PRIMARY MALIGNANCIES OF NOSE AND PARANASAL SINUSES. A SURGICAL SERIES OF 91 CASES

S 32

OPTlMlSlNG MULTIDISCIPLINARY TREATMENT (SURGERY, RADIOTHERAPY, CHEMOTHERAPY)

CTV3 (low risk subclinical disease) delivered in 30 fractions. Dose costraints to minimize the dose to OARSwere prescribed. Megavoltage CT scans were obtained for patient alignment before each treatment. PTV doses were accorded to the following: at least 95% of the volume should be covered by the 95% of the dose; at least 99% of the volume should be covered by the 90% of the dose and at least no more than 1%should receive more than 7% of the prescription dose. Results: For all patients dose volumes results for PTVs and some of the critical structures are reported in table 1. Seven CR and 2 PR (post-6 months residual disease tissue at RMN) were observed. Three patients are not yet evaluable. Good compliance to the treatment was observed. The most commonly late effect was xerostomia, but the severity decreased over time and for patients with FU>/=l year only 2 showed grade II xerostomia.

I

PNl

65.8

61.5

83.8

67.5

PNZ

W.2

55.1

57.7

62.7

63.8

Plv3

54.4

55.8

55.8

1

Max dose

Conclusions: HT improves homogeneity in the dose distribution and in our initial experience allows a significantly good sparing of the organ at risk with a good clinical response rate. Acute and late toxicity will be reported.

81 poster PRIMARY MALIGNANCIES OF NOSE AND PARANASAL SINUSES. A SURGICALISERIES 2 F 91 CASES G. Almadori , F. Bussu , M. Rigante', J. Galli', G. Cadoni', N. Dinapoli', V. Valentinil, P. Gaetano' POLlCLlNlCO UNlVERSlTARlO "AGOSTINOGEMELLI",CATHOLIC UNIVERSITY, Roma, Italy

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Purpose: To evaluate the oncological outcome of the treatment of malignant tumors of nose and paranasal sinuses in relation to site, histological type, stage, performed surgery and occurrence of complementary treatment. Materials: 91 patients (mean age 64.39 (range 14-90)) affected by nose and paranasal sinuses malignancies were observed from Jenuary 1990 to December 2006. 65 of these neoplasms arised in the maxillary sinus, 21 in the nasal cavity, 5 in the ethmoid sinuses The histology was SCC for 38 (40.4%), adenocarcinoma for 11 (11.7%); melanoma for 10 (10.6%). esthesioneuroblastoma for 8 (8.5%), lymphoma for 8 (8.5%), sarcomas for 8 (8.5%), adenoidocystic carcinoma for 5 (5.3%), neuroendocrine tumor for 5 (5,3%) and cordoma for 1. According to the stage, 2 were in stage I, 15 in stage II, 31 in stage 111, 29 in stage IVa, 16 in stage IVb. 69 (75.9%) patients underwent primary surgery (43 partial maxillectomies (47.2%), 10 total maxillectomies (10.9%), 7 enlarged maxillectomies (7,6%), 6 craniofacial resection (6.6%), 3 endoscopic resection (3.3%). Results: 3-year overall survival was 61%, while disease specific survival was 67%. According to the histotype 3-year 0s was 69% for SCC, 60% for adenocarcinoma, 45% for melanoma and 37% for esthesioneuroblastomawhile DSFS was respectively 70%, 69%, 60%, 64%. When considering only SCCs, DSFS according to the stage was 100% for stage 2, 83% for stage 111, 64% for stage IVa, 53% for stage IVb. 24 (42.8%) patient presented recurrences local in the 79% of the cases were, regional in 8%, both local and regional in 12% and distant in 2%. Conclusions: Surgery, if feasible, represents the treatment of choice, combined with adjuvant radiotherapy in advanced stages. The surgical approaches of choice remain, for the majority of cases, the external transfacial or combined craniofacial ones, with an en block resection of the malignant lesion, even if in the last years endoscopic resection is gaining room, especially for early well selected cases. Total maxillectomy possibly enlarged to the pterygomaxillary fossa in maxillary tumors with a spread through the posterior wall (T3-T4) improves the local control and decreases the incidence of local recurrence, which relevantly influences prognosis nose and paranasal sinus malignancies.

82 poster ~~

RANDOMIZED TRIAL OF CONCURRENT CHEMORADIATION WITH CARBOPLATIN AND 5 FLUOROURACIL VERSUS CONCOMITANT BOOST IRRADIATION IN LOCALLY ADVANCED HEAD AND NECK CANCER I.Chitapanarux', P. Kamnerdsupaphon'

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CHIANGMAI UNIVERSITYHOSPITAL,Division of Therapeutic Radiology and Oncology, Chiang Mai, Thailand Purpose: To date, no randomized trial compare concurrent chemoradiotherapy with accelerated hyperfractionation radiotherapy in patients with locally advanced squamous cell carcinoma of head and neck (SCCHN), both in primary treatment and in postoperative setting. Based on the first meta-analysis of MACH-NC showed a small significant survival benefit in concurrent radiochemotherapy.This study was conducted to compare the efficacy and toxicity of accelerated hyperfractionationwith concomitant boost versus concurrent chemoradiotherapy as a primary treatment in patients with stage Ill-IV SCCHN. Materials: Non metastatic stages llllV locoregional advanced head and neck cancer patients were enrolled in this study. The patients were randomized to receive either 3 cycles of a 4-day carboplatin (70 mg/m2 per day) and continuous infusion 5-fluorouracil (600 mg/m2 per day) plus conventional radiotherapy with 2 Gy/fraction ,to a dose of 70 Gy in 35 fractions over 7 weeks ( concurrent chemoradiotherapy; Arm CCRT) or accelerated radiotherapy in the form of concomitant boost irradiation : 2 Gy / fraction, 5 fractions /week for the first 3 weeks, then 2 fractions (1.8 and 1.2 Gy) per day, 5 fractions / week, with total dose of 69 Gy (concomitant boost; Arm CCB). The two arms were equally balanced with regard to age, sex, stage, performance status, histology, and primary tumor site. The primary and secondary end points were overall survival and toxicities respectively. Results: A total of 85 patients accrued from January 2003 to December2007, 48 patients received CCRT and 37 received CCB. Radiotherapy compliance including the planned total dose, overall treatment time, and treatment break was 40.5% and 77.1% in the CCRT arm and CCB arm, respectively. The median overall treatment time of CCRT arms was 55.5 days (range 42-103), whereas 49 days (range 40-69) in the CCB arm.The rate of grade 2 and 3 acute radiation toxicities was statistically significantly higher in CCB arm (78.38%; 95%CI = 62.56, 88.86) than in CCRT arm (50.00%; 95% CI = 36.39, 63.61), p= 0.007. Hematologic toxicities were higher in CCRT arm: grade 3 and 4 anemia, neutropenia, and thrombocytopenia were found in 2.08%, 18.75%, and 6.25%, respectively. No grade 3-4 hematologic toxicities were found in CCB armwith a median follow up of 38 months (rage 3 88 ).The 3 year locoregional control rate was not difference between both arms : 67.7%; 95% CI = 50.6, 84.7 in CCB arm versus 81.1%; 95% CI = 69.1, 93.1 in CCRT arm (p= 0.122).There was no difference in overall survival. Patients treated with concomitant boost radiotherapy had a 3-year overall survival rate of 94.2% vs 91.1 % in concurrent chemoradiotherapy , p = 0.932. Conclusions: Our results demonstrated that the locoregional control and overall survival were not difference between two treatment arms. But the statistically significant higher hematologic toxicities and poor radiotherapy compliance rate that found in concurrent chemoradiotherapy arm supports the use of concomitant boost radiotherapy as a treatment in the management of locally advanced head and neck cancer. 83 poster RESULTS OF CONCURRENT CHEMORADIATION IN HEAD AND NECK CANCER WITH HYPOFRACTIONATED PROTOCOL OF 60GY/25#/5 WEEKS WITH WEEKLY CISPLATIN. M. Kumar', G. M2, B. Satheesan3, S. Babu T3, S. Salih3, L. Narayana3, A. Alexander4, S. EP', D. M2, S. B5, G. S2,S. A Kumar5 MALAEAR CANCER CENTRE, Radiation Oncology, Kannur, India MALAEAR CANCERCENTRE,Department of Radiation Oncology, Kannur, India MALABAR CANCER CENTRE, SUrgiCal Oncology, Kannur, India MALABAR CANCERCENTRE,Anesthesia, Kannur, India MALABARCANCERCENTRE,Department of Medical Physics, Kannur, India

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Purpose: Hypofractionated regimens in head and neck cancers have been in use in various centers around the world for radical radiotherapy treatment. There is little data on tolerability and outcome if hypofractionated regimen of 60Gy/25 #/5 weeks is combined with weekly cisplatin chemotherapy. Materials: We retrospectively analysed patients of squamous carcinoma of head and neck treated with concurrent chemoradiation at our institution from Jan 2010 to August 2010. A total of 37 cases of head and neck malignancies were treated with concurrent chemoradiation with radical intent in this period. Out of them 16 cases were treated with 60 Gy/ 25 #/5 weeks on telecobalt. These patients were good performance status patients with advanced stage 3 or 4 disease. The field arrangement was parallel opposed to bilateral face and neck with low anterior neck beam planned with simulator. Weekly cisplatinum(CDDP) was administered at dose of 50mglm2 intravenously. Results: There were 14 males and 2 females in the analysis with age rang-