Oropharyngeal Squamous Cell Carcinomas (OP-SCC) Treated With. Transoral .... symptoms of pharyngeal retention, aspiration, and nasal regurgitation. Proton.
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International Journal of Radiation Oncology Biology Physics
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administration of chemoradiation (CT + RT). Our goal was to assess the impact of transcutaneous neuromuscular electrical stimulation (TNMES) therapy given during the course of CT + RT on the swallowing function outcomes. Materials/Methods: We performed a retrospective analysis of a prospectively maintained database of locally advanced head and neck cancer patients treated with TNMES. Forty three consecutive patients (treatment group) who received more than 10 TNMES treatments were compared to 55 patients with similar characteristics who received none or 10 pack years smoking (OR Z 0.124, 95% CI Z 0.024-0.646; p Z 0.013), cisplatin use (OR Z 0.194; 95% CI Z 0.045-0.834; p Z 0.028) when using the SPSS scores and a trend in the 8 point score with use of cisplatin (OR Z 0.251; 95% CI Z 0.056-1.115; p Z 0.069), and erbitux (OR Z 0.096; 95% CI Z 0.008-1.124; p Z 0.062). Conclusions: CT + RT results in worsening of swallowing function in most patients. We observed a significant benefit in 2 of the 3 swallowing scores of patients treated with TNMES as compared to the control group. TNMES therapy could be considered as an adjunct to dysphagia reduction and possible prevention in locally advanced head and neck cancer patients. Author Disclosure: A.D. Bhatt: None. N. Goodwin: None. G. Bhatt: None. C.L. Silverman: None. W.J. Spanos: None. J.M. Bumpous: None. K. Potts: None. L. Wilson: None. N.E. Dunlap: None.
WITHDRAWN
152 Late Consequential Surgical Bed Soft-tissue Necrosis in Advanced Oropharyngeal Squamous Cell Carcinomas (OP-SCC) Treated With Transoral Robotic Surgery (TORS) and Postoperative Radiation (PORT) J.J. Lukens,1 A. Lin,1 S. Grover,1 E.M. McMenamin,1 G.S. Weinstein,1 B.W. O’Malley,1 and H. Quon1,2; 1University of Pennsylvania, Philadelphia, PA, 2Johns Hopkins University, Baltimore, MD Purpose/Objective(s): Select patients (pts) with OP-SCC are managed with initial TORS resection and PORT +/- chemotherapy as indicated. A subset of pts develop soft tissue necrosis (STN) in the surgical bed months after completion of PORT. We sought to identify the incidence of and risk factors for surgical bed STN. Materials/Methods: We performed a retrospective analysis of OP-SCC pts treated with TORS and PORT with at least 6 months of follow-up. Surgical bed STN was clinically defined as the development of worsening pain at least 6 weeks after completion of PORT associated with non-healing ulceration of the surgical bed. The STN grade was defined according to CTCAE v4.0: Grade 2 necessitating medical intervention (usually narcotics) and Grade 3 necessitating invasive interventions (biopsy and/or hyperbaric oxygen [HBO]). Clinical, pathologic, and RT details were collected for all pts. Tonsillar cases were compared to randomly selected tonsillar SCC pts treated with TORS and PORT who did not develop STN (n Z 18) using standard parametric statistics. Results: We identified 41 pts with surgical bed STN, for an overall incidence of 24% among OP-SCC (41/170). The incidence among tonsillar pts was 34% (35/103) versus 9% (6/67) for base of tongue pts. Pathologic Tstage distribution was: 10 T1 (24%), 23 T2 (56%), 6 T3 (15%), and 2 T4a (5%). Median tumor size was 3.0 cm (range 1.0 - 5.6 cm), and median depth of resection was 2.1 cm (range 1.0 - 5.1 cm). Median total RT dose and dose/fraction to the area of subsequent ulceration was 6600 cGy, and 220 cGy respectively. 27 pts (66%) received concurrent chemotherapy. Median time to STN after PORT was 2.5 months (range 1.5 - 4.6). 25 pts had Grade 3 STN and 16 had Grade 2 STN. Biopsy in 16 pts was negative for malignancy in each case. All pts had resolution of STN, with a median time to resolution of 3.9 months (range 1.2 - 5.1). Comparing tonsillar cases to controls, risk factors for STN on univariate analysis included depth of resection (odds ratio [OR] 4.4, p Z 0.016), tumor size (OR 2.1, p Z 0.02), mucosal dose/fraction (OR 1.12, p Z 0.005), and Grade 3 mucositis during RT (OR 6.6, p Z 0.003). Significant factors on multivariate analysis were depth of resection (OR 7.0, p Z 0.048), mucosal dose/fraction (OR 1.22, p Z 0.02), and grade of acute mucositis (OR 16.6, p Z 0.03). Conclusions: A subset of pts with OP-SCC treated with TORS and PORT are at risk for developing surgical bed STN several months after treatment, and tonsillar pts are more susceptible. Risk factors include depth of resection, mucosal dose/fraction, and grade of acute mucositis, suggesting this is a late consequential effect. This has implications for treatment planning and patient management. Author Disclosure: J.J. Lukens: None. A. Lin: None. S. Grover: None. E.M. McMenamin: None. G.S. Weinstein: G. Consultant; Intuitive Surgical. B.W. O’Malley: G. Consultant; Intuitive Surgical. H. Quon: F. Honoraria; Intuitive Surgical. H. Travel Expenses; Intuitive Surgical.
153 Impact of Transcutaneous Neuromuscular Electrical Stimulation for Dysphagia in Head-and-Neck Cancer Patients Treated With Definitive Chemoradiation A.D. Bhatt,1 N. Goodwin,1 G. Bhatt,1 C.L. Silverman,1 W.J. Spanos,2 J.M. Bumpous,1 K. Potts,1 L. Wilson,1 and N.E. Dunlap1; 1University of Louisville, Louisville, KY, 2University of California, San Diego, CA Purpose/Objective(s): Dysphagia is a common presenting symptom in head and neck cancer patients and is often worsened during the
154 Swallowing Function After Proton Beam Therapy for Nasopharyngeal Cancer: A Prospective Study T. Goldsmith, A.S. Holman, R.J. Parambi, E. Weyman, P.M. Busse, E. Viscosi, L.J. Wirth, J.R. Clark, S.M. Rothenberg, and A.W. Chan; Massachusetts General Hospital, Boston, MA Purpose/Objective(s): Long-term dysphagia is common after concurrent conventional chemoradiation for nasopharyngeal carcinoma (NPC) with symptoms of pharyngeal retention, aspiration, and nasal regurgitation. Proton beam allows smaller volumes of normal tissues to be irradiated than is feasible with any photon technique. The purpose of this study was to prospectively determine objective swallowing function after proton beam for NPC. Materials/Methods: Between 2006 and 2011, 24 consecutive patients were enrolled in our single-institution phase II trial of proton beam with chemotherapy for stage III - IV nasopharyngeal carcinoma. Median age was 48.9 years (range, 31-66 years).and dose to the primary tumor volume was 70 Gy (RBE). The nasopharynx and upper neck were treated with proton, whereas the low neck was treated with photon therapy. Chemotherapy consisted of 3 cycles of concurrent cisplatin followed by 3 cycles of adjuvant cisplatin and 5-fluorouracil. A primary endpoint of the study included objective swallowing function. Videofluoroscopic swallowing studies (VFSS) were
