ESTRO 36 Abstract Book

S573 ESTRO 36 2017 _______________________________________________________________________________________________

Patients were randomized to orally receive either glutamine or placebo at a dose of 10 g 3 times a day throughout the CRT course. Mucositis was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. The primary end point was mucositis severity. Seventy biopsy proven patients with head and neck cancer receiving primary or adjuvant radiation therapy were randomized to receive either oral glutamine suspension daily 2h before radiation in the study arm (10 g in 1000 ml of water) ( n = 35) or placebo before radiation; control arm ( n = 35) Results Total 30 patients in the glutamine arm and total 33 patients in placebo developed mucositis. Grade 3 mucositis and grade 4 mucositis in the study arm (who received oral glutamine) were significantly less in the glutamine arm. The mean duration of grade 3 or worse mucositis (grade 3 and grade 4) was significantly less in study arm with P < 0.001. Mean time of onset of mucositis was significantly delayed in patients who took glutamine in comparison to control arm with P < 0.001. Overall, glutamine was associated with a significant reduction of mucositis, WL, and enteral nutrition. Conclusion Glutamine delays oral mucositis in the head neck cancer patients. Moreover, it reduces the frequency and duration of grade 3 and grade 4 mucositis. More of the patients not receiving glutamine developed severe malnutrition when compared with those receiving this supplement, but there were no differences in other outcomes such as interruption of RT, hospitalization, use of opioid analgesics, or death during RT. Glutamine may have a protective effect during RT, reducing the risk and severity of OM, preventing weight loss, and reducing the need for nutritional support. EP-1046 Hypofractionated palliative radiotherapy in head and neck cancer P. Vargas Arrabal 1 , I. Tovar Martin 1 , C. Prieto Prieto 1 , M. Zurita Herrera 1 , R. Guerrero Tejada 1 , J. Exposito Hernandez 1 , R. Del Moral Avila 1 , A. Ruiz Martinez 1 , S. Rodriguez Pavon 1 , R. Ching 1 1 Complejo Hospitalario de Granada, Radiation Oncology, Granada, Spain Purpose or Objective There are few published studies on the choice of the best palliative treatment option for head and neck cancer, as well as high toxicity and its impact on symptom control and quality of life, once ruled treatment with curative intent . The objective is to evaluate the role of radiotherapy (RT) in the palliation of tumors advanced head and neck: identifying patients optimal candidates, appropriate dose, outcome and duration of palliation and secondary toxicity. Material and Methods We retrospectively reviewed 31 patients treated between 2006-2015 histological diagnosis of epidermoid head and neck cancer stage IV, not candidates for radical treatment under perfomance status with advanced locoregional recurrent disease or metastatic. All patients are treated with three-dimensional conformal external beam radiotherapy (3D) with different schemes hypofractionation: dose 30 Gy fractions of 6 Gy (2 x week): 52.4% (16), 30 Gy fractions of 3 Gy (5 x week): 14.3% (5), 20 Gy to 4 Gy fractions (5 x week): 9.5% (3) 23.8% other (7). Results With a mean follow up of 20 months, 90% of patients completed RT scheme originally planned. The median time to progression of symptoms is 5 months. The objective tumor response is complete response: 23.8% (7), Partial / stabilization: 57.1% (18). The median time to tumor progression 3 months. The median overall survival is 9 months (2-57).

The acute toxicity is recorded after RT oromucositis G2 9.5% (3), G3 57% (18), radiodermitis G2 9.5% (3), dysphagia G2 71.4% (22). Conclusion In patients with advanced head and neck cancer and no subsidiary of radical treatment, palliative RT Hypofractionated, provides a satisfactory rate of disease control and symptom control with a secondary tolerable toxicity and better life quality. EP-1047 Comparison of TPF and CF induction chemoradiotherapy for radical treatment of head and neck cancer. C. Adkin 1 , D. Adjogatse 1 , T. Guerrero Urbano 1 , M. Lei 1 1 Guy's and St.Thomas' Hospital NHS Foundation Trust, Clinical Oncology, London, United Kingdom Purpose or Objective To compare the impact of induction chemotherapy using the TPF (Docetaxel, Cisplatin and 5-fluorouracil) and standard CF (Cisplatin and 5-fluorouracil) regimens on toxicity and hospital admissions for radical treatment of locally advanced head and neck cancer. The aim was to assess if the TPF regimen increases toxicity during induction and concomitant chemoradiotherapy and if this results in increased burden of hospital admissions and clinic attendance. Material and Methods Patients undergoing radical chemoradiotherapy for locally advanced head and neck cancer at Guy’s hospital during 2015 were selected. Timing, dose and duration of chemoradiotherapy were recorded. All admissions were included up to 3 months after completion of radiotherapy. These admissions were attributed to radical treatment. The number and duration of hospital admissions, both elective and acute were assessed, as well as the number of acute outpatient clinic attendances. The number of episodes of neutropenia was recorded, as well and the need for nasogastic/jejunal or gastrostomy feeding tubes. The cohort was followed up to assess clinical and radiological response to treatment as well as recurrence and survival at 3 and 12 months. Results 44 patients were included (10 TPF, 34 CF). Per patient, the TPF regime was shown to increase the number of acute clinic attendances (4.5 vs 2.7), acute admissions (2.4 vs 1.0), length of stay per admission (4.9 days vs 3.8 days) and total length of stay (13.4 days vs 8.6 days). There was a considerable increase in the number of episodes of neutropenia per patient with TPF (1.2 vs 0.4). There was only a modest increase in elective admissions (0.5 vs 0.4) and the need for feeding tubes (0.7 vs 0.6). There were 4 deaths during the observed period, all amongst the CF group. Conclusion Within the group of patients selected, the use of TPF induction chemotherapy appears to increase toxicities, including neutropenia, the need for clinic attendance and inpatient admission. The length of stay also appears to be longer, which may act as a surrogate for severity of admission. Overall, the TPF induction regimen carries an increased cost, in terms of morbidity, patient quality of life and a financial burden of hospital admission and clinic attendance. This will need to be weighed up against the potential added benefit over standard CF induction chemotherapy, in terms of efficacy of response, extended time to progression and survival. EP-1048 Phantom Tumour Phenomenon in Nasopharyngeal Carcinoma Patients after Radiotherapy Y.M. Jen 1 , S. Shi 2 1 Yee-Ren Hospital, Department of Radiation Oncology, Nei Hu- Taipei, Taiwan 2 Chenzhou NO.1 People's Hospital, Radiation Therapy Center, chenzhou, China