Esthesioneuroblastoma: A Modern Experience at the University of Miami
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2601 Hypofractionated Stereotactic Radiotherapy using the CyberKnife for External Auditory Canal Carcinoma K. Sato 1 , H. Iwata 2 , M. Inoue 1 , S. Kamata 3 1 Yokohama CyberKnife Center, Yokohama 241-0014, Japan, 2 Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan, 3 Center for Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan Purpose/Objective(s): This is a retrospective study to evaluate the outcomes of external auditory canal carcinoma (EACC) treated with CyberKnife (CK) alone. Materials/Methods: Between May 2005 and March 2010, 37 patients with EACC were treated with hypofractionated SRT using CK at Yokohama CK center. The beam energy was 6 MV. Patients were lightly restrained with a custom-made thermoplastic face mask, and the 6D automated skull-tracking tracking method was utilized in all cases for patient alignment and target position cor- rection during treatment. Of them, 24 patients were followed up more than 12 months, which were analyzed. They were 12 male and 12 female. According to Stell classification, 4 patients were Stage I, 8 patients were Stage II, and 12 patients were Stage III. Age was ranging 47 years to 89 years, median 61 years. Tumor volume was raging 7.2ml to 105.6ml, median 42.6ml. The subscribed marginal dose (D95) was 28.0Gy to 42.5Gy (median 35.0Gy) with 3 to 5 stereotactic radiotherapy (SRT). No patient underwent previous radiation therapy. Results: Follow-up periods was raging three to 32 months, median 26 months. One patient died of acute myocardial infarction 4 months after CK treatment. The control rate of Stell I, II and III was 75%, 62% and 75%, respectively. One patient with Stell III was showing cerebella abscess three months after CK treatment. This patient was showing dural invasion at CT treatment. There was no direct radiation injury observed at present. Facial nerve function was preserved. Conclusions: Surgical approach to EACC is invasive and results in mal function of facial movement and mandible. Our data is preliminary; however showing CK treatment is feasible for EACC. CK treatment is less invasive and able to maintain function. Author Disclosure: K. Sato, None; H. Iwata, None; M. Inoue, None; S. Kamata, None. 2602 In Larynx Cancer Patients with Small Tumor Volume the Extent of Laryngeal and Extralaryngeal Involvement is Crucial for Organ-Preservation after Definitive Accelerated Radiation Therapy K. A. Skladowski, W. Przeorek, A. Heyda, M. Hutnik, M. Golen, A. Wygoda, T. Rutkowski, B. Lukaszczyk-Widel, B. Bobek-Billewicz, B. Maciejewski Institute of Oncology-Maria Sklodowska-Curie, Gliwice 44-100, Poland Purpose/Objective(s): The number of 3348 patients treated at MSCMCCIO from 1963-2002 with definitive radiation and re- ported world-wide over 45 years has proved the remarkable institutional experience toward the treatment of larynx-preservation (LP). Presented approach have been established in 2002 and is based on definitive conformal accelerated radiotherapy (DCART) dedicated for patients who meet following criteria: all T 1-2 and selected T 3-4 stages of primary tumor which have the volumes less than 12cm 3 and no gross cartilage involvement evaluated on the CT. Materials/Methods: Over the period 2002-2006 RT has been using in 310pts with larynx cancer. From that number 248pts were treated by definitive RT alone and 205pts (83%) have met the criteria of LP treatment. DCART has consisted in three fractionation regimens dedicated for different T-stage patients: 51Gy in 17 fractions over 3.5 weeks for T 1 glottic pts, 62.5Gy in 25 fractions over 5 weeks for T 2 glottic pts and 66.6-72Gy in 37-40 fractions over 37-40 days in T 2-4 extraglottic pts. There were 58 T 1 , 77 T 2 , 28 T 3 and 42 T 4 pts; 160 N 0 , 13 N 1 , 29 N 2 and 3 N 3 pts; altogether - 57pts in stage I, 63pts in stage II, 23pts in stage III and 62pts in stage IV; the tumor invaded the pharynx in 50pts (24%). LP status has been evaluated by ENT specialist during each follow-up visit and once by psychologist who performed quality of live evaluation. Locally relapsed patients were scored as non-LP patients. Results: The 3-year rate of grade 3-4 late morbidity of the larynx is 5%, what correspond with 85% of actuarial 3-year LC and 80% of LC with LP (LC/LP). Respective T-dependent rates are as follow: 97% vs. 97% in T 1 pts, 82% vs. 80% in T 2 pts (independently on T-site), 83% vs. 70% in T 3 pts and 68% vs. 61% in T 4 pts. Patients who had the tumor both in glottis and supraglottis have 6% less LC/LP rate compare to their LC. In pts with the tumor invading three levels of the larynx and in pts with pharynx infiltration the corresponded rates are respectively 22% and 16% less. The probability of LC/LP in T 3-4 pts clearly correlates with CTVs of primary tumor from radiotherapy planning. Conclusions: Proper patient selection to the DCART, based on T stage and CT tumor-volume measurement, gives excellent local control and larynx-preservation outcome with minimal risk of serious adverse events. For those patients the extent of tumor involvement within and beyond the larynx is the main prognosticator of organ preservation. Author Disclosure: K.A. Skladowski, None; W. Przeorek, None; A. Heyda, None; M. Hutnik, None; M. Golen, None; A. Wygoda, None; T. Rutkowski, None; B. Lukaszczyk-Widel, None; B. Bobek-Billewicz, None; B. Maciejewski, None. 2603 Esthesioneuroblastoma: A Modern Experience at the University of Miami J. L. Sperry, I. Reis, R. R. Casiano, F. J. Civantos, D. T. Weed University of Miami Sylvester Comprehensive Cancer Center, Miami, FL Purpose/Objective(s): Esthesioneuroblastoma is a rare neuroendocrine tumor arising from the olfactory epithelium. Recently, more cases are being reported due to increasing awareness and improved histopathological diagnostic methods. We report one of the largest modern institutional experiences during the era of advanced surgical techniques and radiation technology. Materials/Methods: We reviewed the records of 30 patients with esthesioneuroblastoma treated at the University of Miami be- tween 1991 and 2008. All sides were reviewed by a dedicated head and neck pathologist to exclude other neuroendocrine tumors. The rates of local and regional recurrences as first site of failure were estimated by the method of cumulative incidence allowing for competing risks. Disease-free survival (DFS) and overall survival (OS) were calculated using the Kaplan-Meier method. S472 I. J. Radiation Oncology d Biology d Physics Volume 78, Number 3, Supplement, 2010
Transcript of Esthesioneuroblastoma: A Modern Experience at the University of Miami
S472 I. J. Radiation Oncology d Biology d Physics Volume 78, Number 3, Supplement, 2010
2601 Hypofractionated Stereotactic Radiotherapy using the CyberKnife for External Auditory
Canal CarcinomaK. Sato1, H. Iwata2, M. Inoue1, S. Kamata3
1Yokohama CyberKnife Center, Yokohama 241-0014, Japan, 2Department of Radiology, Nagoya City University GraduateSchool of Medical Sciences, Nagoya, Japan, 3Center for Head and Neck Oncology and Surgery, International University ofHealth and Welfare, Mita Hospital, Tokyo, Japan
Purpose/Objective(s): This is a retrospective study to evaluate the outcomes of external auditory canal carcinoma (EACC) treatedwith CyberKnife (CK) alone.
Materials/Methods: Between May 2005 and March 2010, 37 patients with EACC were treated with hypofractionated SRT usingCK at Yokohama CK center. The beam energy was 6 MV. Patients were lightly restrained with a custom-made thermoplastic facemask, and the 6D automated skull-tracking tracking method was utilized in all cases for patient alignment and target position cor-rection during treatment. Of them, 24 patients were followed up more than 12 months, which were analyzed. They were 12 maleand 12 female. According to Stell classification, 4 patients were Stage I, 8 patients were Stage II, and 12 patients were Stage III. Agewas ranging 47 years to 89 years, median 61 years. Tumor volume was raging 7.2ml to 105.6ml, median 42.6ml. The subscribedmarginal dose (D95) was 28.0Gy to 42.5Gy (median 35.0Gy) with 3 to 5 stereotactic radiotherapy (SRT). No patient underwentprevious radiation therapy.
Results: Follow-up periods was raging three to 32 months, median 26 months. One patient died of acute myocardial infarction4 months after CK treatment. The control rate of Stell I, II and III was 75%, 62% and 75%, respectively. One patient with StellIII was showing cerebella abscess three months after CK treatment. This patient was showing dural invasion at CT treatment. Therewas no direct radiation injury observed at present. Facial nerve function was preserved.
Conclusions: Surgical approach to EACC is invasive and results in mal function of facial movement and mandible. Our data ispreliminary; however showing CK treatment is feasible for EACC. CK treatment is less invasive and able to maintain function.
Author Disclosure: K. Sato, None; H. Iwata, None; M. Inoue, None; S. Kamata, None.
2602 In Larynx Cancer Patients with Small Tumor Volume the Extent of Laryngeal and Extralaryngeal
Involvement is Crucial for Organ-Preservation after Definitive Accelerated Radiation TherapyK. A. Skladowski, W. Przeorek, A. Heyda, M. Hutnik, M. Golen, A. Wygoda, T. Rutkowski, B. Lukaszczyk-Widel,
B. Bobek-Billewicz, B. Maciejewski
Institute of Oncology-Maria Sklodowska-Curie, Gliwice 44-100, Poland
Purpose/Objective(s): The number of 3348 patients treated at MSCMCCIO from 1963-2002 with definitive radiation and re-ported world-wide over 45 years has proved the remarkable institutional experience toward the treatment of larynx-preservation(LP). Presented approach have been established in 2002 and is based on definitive conformal accelerated radiotherapy (DCART)dedicated for patients who meet following criteria: all T1-2 and selected T3-4 stages of primary tumor which have the volumes lessthan 12cm3 and no gross cartilage involvement evaluated on the CT.
Materials/Methods: Over the period 2002-2006 RT has been using in 310pts with larynx cancer. From that number 248pts weretreated by definitive RT alone and 205pts (83%) have met the criteria of LP treatment. DCART has consisted in three fractionationregimens dedicated for different T-stage patients: 51Gy in 17 fractions over 3.5 weeks for T1 glottic pts, 62.5Gy in 25 fractions over5 weeks for T2 glottic pts and 66.6-72Gy in 37-40 fractions over 37-40 days in T2-4 extraglottic pts. There were 58 T1, 77 T2, 28 T3
and 42 T4 pts; 160 N0, 13 N1, 29 N2 and 3 N3 pts; altogether - 57pts in stage I, 63pts in stage II, 23pts in stage III and 62pts in stageIV; the tumor invaded the pharynx in 50pts (24%). LP status has been evaluated by ENT specialist during each follow-up visit andonce by psychologist who performed quality of live evaluation. Locally relapsed patients were scored as non-LP patients.
Results: The 3-year rate of grade 3-4 late morbidity of the larynx is 5%, what correspond with 85% of actuarial 3-year LC and 80%of LC with LP (LC/LP). Respective T-dependent rates are as follow: 97% vs. 97% in T1 pts, 82% vs. 80% in T2 pts (independentlyon T-site), 83% vs. 70% in T3 pts and 68% vs. 61% in T4 pts. Patients who had the tumor both in glottis and supraglottis have 6%less LC/LP rate compare to their LC. In pts with the tumor invading three levels of the larynx and in pts with pharynx infiltration thecorresponded rates are respectively 22% and 16% less. The probability of LC/LP in T3-4 pts clearly correlates with CTVs of primarytumor from radiotherapy planning.
Conclusions: Proper patient selection to the DCART, based on T stage and CT tumor-volume measurement, gives excellent localcontrol and larynx-preservation outcome with minimal risk of serious adverse events. For those patients the extent of tumorinvolvement within and beyond the larynx is the main prognosticator of organ preservation.
Author Disclosure: K.A. Skladowski, None; W. Przeorek, None; A. Heyda, None; M. Hutnik, None; M. Golen, None; A. Wygoda,None; T. Rutkowski, None; B. Lukaszczyk-Widel, None; B. Bobek-Billewicz, None; B. Maciejewski, None.
2603 Esthesioneuroblastoma: A Modern Experience at the University of Miami
J. L. Sperry, I. Reis, R. R. Casiano, F. J. Civantos, D. T. Weed
University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
Purpose/Objective(s): Esthesioneuroblastoma is a rare neuroendocrine tumor arising from the olfactory epithelium. Recently,more cases are being reported due to increasing awareness and improved histopathological diagnostic methods. We report oneof the largest modern institutional experiences during the era of advanced surgical techniques and radiation technology.
Materials/Methods: We reviewed the records of 30 patients with esthesioneuroblastoma treated at the University of Miami be-tween 1991 and 2008. All sides were reviewed by a dedicated head and neck pathologist to exclude other neuroendocrine tumors.The rates of local and regional recurrences as first site of failure were estimated by the method of cumulative incidence allowing forcompeting risks. Disease-free survival (DFS) and overall survival (OS) were calculated using the Kaplan-Meier method.
Proceedings of the 52nd Annual ASTRO Meeting S473
Results: The median follow-up time for surviving patients was 52 months (range 12-218). There were 17 males and 13 femaleswith a median age of 53.5 years (range 30-82). Seventy percent had Kadish stage C, 23.3% had stage B, and 6.7% had stage A. Onlyone patient (3.3%) presented with nodal involvement and none had metastatic disease. Ninety percent of patients underwent sur-gery, 51.9% as traditional open craniofacial resection, 44.4% as minimally-invasive transnasal endoscopic resection, and 3.7% asendoscopic-assisted cranionasal resection. Of the 27 surgical patients, 75.9% received post-operative radiation: 77.3% as radiationalone and 22.7% as combined chemoradiation. The remaining 10% of patients received definitive chemoradiation. Radiation wasdelivered to the involved site only. No elective nodal irradiation was given. Chemotherapy consisted of a platinum-based regimen.The cumulative incidence of local failure was 17.6% at 2 years and 43.6% at 5 years. The cumulative incidence of regional failurewas 10.8% at 2 years and 15.7% at 5 years. The median time to local and regional failures was 28 months (range 3-80) and31 months (range 14-141), respectively. The 2-year and 5-year DFS rates were 71.6% and 40.7%. The 2-year and 5-year OS rateswere 85.9% and 80.2%. Of the 5 patients that did not receive post-operative radiation, 4 had local recurrences and all 4 weresuccessfully salvaged with no evidence of disease at last follow-up.
Conclusions: Although the majority of patients had advanced Kadish stage C, most were able to undergo surgical resection followedpost-operative radiation in order to best achieve local control. Minimally-invasive surgical approaches did not appear to lead to worseoutcomes in appropriately selected patients. Most failures were local with few regional recurrences in the neck. Elective nodal irra-diation is likely not indicated. Successful surgery is possible with excellent outcomes. Late recurrences warrant long-term follow-up.
Author Disclosure: J.L. Sperry, None; I. Reis, None; R.R. Casiano, None; F.J. Civantos, None; D.T. Weed, None.
2604 Longitudinal Changes of Parotid Glands after 30Gy Irradiation in Patients with Oral Cavity Cancer
Treated with Preoperative Conventional Radiation TherapyE. Tomitaka1, R. Murakami2, K. Teshima2, T. Nomura2, T. Hirai2, A. Hiraki2, Y. Yamashita2, M. Shinohara2, N. Oya2,
S. Tomiguchi2
1National Hospital Organization, Kumamoto, Japan, 2Kumamoto University, Kumamoto, Japan
Purpose/Objective(s): Xerostomia is a common debilitating adverse effect of radiation therapy (RT) in patients with head-and-necktumors. The patients with xerostomia should receive oral care to prevent mucositis, dental caries, oral infection, difficulty speaking anddysphagia. To spare glandular function, the recommended dose to the parotid gland is less than 25-30 Gy. Although many studiesevaluated functional changes in the parotid glands, i.e. subjective symptoms of dry mouth, salivary flow and radiological findings,reports concerning the parotid volume are limited. The purpose of this study was to evaluate longitudinal changes in the parotid volumeand saliva production after preoperative 30Gy irradiation.
Materials/Methods: We retrospectively evaluated 15 assessable patients with advanced oral cavity cancer. Eligibility criteria werea pathologic diagnosis of squamous cell carcinoma, preoperative RT with a total dose of 30Gy delivered in 15 fractions, and lon-gitudinal data of anatomic assessment with CT and functional assessment with the Saxon test including before and 1-, 6-, 12-, and24 months after 30Gy irradiation. The ipsilateral and contralateral parotid volumes on CT were consensually assessed by twoobservers. For the Saxon test, saliva production was measured by weighing a folded sterile gauze pad before and after chewing;the low-normal value is 2 g/2 min. Repeated-measures analysis of variance with Bonferroni adjustment for multiple comparisonswas used to determine the longitudinal changes in anatomic and functional data.
Results: The ipsilateral parotid volumes (mean ± SD) before and 1-, 6-, 12-, and 24 months after 30Gy irradiation were 31.5 ± 5.7 cm3,23.1 ± 4.5 cm3, 20.6 ± 4.8 cm3, 21.5 ± 4.5 cm3, and 25.3 ± 7.0cm3, respectively. The contralateral volumes were 32.5 ± 6.6 cm3, 23.2 ±5.6 cm3, 21.3 ± 4.2 cm3, 24.3 ± 5.0 cm3, and 27.5 ± 6.6cm3, respectively. The bilateral parotid volumes were significantly decreasedafter 30Gy irradiation (p \ 0.01), and the recovery was observed 12 months after 30Gy irradiation (p \ 0.05). The longitudinalchanges in saliva production were 3.7± 1.9 g, 1.1 ± 0.8 g, 1.2 ± 0.9 g, 1.3± 1.0 g, and 2.2 ± 1.4 g, respectively. The substantial recoveryof saliva production was observed 24 months after 30Gy irradiation (p\0.05).
Conclusions: The parotid volume and saliva production were decreased after 30Gy irradiation. The anatomic and functionalparotid changes cannot recover within 12 months. These patients should receive oral care for at least 24 months after RT.
Author Disclosure: E. Tomitaka, None; R. Murakami, None; K. Teshima, None; T. Nomura, None; T. Hirai, None; A. Hiraki,None; Y. Yamashita, None; M. Shinohara, None; N. Oya, None; S. Tomiguchi, None.
2605 Need for Prophylactic Contralateral Neck Irradiation in all Locally Advanced Oral Cavity Squamous
Cell Carcinomas?S. R. Trivedi, S. Ghosh Laskar, J. P. Agarwal, T. Gupta, A. Budrukkar, V. Murthy, D. Chaukar, P. Chaturvedi, P. Pai, A. D’Cruz
Tata Memorial Centre, Mumbai, India
Purpose/Objective(s): Current guidelines recommend prophylactic irradiation of contralateral neck in all locally advanced oralcavity squamous cell carcinomas (SCC). This study was done to evaluate outcomes in post operative oral cavity SCC patientstreated with adjuvant radiotherapy (RT), to assess the impact of unilateral irradiation and critically appraise the existing practicesand guidelines.
Materials/Methods: We retrospectively reviewed 178 patients of newly diagnosed oral cavity SCC who underwent radical surgeryand postoperative radiotherapy at our Institute between April 2005 and March 2009. Due to differences in natural history and treat-ment outcomes, the cohort was divided into gingivobuccal SCC group (129 patients) and tongue SCC group (49 patients). We reportthe analysis of the gingivobuccal group. 123 patients (95%) were pathological AJCC stage IV. 20 patients (15.5%) had bilateral necknodal dissection. All patients received postoperative RT using 60Cobalt teletherapy with conventional shrinking fields to a mediandose of 60 Gy/ 30 fractions treated 5 days a week. 86.8% (112/129) patients received unilateral nodal irradiation with anterolateralfields. The remaining 17 patients received bilateral nodal irradiation in view of disease crossing midline, multiple ipsilateral orbilateral nodal metastases. 87.6% (113/129) patients completed RT as planned. Concurrent weekly cisplatin (30 mg/m2) was offeredto 34 patients with multiple nodal metastases, extracapsular extension and/or inadequate cut margins.
Results: At a median follow-up of 16 months, the 2 year local control, locoregional control (LRC) and disease free survival was83.6%, 70% and 61% respectively. The 2 year LRC for pN0-N1 and pN2 was 78.8% and 56.3% respectively (p = 0.008). The 2year LRC with N0, 1, 2-3 and $ 4 metastatic neck nodes was 80.3%, 69.1%, 64.3% and 43.2% respectively (p = 0.02). Among
