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Oral Papers
treated off-protocol. Five (38%) of the 13 were NED at last follow-up,
4 (31%) died within one year of completing therapy, 3 (23%) did not
complete therapy and died of disease, and 1(8%) was lost to follow-up
at 1 year. Older patients with advanced head and neck cancer may be
appropriate for clinical trial enrollment, and further research in needed
into the barriers to enrollment faced by these patients.
S007
SALVAGE SURGERY AFTER ORGAN PRESERVATION REGIMENS.
Rachel M Brock, MD, Nathan Hales, MD, Greg Krempl, MD, Jesus E
Medina, MD; Oklahoma University Health Sciences Center, Department
of Otorhinolaryngology.
Introduction: Most laryngectomies today are done for persistent or
recurrent tumor after organ preservation attempts using radiation
therapy (RT) or chemotherapy and radiation (CRT). The outcomes
reported by RTOG (RTOG-911) for local regional control (LRC), overall
survival (OS) and complication rates were encouraging. However recent
publications report abysmal outcomes. Therefore it seems critical to
report outcomes from different institutions in order to better define
the expectations of patients and clinicians following salvage surgery.
Furthermore, the role of elective neck dissection (END) in these cases
needs to be defined. Purpose/Objective(s): The purpose of this study
is to determine the rates of LRC, OS, and complications with salvage
surgery after previous treatment with radiation +/- chemotherapy and
also determine the prevalence and location of subclinical cervical
lymph node metastases in patients undergoing salvage laryngectomy.
Materials/Methods: Retrospective review of 50 patients who underwent
salvage total laryngectomy (STL) after organ preservation treatment for
laryngeal and pharyngeal cancer. 33 patients had definitive RT and 17
had CRT. Results: At time of salvage tumor staging was T3 or T4 in
56% of patients in the RT group, 43% in the CRT group. Median time
to recurrence after initial therapy was 11 mos. in both groups. Median
follow-up after STL was 29 mos. in the RT group and 20 mos. in the CRT
group. The median OS after salvage in the RT group was 35 mos. (4-
94 mos.) while in the CRT group it was 31 mos. (8-97 mos.). At the last
follow-up OS is 60% after RT and 71% after CRT. Median disease free
survival (DFS) is 24 mos. in the RT group and 18 mos. in the CRT group.
LRC in the RT group was 58% after RT and 76% after CRT. Recurrence
occurred locally in 24% of RT patients and 5.8% of CRT patients. Neck
recurrence most commonly involved II and III and occurred in 18% and
11.7% in both groups. Distant metastases occurred in 21% and 5.8%
respectively. 47 patients were staged clinically N0 and 3 were clinically
N+ at the time of surgery. END was performed with STL in 36 patients.
In these patients, metastases in the lymph nodes were found in 15%
of the RT group and in 7% of the CRT group. A pharyngocutaneous
fistula occurred in 21% of patients in the RT group and 24% in the CRT
group. Conclusions: The LRC (58 - 76%) and OS (60 - 71%) observed
in our study are encouraging. Fistula rates are lower than those reported
in the literature yet they warrant improvement. The presence of occult
metastases (7-15%) is low.
S008
IMPACT OF TIME INTERVAL FROM BIOPSY TO START OF
TREATMENT. Gregory J Kubicek, MD, Seungwon W Kim, MD,
Umanmaheswar Duvvuri, MD, Robert Ferris, MD, Jonas Johnson, MD,
Dwight E Heron, MD FACRO; University of Pittsburgh Medical Center.
Purpose: To investigate the relationship of interval from biopsy to start
of radiotherapy (RT) in head and neck cancer (HNC). Patients and
Methods: 579 consecutive HNC patients treated between 2002 and
2006 were retrospectively reviewed; all patients received treatment
consisting of either surgery and adjuvant RT (249) or definitive RT with
or without chemotherapy (264). RT was IMRT in all patients. Median
age was 63 years, the majority patients were stage III (27%) or IV (51%),
238 (41%) received concomitant chemotherapy. Results: In definitive
RT and definitive chemoradiotherapy patients the median time from
biopsy to the start of RT was 41 days. Patients starting definitive RT ≤
40 days from biopsy had an improved outcome versus > 40 days (overall
survival 2.5 vs. 2.1 years p = 0.07). For patients who underwent surgical
resection, median time from biopsy to surgery was 10 days; there was
no difference in outcomes for patients with a longer interval in the time
from biopsy to surgery. Median start to adjuvant RT was 64 days from
the biopsy (54 days from surgery). Patients with a median start time ≤
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90 from biopsy had an improved overall survival (3.3 versus 2.4 years,
p = 0.015). Conclusion: While the effects of overall treatment time are
well known, less information is available regarding the effects of initiation
of treatment. We found a detriment in overall survival for patients with a
longer interval from the time of biopsy to start of RT.
S009
MANAGEMENT OF EARLY T-STAGE TONSILLAR CARCINOMAS -
RETROSPECTIVE COMPARISON OF RADICAL TONSILLECTOMY
VERSUS RADIATION FROM A SINGLE INSTITUTION. Eric D Lamarre,
MD, Rahul Seth, MD, Robert R Lorenz, MD, Ramon Esclamado, MD,
David J Adelstein, MD, Christina P Rodriguez, MD, Jerrold Saxton, MD,
Joseph Scharpf, MD; Cleveland Clinic.
Objective: T1 and T2 squamous cell carcinomas of the tonsil can
be managed with either definitive radiation therapy or a radical
tonsillectomy, which involves en bloc resection of the tonsil, underlying
superior constrictor, partial base of tongue, soft palate and pharynx
with or without reconstruction of the defect. We report a retrospective
comparison of the Cleveland Clinic survival and functional outcomes
using both of these approaches. Method: All patients diagnosed with
T1-2, N0-2, M0 squamous cell carcinoma of the tonsil and treated at
the Cleveland Clinic between 1994 until 2007 were included in this
review. The minimum follow-up for survival was 2 years, and patients
with a second primary upper aerodigestive cancer were not included
in the functional data. Swallowing was graded on a scale of 1-4 with 1
being a normal diet and 4 being feeding tube dependence. Results:
There were 27 patients treated surgically and 84 patients treated with
radiation. For the surgical patients, 74% of patients were staged as T1,
33% of patients N2, 30% N1 and 37% N0. For the radiation patients,
71% of patients were staged as T2, 61% of patients N2, 20% N1 and
19% N0. 48% of the surgical patients also had postoperative radiation
and 15% had concurrent chemotherapy secondary to extent of neck
disease. 61% of the radiation patients had concurrent chemotherapy
and 25% had staged neck dissections. The 2 year disease free survival
was 85.7% for the surgical patients and 83.9% for the radiation patients
(p=0.44). Within the first two months after completion of therapy,
72% of surgical patients had grade 1 swallowing versus 18.9% of
radiation group (p