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 77

Purpose or Objective Radiation therapy of sinonasal carcinoma (SNC) is challenging to treat due to the tumors’ location close to the brain and optical pathways. Proton therapy (PT) may be beneficial, as normal tissue may be spared, and the radiation-induced sequelae thus reduced. In order to perform proper patient selection and evaluate the effect of future PT, we aimed to objectively assess and record the organ-specific late sequelae and quality of life (QoL) in patients treated with intensity modulated radiotherapy (IMRT) for SNC. Material and Methods A cross sectional study of all patients who were alive without recurrence and had received IMRT for SNC in the period January 2008 - January 2017 was performed. Of 26 eligible patients, 18 were enrolled in the study. They had been treated with either primary or postoperative RT with or without concomitant chemotherapy. Sequelae were evaluated with an objective ophthalmologic examination encompassing all parts of the eye and the visual pathway, blood samples visualizing all axes including synachten test, and the Brief Smell Identification Test (BSIT). QoL was assessed via EORTC QLQ-C30, EORTC QLQ-BN20, SNOT-22 and Hospital Anxiety the Depression Scale (HADS). In addition, diffusion weighted MRI scans of the brain and tests of neuropsychological function were performed, results of those tests are not yet available. Results 18 patients were enrolled, 13 males and 5 females. Median age was 70.5 years (range 47-83). They were treated with IMRT to a prescribed dose of 60-68 Gray (Gy) to T-sites in the nasal cavity (n=11) or the maxillary sinus (n=7). A significant correlation between max dose to the chiasm and grade 3 visual acuity impairment (p=0.046) (CTCAE ver. 4.0) was revealed. Analysis of the function of the pituitary gland did not present any significant correlations; however, a clear tendency of higher doses related to more affected levels of hormones of the pituitary gland were present for all axes. BSIT showed impaired smell identification (≤ 8 points) in 15/18 patients. In the analysis of global QoL (EORTC QLQ-C30 and QLQ-BN20), social-, emotional-, and physical function were the most affected domains, whereas drowsiness and fatigue was the highest scoring symptoms. HADS revealed no abnormal depression scores, but 15/18 in the study population reported anxiety exceeding the norm. Anxiety was related to a poorer outcome in the global QoL score (p=0.029). Symptoms from the sinonasal area and the impact on the QoL were measured with the Sinonasal Outcome Test (SNOT-22). The median total score was 18 (range 6-77). The areas that affected the quality of life most were lack of smell or taste, thick nasal discharge, need to blow the nose, and blocked nose. Conclusion The results of the study indicate substantial late radiation induced morbidity with a significant impact on the quality of life. Due to these findings, a larger nationwide study is now intended. PO-147 Functional outcome of postoperative IMRT after laryngeal conservative surgery S. Volpe 1,2 , A. Bagicalupo 3 , D. Alterio 1 , L. Belgioia 3,4 , A. Ferrari 1 , V. Zurlo 5 , V. Santomauro 6 , G. Marvaso 1 , M. Montesano 1,2 , M. Augugliaro 1,2 , I. Turturici 7 , S. Vigorito 8 , R. Corvò 3,4 , B.A. Jereczek-Fossa 1,2 1 European Institute of Oncology IRCCS, Department of Radiation Oncology, Milan, Italy; 2 University of Milan, Department of Oncology and Hemato-Oncology, Milan, Italy; 3 IRCCS San Martino-IST, Department of Radiation

Oncology, Genoa, Italy; 4 University of Genoa, Department of Health Sciences DISSAL, Genoa, Italy; 5 European Institute of Oncology IRCCS, Department of Head and Neck Surgery, Milan, Italy; 6 IRCCS San Martino-IST, ENT Department, Genoa, Italy; 7 University of Rome- Tor Vergata, Department of Radiation Oncology, Rome, Italy; 8 European Institute of Oncology IRCCS, Department of Medical Physics, Milan, Italy Purpose or Objective Historical data have shown the detrimental effect of post- operative radiation therapy (PORT) with 3D- conformal technique on functional outcomes of laryngeal cancer patients treated with organ preservation surgery. As intensity-modulated radiation therapy (IMRT) has become the standard of care for head and neck cancer, the aim of the present study is to evaluate whether its use could improve the toxicity profile of multimodality treatment in All patients treated with conservative surgery and postoperative IMRT between March 2014 and April 2018 at our Department were prospectively evaluated. Exclusion criteria were: 1) recurrent tumors 2) previous surgery and/or RT in head and neck region 3) swallowing and/or laryngeal dysfunction at baseline. Acute and late functional outcomes were prospectively evaluated, both physician rating tools and patient-reporting outcome (PRO) questionnaires were administered at the following time points: baseline and 2, 6, 12 and 24 months after the end of PO-IMRT. Objective report of toxicity was performed per Common Terminology Criteria Adverse Event (CTCAE 4.03); Murphy Trigger symptoms was evaluated by a dedicated speech pathologist. The presence of tracheostomy and the need of enteral nutrition via either feeding tube or percutaneous gastrostomy were recorded as well. PROs were investigated through the administration of EORTC QLQ- H&N35 and the Voice Handicap Index questionnaires. Oncological outcomes were collected as well. Results Data from 20 predominantly male patients are currently available for the analysis. Median age was 63 years; 17 cases presented with locally advanced laryngeal cancer (stage III and IV), supraglottic tumors were the most (60%) represented in our cohort. Surgical margins were negative, close and positive in 10, 5 and 5 cases, respectively. Six pts received concurrent chemotherapy. Median RT dose was 66 Gy (mean 63 Gy, range 59.4-66 Gy). After a median follow-up of 16 months, 12 pts were alive without disease, 1 was alive with local recurrence and 4 pts had died. Grade 1 and 2 functional acute mucositis were recorded in 11 and 9 patients, respectively, no patient experienced grade 3 toxicity. No pt reported clinically-significant dyspnea. Grade 2 laryngeal edema was recorded in only one case, which required surgical removal of the mucosal laryngeal flap 3 months following PORT. Late toxicity after a median follow up of 11 months was available for 16 pts. Of those, 5 had grade 1 dysphagia. No pt required either tracheostomy or enteral nutrition due to treatment-related toxicity. Conclusion Despite the short follow-up, preliminary data on functional and toxicity outcomes are encouraging. Further analyses including the incorporation of dosimetric parameters are underway in order to better define the functional impact of PORT by IMRT in this subset of patients. this subset of patients. Material and Methods