Annals of Oncology
To compare two oral mucosa contouring methods in predicting acute oral mucocitis in nasopharyngeal carcinoma treated with helical tomotherapy
Y-Y. Chen1, P-J. Li2 Department of Radiotherapy, Zhejiang Cancer Hospital, Hangzhou, China, 2 Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, China 1
Induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) in nasopharyngeal carcinoma (NPC)
G. Kaval1, M. Altun1, K. Ibis1, K. Ozkaya1, R. Meral1, A.N. Karadeniz1, M. Sarı2, M. Ekenel2, M. Basaran2, S. Bavbek2 1 Radiation Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey, 2 Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey Background: Current treatment of locoregionally advanced NPC (LRA-NPC) is CCRT with or without adjuvant chemotherapy (CT). The value of adding IC to CCRT in LRA-NPC is unclear. We retrospectively evaluated LRA-NPC patients treated with IC followed by CCRT in a single tertiary center in Turkey. Methods: Between 2004 and 2016, 202 patients with nonmetastatic LRA-NPC (stage 34), 144 males and 58 females ranging from 17 to 75 (median 49) years old, were treated with IC followed by CCRT. Eleven (%5.4) patients had keratinised (WHO I), and 191 (%94.6) had nonkeratinised or undiffrentiated (WHO II-III) carcinoma. Cumulative radiation dose to primary tumor ranged from 60 to 74 (median 70) Gy. Ninety-one (%45) of the patients received 2-dimensional and 111 (%55) received intensity modulated radiotherapy (IMRT). IC consisted of taxane (T)(75 mg/ m2) and platinum (P)(75 mg/m2) combination (199 patients) or P and fluorouracil or epirubicine (3 patients) combination and 188 of the patients received 3 cycles of IC. Concomittant P was used either weekly (40 mg/m2, 25 patients) or every 3-weekly (100 mg/m2, 177 patients) application. Follow-up ranged from 5 to 167 months (median, 72.5 months).
Stage III IVA IVB Number of induction courses 234 Concomittant type Every 3 weeks (100 mg/m2) Every week (40 mg/m2) RT technique 2-dimensional Intensity modulated Radiation dose to primary (Gy) 70 > 70
Efficiacy of different nutritional intervention on nutritional status and quality of life for local advanced nasopharyngeal carcinoma patients: A prospective clinical trial
Y-Y. Chen, S. Huang, X. Chen, Q. Hu Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China Background: Local advanced nasopharyngeal carcinoma (NPC) patients receiving neoadjuvant chemotherapy (NACT) and concurrent chemoradiotherapy (CCRT) suffered from malnutrition and declining quality of life. We investigate the impact of prophylactic or reactive nutritional support on nutritional status and quality of life. Methods: Enrolled patients were randomly assigned to receive prophylactic (group A) or reactive nutrition intervention (group B). Group A was supported with enteral nutrition beyond daily diet from the beginning of radiotherapy (RT). Group B was treated with conventional diet guidance, appropriate nutritional intervention will be given when needed. Patients were asked to complete the EORTC QLQ-C30 and QLQH&N35 questionnaires at the baseline, before, during and after CCRT. Weight and hematological indexes were also collected. Statistical analyses are using SPSS 18.0. Results: From October 2016 to May 2018, 114 patients were randomly assigned into the group A (n ¼ 58) and B (n ¼ 56). 80.7% of patients completed concurrent chemotherapy (A vs B ¼ 90% vs 71%, P ¼ 0.013, 95%IC¼0.038-0.326). All patients experienced weight loss during the CCRT. Comparing to baseline, the rate of weight loss 5% before, during, at the end of RT and 1- and 3-month after RT were 3.5%, 28.9%, 29.8%, 64.7% and 33.2%. After treatment, Total serum protein and albumin of group A were better than B (68.766.31 vs 65.665.27 g/L, p ¼ 0.003 and 41.8664.05 vs 39.5263.93 g/L, p ¼ 0.001). Incidence of anemia at these times were 2%,37%,53%,55% and 19%. But no differences were found in two groups. Global health status scores in QLQ-C30 and QLQ-H&N35 decreased during NAT and CCRT. After RT, quality of life issues significant improved at the 1-and 3-months follow-up comparing to the end of treatment (65.34 and 76.4 vs 39.8, p ¼ 0.00). But no statistical advantages of QoL were found in Patients in group A except feeling ill. Conclusions: The nutrition status and QoL of NPC patients decreased during treatment. Though prophylactic nutritional intervention can enhance the completion of concurrent chemotherapy and keep the plasma protein stable, but it has no advantage in weight loss and quality of life except feeling ill. Clinical trial identification: NCT02948699. Legal entity responsible for the study: Zhejiang Cancer Hospital. Funding: Nutricia. Disclosure: All authors have declared no conflicts of interest.
Apatinib in treating patients with platinum-resistant or platinumrefractory recurrent or metastatic nasopharyngeal carcinoma
C. Tao, X. Chen Radiotherapy Department, Zhejiang Cancer Hospital, Hangzhou, China,
Table: 1143P Patient and treatment characteristics
149 (73.7%) 30 (14.9%) 23 (11.4%) 10 (5%) 188 (93.1%) 4 (2%) 177 (87.6%) 25 (12.4%)
91 (45%) 111 (55%) 8 (4%) 194 (96%)
v464 | Head And Neck Cancer, Excluding Thyroid
Background: To evaluate the efficacy and safety of apatinib in treating patients with platinum-resistant or platinum-refractory recurrent or metastatic nasopharyngeal carcinoma. Methods: In this phase 2, single-arm, prospective study, we recruited patients aged 18–65 years with platinum-resistant or platinum-refractory recurrent /metastatic nasopharyngeal carcinoma. Patients were treated with apatinib at an initial dose of 500 mg once daily and continued until disease progression, patient withdrawal, or unacceptable toxic effects. The primary endpoint was clinical benefit rate (CBR) and toxicity. Secondary endpoints included progression-free survival (PFS) at 3 months and overall survival (OS). We used Simon’s two-stage design, and analysed efficacy and toxicity in the per-protocol populations and intention-to-treat. This study is registered with ClinicalTrials.gov, number NCT03213587. Results: Between Aug 5,2017 and Apr 17,2019, we enrolled 16 patients. Until the final follow-up (Apr 17, 2019), the CBR (complete response þ partial responseþ stable disease) was 61.5% (8/13) in the per-protocol population. Median PFS and 3-month PFS rate were 5.53 (95% CI, 2.57-8.49) months and 68.7%, respectively. Median OS and 1year OS rate were 12.67 (95% CI 8.22-17.12) months and 44.4%, respectively. The most common grade 3-4 adverse events were neutropenia (1[6.25%]), hand-foot syndrome
Volume 30 | Supplement 5 | September 2019
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Background: The purpose of this study was to evaluate prediction effect for acute radiation-induced oral mucositis (A-ROM) of two oral mucosa contouring methods in nasopharyngeal carcinoma (NPC) patients treated with helical tomotherapy. Methods: A total of 151 AJCC 7th stage II-IVB histologically proven NPC patients receiving radical tomotherapy (TOMO) from Zhejiang Cancer Hospital were included. All patients received 0-4 cycles of platinum-based induction chemotherapy61-3 cycles of concurrent chemotherapy (all patients received at least one chemotherapy). Oral cavity contour (OCC) and mucosa surface contour (MSC) were applied to radiation treatment plans. A-ROM were prospectively assessed weekly according to RTOG scoring criteria. Absolute DVH data was exported from RayStation V3.0 system. T-test, X2 test, binary logistic regression and ROC curve were used to analyses. Results: Morbidity of 3 grade A-ROM was 30.4%. In univariate analysis: V10, V15, V45, V55, V60, V65, V70 of OCC and V15, V55, V60, V65, Dmean of MSC were significant related to 3 grade A-ROM (Vx, percentage volume of organ received more than Gy, all P0.05). In binary logistic regression analysis, gender, smoking were found significantly related to 3 grade A-ROM by using OCC (male vs. female : OR¼0.070, 95%CI¼0.019-0.411, P ¼ 0.008 ; smoking vs. non-smoking: OR ¼ 15.250, 95%CI¼4.421-61.980, P ¼ 0.001). For MSC, gender, smoking and MSC V55 were independent predictors (male vs. female : OR¼0.152, 95%CI¼0.037-0.642, P0.001 ; smoking vs. non-smoking: OR ¼ 4.028, 95%CI¼2.145-32.079, P ¼ 0.032 ; MSC-V55 : OR¼2.665, 95%CI¼1.172-3.365, P0.004). The cutoff of MSC-V55 was 10.38%, area under curve was 0.697, with sensitivity and specificity of 0.635 and 0.704, respectively. Conclusions: We recommend MSC as a more reasonable method for oral mucosa contouring in TOMO treatment plan for nasopharyngeal carcinoma patients. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Results: Treatment failure was observed in 52 (%25.7) of the patients (21 local, 13 regional and 27 distant). Distant failure rate of all the patients exceeds 13%. Five and 10 years disease free survival (DFS) rates are 75.2% and 70.4% and overall survival (OS) rates are 78.9% and 64% respectively. In univariate analysis patient age favoring those below 49 and stage of disease favoring WHO II-III were all significant predictors of DFS and OS. In addition pathology was a significant predictor of DFS. Conclusions: LRA-NPC patients treated with IC followed by CCRT have a high locoregional control (LRC) rate. Despite the use of IC distant control remains insufficient and continues to be a challenge in NPC. Besides improving LRC, more effective systemic therapy is needed. Legal entity responsible for the study: Musa Altun, MD. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.