Samy El-Sayed MD, Abstract Co-Author: Nothing to Disclose

Mohammed Yahia Almaghrabi MD, Presenter: Nothing to Disclose

Purpose:Radical Radiotherapy remains the main stay of treatment in patients with SCCHN. IMRT have become the norm in north America even before the benefits were proven. Previous studies have addressed some of the toxicities. The purpose of this prospective study is to profile the all aspects of the toxicity of IMRT treatment in patients with local-regionally advanced SCCHN.Methods: This study was carried out From 2006 - 2012. Patients included had a histologically confirmed loco-regionally advanced SCCHN to be treated to the primary site and regional lymphatics to 70 Gy in 35 Fractions, ECOG PS of ≤ 2, ≥18 years of age, with no other active malignancy. Radical radiotherapy had to include initial phase of 50 Gy in 25 Fractions to involved areas and areas at risk to be followed by a boost of 20 Gy in 10 Fractions to the involved areas only using the same Fractionation as conventional radiotherapy.Treatment related toxicities were evaluated by OMAS ( Oral mucositis assessment scale), RTOG and CTCAE acute and late assessment scales.Weekly mucositis assessment were collected using the OMAS and RTOG scales during the treatment and every 2 weeks after treatment until resolution. Prospective information were collected on QOL Using EORTC H&N QOL module.Result: 92 patients were enrolled: 87 of them were evaluable, 48 % had undergone concomitant chemotherapy. Median age was 60 year-old, 78 % were male. Most common primary tumour site was oropharynx 67 %. 80% of the patients were smokers, 35% of them continue to smoke.Acute mucositis was evaluated using the OMAS score. 5, 15, 74 and 6% have developed grade 1, 2, 3, and 4 mucositis respectively. Pattern of mucositis will be presented. Grade 1, 2, 3, skin reaction were recorded in 26, 59 and 15 % respectively. 22% of our patients reported Grade 3 dysphagia. Only 9% suffered long term salivary gland dysfunction with Xerostomia. Grade 3 mucositis had a higher incidence in the combined modality group, while Grade 3 dysphagia was more in XRT alone (56%). 19 patients (41%) in the radiotherapy group required tube feeding compared to 26(62%) combined modality patients. 4.5% of our patients suffered radiation necrosis at the high dose area despite adequate dental evaluation and use of fluoride trays.Conclusion:This study provides a bench mark for the rate and pattern of toxicity caused by IMRT Radiotherapy in a population cohort of patients with SCCHN. Compared with toxicities of conventional radiotherapy, there seems to be a significant improvement overall but with perhaps a different pattern. Part of the improvement could be due to better supportive care. Longer than 5 years follow up is required to rule out other long term toxicities such as secondary tumours and muscle dysfunction.

El-Sayed, S, Almaghrabi, M, A Prospective Study of Toxicity Profiling in Patients with Squamous Cell Carcinoma of the Head and Neck (scchn) Treated with Helical Tomotherapy Intensity Modulated Radiotherapy (htimrt), 5 Year Results.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14043222.html