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

370s Head and Neck Cancer
5556 General Poster Session (Board #23H), Sat, 1:15 PM-5:15 PM
Organ preservation with daily concurrent chemoradiotherapy using a new
superselective intra-arterial infusion for stage III, IV tongue cancer.
Presenting Author: Iwai Tohnai, Department of Oral and Maxillofacial
Surgery, Yokohama City University School of Medicine, Yokohama, Japan
Background: Combined radiotherapy and intra-arterial chemotherapy, which
delivers a very high concentration of anticancer agent to the tumor, is
currently used to treat advanced head and neck cancer. However, chemotherapy
and radiotherapy cannot be performed simultaneously on a daily
basis under conventional methods because long-term catheterization is not
possible. Therefore, we developed a new method using superselective
intra-arterial infusions via the superficial temporal artery and the occipital
artery, and used it to perform daily concurrent chemoradiotherapy for the
treatment of advanced tongue cancer. Methods: Seventy-two patients with
advanced tongue cancer underwent chemoradiotherapy using this superselctive
intra-arterial infusion method. Catheters were inserted superselectively
to the feeding arteries of the tumor via the superficial temporal artery
and the occipital artery. Long-term catheterization is possible in this
method. Daily concurrent combined therapy with radiotherapy (total dose:
60 Gy), superselective intra-arterial chemotherapy using DOC (total dose:
60 mg/m2 ) and CDDP (total dose: 150 mg/m2 ) was performed. The
anticancer agent was injected in a bolus through the intra-arterial catheter
simultaneously with radiotherapy. Results: No major complications were
observed. Clinical efficacy was CR in 64 (88.9 %) patients and PR in 8
(11.1 %). With a median follow-up period of 31 months (range 6 to 72
months), the overall survive rate was 74.8 % and the local control rate was
93.7%. Conclusions: This superselective intra-arterial infusion allows for
long-term catheterization, unlike the conventional method, so that chemotherapy
can be performed simultaneously with radiotherapy on a daily
basis. This treatment method promises to be the strategy of choice for the
treatment of advanced tongue cancer.
5558 General Poster Session (Board #24B), Sat, 1:15 PM-5:15 PM
Recombinant adenoviral human p53 gene combined with radio- and
chemotherapy in treatment of advanced nasopharyngeal carcinoma: A
randomized clinical study. Presenting Author: Guiping Lan, The People’s
Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
Background: Studies showed p53 gene therapy could enhance the antitumor
effect of both chemo- and radiotherapy. The anti-tumor function of
p53 gene is associated with up-regulated expression of p21 and Bax. Here,
we investigate the beneficial role of recombinant adenoviral human p53
gene (rAd-p53) combined with chemoradiotherapy in treatment of advanced
nasopharyngeal carcinoma (NPC), and p21 and Bax protein
expression in pre- and post-treatment tumor tissues. Methods: Sixty-three
patients with historically-diagnosed advanced NPC, with ECOG performance
status less than 2, life expectancy greater than 3 months and
adequate organ function tests, were randomly assigned into two groups: 32
in experimental group (EG) and 31 in control group (CG). EG received
intratumoral injection of 1�1012 rAd-p53 viral particles (VP) per 3 days for
6-8 times, carboplatin 300 mg/m2 on day1 and continuous infusion of a
total dose of 2000 mg/m2 of 5-Fu on day1-5 for 3 cycles, and radiotherapy
at a dose of 2Gy/fraction for a total dose of 70-76 Gy/35-38f. CG received
the same chemo- and radiotherapy. Pre- and post-treatment tissue samples
were analyzed for Bax and p21 protein levels. Results: The median
follow-up time was 28 months. EG achieved a complete response rate (CR)
of 62.5% and overall response rate (RR) of 90.6%, both rates being
statistically significantly higher than that of CG (CR�35.5%, RR�74.2%).
One-year of overall survival (OS) was 100.0% for EG and 90.3% for CG,
and one year of progress free survival (PFS) was 96.7% and 77.4% for EG
and CG, respectively. Two-year OS was 95.7% and 86.4% for EG and CG,
respectively, and two-year of PFS was 79.6% and 73.5% for EG and CG,
respectively. After treatment, both Bax and p21 protein levels in EG
increased significantly. In CG, both proteins levels also increased after
treatment but not significantly. The main side effects of rAd-p53 were
self-limited fever, occurring in all of EG patients. Conclusions: RAd-p53 as
a component of the comprehensive therapy for advanced NPC contributes
significant beneficial effects. Increased levels of Bax and p21proteins after
treatment represent two mechanisms of p53 anti-tumor activities.
5557 General Poster Session (Board #24A), Sat, 1:15 PM-5:15 PM
Gemcitabine versus cisplatin concurrent with radiation therapy in locally
advanced head and neck squamous cell carcinoma. Presenting Author:
Magda Mostafa, Kasr Al Aini Center of Clinical Oncology and Radiation
Therapy (NEMROCK), Cairo, Egypt
Background: In locally advanced head and neck squamous cell carcinoma
(HNSCC) weekly cisplatin concurrent with radiation therapy is the standared
treatment. However some patients cannot tolerate cisplatin. So we
conduct a prospective randomized trial comparing cisplatin versus gemcitabine.
Methods: This trial was done in Kasr El-Ainy Center of Clinical
Oncology and Radiation therapy (NEMROCK), during the period from
March 2010 till June 2011. Sixty patients with locally advanced HNSCC
were randomized to receive Cisplatin (30 mg/m2 ) weekly for 6 consecutive
weeks (30 patients) or Gemcitabine (50 mg/m2 ) weekly for 6 consecutive
weeks (30 patients) both concomitant with radiation therapy reaching a
dose of 70 Gy over 7 weeks. Primary end points include response rate,
progression free survival and toxicity. Toxicities were graded according to
NCI-CTCAE v3.0. Results: Thewhole study group included 48 (80%) males
and 12 (20%) females. Mean age was 47.9 (� 6.5) years (range 26-61).
Both arms were comparable regarding their age, gender, performance
status and stage. There were 9 (30%) CR, 7 (23.3%) PR, 2 (6.7%) SD and
12 (40%) PD in cisplatin arm versus 12 (40%) CR, 4 (13.3%) PR, 1
(3.3%) SD and 11 (36.7%) PD in gemcitabine arm. Median progression
free survival (PFS) in cisplatin arm was 9 months versus 11months in
gemcitabine arm with a hazard ratio of 0.08 (95% CI 0.005 – 1.47). We
did not reach median overall survival. Radiotherapy induced skin toxicity
(slight or patchy atrophy), nausea, vomiting, mucositis, salivary gland
affection and weight loss were equally distributed in both arms. Dysphagia
and fatigue were markedly higher in gemcitabine arm. While infection and
neutropenia were slightly higher in cisplatin arm. Conclusions: Weekly
gemcitabine 50mg/m2 concomitant with radiotherapy was found to be of
equal efficacy and toxicity comparable with weekly cisplatin in the
treatment of locally advanced HNSCC.
5559 General Poster Session (Board #24C), Sat, 1:15 PM-5:15 PM
Outcomes of occult primary (OP) of the head and neck squamous cell
carcinoma (HNSCC) treated with oropharynx (OPX)-targeted radiotherapy
(RT) and concurrent chemotherapy (CCRT). Presenting Author: Kenneth
Hu, Beth Israel Medical Center, New York, NY
Background: OP of HNSCC is commonly treated with comprehensive
mucosal RT including nasopharynx, OPX, hypopharynx and larynx and
bilateral neck. We are reporting the long term outcomes of a conservative
mucosal sparing technique consisting of targeting only the OPX mucosa
and bilateral necks. Methods: This is a single-institution retrospective
study. From January 1998-2010, a total of 68 patients with OP of HNSCC
were treated with CCRT (90%) or RT alone (10%), 40% with IMRT. RT
fields comprehended OPX mucosa only and bilateral necks. Gross disease
in the neck received 70Gy, involved neck 63 Gy, OPX 60 Gy, uninvolved
neck and ipsilateral retropharyngeal nodes 54 Gy. All fractions were given
at the rate of 1.8-2 Gy/fraction. The median age was 58 (21-87), 80%
Caucasian, and 75% males. Stage IVa (N2) was 75% of the population,
while stages III (N1), and IVb (N3) were 9, and 16% respectively. 16
patients (9N3�7 bulky N2) underwent neck dissection (ND). The median
time interval from diagnosis to RT and RT duration were 60 (13-70) and 50
days (49-63) respectively. The Median number of Chemotherapy cycles
was 2 (1-3). Cisplatin was given to 70% of pts, while Carboplatin and
Cetuximab were 10 and 20% respectively. Results: With a median follow-up
of 5.3 years (1– 13.6), the loco-regional control, (LRC) for all stages is 95.6
%. The median time to LRF is 18 months (12 - 63). Chronic CCRT toxicity
was; grade (1) xerostomia (67%), dysphagia (35%), altered taste (28%),
neck stiffness (15%), skin toxicity (12%), dysphonia (9%), and trismus
(6%). One HIV patient developed grade 4 dysphagia. No patients experienced
distant metastases. The emergence of primary was (1.5%) 1 patient
developed subglottic SCC 2 years after CCRT, 2 patients failed in the neck
(originally N3) all the 3 patients were salvaged successfully by surgery.
Kaplan-Meier curve shows the 5-year cause-specific survival to be 100.
Conclusions: Our data show that CCRT or definitive RT alone to the OPX and
bilateral neck provides excellent oncologic and functional outcomes.
Sparing the mucosal surfaces of the nasopharynx, hypopharynx, and larynx
seems reasonable and likely reduces toxicity.
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