ESTRO 36 Abstract Book

S593 ESTRO 36 2017 _______________________________________________________________________________________________

Head and Neck (H&N) cancer survivors are an increasingly population, due to the improvement in diagnosis and treatment. The aim of this study is to analyse the health status and physical activity in H&N cancer survivors in a single institution. Material and Methods The population was composed of a series of 50 H&N cancer patients survivors (>3 years post-diagnosis) treated in our institution from 2006 to 2013, having no signs of cancer recurrence to the date. They were reviewed based on personal interviews and specific questionnaires. The health status items measured were: nutritional assessment (with the Body Mass Index (BMI), the Malnutrition Universal Screening Tool (MUST) and the Subjective Global Assessment (SGA)), cardiovascular risk (with the HeartScore® tool), toxic habits (tobacco and alcohol by the Alcohol Use Disorders Identification Test (AUDIT)) and physical activity (with the Global Physical Activity Questionnaire(GPAQ)). Results The mean age was 64 years (range, 43-84 years) and 46 patients (92%) were male. The most frequent site of the primary tumour was larynx (48%) and the main histology squamous cell carcinoma (76%). 72% of patients had advanced cancers (stages III and IV), whereas 26% had stages I and II. All patients received radiotherapy, of which 31 patients (62%) were given 3DRT technique and 19 patients (38%) IMRT technique. Surgery was performed in 17 patients (34%), and 20 patients (40%) underwent neck dissection. The most part of our population had overweight (BMI 27 ± 3). The MUST score showed that 7 patients (14%) were at high risk of malnutrition, and regarding SGA, 12 patients (24%) were suspected of malnutrition. Cardiovascular risk was high or very high in 12 (24%) and 19 (19%) patients, respectively. Taking into account toxic habits, 6 patients (12%) were active smokers, while 38 (76%) were ex-smokers. AUDIT score showed that 3 (6%) were risk drinkers and 3 (6%) had problems related with alcohol abused. 86% of the patients accomplished WHO recommendations of physical exercise. Conclusion Our study indicates that head and neck cancer survivors could have clinical issues regarding health status, and efforts should be done to identify these patients, especially those with risk of malnutrition, high cardiovascular risk or toxic habits, in order to offer the best clinical care. EP-1087 Real-world Cetuximab toxicity in curative and recurrent/metastatic setting in HNSCC patients. I. Desideri 1 , C. Muntoni 1 , C. Ciabatti 1 , M. Lo Russo 1 , P. Bonomo 1 , M. Loi 1 , D. Greto 1 , I. Meattini 1 , L. Livi 1 1 University of Florence, Radiotherapy, Firenze, Italy Purpose or Objective Observational monocentric study to assess, in patients affected by head and neck squamous cell carcinomas (HNSCC), the acute toxicity of Cetuximab (CTX) administered concurrently with radiotherapy (RT) in the curative setting, or as a chemotherapy (CT) in patients with recurrent/metastatic disease. Material and Methods A total of 110 HNSCC patients undergoing chemotherapy with Cetuximab were retrospectively analyzed. Patients were treated in our Institution between February 2007 and May 2016. Performance Status (PS) evaluated with the Eastern Cooperative Oncology Group (ECOG) scale. Relevant comorbidity were evaluated with the Charlson Comorbidity Index (CCI). Skin toxicity was evaluated according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.03. Results The median age was 67 years (range 32-84 years); 83 (75.5%) patients were male. Ninety (82%) were smokers, most of them had a smoking history > 20 pack/years. PS

was scored ≤ 1 in 100 (90.9%) patients. The median CCI was 6 (range 1- 13). The most represented head and neck subsites in the study were the oropharynx (27%) and the larynx (32%). Fourty-three (39.1%) patients underwent a curative treatment with a concomitant CTX-RT treatment, while 67 (60.9%) received a CTX-containing chemotherapy regimen. In patients undergoing a curative treatment, the median number of CTX cycles administered amounted to 6 (range 2-8) ; median RT dose was 67Gy (range 66-70). Acute mucositis G≤2 and G3 was observed in 24 (55,8%) and 18 (41,9%) patients respectively. Actinic dermatitis G≤2 was observed in 25 (58,1%) patients, while G3 and G4 dermatitis was present in 17 (39,5%) and in 1 (2.3%) patient, respectively. In the advanced disease subgroup, CTX was administered as first- line CT in 39 cases (53.6%) as a triplet combination (cis/carboplatin, 5-FU, CTX), and in 21 (26.8%) as a 2-drugs regimen (carboplatin / CTX); 7 patients (19.6%) received CTX monotherapy. Incidence of acneiform rash G1-G2 was 37.3%, while G3 was 3.0%(25 and 2 patients, respectively); incidence of hypomagnesemia G1-G2 was 4.5% (3 patients), no G3 toxicity was reported. Infusion reactions G2 was reported in 2 (3.0%) patients. Conclusion Cetuximab is a mainstay in the radical and palliative treatment in HNSCC patients but its toxicity in our serie is not negligible, though in line with data from literature. Accurate patients selections and toxicity management during treatment are mandatory to ensure safety and clinical benefit. EP-1088 EGFR as blood biomarker improves prognostic value of nomogram for survival in laryngeal carcinoma F.W.R. Wesseling 1 , G. Feliciani 1 , C. Oberije 1 , M.P. Van de Waarenburg 2 , C.G. Schalkwijk 2 , P. Lambin 1 , F.J. Hoebers 1 1 Maastricht Radiation Oncology MAASTRO clinic- GROW - School for Oncology and Developmental Biology- Maastricht University Medical Centre, Department of Radiation Oncology, Maastricht, The Netherlands 2 Laboratory for Metabolism and Vascular Medicine- Maastricht University, Department of Internal Medicine, Maastricht, The Netherlands Purpose or Objective To improve the prognostic value of a previously validated nomogram for laryngeal carcinoma derived from clinical parameters 1 by adding blood biomarker results for hypoxia, inflammation, tumor load and cell growth. Material and Methods For 50 patients treated for laryngeal carcinoma at our clinic by radiotherapy with curative intent, blood samples were stored in a blood biobank ( ClinicalTrials.gov: NCT01084785) before start of treatment. Eight biomarkers representing hypoxia, inflammation, tumor load and cell growth were selected and measured with commercially available kits: IL6, IL8, CEA, c-kit, E-cad, EGFR, MMP-9 and osteopontin. Primary outcome was overall survival (OS). Blood biomarker results and a prognostic score, based on our previously developed nomogram were entered in a Cox regression analysis using least absolute shrinkage and selection operator (LASSO) variable selection procedure with 10-fold cross validation. Significant biomarkers were added to the nomogram score to investigate whether the prognostic value would be improved. Concordance index (C-index) was used to evaluate the performance of the model. Results Clinical staging was: St. I: 18%, St. II: 20%, St. III: 34% and St. IV: 28%. Most patients were treated with accelerated locoregional radiotherapy (68%) or local radiotherapy (16%). After a median follow up of 56 months, 2 and 5 year OS was 75% and 58%. LASSO procedure selected EGFR and the nomogram score as variables significantly associated with OS. Spearman ρ coefficient and visual inspection