ESTRO 36 Abstract Book

S595 ESTRO 36 2017 _______________________________________________________________________________________________

patients initially presented with cervical lymph node metastasis and 4 patients already underwent a previous RT. The treatment consisted of either IMRT (n=5) or CIRT (n=4) or a combination of both techniques (n=8). Applied median doses were 60 Gy in 30 fractions (IMRT only), 51 Gy (RBE) in 17 fractions (CIRT only) and 52 Gy in 26 fractions as well as 21 Gy (RBE) in 7 fractions (bimodal RT). Overall survival and local control rates were determined after a median follow-up of 8 months (range: 2-72 months). Acute toxicity was evaluated up to three months after completion of the radiotherapy according to CTCAE criteria (Version 4.03). Results Local recurrence-free survival and overall survival rates were 90% after a follow-up of 6 months (n=9/10) and 86% after a follow-up of 12 months (n=6/7). One patient died 5 months after the treatment. Local recurrence occurred in another patient after 36 months who died 26 months later. Both of these patients belonged to the group who underwent a previous RT before. 15 of 17 patients (88%) are still alive and recurrence-free so far. Grade I toxicity (100%; n=17) and grade II toxicity (65%; n=11) were frequently observed. The most common toxicities were nasal and/or oral mucositis (76%; n=13) and radiation dermatitis (82%; n=14). Only one patient (6%; n=1) developed a grade III toxicity (hyposmia). Conclusion Considering the advanced tumor stage of the cohort the results showed good local control and overall survival rates in short term follow-ups. Our results show that IMRT, CIRT or a combined approach seem to be a feasible and effective treatment in esthesioneuroblastoma without leading to severe acute treatment-related side effects. Further follow-up will be needed to investigate the benefit of CIRT. EP-1091 Low dose fractionated RT in association to TPF as induction therapy in advanced head and neck cancer R. Autorino 1 , M. Massaccesi 1 , A. Pesce 1 , M. Balducci 1 , N. Di Napoli 1 , T. Tartaglione 2 , V. Rufini 3 , F. Bussu 4 , J. Galli 4 , S. Chiesa 1 , G. Paludetti 4 , V. Valentini 1 , F. Miccichè 1 1 Polyclinic University A. Gemelli- Catholic University, Institute of Radiotherapy, Rome, Italy 2 Polyclinic University A. Gemelli- Catholic University, Institute of Radiology, Rome, Italy 3 Polyclinic University A. Gemelli- Catholic University, Institute of Nuclear Medicine, Rome, Italy 4 Polyclinic University A. Gemelli- Catholic University, Institute of Otorhinolaryngology, Rome, Italy Purpose or Objective To analyze the efficacy and the feasibility of induction chemotherapy (ICT) with low-dose radiotherapy (LDR) compared to ICT alone prior to chemoradiation (CRT) in locally advanced head and neck squamous cell carcinoma. Material and Methods Between September 2008 and May 2012, 59 patients, with locally advanced stage III and IV squamous cell carcinoma of head & neck cancer, received three courses of induction chemotherapy with docetaxel (75 mg/mq), cisplatin (75 mg/mq) and 5-fluoruracil (750 mg/mq/day on days 1-5) followed by radiotherapy plus two or three cycles of concurrent cisplatin 100 mg/mq (Group A). Twenty-nine of this patients received low dose radiotherapy concomitantly to induction chemotherapy (Group B). Treatment courses, hematological data and other parameters were also investigated. Results Three cycles of ICT were administered in all patients: only one (Group B) received two cycle because of high hematological toxicity. After neoadjuvant therapy completation, clinical tumor response was observed in 49 patients (83%); patients undergone low dose radiotherapy showed better complete remission (p=0.08). Grade > 3

toxicity with dose reduction occurred in 5 patients (8%). Median time from the final cycle of TPF to starting radiotherapy was 21 days. All patients received radical radiotherapy; one, two and three cycles of concurrent cisplatin was delivered in 0 (0.0%), 17 (58.6%), 10 (41.4%) patients of Group A and 1 (3.5%), 28 (96.5%), 0 (0.0%) patients of Group B, respectively. With a median follow- up of 28 months (range 2-58), one-year local control was 66% and 81% for Group A and Group B, respectively (p=0.05). No difference was observed in terms of overall survival and disease free-survival between the two groups (p=0.9 and 0.8). Toxicity during chemo-radiation was acceptable in both groups without difference, specially, in terms of hematological toxicity (p=0.76). But we found a correlation between hematological toxicity > G3 and local control (p=0.03). Conclusion Low dose radiotherapy in association with ICT prior to CRT, even if it is not the standard, could be considered tolerable, with encouraging efficacy in terms of response and local control, in locally advanced head and neck squamous cell carcinoma. Further investigation is warrented to confirm these data. EP-1092 Perioperative high dose rate brachytherapy in previously irradiated head and neck cancer: Results M.I. Martinez Fernandez 1 , M. Cambeiro 1 , J. Alcalde 2 , R. Martínez-Monge 1 1 Clinica Universitaria de Navarra, Departament of Oncology, Pamplona, Spain 2 Clinica Universitaria de Navarra, Departament of Otolaryngology, Pamplona, Spain Purpose or Objective This study was undertaken to determine the feasibility of salvage surgery and perioperative high dose rate brachytherapy (PHDRB) in patients with previously irradiated, recurrent head and neck cancer or second primary tumors arising in a previously irradiated field. Material and Methods Sixty-three patients were treated with surgical resection and perioperative high dose rate brachytherapy (PHDRB). The PHDRB dose was 4 Gy b.i.d. x 8 (32 Gy) for R0 resections (surgical margins equal to or greater than 10 mm) and 4 Gy b.i.d x 10 (40 Gy) for R1 resections (close or microscopically positive surgical margins, or the presence of extra- capsular nodal extension), respectively. Further external beam radiotherapy or chemotherapy was not given. Results Resections were categorized as R0 in 7 patients (11.1%) and R1 in 56 patients (88.9%). Thirty-four patients with R1 resections (54.0%) had microscopically positive margins, and 22 patients (34.9%) had close margins. Thirty-two patients (50.8%) developed RTOG grade 3 or greater adverse events including 3 fatal events. After a median follow-up of 6.8 years, the 5-year locoregional control rate and 5-year overall survival rates were 55.0% and 35.6%, respectively. Conclusion Surgical resection and PHDRB is a successful treatment strategy in selected patients with previously irradiated head and neck cancer. Long-term locoregional control can be achieved in a substantial number of cases despite a high rate of inadequate surgical resections although at the expense of substantial toxicity. F. Meniai-Merzouki 1 , B. Coche-Dequeant 1 , E. Bogart 2 , T. Lacornerie 3 , X. Mirabel 1 , E. Lartigau 1,4 , D. Pasquier 1,5 1 Centre Oscar Lambret, Radiation oncology, Lille, France 2 Centre Oscar Lambret, Biostatistics departement, Lille, France 3 Centre Oscar Lambret, Medical Physics, Lille, France EP-1093 Hypofractioned robotic stereotactic radiotherapy of Head and neck Paragangliomas