Muñoz Garzón, V.

Nieto Regueira, I.

Ochagavia Galilea, V.

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IMRT in nasopharyngeal cancer patients with skull base infiltration 

reports of practical oncology and radiotherapy 1 8 ( 2 0 1 3 ) S237–S258 S245
Hyperfractionated radiotherapy and cetuximab with concurrent chemotherapy in locally advanced stage IV head
and neck carcinomas
M. Lloret1, J. Martínez2, R. Carmona1, R. Cabrera1, A. Rivero1, C. Fuentes2, P. Lara1
1 Hospital de Gran Canaria Dr. Negrin, Oncología Radioterápica
2 Complejo Hospitalario Nuestra Sen˜ora de Candelaria-ofra, Oncología Radioterápica
Introduction. Treatment of locally advanced squamous cell carcinomas of head and neck (LA-SCCHN) is evolving. The aim of the
present study is to analyze clinical outcomes and toxicity in far advanced cancer with combined triple therapy of chemotherapy
(CHT), hyperfractionated radiotherapy (HF-RT) and cetuximab (CTX).
Material and methods. 27 newly diagnosed LA-SCCHN patients were included between September 2009 and December 2012. RT
consisted in HF-RT: 1.15Gy/fraction, BID, 5 days/week, 7 weeks. Carboplatin was administered 5mg/m2 before each fraction of
RT. Cetuximab was administered 400mg/m2 one week before RT-CTH and then 250mg/m2 weekly while RT-CHT. Patients were
evaluated for response two months after completing treatment. Toxicity was scored by CTCA 4.0 criteria.
Results. Median age was 51.6 years (44–65), 85% were males. All patients were stage IV. Tumors were located mainly in oropharynx
(47%) and hypopharynx (30%). One patient were excluded due to an allergic reaction in the ﬁrst infusion of CTX and 26 patients
(96%) received the completeplanned treatment andwere evaluated for response.All patients achievedobjective response, 22 (85%)
had a complete response (CR) and 4 a partial response. Two patients with CR had a locorregional relapse (one with syncronous
pulmonar metastasis). 3 out of 6 patients with progressive disease were eligible either for surgical rescue (1) or CHT (2). With a
median follow-up of 16.7 months (5–39), 23 of 26 patients were alive, with an actuarial survival at 3 years of 88.5%. Massive nodal
invasion N3 was a strong prognostic factor for survival (p<0.007). Among the 26 evaluable patients for toxicity, 85% had grade 3
radiodermitis and 82% grade 3 mucositis. Acneiform rash was grade 3 in 78% of the patients.
Conclusion. This is a feasible treatment in patients with an optimal Karnofsky Status and far advanced SSCHN obtaining an
immediate response in all cases, with an acceptable tolerance and encouraging overall survival ﬁgures.
http://dx.doi.org/10.1016/j.rpor.2013.03.266
Hypopharyngeal cancer and organ preservation
L. Gutierrez Bayard, M. Salas Buzón, L. de Ingunza Barón, E. Gonzalez Calvo
Hospital Universitario Puerta del Mar, Oncología Radioterápica
Introduction. Hypopharyngeal cancer accounts for about a quarter of all malignancies of the head and neck. The diagnosis in
advanced stages and high incidence of early metastases, place overall survival rates after ﬁve years on ﬁgures from 30% to 35%.
No treatment by itself, surgery at different options, radiotherapy and/or chemotherapy, offers a clear advantage in survival.
Purpose. A descriptive study of 83 patients with hypopharyngeal cancer treated with radiotherapy (initial stage) or concomi-
tant radiotherapy and chemotherapy (neoadyuvant chemotherapy and radio-chemotherapy, or radiotherapy and concurrent
chemotherapy) as a ﬁrst therapeutic option in the period from January 2008 to June 2012.
Methods. 68% of patients were smokers and 76.5% alcohol at the time of diagnosis. The symptom of initial consultation was the
presence of a lateral adenopathy. In 75% of patients followed by odynophagia. With regard to staging the initial stages were 2.6%
and 97% advanced stage with 78% stage IV. In 7.7% had local or locoregional surgical salvage for persistent or recurrent tumor.
Results. Of all patients 64% died of distant metastases or locoregional relapse. Increased risk of locoregional recurrence or distant
metastasis is located in the ﬁrst two years, in the ﬁrst year was detected in 63% of patients and the second years was detected
in 37% of patients.
Conclusions. The improvement in overall survival in carcinoma of the hypopharynx is still present a challenge for professionals.
The initial therapeutic option will depend on the patient, tumor stage, status performance, the experience of professionals and
treatment facilities available. Treatmentdecisions should bedecidedbyaCommitteeHeadandNeckCancer andmultidisciplinary
therapy that will be essential in the comprehensive management of the tumor.
http://dx.doi.org/10.1016/j.rpor.2013.03.267
IMRT in nasopharyngeal cancer patients with skull base inﬁltration
I. Nieto Regueira, V. Ochagavia Galilea, V. Mun˜oz Garzón
Hospital do Meixoeiro, Oncología Radioterápica
Radiotherapy, with or without chemotherapy, is the standard treatment of nasopharyngeal cancer. IMRT allows to give higher
dose to the PTV, and lower dose to adjacent organs. We reviewed our experience with this group of patients. We wished to assess
the local control (partial or total response on CT or MRI evaluation) and incidence of late side-effects incidence. Between February
2007and March 2012, we treated 16 nasopharyngeal cancer patients with skull base inﬁltration (T4 stage) with IMRT. Eleven were
males and ﬁve females, median age 65 (range 15–81). Thirteen patients had undifferentiated carcinoma (81%) and 3 squamous
carcinoma (19%). Six patientswere treatedwith forward IMRT: 72–74Gyof total dose, 1.8Gyper day, 40 days. Remaining 10 patients
(62%) were treated with inverse planiﬁcation IMRT: 70–73Gy (m=72) 2.20–2.35Gy/fraction (m=2.29) 30–32 fractions (m=30.2). Six
patients received neoadjuvant chemotherapy (37%), and 14 concomitant and adjuvant chemotherapy (87%) Median follow-up is
S246 reports of practical oncology and radiotherapy 1 8 ( 2 0 1 3 ) S237–S258
4.3 years (3 month–6 years). One patient died three months after the end of the treatment due to the tumor spread in CSF. We
observe local control at 1-year follow-up in 13 of the remaining patients (81%). Two patients relapsed in the cavernous sinus and
in Eustachian tube/middle ear respectively. Both patients were subsequently treated with reirradiation using IMRT achieving
a complete response that persists nowadays. Two patients (12%) died from lung metastasis without evidence of local relapse.
Side-effects: nasal dryness 60%, G1 and G2 xerostomia (33% and 7% of patients respectively), otitis media in 40%, esophageal
stenosis 7%. One of three patients with pericarotid tumor involvement developed massive hemorrhage due to the rupture of a
carotid aneurysm that required urgent vascular surgery. IMRT was associated with excellent local control and survival. Inclusion
of more patients and a longer follow-up are required to conﬁrm these results
http://dx.doi.org/10.1016/j.rpor.2013.03.268
Induction chemotherapy with docetaxel, cisplatin and 5-ﬂuorouracil (TPF) followed by radiation and concurrent
cetuximab or cisplatin in locally advanced squamous cell carcinoma of the head and neck
G. Asín Felipe1, F. Arias de La Vega1, M. Errasti Viader1, F. Man˜eru2, R. Vera3, I. Hernández3, A. Viúdez3,
V. Chicata Sutmöller1, C. Eíto Valdovinos1, M. Barrado1, E. Oria Mundín4, M. Ciria5, M. Uzcanga6,
J. Sáenz Ban˜uelos7, F. García-bragado8, A. Manterola Burgaleta1, M. Domínguez Domínguez1
1 Complejo Hospitalario de Navarra (CHN), Oncología Radioterápica, Pamplona
2 Complejo Hospitalario de Navarra (CHN), Radiofísica Hospitalaria, Pamplona
3 Complejo Hospitalario de Navarra (CHN), Oncología Médica, Pamplona
4 Complejo Hospitalario de Navarra (CHN), Dietética y Nutrición, Pamplona
5 Complejo Hospitalario de Navarra (CHN), Cirugía Maxilofacial, Pamplona
6 Complejo Hospitalario de Navarra (CHN), ORL, Pamplona
7 Complejo Hospitalario de Navarra (CHN), Radiología, Pamplona
8 Complejo Hospitalario de Navarra (CHN), Anatomía Patológica, Pamplona
Background. We conducted a prospective study in patients with locoregionally advanced head and neck squamous cell can-
cer (LAHNC) to evaluate the feasibility and efﬁcacy of combining 3-drug taxane-containing induction chemotherapy (IC) with
radiation and concomitant single-agent cetuximab or cisplatin.
Methods. Three cycles of TPF induction chemotherapy with prophylactic G-CSF followed by deﬁnitive radiation and concurrent
cetuximab (400mg/m2 loading dose and 250mg/m2 per week during RT) or cisplatin (30mg/m2/w or 100mg/m2 120-h continuous
infusión of weeks 1 and 5). Radiotherapy was delivered with accelerated hyperfractionation concomitant boost (72Gy/42 fr/6w)
or standard fractionation (70Gy/35 fr/7w).
Results. There were 51 eligible and evaluable patients enrolled between May 1, 2007, and August 31, 2012. According to the AJCC 6
ed., 2010, 48 (94%) had stage IV disease and 3 (5.9%) stage III. Larynx 24 (45.5%) was the most common site followed by oropharynx
10 (19.6%), hypopharynx 10 (19.6%), oral cavity 3 (5.9%), nasopharynx 2 (3.9%) and paranasal sinus 1 (1.9%). Concurrent with
radiotherapy 42 patients (82.3%) received cetuximab and 9 patients (17.6%) cisplatin. The percentage of patients completing ICT
was 98.04%, radiation 100%, and cetuximab or cisplatin 98%. During TPF G 3 non-haematological toxicity occurred in 7 patients
(13.7%) and G4 in 2 (3.9%). Acute G 3–4 toxicity of concurrent treatment included dermatitis in 37 patients (36 G3, 1 G4) and
mucositis in 39 (38 G3, 1 G4). Forty-ﬁve percent of patients received enteral feeding. The overall response rate was 94.1%. Tumor
response (RECIST) at 12 weeks following completion treatment was 64.7% complete response and 29.4% partial response. The
2.5-year overall survival estimates were 58.1%, with 2.5-year progression-free survival estimates of 55.3% and 2-year local control
estimates of 81.3%.
Conclusions. Triple drug-based sequential therapy in patients with LAHNC is tolerable, with encouraging efﬁcacy.
http://dx.doi.org/10.1016/j.rpor.2013.03.269
Institutional experience for replanning in head and neck tumor IMRT
A. Fondevilla Soler1, M. Dzhugashvili 1, P. Sempere Rincón1, J. Díaz Cobos2, P. Castan˜eda2, R. Hernández2
1 Instituto Oncológico del Suereste (Grupo IMO), Radiation Oncology
2 Instituto Oncológico del Suereste (Grupo IMO), Radiophysics Department
Purpose. Is described our experience in protocol for adaptive radiotherapy for head and neck tumors treated with Boost integrated
IMRT.
Material and method. IMRT in head and neck cancer provides an essential role in such diseases, and this technique provides a high
level of coverage with a low threshold dose distribution in critical organs (cord, brainstem, mandible, parotid glands), comparing
to 3D conventional technique. (a) Starting from 2011 we began conducting the protocol to assess replanning in IMRT: a new
CT-scan is performed at 4 weeks from starting treatment and is fussioned with the preplanning-CT as a dose of 45Gy; when
there nodal regression and inclusion of the parotids to the high dose region, and for that dose, weight loss is more apparent on
the anatomical structures of the head and neck. (b) 79 patients were treated between 2011 and 2012 with the diagnosis head
and neck cancer. We report our experience for replanning in IMRT treatment. (c) 14 of 79 patients (17%) were replaniﬁcated with


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IMRT in nasopharyngeal cancer patients with skull base infiltration

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