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

5568 General Poster Session (Board #26A), Sat, 1:15 PM-5:15 PM
Feasibility and short-term efficacy of four facio-cervical fields’ conformal
radiotherapy for nasopharyngeal carcinoma. Presenting Author: Wang fang
Zheng, Zhejiang Cancer Hospital, Hangzhou, China
Background: Conventional bilateral facio-cervical fields increased the local
control and overall rates for nasopharyngeal carcinoma, and generated
severe late complications, while intensity-modulated radiation therapy
(IMRT) may take up a lot of labor power and material resources.This study
was to explore feasibility and short-term efficacy of four facio-cervical
fields’ conformal radiotherapy (4F-CRT) for nasopharyngeal carcinoma.
Methods: Between November 2007 and June 2009, 101 patients with
histology-proven nonmetastatic NPC were rolled into this study and
received 4F-CRT. 90 of all patients received four cycles chemotherapy.
Results: The treatment was completed for all patients within 7 weeks. The
complete response (CR) rate was 95.0% (96/101) and the partial response
(PR) rate 5.0% (5/101). Overall response was 100% for nasopharyngeal
lesions. The CR rate was 90.0% (91/101) and the PR rate 7.0% (7/101) in
lymph node lesions. One year local control, regional control, overall survival
(OS) rate, metastasis-free survival (MFS) and disease-free survival (DFS)
rate are 100%, 100%, 100%, 97%, 97%, respectively. The major
toxicities observed were grades 1-2 leukocytopenia. Conclusions: 4F-CRT
can generate desirable dose distribution of tumor volume for nasopharyngeal
carcinoma. The short-term efficacy of 4F-CRT is satisfactory and its
acute toxicities are tolerable.
5570 General Poster Session (Board #26C), Sat, 1:15 PM-5:15 PM
Paranasal sinus squamous cell carcinomas (PNSSCC) incidence and
survival trends. Presenting Author: Benjamin Ansa, Morehouse School of
Medicine , Atlanta , GA
Background: PNSSCC are rare, accounting for 3 percent of all head and
neck malignancies. They generally present with local invasion and have a
high rate of local recurrence. There has been little information on the trends
in incidence and survival of PNSSCC and no randomized trials to guide
therapy. We analyzed the incidence rates and survival outcomes for
patients diagnosed with PNSSCC in the SEER database. Methods: Data
were obtained from the U.S. National Cancer Institute’s Surveillance,
Epidemiology, and End Results (SEER) Program. Newly diagnosed PNS-
SCC reported to SEER from 1973 through 2008 were categorized according
to the patient’s sex, age, year of diagnosis, and stage. The incidence
and survival were then examined and compared across different demographic
and disease-related categories. Results: A total of2,323 patients
were identified. The mean age was 62 years, range: 14-85 yrs; malesaccounted
for 62.7%. Whites accounted for 75.8%, blacks for 12.2 % and
12.0% were of asian or pacific islanders and other groups. Maxillary sinus
primary accounted for 76.3%, ethmoid (10.2%), sphenoid (4.3%). The
disease was localized in 9.5%, had regional spread in 72.0% and distant
disease in 12.2%, at diagnosis. A statistically significant decrease (Annual
Percent Change of -1.6%, 95%CI� [-2.0, -1.1]) in the overall incidence
was observed by Joinpoint analysis (p�0.01). The decrease in incidence
was significant in patients with maxillary sinus (p�0.01) and was more
pronounced in the white population compared to other groups. Both the
observed and relative 5-year survival significantly increased over time and
this was more notable in the white population compared to other groups.
The observed 5-year survival rate increased from 24.9% (95% CI �
[20.3-29.6]) during the 1975-1983 time-period to 40.8% (95% CI �
[33.4-48.0]) during the most recent period of 2002-2008. Conclusions:
There has been a decline in the overall incidence of PNSSCC more notably
in the white population and for patients with maxillary sinus tumors. The
5-year observed and relative survival has significantly increased. Our
findings should incite more efforts to understand the factors behind the
change in incidence and survival.
Head and Neck Cancer
373s
5569 General Poster Session (Board #26B), Sat, 1:15 PM-5:15 PM
Effects of vandetanib on body composition in patients with advanced
medullary thyroid carcinomas: Results from a placebo-controlled study.
Presenting Author: Marie-Helene Massicotte, Institut Gustave Roussy,
Nuclear Medicine and Endocrine Oncology Service, Villejuif, France
Background: Muscle (MT) and adipose tissue (AT) share common intra
cellular pathways with tumor, thus it is not surprising to observe metabolic
consequences with targeted therapies. The aim of the study was to assess
the effects of vandetanib, a tyrosine kinase inhibitor (TKI) which demonstrated
efficacy for the treatment of advanced medullary thyroid carcinoma
(MTC), on MT and AT. Methods: 33 patients (25 men and 8 women, mean
age of 54 years) with metastatic MTC received vandetanib 300 mg/d
(n�23) or placebo (n�10) in the setting of the ZETA study. Cross-sectional
areas (cm2 ) of visceral adipose tissue (VAT), subcutaneous adipose tissue
(SAT) and MT were assessed by computed tomography imaging at 3rd
lumbar vertebra and were indexed for height (cm2 /m2 ). Comparisons
between treatment and placebo were made at 3 months, and long-term
evolution was evaluated over 12 months. Results: At 3 months, compared to
baseline, patients treated with vandetanib gained 1.5 kg, 1.3 cm2 /m2 of
MT, 5.1 cm2 /m2 of VAT and 4.5 cm2 /m2 of SAT. In contrast, patients under
placebo lost 1.5 kg (p�0.02), 1.0 cm2 /m2 of MT (p�0.009), 5.5 cm2 /m2 of SAT (p�0.004) and gained significantly less VAT (0.6 cm2 /m2 )
(p�0.02). At 12 months, compared to baseline, patients treated with
vandetanib gained 2 kg (NS), lost 0.3 cm2 /m2 MT (NS), gained 3.4 cm2 /m2 of VAT (NS) and 8.7 cm2 /m2 of SAT (95% CI, 1.1 to 16.2). A significant
decrease of calcitonin (defined as �50% compared to baseline) was
associated with higher weight (p�0.01), VAT (p�0.01), and total adipose
tissue (p�0.02). Conclusions: Beyond its proved efficacy in MTC treatment,
and despite common intracellular pathways, vandetanib is the only studied
TKI to preserve MT and to restore AT. Further research is needed to explore
whether the relationship between changes of VAT and vandetanib treatment
results from a direct metabolic action of vandetanib or is a
consequence of biochemical tumor control.
5571 General Poster Session (Board #27A), Sat, 1:15 PM-5:15 PM
Impact of p16 status on the QOL effects of chemoradiation for locally
advanced oropharynx cancer: Results of TROG 02.02. Presenting Author:
Jolie Ringash, Princess Margaret Hospital and University of Toronto,
Toronto, ON, Canada
Background: We report the impact of p16 status on quality of life (QOL) for
patients with stage III or IV (excluding T1-2N1 and M1) squamous cell
carcinoma of the oropharynx (OPC) treated with concurrent chemoradiotherapy
in a large international phase III trial (TROG 02.02/HeadSTART).
Methods: The 861 patients accrued received definitive radiotherapy (RT)
(70 Gy/7 weeks) concurrently with 3 cycles of either cisplatin (100mg/m2 )
or cisplatin (75 mg/m2 ) plus tirapazamine (290 mg/m2 /day) by random
assignment, as previously described. QOL was measured with the FACT-
H&N at baseline, 2,6,12, 23 and 38 months. No significant difference in
overall or subscale QOL score change from baseline was observed between
arms at any subsequent time point; results for the oropharynx subgroup by
p16 status are reported for both treatment arms combined. Results: Of 853
eligible participants, 465 had OPC, for whom p16 status could be
determined in 206. Of 179 who received adequate RT (� 60 Gy, no major
deviations) and completed baseline QOL, 104 were p16� and 79 were
p16-. p16� patients had better baseline ECOG PS, lower T-category,
higher N-category, were younger and were less likely to be current smokers.
Baseline mean FACT-H&N score was statistically and clinically significantly
better in p16� patients (111 vs. 102, p�0.001). The drop in QOL
from baseline to 2 months was more severe in p16� cases (-20.4 vs -9.1,
p�0.001), resulting in an equalization of 2 month scores (p16�: 90.6,
p16-: 93.6, p�0.16). At 6 and 12 months post-treatment, no difference in
score changes from baseline by p16 status was seen (6 mo, p16�: -6.2,
p16 -:-1.2, p�0.22; 12 mo, p16 �: -0.3, p16 -: �2.0, p�0.82).
Conclusions: p16 associated oropharyngeal cancer has been shown to be a
distinct entity with different demographic features. In our study, such
patients exhibited better baseline QOL and a more severe drop immediately
after treatment, but did not differ in long-term QOL response to the effects
of aggressive concurrent chemoradiation. Given the favorable prognosis of
p16-associated oropharyngeal cancer, efforts to reduce the QOL burden of
treatment are warranted.
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