ESTRO 2023 - Abstract Book

S588

Monday 15 May 2023

ESTRO 2023

P. Blanchard 1 , B. Lacas 2 , J. Bourhis 3 , E. Limkin 1 , M. Parmar 4 , L. Licitra 5 , Q. Le 6 , C. Fortpied 7 , J. Langendijk 8 , J. Vermorken 9 , J. Bernier 10 , A. Trotti 11 , J. Overgaard 12 , J. Harris 13 , J. Pignon 2 , A. Aupérin 2 1 Gustave Roussy, Radiation Oncology, Villejuif, France; 2 Gustave Roussy, Biostatistics, Villejuif, France; 3 CHUV, Radiation Oncology, Lausanne, Switzerland; 4 University College London, MRC Clinical Trials Unit , London, United Kingdom; 5 Istituto Nazionale dei Tumori and University of Milan, Medical Oncology, Milano, Italy; 6 Stanford University School of Medicine, Radiation Oncology, San Francisco, USA; 7 EORTC, Statistics, Brussels, Belgium; 8 University Medical Center Groeningen, Radiation Oncology, Groeningen, The Netherlands; 9 Antwerp University Hospital, Medical Oncology, Antwerp, Belgium; 10 Clinique de Genolier, Radiation Oncology, Genolier, Switzerland; 11 Moffitt Cancer Center, Radiation Oncology, Tampa, USA; 12 Aarhus University Hospital, Radiation Oncology, Aarhus, Denmark; 13 NRG Oncology, Headquarters, Philadelphia, USA Purpose or Objective A retrospective study based on 655 patients treated in a single center in Switzerland suggested that head and neck squamous cell cancer (HNSCC) patients receiving radiotherapy (RT) during “dark” season (fall/winter) may have better outcomes than those treated during ”light” season (spring/summer) (Elicin et al, Radiother Oncol 2021). The possible rationale is that seasons have an impact on cell cycle progression. We tested this hypothesis on large databases of randomized controlled trials (RCT). Materials and Methods The databases of the meta-analysis of chemotherapy in head and neck carcinoma (MACH-NC) and of the meta-analysis of radiotherapy in head and neck carcinoma (MARCH) were queried for individual patient data from RCT of non-metastatic HNSCC patients with available RT duration. For MACH-NC, we selected only patients from the arms of concomitant chemo RT. Treatment season was defined by RT mid-treatment date being during dark season (from autumn equinox to spring equinox) or during light season (from spring equinox to autumn equinox). As RT dates were often not available, RT mid treatment date was estimated for each patient using the date of randomisation and RT duration. Progression free survival (PFS) was the primary endpoint. In each meta-analysis, the hazard ratio (HR) of dark season versus light season and its 95% confidence interval (95%CI) were estimated by a Cox model stratified by trial, and, as in the Elicin et al publication, adjusted on sex, tumor site, stage. In the MARCH subset, we also adjusted for the type of RT fractionation (standard versus modified). Sensitivity analyses were performed, restricted to patients who received at least 60 Gy in less than 10 weeks (“complete” RT) and, in the MARCH subset, to trials performed in Northern Europe where differences in daylight between winter/summer are maximal. Statistical and sensitivity analyses were planned a priori. Results We included 11,906 patients from 35 trials of MARCH and 3,289 from 31 trials of MACH-NC. In both patient subsets, patient sex, tumor site and tumor stage were strong prognostic factors for PFS. There was no evidence of a benefit on PFS of the dark season for RT delivery in the MARCH (HR: 1.02 [95%CI 0.98; 1.07], p=0.33) or in the MACH-NC (HR: 0.99 [95%CI 0.91; 1.07], p=0.79) subset. Similar results were observed in sensitivity analyses: in patients with “complete” RT, HR were 1.01 [95%CI 0.96; 1.05] in MARCH (10,725 patients) and 0.97 [95%CI 0.87; 1.09] in MACH-NC (1,733 patients); in 2,634 patients from Northern trials with “complete” RT in MARCH, HR was 0.93 [95%CI 0.85; 1.02]. Conclusion Using two large databases of non-metastatic HNSCC RCT, we did not find any effect of season of RT delivery on PFS. We could not confirm the findings from the single center retrospective study, which is possibly a false positive result. MO-0718 Improved tolerance and treatment intensity in patients with locally advanced head and neck cancer C. Billard-Sandu 1 , P. Blanchard 1 , Y.G. Tao 2 , F. Nguyen 2 , G. Dumitrescu 2 , E. Rassy 2 , T. Assi 2 , J. Zeghondy 2 , R. Sun 3 , F. Scotte 4 , M. Di Palma 4 , I. Breuskin 5 , S. Temam 5 , S. Akla 6 , E. Deutsch 2 1 Gustave Roussy, Oncology- Radiotherapy, Villejuif, France; 2 Gustave Roussy, Oncology-Radiotherapy, Villejuif, France; 3 Gustave Roussy, Oncology- Rdaiotherapy, Villejuif, France; 4 Gustave Roussy, Interdisciplinary Department of Organization of the Patient Journey, Villejuif, France; 5 Gustave Roussy, Head and neck Surgery, Villejuif, France; 6 Hôpital André Mignot, Oncology-Hematology, Le Chesney, France Purpose or Objective High-dose cisplatin (100 mg/m ² ) is considered the standard systemic regimen given concurrently with postoperative or definitive radiotherapy in locally advanced head and neck cancer. This chemoradiation regimen (CRT) is associated with 34,2% of acute kidney injury (AKI) of all grades with an impact on treatment intensity and ultimately survival. The objectives of this study were to investigate the impact of our institutional one-week at-home hydration protocol after each administration of cisplatin on tolerance and treatment dose intensity. Materials and Methods We collected data from all patients with locally advanced head and neck cancer (all histological types) treated with at least one cycle of cisplatin 100 mg/m ² concomitantly with radiotherapy at Gustave Roussy between January 2015 and December 2020. Our institutional protocol for cisplatin 100 mg/m ² every 3 weeks includes a hospital stay during which the patient receives an infusion of Bionolyte G5 3L/12h before and 2L/6h after the infusion of cisplatin for 3h. The External Care Coordination Service (CSE) organise at home after each cycle of cisplatin, the administration of 1 L of 0.9% saline solution for 12 h during the night for one week, leaving patients available for medical appointments during the day. Furthermore, remote monitoring by coordinating nurses from CSE has been set up to establish the link between hospital and home: patient-home nurses-doctors. Results 494 head and neck cancer patients were analyzed ; 381 (77%) were men, 470 (95%) aged < 70 years, 97 (20%) had hypertension and 9 (0,2%) diabetes. 332 patients (67%) were smokers and 208 (42%) had a current use of alcohol. Before CRT, 73 (14%) patients had previously received induction chemotherapy and 127 (25%) had undergone surgery. 451 patients (91%) received ≥ 200 mg/m ² and 242 (49%) completed the 300 mg/m ² dose. The mean cumulative dose of cisplatin during