ICHNO-ECHNO 2022 - Abstract Book

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ICHNO-ECHNO 2022

Patients were followed up with an HRCT/ MRI of the temporal bone at first follow up. Subsequent imaging was repeated annually or when there was a clinical suspicion of recurrence. The acute and late toxicity was graded as per Radiation Therapy Oncology Group (RTOG) acute and late morbidity schema (14) . Results One hundred and thirty patients were eligible for analysis. The median age was 55 years and most patients were male (n=89). The most common histology was Squamous Cell Carcinoma (n=112). The median follow-up of surviving patients was 50.1 months (IQR:35.1 – 65.6 months). Within the cohort of patients treated with a curative intent (n=121), 97 (88 upfront, 9 post neoadjuvant chemotherapy) could undergo surgery and 101 received RT (either definitive or adjuvant). The 5-year LRC, EFS and OS was 70.4%, 61.2%, and 66.5% for the curative cohort. The predominant pattern of failure was local (n=32, 26.4%). Regional failure was seen in only 5 patients, none of which were in patients in whom elective nodal irradiation was omitted post-operatively. A higher T stage and treatment with a non-surgical modality were associated with inferior EFS on univariate analysis. Treatment with IMRT as compared to conventional/3D-CRT technique had lesser ≥ grade 2 late subcutaneous fibrosis (10.4% vs 36.3%). Conclusion Surgery followed by adjuvant therapy should remain the mainstay of treatment for EAC tumours. IMRT should be the preferred modality for RT due to potentially less late morbidity. Elective nodal irradiation is routinely not warranted in the post-operative setting for EAC tumours. 1 North Middlesex University Hospital, Radiotherapy, London, United Kingdom; 2 University College London Hospital , Radiotherapy, London, United Kingdom; 3 North Middlesex University Hospital, Oncology, London, United Kingdom; 4 North Middlesex University Hospital, Speech and Language Therapy , London, United Kingdom Purpose or Objective Adjuvant post-operative radiotherapy (PORT) is used to improve loco-regional control and survival following surgery for high risk head and neck cancer. The British Association of Head and Neck Oncologists (BAHNO) standards for oral cavity cancer state that PORT should start within 6 weeks of surgery (1). The evidence to support this recommendation is higher loco-regional control and survival rates seen when PORT is delivered within 5 weeks of surgery compared to 7 weeks (2). Cumulative duration of PORT has significant impact on loco-regional control and survival rates. In North Central London, University College London Hospital (UCLH) is the surgical centre for all head and neck surgery however PORT maybe given either at UCLH or North Middlesex University Hospital NHS Trust (NMUH). An audit was undertaken at both centres to review the percentage of patients starting PORT within 6 weeks of surgery and identify common factors preventing this. Materials and Methods All patients treated with PORT at UCLH or NMUH between May 2020 and May 2021 were identified using the Aria radiotherapy database at each site. Cancer pathology, stage and operation date were obtained from clinical notes and radiotherapy start dates were based on Aria Records and the Verify system. Patients not starting PORT within 6 weeks of their operation had their clinical notes reviewed and contributing reasons for delay were identified. Results 45 patients were identified as having received PORT in this time frame (UCLH=21, NMUH=24). 58% (n=26) of patients did not commence PORT within 6 weeks of surgery. Of these, 10 patients were at NMUH (38%) and 16 were at UCLH (62%). Factors identified at UCLH causing delay included: post-op complications such as delirium and aspiration pneumonia, patient choice, pathology reporting delays and radiation planning time. Factors identified at NMUH were delayed healing from surgery, delayed discharge from UCLH and pathology reporting delays. Conclusion This review of data identified some common causes of delays for starting PORT between the 2 centers. Some of the causes are unavoidable but others may be improved with good communication between the multi-disciplinary team. Most patients are identified as requiring PORT at diagnosis and the pathway can be streamlined accordingly to minimise delays. However if the recommendation for PORT cannot be made until the final pathology is available, including bone decalcification for example, the pathway is more likely to be delayed and this may impact on local control and/or survival. MDT’s and radiotherapy departments need to be aware of this and create streamlined / flexible pathways to allow these patients to start PORT with minimal delay where possible. Local control rates: 76% for <11 weeks vs 38% for >13 weeks. Survival rates: 48% for <11 weeks vs 25% for >13 weeks (3). PO-0115 Factors preventing H&N patients starting post-operative radiotherapy within 6 weeks of surgery S. English 1 , S. Khan 2 , A. Thompson 3 , N. Gilbody 4 , A. Khan 3

PO-0116 Non-conventional laryngeal malignancies: a multicentre review of management and outcomes

R. O'Neill 1