Conclusion Our findings indicate that the size of the primary tumor and number of positive lymph nodes (≥ 5) are prognostic factors for PFS in patients with Stage I HPV associated oropharyngeal cancer. Further evaluation radiomics features are underway. These may aid in selecting patients for de‐escalation protocols.