Bhavana Vangara Chapman BS, Presenter: Nothing to Disclose

Peyman Kabolizadeh MD, PhD, Abstract Co-Author: Nothing to Disclose

Hebist Berhane MD, Abstract Co-Author: Nothing to Disclose

Ryan P. Smith MD, Abstract Co-Author: Nothing to Disclose

David Clump, Abstract Co-Author: Nothing to Disclose

Dwight E. Heron MD, Abstract Co-Author: Nothing to Disclose

Purpose/Objectives:Despite aggressive post-operative radiotherapy with or without chemotherapy for advanced head and neck cancer, locoregional recurrence rates remain suboptimal. With respect to radiation treatment, patients are generally treated with sequential planning radiation treatment in which the same dose is delivered to shrinking tumor volumes. Accelerated hypofractionated schedules with the simultaneously integrated boost-intensity modulated radiation therapy (SIB-IMRT) technique have gained increased interest in hopes of obviating tumor repopulation. This study aimed to assess toxicities and outcomes in patients with head and neck cancer treated with SIB-IMRT post-operatively at a single institution.Materials/Methods:Between 2003 and 2012, 25 patients (21 males, mean age 57) with head and neck cancer were treated with post-operative SIB-IMRT at a single institution. Seventeen patients (68%) received chemotherapy. The median KPS at the time of treatment was 80 (80-100). Toxicities were recorded according to the Common Terminology Criteria for Adverse Events Version 4.0. Kaplan-Meier survival analyses were used to estimate local control (LC) and overall survival (OS) rates. The multivariate Cox regression method was used to model predictors of outcome.Results:The median follow-up after SIB-IMRT was 36 months (7-112 months). Four percent of patients had stage II disease while 20% and 76% of patients had stage III and IV disease, respectively. The majority of patients had laryngeal (40%) and oropharyngeal (20%) cancer, while remaining patients had oral cavity, hypopharynx, paranasal sinus, salivary, and unknown primary cancers. The median prescription dose was 66.0 Gy (60.0-70.4 Gy) delivered in 30 fractions (30-35 fractions). High-risk tumor volumes received a median dose of 2.12 Gy (2.00-2.25 Gy) per fraction while the low-risk volumes received a median dose of 1.80 Gy (1.64-2.00 Gy) per fraction. The 1/2/4-year LC, OS, and distant metastasis-free survival rates were 95.8/85.1/71.4%, 91.0/81.3/75.1%, and 95.0/95.0/88.0%, respectively. Five patients (20%) experienced acute grade 3 toxicity and one patient (4%) had late grade 3 toxicities. No acute or late grade 4 toxicity was reported. On univariate analysis, no risk factors were identified as significant predictors of local failure or OS.Conclusion: Post-operative SIB-IMRT is an effective and safe technique in the treatment of patients with head and neck cancer with or without concurrent chemotherapy. Our results with respect to outcome and toxicity are comparable to those obtained with conventional radiotherapy. For select patients, SIB-IMRT is a reasonable alternative strategy with potential clinical and operational advantages.

Chapman, B, Kabolizadeh, P, Berhane, H, Smith, R, Clump, D, Heron, D, Post-Operative Simultaneous Integrated Boost-Intensity Modulated Radiation Therapy in Head and Neck Cancer: Outcomes From a Single Institution Series.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14042493.html