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

5584 General Poster Session (Board #31B), Sat, 1:15 PM-5:15 PM
Sentinel lymph node biopsy for clinically N0 oral squamous cell carcinoma.
Presenting Author: Hiroyuki Goda, Ehime University Graduate of Medicine,
Department of Oral and Maxillofacial Surgery, Ehime, Toon, Japan
Background: Regionallymph node metastasis is an important prognostic
factor in oral squamous cell carcinoma (OSCC). Sentinel lymph node
biopsy (SLNB) is a widely accepted procedure in various human malignancies.
In clinically N0 (cN0) OSCC cases, SLNB has received considerable
attention for its role in deciding whether to perform neck dissection. In this
study, we assessed the efficiency of SLNB for cN0 OSCC case in a
single-institution experience. Methods: 100 patients with cN0 OSCC
underwent SLNB between 2001 and 2011, of which 95 were clinically T1
and T2. The primary site was tongue, gingiva, oral floor, buccal mucosa,
and lip in 50%, 36%, 8%, 5%, and 1%, respectively. The location of
sentinel lymph node (SLN) was determined by radioisotope (RI) method
with preoperative lymphoscintigraphy and intraoperative use of a handheld
gamma probe and/or dye method, and evaluated by histopathological
examination and genetic analysis. Results: SLNB was performed with RI
and dye method (79%), only dye method (14%), or only RI method (7%).
SLN was successfully identified with RI method (100%) and dye method
(71%). The average number of SLN was 2.5 with dye method and 1.9 with
RI method. The rate of SLN identified side was 84% in ipsilateral, 10% in
bilateral, and 6% in contralateral. Fifteen of 100 patients (15%) had
metastasis-positive SLN, and 3 patients was up-grade to stage III and
others to stage IVA. Eight patients with negative SLN developed latent neck
lymph node metastasis. The sensitivity, specificity, accuracy, and negative
predictive value was 65% (15/23), 100% (77/77), 92% (92/100) and
91% (77/85). Disease specific survival rate for SLNB-negative patients
were 98% (79/81), and for SLNB-positive patients were 73% (11/15),
respectively. Conclusions: SLNB is a minimally invasive and highly reliable
means of staging the cN0 neck for patients with OSCC. Patients with
negative SLNB showed more excellent neck control rate and SLNB provides
more accurate staging than elective neck dissection or wait and see.
5586 General Poster Session (Board #31D), Sat, 1:15 PM-5:15 PM
Importance of HPV involvement and FOXP3� T-cell status as prognostic
factors in tonsilar squamous cell carcinoma. Presenting Author: Kwonoh
Park, Department of Oncology, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, South Korea
Background: Human papillomavirus (HPV) status is a strong and independent
favorable prognostic factor for survival in tonsilar squamous cell
cancer (TSCC). The reason for the improved survival in HPV associated
TSCC is unclear. Recently, activation of immune surveillance mechanism
against non-self Ag is postulated to one of reasonable causes as favorable
prognosis of HPV associated with TSCC. Methods: We reviewed the medical
records of histologically confirmed locally advanced TSCC patients, curatively
treated in Asan Medical Center from January 2000 to December
2008. The immunohistochemistry (IHC) assays for p16 and FOXP3 were
done in TSCC pafaffin-embedded samples. Results: We identified 79
patients who met the inclusion criteria. The median age was 54 years
(range 32-76) and 16 (20%) patients were stage III and the others were all
stage IV. With the median follow up of 62.9 months (95% CI, 59.2 - 66.7),
sixty three (80%) were HPV-positive with p16 overexpression, and 38
(48%) were Treg-positive with FOXP3. Treg involvement was significantly
related to HPV positive status (P�0.011). The result was the same after
adjustment of age, T&Nstage, smoking exposure and alcohol consumption.
(Odd ratio � 6.54, 95% CI 1.58-27.1, P�0.01) Five-year overall
survival (OS) rate in HPV-positive group was significantly higher than that of
HPV-negative group (78% and 63%, Hazard Ratio (HR)�0.347, 95% CI
0.14-0.87, P�0.025), and 5-year OS of Treg-positive group was also
higher than that of Treg-negative group (89% and 61%, HR�0.158, 95%
CI 0.05-0.53, P�0.003). In multivariate analysis, the Treg status was an
independent prognostic factor (HR�0.11, 95% CI 0.03-0.40, P�0.001),
as well as HPV status. (HR�0.28, 95% CI 0.10 - 0.78, P�0.016).
Conclusions: HPV positivity was associated with Treg positivity in TSCC and
both were found to be favourable prognostic factors for survival.
Head and Neck Cancer
377s
5585 General Poster Session (Board #31C), Sat, 1:15 PM-5:15 PM
Neoadjuvant chemotherapy followed by definitive local treatment in locally
advanced carcinoma maxillary sinus. Presenting Author: Vijay Patil, TMH,
Mumbai, India
Background: Locally advanced carcinoma of maxillary sinus has been
historically reported to have poor prognosis. We evaluated the role of
neoadjuvant chemotherapy in improving the outcome in these patients.
Methods: 41 patients with locally advanced borderline resectable (stage
IVa) or unresectable maxillary carcinoma (stage IVb) were treated with
induction chemotherapy between 2008 and 2011. The protocol included 2
cycles of chemotherapy, response assessment and multidisciplinary clinic
review for definitive local treatment. The demographic profile, response to
induction therapy, toxicity of chemotherapy, definitive treatment received,
time to treatment failure (TTF) and overall survival (OS) were analysed.
Univariate and multivariate analysis was performed to determine factors
associated with response, TTF and OS. Results: The cohort of 41 patients
had a median age of 48 years (22-71) with male preponderance (80.5%).
The chemotherapy included two drugs (platinum and taxane) in 34 patients
(82.9%) and three drugs (platinum, taxane and 5 FU) in 7(17.1%) The
taxane utilized was docetaxel in 22 patients (53.7%) and paclitaxel in 19
patients (46.3%). There was no complete response, stable disease in 18
(43.9%), partial response in 16 (39%), and progression in 7 (17.1%)
patients. All patients competed two cycles of chemotherapy, adequate dose
intensity was maintained in 33 patients (78%) and there were no deaths.
Post-induction, the treatment planned included surgery in 12 (29.3%),
CT-RT in 24 (58.5%), radical RT in 1 (2.4%), palliative RT in 1 (2.4%) and
palliative chemotherapy in 3 ( 7.3%) patients. Overall, the median TTF was
10.2 months. With 16 deaths, the median OS was not reached. Only
response post-induction was significantly associated with better TTF
(p�0.02). Grade 3 tumor (p�0.04) and baseline serum albumin more than
4 mg/dl (p�0.02) were associated with better OS. Grade 3-4 neutropenia,
febrile neutropenia and loose motions were seen in 21.1%, 23.8% and
15.8% respectively. Conclusions: In unresectable maxillary carcinoma,
induction chemotherapy has clinically significant benefit with acceptable
toxicity. Response to induction was the only significant factor for improved
TTF.
5587 General Poster Session (Board #31E), Sat, 1:15 PM-5:15 PM
Pretreatment neurocognitive function (NCF) status in head and neck
cancer (HNC) patients (pts) with comparison to control cohort. Presenting
Author: Albiruni Ryan Abdul Razak, Princess Margaret Hospital, Toronto,
ON, Canada
Background: There is increasing evidence that NCF abnormalities may
occur in cancer pts. Data on pre-treatment NCF in HNC pts are lacking.
This study reports NCF in pts with newly diagnosed, curable HNC compared
to controls. Methods: HNC pts underwent a 2-hour battery of NCF tests prior
to radio �/-chemo(bio)therapy. Domains tested were intelligence (IQ),
memory, language, attention, processing speed, executive function and
manual dexterity. Test performances were transformed into Z-scores using
normative data (score � -1 signified deficit). Pts also had self-reported
assessments for NCF, quality of life (QOL), fatigue and affect. Data
obtained were compared to non-cancer controls who underwent the same
tests. Results: Eighty HNC and 30 control subjects were assessed. Objective
NCF testing demonstrated that HNC and control cohorts were similar
across all domains, except for IQ, with pts having higher scores (mean 0.55
vs 0.12, p�0.03). However, individual analysis showed that 39% of HNC
and 43% of control subjects had abnormal Z-scores in � 2 domains.
Multivariable analysis of factors associated with � 2 abnormal NCF
domains included: low education level, significant smoking history (� 10
pack year), previous mild brain injury, gender, and group (pt vs control).
Amongst pts, HPV -ve status and non-oropharyngeal tumors were also
associated with decreased NCF. Pts reported statistically worse subjective
baseline symptoms compared to controls: NCF (mean FACT-COG 33.7 vs
18.2, p�0.002), QOL (FACT H&N 33.8 vs 14.9), fatigue (FACT-F 35.1 vs
15.1), anxiety (HADS 7.0 vs 3.1) and depression (HADS 3.9 vs 1.2),
p�0.01 for all five parameters. Conclusions: Objectively assessed NCF was
similar between HNC pts and controls, but a proportion of participants in
both cohorts have multi-domain abnormal Z-scores. Several patient demographics
and disease characteristics were associated with abnormal NCFs.
Subjectively, pts reported worse NCF, QOL, fatigue and affect. These data
suggest that participant and disease characteristics may play a larger role
in determining NCF than previously shown. Whether such characteristics
impact subsequent NCF is under investigation in a longitudinal study.
Visit abstract.asco.org and search by abstract for the full list of abstract authors and their disclosure information.