Abstract Book

ESTRO 37

S361

observe. Further studies are needed to evaluate the impact of prophylactic swallowing rehabilitation in the follow-up of HNC. FUNDING: The study is supported by a grant from the “Asociación Española Contra el Cancer” (AECC) PO-0706 Sensorineural hearing loss and radiotherapy for head and neck cancer. C. Adkin 1 , P. Premachandra 2 , C. Thomas 1 , T. Guerrero Urbano 1 , M. Lei 1 1 Guy's and St.Thomas' Hospital NHS Foundation Trust, Clinical Oncology, LONDON, United Kingdom 2 Guy's and St.Thomas' Hospital NHS Foundation Trust, Audiology, LONDON, United Kingdom Purpose or Objective Objective: Patients undergoing treatment for head and neck cancer (HNC) can report tinnitus and hearing loss during and after treatment, both conductive and sensorineural. Radiotherapy (RT) has been implicated in damage to the inner ear and suggested to contribute to hearing deterioration. This can be exacerbated further by the ototoxic effects of platinum-based chemotherapy This hearing loss can have a significant impact on patients’ communication, social interaction and ability to work and negatively impacts their overall wellbeing. Here we report the local experience of a cohort of patients at Guy’s hospital and assess the relationship between the RT dose received by the cochlea and the degree of sensorineural hearing loss (SNHL) detected by audiometry. Material and Methods During a 6 month period, 50 patients, median age 61 (range 37-86), undergoing planning of curative intensity modulated radiotherapy (IMRT) for HNC were identified prospectively and consented to undergo puretone audiometry pre-treatment, at end of treatment, 3 months and 12-24 months post-treatment. On completion of IMRT, both cochlea organs were delineated retrospectively on the clinical IMRT plans, to calculate mean cochlea doses. Spearman correlation was used to assess the correlation between cochlea dose and SNHL by bone conduction at 4000Hz. In addition, the mean hearing loss was compared between treatment groups using Mann-Whitney U-test. Data regarding treatment with platinum-containing chemotherapy was also collected. Results Across the cohort, the mean SNHL at 4000Hz in the ipsilateral ear at end of treatment, 3 months post treatment and 12-24 months post treatment was 6.4 Db, 6.7 Db and 11.9 Db respectively. The mean ipsilateral cochlea dose was 27.6 Gy (range 1.6 - 58.6 Gy). Spearman correlation showed only a weak correlation between cochlea dose and hearing loss. There was a moderate to weak correlation between cumulative cisplatin dose and hearing loss. There was no significant difference between patients who had surgical treatment with adjuvant radiotherapy compared to those who had primary radical radiotherapy. There was a significantly greater hearing loss in those who had chemoradiotherapy compared to radiotherapy only. There was no correlation between age and degree of hearing loss. Conclusion Although radiotherapy does appear to contribute to SNHL, we demonstrate only a weak correlation between dose to the cochlea and hearing loss. There was a stronger association with hearing loss and the cumulative dose of cisplatin, which is known to be ototoxic. This is borne out by the significant difference shown between the hearing loss in patients receiving chemoradiation compared to those having radiotherapy only. Although efforts should be made to monitor hearing loss during and after treatment and attempts made to reduce it where

possible, it may not be possible to significantly reduce the rates of hearing loss by tailoring radiotherapy plans to avoid the cochlea. PO-0707 Impact of HPV status, presence of a caregiver and smoke habit on QoL in HNC patients N.A. Iacovelli 1 , N. Facchinetti 1 , M. Carrara 2 , D. Musio 3 , F. De Felice 3 , A. Bacigalupo 4 , S. Callegari 4 , P. Bossi 5 , C. Fallai 1 , S. Naimo 1 , P. Steca 6 , A. Greco 6 , E. Orlandi 1 1 Fondazione IRCCS Istituto Nazionale dei Tumori, Radiation Oncology 2, Milan, Italy 2 Fondazione IRCCS Istituto Nazionale dei Tumori, Medical Physics, Milan, Italy 3 Ist. di Radiologia - Università La Sapienza - Policlinico Umberto I, Radiation Oncology, Rome, Italy 4 IRCCS A.O.U.San Martino - IST -Istituto Nazionale per la Ricerca sul Cancro, Radiation Oncology, Genoa, Italy 5 Fondazione IRCCS Istituto Nazionale dei Tumori, Medical Oncology 3, Milan, Italy 6 University of Milan "Bicocca", Department of Psychology, Milan, Italy Purpose or Objective To prospectively and longitudinally assess health related (HR) quality of life (QoL) in head and neck cancer (HNC) patients (pts) receiving curative treatment and to investigate relationships between QoL, social-cognitive beliefs, pts and disease characteristics. Material and Methods This is a preliminary report from a prospective observational multicenter trial of HR QoL in HNC pts enrolled since 2016 and curatively treated at 3 Italian cancer centers, on behalf of the Italian Association of Radiation Oncology HN working Group. HR QoL was detailed by the M.D. Anderson Symptom Inventory (MDASI)-HN and EURO-QoL5D (EQ-5D) questionnaires (qst) before, within the 4th week, at the end of RT, 3 and 6 months after RT. At every observation time, 3 average parameters were extracted from the MDASI-HN qst considering 3 different subscales: MDASI-A, -B and -C referred to general symptoms, local symptoms perception and how symptoms interfere with daily life activities, respectively. For EQ-5D, only the health state assessment (VAS) was taken into account (i.e., graduated scale from 0, worse status possible, to 100, better status). All data were dichotomized to the baseline by subtracting this value from all the consecutive ones. Patients were grouped according to their sex, HPV status, global stage, presence of caregiver (possible surrogate marker of marital status) and smoke habit. A Mann-Whitney statistical test for unpaired samples was performed to correlate these parameters to the normalized mean scores at every observation time. The same test was also applied to investigate significance of absolute qst baseline data. Results We considered 72 pts for this analysis (Table 1). Considering absolute baseline scores, smokers had worse MDASI-B and –C compared to non-smokers pts (p=0.05; p=0.03, respectively); HPV negative pts had worse MDASI- B compared to HPV positive pts (p=0.01). Patients with caregiver had significantly better baseline MDASI-A and –B (p=0.03) compared to pts without. Global stage did not impact on QoL. Correlations with normalized data showed that males had worse MDASI-B than female in the mid of RT (p=0.03); at the 4th week HPV positive pts had worse MDASI-B, -C and VAS compared to HPV negative pts (p=0.01, p=0.004, p=0.0005,respectively). Trends for each MDASI subscales are provided in Figure 1. At the end of RT, all MDASI subscales and VAS were significantly worse for HPV positive pts. Six months after RT completion, pts with caregiver had statistically better MDASI-A than pts without (p=0.04).