ESTRO 37 Abstract book

S655

ESTRO 37

Purpose or Objective Dysphagia after radiotherapy (RT) for head and neck squamous cell carcinoma (HNSCC) has a huge influence on the quality of life of patients. The aim of this study was to correlate the following clinical characteristics: up- front neck dissection (UFND), concurrent chemotherapy, T- and N-category, tumour subsite, age and gender, with dysphagia scored by the physician, by the patient and on swallowing videofluoroscopies (VFS). Material and Methods 63 patients from 2 different centres treated with RT for HNSCC were evaluated for dysphagia at baseline, 6 and 12 months of follow-up. VFS were scored by 2 experienced observers with the Penetration Aspiration Scale (PAS) and Swallowing Performance Scale (SPS). Physician and patient scored dysphagia was recorded according to the CTCAE scoring system for acute toxicity, the EORTC/RTOG scoring system for late toxicity and the EORTC-QLQ H&N35 quality of life questionnaire. All data was collected prospectively. Proportional odds models were used for ordinal response variables and linear regression models for continuous response variables. Random effects were modelled to deal with longitudinal measurements. For PAS and SPS multivariable analysis was performed. Results All patients received a baseline VFS, 54 patients received an additional VFS at 6 months and 39 patients at 12 months. Univariable analysis revealed at baseline a significant association between tumour subsite, particularly hypopharynx, and higher SPS scores (p= 0.02) and patient scored dysphagia (p=0.02). At 12 months, tumour subsite, particularly unknown primary (CUP), was significantly associated with higher PAS and SPS scores. After multivariable analysis, tumour subsite and higher SPS scores at baseline and at 12 months remained significantly associated (p=0.03 and p=0.01 respectively). Pairwise comparison showed that hypopharyngeal cancer at baseline and CUP at 12 months were associated with more dysphagia. UFND was in univariable analysis significantly associated with a higher SPS score and physician scored dysphagia at baseline, 6 months and 12 months. At the latter time point, there was also a significant association with higher PAS (p<0.01) and patient reported dysphagia (p<0.01). After multivariable analysis, the association between UFND and more dysphagia scored with PAS (p<0.01) and SPS (p<0.01) at 12 months remained significant. There was a significant association between higher N- category and higher SPS scores (p=0.03) and physician scored dysphagia (p=0.02). T-category, concurrent chemotherapy, gender and age were not associated with more dysphagia. Conclusion Hypopharyngeal tumours and CUP had more dysphagia at baseline and at 12 months, respectively. Furthermore, UFND was associated with more dysphagia at 12 months scored by physicians, patients and on VFS. To our knowledge, this is the first study looking at the relationship between UFND and dysphagia on VFS. We advocate to abandon UFND and preserve neck dissection as a salvage option after primary radiotherapy. EP-1171 Toxicity and outcome for simultaneous integrated boost radiotherapy in head and neck cancer patients T. Dragan 1 , S. Beauvois 1 , M. Moreau 2 , D. Van Gestel 1 1 Institut J. Bordet, Radiotherapy, Brussels, Belgium 2 Institut J. Bordet, Information Management Department, Brussels, Belgium Purpose or Objective Multidisciplinary treatment for head and neck cancer has improved clinical results but acute and late toxicity remain a major problem.

presence of nasogastric tube, history of Diabetes mellitus and prior history of Tuberculosis(TB) were proven statistically significant. On Univariate analysis out of the 5 risk factors only TB, dysphagia (grade III-IV) and presence nasogastric tube were proven to be statistically significant and were taken up for multivariate logistic regression. After applying that, an equation that predicts the development of aspiration pneumonia was created, 2.9(TB) + 1.1(nasogastric tube) + 1.5(dysphagia grade III- IV). Patients with a score of 5.5 had a 97% chance of developing aspiration pneumonia and a score of 0 resulted in a 0% chance of developing pneumonia during the course of treatment. The most common causative organism was Klebsiella pneumoniae followed by pseudomonas aeruginosa and the mean treatment delay caused by aspiration pneumonia was 4.25 days.

Conclusion Aspiration pneumonia in patients undergoing radiation is associated independently with the presence of nasogastric tube, dysphagia(III-IV) and history of prior TB. Other dependent risk factors are mucositis(III-IV) and diabetes. This study is the first study to come up with a scoring system that predicts the development of aspiration pneumonia in patients who are undergoing radiation. With this scoring, various management strategies can be planned that would reduce the development of these risk factors. The proposed equation for predicting aspiration pneumonia needs to be validated by further studies on independent datasets so that a more robust risk stratification and prediction is done. EP-1170 Clinical factors impacting on late dysphagia in head and neck cancer following radiotherapy S. Deschuymer 1 , D. Nevens 1 , F. Duprez 2 , A. Laenen 3 , E. Dejaeger 4 , W. De Neve 2 , A. Goeleven 5 , S. Nuyts 1 1 University Hospital Gasthuisberg, Radiotherapy, Leuven, Belgium 2 Ghent University Hospital, Radiotherapy, Ghent, Belgium 3 University of Leuven, Biostatistics and Statistical Bioinformatics centre, Leuven, Belgium 4 University Hospital Gasthuisberg, Department of Geriatric Medicine- Swallowing Clinic, Leuven, Belgium 5 University Hospital Gasthuisberg, Department of ENT - Swallowing Clinic, Leuven, Belgium