ESTRO 36 Abstract Book

S599 ESTRO 36 _______________________________________________________________________________________________

Purpose or Objective Esthesioneuroblastoma or olfactory neuroblastoma is a rare tumor entity originating from the olfactory neuroepithelium. There is only few data about the efficacy of different treatment strategies so far. Several approaches have been made and a combination of radiation and surgery is thought to be effective. Most tumors are situated in the nasal cavity and thus applied radiation therapy (RT) should be very precise. Intensity modulated radiotherapy (IMRT) and carbon ion radiotherapy (CIRT) are highly precise techniques with advanced dose conformity and improved sparing of organs at risk which might translate into improved local control and moderate radiation induced toxicity. Material and Methods The retrospective analysis contained 17 patients with esthesioneuroblastoma (Kadish stage ≥ C: 88%; n=15). 4 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.

2. Ang KK et al. Impact of Epidermal Growth Factor Receptor Expression on Survival and Pattern of Relapse in Patients with Advanced Head and Neck Carcinoma. Canc Res. 2002;(713):7350. EP-1089 Prospective study of body composition changes during IMRT for H&N cancer as assessed by DXA scans J. Johansen 1 , A. Hermann 2 , S. Lønbro 3 1 Odense University Hospital, Oncology, Odense, Denmark 2 Odense University Hospital, Dept. of Endocrinology, Odense, Denmark 3 Aarhus University, Dept. of Public Health- Section for Sport Science, Aarhus, Denmark Purpose or Objective Weight loss is common after radiation treatment of head and neck cancer (H&N) as assessed by only pre/post measurements. Thus, only scarce data exists regarding body changes during overall treatment time. This study investigated changes in weight and body composition of H&N patients during radical radiation treatment, and correlated the findings to individual tests of muscle strength. Material and Methods Prospective study of 30 H&N patients undergoing IMRT (60- 68 Gy) during a 16 month period. Patients were followed weekly during treatment, and all had individualized nutritional counseling. At baseline, and with 2-week intervals during IMRT and 2 weeks after, patients underwent whole-body dual-energy X-ray absoptiometry (DXA) scans, as well as weight measurements and pre/post treatment maximal muscle strength tests (n=21)(one- repetition maximum chest press, leg press, and knee extension). Changes over time were analyzed by linear regression, and pre/post data were compared by Student’s paired t-tests. Results A total of 131 DXA scans were obtained. Mean age was 58.2, and the patients were predominantly stage II-IV (77%). Two-thirds received concomitant chemotherapy. Baseline BMI was 27.4 (± 4.8). Significant overall declines (p<0.001) were observed in weight (-8.2%; range +2.0 to - 18.4), fat mass (10.3%; range +2.4 to -29.1), and lean body mass (10.7%; range +0.8 to -23.9). All changes were mutually correlated in regression analysis, e.g., R 2 =0.74 (p<0.001) for weight loss versus lean body mass. The decline in lean body mass was correlated with loss of muscle strength as assessed by chest press (R 2 =0.61; p<0.001) and knee extension (R 2 =0.25; p=0.03), but not with leg press (p=.08). Concomitant chemoradiation was associated with a 10% decline in lean body mass in univariate analysis, however, no independent predictors were discerned in multivariate regression. Conclusion The overall weight loss during IMRT for H&N was 8.2%. Weight loss correlated proportionally with the percentage decline in both fat mass and lean body mass. Loss of lean body mass correlated well with loss of muscle strength during treatment. The proportional loss of fat and lean body mass indicates that physical exercise during radiotherapy may be required to favor muscle/fat distribution. EP-1090 Particle therapy and IMRT for patients with esthesioneuroblastoma: a single-institution experience J. Liermann 1 , M. Syed 1 , D. Bernhardt 1 , N. Bougatf 2 , S.B. Harrabi 1 , A. Paul 1 , T. Sprave 1 , S. Rieken 1 , T. Haberer 2 , K. Herfarth 1 , J. Debus 1 , H. Hauswald 1 , S. Adeberg 1 1 University Hospital of Heidelberg, Department of Radiation Oncology, Heidelberg, Germany 2 University Hospital of Heidelberg, Heidelberg Ion-Beam Therapy Center HIT, Heidelberg, Germany