None. A.S. Garden: None. D.I. Rosenthal: None. W.H. Morrison: None. M.S. Kies: None. G.B. Gunn: None. C.D. Fuller: None. J. Phan: None. B.M. Beadle: None.
Volume 93 Number 3S Supplement 2015
Poster Viewing Session E299
chronic toxicities were prospectively graded per Common Terminology Criteria for Adverse Events version 4.0. Results: The median radiation dose was 60Gy (RBE) (range 50-70), and 11 patients received concurrent chemotherapy. Patients deviated their eyes away from the tumor target during treatment to decrease dose to the ipsilateral cornea. Maximum doses to the ipsilateral optic nerve, eye, and cornea are given in the Table. The median follow-up was 19.7 months. No patient experienced local failure, 1 patient experienced regional failure, and 1 patient experienced distant failure. Seven patients developed acute grade 3 (G3) radiation dermatitis. Three patients developed chronic G3 epiphora, 2 patients developed G3 exposure keratopathy, and 1 patient developed chronic G4 corneal ulceration and symptomatic retinopathy. Eight patients had an objective visual status change: either decreased visual acuity (NZ4) or asymptomatic retinopathy (NZ3). All patients maintained functional vision except the patient with G4 chronic toxicities. The maximum doses to the ipsilateral optic nerve, eye, and cornea are given in the Table. Those with a G3+ chronic ocular toxicity had a higher median maximum dose in Gy (RBE) to the ipsilateral cornea (46.3 [range 36.6-52.7] vs 37.4 [9.0-47.3]; PZ.017). Conclusion: A globe-sparing approach including PRT for periorbital tumors is effective and well-tolerated. All but one patient maintained vision in the treated eye, and none required exenteration or enucleation. Chronic G3 toxicities are relatively rare and associated with higher maximum dose to the cornea. Use of an eye-deviation technique can be used to limit maximum dose to the cornea.
Poster Viewing Abstracts 2744; Table 1
Ipsi Optic Nerve Max Dose in Gy(RBE); median [range] Ipsi Eye Max Dose in Gy(RBE); median [range] Ipsi Cornea Max Dose in Gy(RBE); median [range]
Acute Grade 3+ Toxicity (Yes vs No); P-value
Chronic Grade 3+ Toxicity (Yes vs No); P-value
Change in Visual Outcome (Yes vs No); P-value
52.7 [24.6-59.4] vs 48.7 [6.2-60.9]; 1.0
53.4 [6.2-60.9] vs 49.6 [37.2-60.7]; PZ.742 64.5 [62.4-69.8] vs 61.9 [18.9-67.1]; PZ.108 46.3 [36.6-52.7] vs 37.4 [9.0-47.3]; PZ.017
51.4 [6.2-60.9] vs 51.6 [24.6-60.7]; PZ1.0 64.2 [50.0-69.8] vs 61.9 [18.9-66.7]; PZ.132 40.9 [35.0-48.2] vs 37.5 [9.0-62.7]; PZ.355
62.4 [59.2-66.4] vs 63.6 [18.9-69.8]; PZ.905 39.9 [9.0-52.7] vs 38.5 [25.3-50.1]; PZ.968
Author Disclosure: E. Holliday: None. B. Esmaeli: None. J. Picknard: None. A.S. Garden: None. D.I. Rosenthal: None. W.H. Morrison: None. M.S. Kies: None. G.B. Gunn: None. C.D. Fuller: None. J. Phan: None. B.M. Beadle: None. M. Anderson: None. S.J. Frank: None.
2745 Risk Factors for Esophageal Dilation in the Elderly Head and Neck Cancer Population G. Green,1 R. Carmona, Jr,1 L. Hwang,2 J.D. Murphy,1 and L.K. Mell1; 1 University of California, San Diego, La Jolla, CA, 2University of California San Diego, La Jolla, CA Purpose/Objective(s): The aim of this study was to compare the incidence of severe esophageal toxicity using alternative treatment approaches for locoregionally advanced head and neck cancer (LAHNC) in the elderly population. Materials/Methods: We identified 6563 patients age 66 or older with LAHNC diagnosed from 2000 to 2009 in the SEER-Medicare database. The primary endpoint was the incidence of esophageal dilation events, defined as a patient receiving any of the following CPT codes: 43249, 43233, 43245, 43233, 43220, 43226, 43248, 43450, 43195, 43196, 43456, 43458, 43214, 43229, 43212, 43213, 43333, 43270, 43453, and 74360.
Time to esophageal dilation was defined from diagnosis to the first event, with censoring at last follow-up or death from any cause. We used Gray’s test to compare the incidence of esophageal dilation for surgery alone (including neck dissection) versus surgery plus adjuvant radiation therapy (RT) or chemoradiation therapy (CRT) versus definitive RT or CRT. We used multivariable Cox regression to estimate effects of factors associated with esophageal dilation events. Results: The cumulative incidence of esophageal dilation at 5 and 10 years, according to treatment, were surgery alone: 3.2% (95% CI, 1.6%4.9%) and 5.1% (95% CI, 1.0%-9.3%); surgery plus adjuvant RT/CRT: 12.1% (95% CI, 9.8%-14.3%) and 21.1% (95% CI, 14.8%-27.5%); definitive RT/CRT: 10.6% (95% CI, 9.3%-11.9%) and 15.8% (95% CI, 13.2%-18.4%). There was no significant difference in esophageal dilation between surgery plus adjuvant RT/CRT or definitive RT/CRT (PZ.36), but the incidence was significantly increased in both groups compared to surgery alone (P
