7th ICHNO Abstract book

page 78 7 th ICHNO Conference International Conference on innovative approaches in Head and Neck Oncology 14 – 16 March 2019 Barcelona, Spain __________________________________________________________________________________________ 7th ICHNO

PO-148 Management of bio-radiation dermatitis in HNSCC: emphasizing the role of calcium alginate dressings P. Bonomo 1 , I. Desideri 1 , M. Loi 1 , L.P. Ciccone 1 , M. Lo Russo 1 , C. Becherini 1 , L. Visani 1 , V. Salvestrini 1 , M. Mariotti 1 , N. Pimpinelli 2 , L. Livi 1 1 Azienda Ospedaliero-Universitaria Careggi, Radiation Oncology, Florence, Italy; 2 University of Florence, Div. Dermatology- Dept. Surgery and Translational Medicine, Florence, Italy Purpose or Objective Severe bio-radiation dermatitis may develop in patients treated with concurrent radiotherapy and cetuximab for head and neck squamous cell carcinoma. Being highly absorbent products, calcium alginate dressings are able to remove excessive exudate while maintaining adequate moisture in the affected tissue. Thus, they represent a very effective treatment option to deal with the extensive, multifactorial moist desquamation frequently observed in these cases. The aim of our work was to report on the impact of a grade-specific management approach on treatment tolerability Material and Methods Concomitant radiotherapy and cetuximab were prescribed for patients deemed inelegible to cisplatin-based chemoradiation. Since 2014, an advanced wound care nursing team was established in our clinic to implement a standardized policy for skin toxicity. A central role of calcium alginate dressings was defined in our management algorithm. In particular, in case of an early patchy moist desquamation (G2, according to Bernier’s proposal on bioradiation dermatitis grading), such as an isolated area developing along skin folds, a calcium alginate dressing was our preferred option. The correlation between patient, disease and treatment features with severe bio- radiation dermatitis and treatment tolerability was evaluated.

Results Between 2007 and 2018, 51 patients were treated at our center with radiotherapy and cetuximab (table 1). The incidence of G3/G4 bio-radiation dermatitis was 43.1%. Comparing two consecutive cohorts of 26 and 25 patients treated before and after January 2014, respectively, the adoption of a grade-specific dermatitis management allowed to improve treatment tolerability. A mean radiation treatment interruption of 8.42 days (SD: 6.73; 95% CI: 5.7 - 11.1) was reduced to 0.86 days (SD: 2.66; 95% CI: -0.28–2.02) in the more recent group (p<0.0001) (figure 1) Mean relative dose intensity of cetuximab was also significantly higher (86.3% vs 74.5%, p=0.0226).