ESTRO 36 Abstract Book

S585 ESTRO 36 2017 _______________________________________________________________________________________________

D. Genovesi 1 1 Ospedale Clinicizzato S.S. Annunziata, Radiotherapy, Chieti, Italy 2 Otolaryngology, Otolaryngology, Chieti, Italy 3 Preventive Medicine and Hygiene, Biomedical Science, Chieti, Italy Purpose or Objective The aim of this study was to evaluate the most common approaches among Italian radiation oncologists (RO) and otolaryngologists (OL) in early nutritional management of head and neck (H&N) cancer patients. Type of nutritional supplements prophylactically used, timing and criteria of percutaneous endoscopic gastrostomy placement (PEG) and role of nutritional counseling were investigated. Material and Methods A questionnaire, focused on different points of nutritional management in H&N cancer patients, was created and approved by a multidisciplinary team (MDT) including RO, OL and nutritionists. The survey, containing 10 multiple- choice questions, was prepared on SurveyMonkey online interface and emailed to 106 Italian centers of radiation oncology and 100 centers of otolaryngology. Responses were collected over a 2-month period. Descriptive analyses in terms of frequencies and percentages was automatically elaborated by SurveyMonkey. Chi-square test was performed to establish any significant difference between interviewed. Results A total of 67/106 and 27/100 questionnaires sent to Italian centers of Radiation Oncology and Otorhinolaryngology were filled in, corresponding to a response rate of 63.2% and of 27% respectively. Respondents answered all questions, so all were included in the analysis. Regarding nutritional counseling before starting treatment, 53.7% of RO claimed to make it rarely, while 26.9% always; 33.3% of OL affirmed to practice a preventive nutritional counseling rarely, 29.6% always and 22.2% almost always. 53.7% of RO affirmed they did not employ any nutritional supplement before starting treatment, while 20.9% declared to use PEG. Among OL, 37.0% affirmed the use of other nutritional supplements in a prophylactic phase, while 29.6% did not use any nutritional supplement (p=0.05). Considering selection criteria for PEG placement, tumor stage (locally advanced) and tumor site (oropharynx) were the most important criteria for both RO (73.1%) and OL (85.2%). To the question 'when you use PEG?”, 26.9% of RO and 11.1% of OL replied to place PEG in a prophylactic phase (p=0.166). PEG is positioned in reactive phase in 73.1% of cases by RO and in 88.9% of case by OL. RO (82.1%) and OL (92.6%) stated that the placement of the PEG before starting treatment should not be a standard procedure (p=0.330); they also respectively stated (85.2% and 88.1%) that the assessment of medical nutritionist before starting a treatment should represent a standard procedure (p=0.971). Finally, 86.6% of RO and 92.6% of OL stated to evaluate H&N cancer patients in MTD. Conclusion Management of early nutritional supplementation in H&N cancer is still controversy. It seems necessary to improve nutritional evaluation among the Italian MDTs of H&N cancer care, because this appear lacking. Participation to surveys should be encouraged in order to better use the information that this precious, fast and cheap tool can provide. EP-1073 Volumetric changes in parotid volume during radiation therapy in head and neck cancer M.R. Tonse 1 1 Tata Memorial Centre, Radiation Oncology- Neuro Oncology, Mumbai, India

late toxicities. Treatments were delivered twice a week for a total of 5 fractions via image-guided volumetric arc therapy with the OAR as the fusion surrogate. Quality of life (QOL) data was collected at consultation and follow up using the MD Anderson Dysphagia Inventory (MDADI), Symptom Inventory – Head and Neck Module (MDASI-HN), and Xerostomia Questionnaire. Local control and overall survival were estimated using the Kaplan-Meier method.

Results Sixty patients were treated to 69 sites (9 for a second metachronous failure). Thirty two patients underwent surgical salvage prior to SBRT. Retreatment sites included the aerodigestive tract (43%), lateral neck (22%), and skull base (35%). The median prior radiotherapy dose was 63.6 Gy and the median reirradiation planning target volume (PTV) was 61.0 cm 3 (range 16.8 to 349 cm 3 ). Despite prioritizing OAR-sparing over PTV coverage, the median V90 was 98.4% and D90 was 99.0%. The 1- and 2- year rates of local control were both 54%. Median survival was 18.5 months after SBRT. Late grade 3 toxicities occurred in 3% of the aerodigestive tract group, 1% of the skull base group, and none treated to the lateral neck. No grade 4 or 5 toxicities were observed. Compared to baseline, patients with skull base reirradiation maintained a stable QOL, while patients treated to the aerodigestive tract demonstrated decreased QOL associated with worsening dysphagia. All groups experienced increased xerostomia. Conclusion OAR-sparing SBRT is able to achieve excellent tumor coverage while protecting the organs at highest risk of reirradiation-related complications. Compared to conventional fractionation, the potential for lowered toxicity and maintained QOL makes SBRT a promising salvage option for recurrent head and neck cancer. Further, prioritizing OARs preserves a treatment option for repeat reirradiation in patients who develop a second in- field tumor recurrence. EP-1072 Early nutritional support in head and neck: survey of Italian radiation oncologists/otolaryngologists. M. Trignani 1 , A. Allajbej 1 , A. Di Pilla 1 , M. Nuzzo 1 , S. Di Biase 1 , M. Di Perna 1 , A. Croce 2 , M. Di Nicola 3 , I. Porfilio 3 ,

Purpose or Objective