Head and Neck Cancer

PV QA 2 - Poster Viewing Q&A 2

MO_27_2471 - Chemoradiation or Altered Fractionation for T2N0M0 Glottic Cancer

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Chemoradiation or Altered Fractionation for T2N0M0 Glottic Cancer
A. Ahamad1, S. Salenius2, R. Ross2, R. N. Selvaraj2, and E. Fernandez3; 1Department of Radiation Oncology, University of Miami / Sylvester Comprehensive Cancer Center, Miami, FL, 221st Century Oncology, Fort Myers, FL, 321st Century Oncology, Fort Lauderdale, FL

Purpose/Objective(s): T2 glottic squamous cell carcinoma (SCC) though amenable to larynx preservation, have a poorer prognosis than T1 tumors. We tested the hypothesis that two treatment intensification approaches improve outcome: [A] concurrent chemoradiation (CCRT) versus radiotherapy RT only and [B] altered RT fractionation (either accelerated fractionation (AFX) using 2.25Gy/fraction, or hyperfractionation (HFX) at <2Gy/fraction twice daily) versus standard fractionation (SFX) using 2Gy/fraction.

Materials/Methods: This is an IRB-approved retrospective study of 180 patients with T2N0M0 SCC treated at 70 centers from 2000-2015. We analyzed [A] CCRT (14.4% of patients) versus RT only, and [B] AFX, HFX, and SFX (14.6%, 14.6% and 70.7% of patients respectively). We calculated rates of acute and late toxicity (by Chi Squared or Fisher’s Exact Tests for univariate analysis (UVA) and logistic regression for multivariate analysis (MVA); overall survival (OS), progression-free survival (PFS), and locoregional recurrence-free survival (LRFS) (by the Kaplan-Meier method for UVA and the Cox Proportional Hazards Model for MVA). SFX included patients who had CCRT.

Results: Summarized in Table 1. [A] CCRT gave a better OS versus RT only (76.9 vs 61.0%, p = 0.83 on UVA but p=0.04 on MVA), higher PFS (88.5 vs 83.1%) and LRFS (88.5% vs 83.8%) neither of which were significant. CCRT had higher acute grade 2-4 toxicity (80.8% vs. 54.5%, p= 0.01and 0.02 on UVA and MVA respectively). [B] AFX and HFX had significantly higher OS than SFX: 75.0%, 70.8% and 62.1% respectively, p= 0.01 and 0.18 on UVA and MVA respectively; with no increased acute toxicity. The only other treatment factor that affected overall survival was treatment duration: 71.4% for <50 days and 53.6% for ≤50 days p=0.03 on UVA. Late toxicity was not affected by CCRT, AFX nor HFX but was increased by current or past use of alcohol on MVA (p=0.02).

Conclusion: The varied approaches reported here reflects a lack of consensus. Altered fractionation, though used in <30% of patients, may be preferred to CCRT because of its lower Grade 2- 4 acute toxicity rate. To find an optimal treatment of T2N0M0 SCC glottis, we recommend a randomized study of concurrent chemotherapy and altered fractionation. Table1. Results for [A] Concurrent chemoradiation (CCRT) [B] Altered fractionation §=univariate analysis; ¶=multivariate analysis; max = maximum

[A] CCRT

No CCRT (%) CCRT (%) § p value ¶ P value
max. acute toxicity rate grade 0-1 45.5 19.2 0.01 0.02
grade 2-4 54.5 80.8
max. late toxicity rate grade 0-1 87.5 88.5 1.0 0.41
grade 2-4 12.5 11.5
OS 61.0 76.9 0.83 0.04
PFS 83.1 88.5 0.69 0.32
LRFS 83.8 88.5 0.74 0.36

[B] Altered fractionation

SFX AFX HFX P value* P value†
max. acute toxicity rate grade 0-1 40.5 45.8 37.5 0.83 0.12
grade 2-4 59.5 54.2 62.5
max. late toxicity rate grade 0-1 86.8 90.0 85.0 0.93 0.13
grade 2-4 13.2 10.0 15.0
OS 62.1 75.0 70.8 0.01 0.18
PFS 84.5 87.5 79.2 0.99 0.75
LRFS 85.3 87.5 79.2 0.99 0.79

Author Disclosure: A. Ahamad: salary; University of Miami. Clinical Director, Radiation Oncology; University of Miami. S. Salenius: salary ; 21st Century Oncology Inc. R. Ross: Salary; 21st Century Inc. R.N. Selvaraj: Salary ; 21st Century Oncology Inc. E. Fernandez: Salary; 21st Century Oncology. SVP Medical Affairs & Medical Director for Latam; 21st Century Oncology. board member and treasurer; 21C CARE. Board member and VP; ACRO.

Anesa Ahamad, MD, MB, BS, FRCR

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