Annual Meeting Proceedings Part 1 - American Society of Clinical ...

5536 General Poster Session (Board #21D), Sat, 1:15 PM-5:15 PM
Gingival cancer: 11 year follow-up at Karolinska University Hospital (2000-
2010). Presenting Author: Rusana Simonoska, Department of ENT, Karolinska
Institutet/Karolinska University Hospital, Stockholm, Sweden
Background: In Sweden, approximately 500-600 cases of oral cancer are
diagnosed every year. These include cancer of the gingiva, retromolar
trigonum, bucca, hard palate, tongue and floor of the mouth. Each year,
around 15 cases of gingival cancer (GC) are diagnosed in the Stockholm
region. The goal of this study was to study the onset of symptoms,
treatment, prognosis, and sequelae of GC in order to optimize the
treatment. Methods: The study consists of a retrospective review of medical
records of all diagnosed cases of GC in Stockholm region between
2000-2010, identified through the ENT-clinic Karolinska Hospital patient
database. Results: Our retrospective study comprised 156 patients diagnosed
with GC. The average age was 72 years sharing equally between the
sexes, 50% were smokers. 98% had a squamous cell carcinoma (scc).
Presenting symptoms were often lump or ulceration in the gums, pain,
bleeding or discomfort/misfit of dentures. Around 30% had premalignant
lessons in the oral cavity before diagnosis. 3/4-th of all GC was localized in
the lower jaw. 66% of the GC-patients presented as aT4 cancer. At
presentation, 26% had a regional metastasis and of those 90% had their
primary tumor in the lower jaw. Six cases had bilateral neck disease. 81%
of the patients with regional metastasis had low to medium grade of scc
differentiation of the primary tumor. 84% of all patients with regional
metastasis had a T4 primary tumor. Neck dissection was performed in 38%
(n�59). Of these 35 cases where staging neck, i.e. N0 at presentation and
in 7 cases (20%) a positive neck disease was found. The risk for second
primary was 15%. The overall 5-year survival was 24%. Conclusions:
Advanced age and high number of T4 cancer at diagnosis partly explains
the poor survival statistics. Almost 30% of the patients in our material have
had premalignant lessons in the oral cavity before the cancer diagnosis and
are at high risk for new tumors (second primary); therefore patients with GC
should be followed up for at least 5 years, possibly longer in the presence of
premalignant lessons. GC of the lower jaw is more likely to metastasize than
GC of the upper jaw. Due to 20% occult metastasis occurrence in the
staging neck cases, we recommend staging neck dissection for patients
with GC.
5538 General Poster Session (Board #21F), Sat, 1:15 PM-5:15 PM
A phase II study of sorafenib in combination with cisplatin and 5-fluorouracil
in the treatment of recurrent or metastatic nasopharyngeal carcinoma.
Presenting Author: Cong Xue, Sun Yat-sen University Cancer Center,
Guangzhou, China
Background: Nasopharyngeal carcinoma (NPC) is a disease with distinctive
epidemiology and clinical behavior compared with Head and neck cancer
(HNC) and more common in South-East Asia. Sorafenib monotherapy has
been shown modest anticancer activity in HNC and NPC (C Elser et al; JCO
2007). This study was to evaluate the efficacy and tolerability of sorafenib
combined with cisplatin and 5-fluorouracil (5-FU) for patients with recurrent
or metastatic NPC. Methods: A phase II, single arm clinical trial was
conducted in three centers in China. Chemotherapy-naive histologically
confirmed NPC patients with recurrent or metastatic disease were enrolled.
Patients received oral sorafenib 400mg bid continuously until disease
progression or unacceptable toxicity, cisplatin 80mg/m2 intravenously (iv)
on day 1-5, and 5-FU 400mg/m2 iv infusion for 96 hours on day 1.
Treatment was repeated every 21 days for a maximum of 6 cycles. Results:
54 patients were enrolled. Most patients were with bone metastases
(70.0%), followed by liver (56%) and lung metastases (56%). The median
chemotherapy administrated was 4.0 cycles (range, 2-6cycles). The
disease control rate (DCR) reached 90.7%, including one complete
response (CR), 41 partial responses (PR) and 7 stable diseases (SD).
Median PFS was 7.2 months (95% CI 6.8-8.4 months) and median OS was
11.8 months (95% CI 10.6-18.7 months). Tumor cavitation after treatment
was observed in 32.1% of patients with lung metastases. Decreased
percentage of contrast update in responder patients (PR and CR) with liver
metastases was also observed by Contrast-Enhanced Doppler ultrasound.
The major toxicities include hand foot syndrome (HFS), myelo-suppression
and gastrointestinal reaction.Dose reduction of sorafenib was required in
22 patients (40.7%) and dose interruption in 14 patients (25.9%) because
of toxicity. Conclusions: Sorafenib combined with cisplatin and 5-FU has an
encouraging efficacy profile with tolerable toxicity. Further randomized
studies are needed to confirm the clinical benefit of sorafenib combined
with chemotherapy in recurrent or metastatic NPC.
Head and Neck Cancer
365s
5537 General Poster Session (Board #21E), Sat, 1:15 PM-5:15 PM
Efficacy of concurrent cetuximab (C225) versus 5-fluorouracil/carboplatin
(5FU/CBDCA) or cisplatin (CDDP) with intensity-modulated radiation
therapy (IMRT) for locally advanced head and neck cancer (LAHNSCC).
Presenting Author: Lauren Quinn Shapiro, Memorial Sloan-Kettering Cancer
Center, New York, NY
Background: We reported inferior outcomes for LAHNSCC patients (pts)
that received concurrent C225 vs. high-dose CDDP with IMRT (IJROBP
2011; 81:915). Prior to FDA approval of C225 for LAHNSCC, non-CDDP
candidates at our institution were treated with 5FU/CBDCA (JNCI 1999;
91:2081). The purpose of this study was to compare the outcomes of
concurrent C225 vs. 5FU/CBDCA vs. CDDP with IMRT for LAHNSCC.
Methods: Retrospective review of records was performed for pts treated at
MSKCC with concurrent C225 (n�49) vs. 5FU/CBDCA (n�52) vs. highdose
CDDP (n�259) and IMRT from 11/02 to 04/08. Overall survival (OS),
locoregional failure-free survival (LRFS), and late toxicity for all pts and
oropharyngeal subset were obtained. Outcomes were analyzed using
univariate/multivariate Cox proportional hazards model or competing-risks
analysis. Multivariate OS analysis was confirmed by propensity score
adjustment. Results: Pts were similar with regard to site, overall stage, and
alcohol/tobacco history. Compared to pts treated with CDDP, those who
received C225 or 5FU/CBDCA were older, with lower performance status,
higher Charlson score, higher T stage, and worse renal function. With
median follow-up of 53.1 months for survivors, the 4-year OS was 40.9%
(95% CI 26.0-55.2%) for C225 vs. 70.2% (95% CI 55.5-80.9%) for
5FU/CBDCA vs. 86.9% (95% CI 82.0-90.6%) for CDDP. Compared with
CDDP, C225 (hazard ratio [HR] 4.01, p�0.0001) but not 5FU/CBDCA (HR
1.54, p�0.15) was associated with worse OS on multivariate analysis.
Propensity score analysis yielded a HR of 2.76 (p�0.01) for treatment with
C225 vs. platinum-based chemotherapy. 4-year actuarial LRF for 5FU/
CBDCA was similar to CDDP (9.7% vs. 6.3%, HR 1.51, p�0.42 by Gray’s
method) and significantly lower than C225 (40.2%, HR 4.95, p�0.002).
Late toxicity was as follows: C225 (6.1%) vs. CDDP (7.7%) vs. 5FU/CBDCA
(21.2%). Conclusions: After adjusting for independent risk factors, there
was no significant difference in OS or LRFS between 5FU/CBDCA and
high-dose CDDP, but C225/RT resulted in significantly inferior OS and
LRFS. Late toxicity was worst with 5FU/CBDCA.
5539 General Poster Session (Board #21G), Sat, 1:15 PM-5:15 PM
Patterns of care in elderly patients with squamous cell carcinoma of the
head and neck: A SEER-Medicare analysis. Presenting Author: Noam
Avraham Vanderwalde, Department of Radiation Oncology, University of
North Carolina at Chapel Hill, Chapel Hill, NC
Background: Head and neck squamous cell carcinoma (HNSCC) is predominantly
a disease of the elderly, however age and co-morbidity may affect
therapy decisions. The purpose of this study was to assess the patterns of
care of elderly HNSCC patients and identify factors associated with
non-receipt of surgery and chemoradiation (CRT). Methods: Using the
Surveillance, Epidemiology, and End Results (SEER)-Medicare linked
database (1992-2007) we identified a retrospective cohort of nonmetastatic
HNSCC patients and categorized them into treatment cohorts.
Comparisons were made between surgery vs. non-surgery, and CRT vs.
non-CRT cohorts. Multivariate logistic regression models examined factors
associated with non-receipt of treatment. Variables included tumor location,
stage, year of diagnosis, age, gender, marital status, race, comorbidity,
race-comorbidity interaction, SEER region, socioeconomic variables,
and hospital affiliations. Results: The final cohort of 11,336 were 63%
male and 83% white. 52% had no co-morbidities, 44% had oral cavity
HNSCC, 52% were diagnosed between 2002 and 2007, 58% had surgery,
and 21% received CRT. For the CRT vs. non-CRT model, increasing age
(OR � 0.93; 95% CI 0.92 -0.94) and non-whites with co-morbidity (OR �
0.71; 95% CI 0.55 – 0.92) were associated with decreased likelihood of
receiving CRT. More advanced staged disease, oropharyngeal tumor location,
and diagnosis after 2002 were associated with increased likelihood of
receiving CRT. For the surgery versus non-surgery model, age was not
associated with receipt of surgery (OR 0.99; 95% CI 0.99-1.00), nor was
existence of comorbidity in white patients (OR 0.97; 95% CI 0.88-1.05).
However, recent year of diagnosis, non-oral cavity tumor location, and
advanced stage were all associated with reduced likelihood of receiving
surgery. During the 15 year surveillance period, patients were less likely to
receive surgery, and CRT was used more often. Conclusions: Age may
influence the non-receipt of CRT in this elderly cohort but does not appear
to be significantly associated with the non-receipt of surgery. There has
been an increasing trend in the receipt of CRT with a decrease in surgery
over the past 15 years.
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