ESTRO 37 Abstract book

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ESTRO 37

into 3 different clinical situations: adjuvant treatment, treatment of loco-regional recurrences and the palliation setting. The experts proposed the use of EBRT as an adjuvant treatment for pT4 tumors with grossly positive margin (R2) and low/no radioiodine uptake (response rate = 100%, per cent of agreement = 81.3 %). Age (< or ≥ 45 y.o.) did not impact on the expert panel’s decision in that situation. In case of recurrence, the expert panel proposed EBRT for surgically unresectable disease with low/no radioiodine uptake. In that situation, the level of agreement was higher for patients ≥ 45 y.o. (response rate = 100%, level of agreement = 100 %) vs patients < 45 y.o. (response rate = 93.8 %, level of agreement = 87.7 %). Finally, the indication of EBRT reached a perfect agreement in the palliative setting, especially if aero- digestive compression (response rate = 100%, level of agreement = 100). Conclusion A consensus agreement has been reached to define the relevant indications for EBRT in DTC. The resulting indications from the expert panel consensus were: (1) in the adjuvant setting, pT4 tumors with grossly positive margin (R2) and low/no radioiodine uptake; (2) for surgically unresectable loco-regional recurrences with low/no radioiodine uptake; (3) in the palliative setting, in case of aero-digestive compression. To our knowledge, this is the first substantial agreement about indications of EBRT for DTC, obtained from an expert panel. We hope our consensus statement will help clinicians in the multidisciplinary treatment management for patients with DTC. EP-1168 THE Impact Of Personalized Supportive Care On Chemoradiotherapy Tolerance For Hnscc Patients A. Gevorkov 1 , A. Boyko 1 , L. Bolotina 2 , S. Shashkov 1 , G. Abuzarova 3 , E. Volkova 4 , R. Plavnik 5 1 Moscow Research Gerzen Oncology Institut, Radiation Oncology, Moscow, Russian Federation 2 Moscow Research Gerzen Oncology Institut, Medical Oncology, Moscow, Russian Federation 3 Moscow Research Gerzen Oncology Institut, Pain center, Moscow, Russian Federation 4 Moscow Research Gerzen Oncology Institut, Nutrition Specialist, Moscow, Russian Federation 5 Moscow Research Gerzen Oncology Institut, Department of Radiation Physics, Moscow, Russian Federation Purpose or Objective Intensification of radiotherapy and chemotherapy for head and neck squamous cell carcinoma (HNSCC) may lead to increased rates of severe side effects. Mucositis and consequent swallowing problems is known to be main side effect and cause of breaks in irradiation for head and neck cancer. Our objective in this study was to further investigate the independent relationship between pre-treatment somatic status, personalized supportive care program and chemoradiotherapy (CRT) tolerance among HNSCC patients. In order to assess this, we examined data on comorbidities, nutritive risk and intervention, tumor characteristics, wound healing facilities, pain control, anti-tumor treatment modality and side effects, as well as breaks and prolonged radiation treatment time. Material and Methods We conducted a retrospective control study of 326 HNSCC patients diagnosed and treated at Moscow Herzen Research Institute, Russia, between 2003 and 2016. Prospective group included 38 HNSCC patients with individual supportive care program in 2016. Clinical data including demographic information, vital status information, and tumor information were abstracted from medical records. The health status items measured

were: nutritional assessment (with the Body Mass Index, the Malnutrition Universal Screening Tool and the Subjective Global Assessment), toxic habits (tobacco and alcohol) and comorbidity. We also evaluated whether prospective group of patients (n=36) had evidence of sarcopenia based on estimations of muscle cross-sectional area assessed from pre-treatment lumbar CT scans. Supportive care program included nutritional management, oral sanitation and pain control before, during and after primary CRT, as well as wound healing biopolymer nanomaterials local therapy. Results Multivariate Cox regression and propensity-score weighted analyses were used to adjust all tumor, patient and treatment parameters. Retrospective analyses revealed that HNSCC patients without pre-treatment malnutrition had slightly less intensive mucositis, although the difference was not significant. Main risk factors of severe side effects and prolonged anti-tumor treatment time were the tumor site (pharynx), comorbidity (especially diabetes), toxic habits, radiation technique, altered fractionation, clinical target volume 70-72Gy≥50cm3 (p<0,05). Patients under individual supportive supervision (prospective group) had better chemoradiotherapy tolerance, compared to retrospective group, regardless of fractionation regimes and total radiation doses (p<0.02). Sarcopenia was negatively associated with radiation gaps (p<0.05). Conclusion Modern supportive care is significantly associated with improved CRT tolerance. Appropriate nutritive management, pain control and local wound healing therapy may have beneficial effects on oral mucositis and consequent swallowing problems. However, patients with comorbidity, toxic habits and aggressive CRT plan are still at high risk of severe side effects and breaks in anti- tumor treatment. EP-1169 Aspiration Pneumonia in patients undergoing irradiation; the perspective of a developing country. R. Kumar 1 , D. Narayanan 1 , V. Perumareddy 1 , G. Narayanan 1 1 Vydehi Institute of Medical Sciences, Radiation Ocology, gurgaon, India Purpose or Objective Head and Neck cancers are one of the most common cancers in our country. It’s often complicated with aspiration pneumonia, especially in irradiated patients. The Incidence of aspiration alone is as high as 68% and that of aspiration pneumonia is 14.54% with a mortality rate of 10%. There is paucity of data on risk factors for developing aspiration pneumonia from the developing world. To the best of our knowledge there is no study that does risk stratification of irradiated head and neck cancer patients who are likely to develop aspiration pneumonia. Hence the need for our study. Material and Methods In this retrospective study, 233 consecutive patients treated with primary or post-operative RT(radiotherapy) with curative intent for head and neck cancers from July 2015 to December 2016 were included. All patients treated with palliative intent, incomplete data and those who abandoned the treatment were excluded. Patients were identified from the departmental database and manual extraction of data was done from the case files. Data was assessed from the time of diagnosis to the response assessment. Data was tabulated in excel and SPSS was used for statistical analysis. Results Results were analysed using Chi square and Fischer’s test to identify risk factors associated with aspiration pneumonia. 31 patients developed aspiration pneumonia with an incidence of 15.5% and 4 died among them(12% mortality rate). Dysphagia (III-IV) Mucositis (III-IV),