Phase I pilot study on fast neutron teletherapy for advanced carcinomas of the head and neck region: Final report on local control rate and survival

20507 Background: To evaluate the role of surgery and radiotherapy in the treatment of soft tissue sarcomas of the head and neck region Methods: Thirty adult patients with head and neck soft tissue sarcoma were retrospectively analyzed. The most frequent histopathologic subtypes were chondrosarcomas (27%) and malignant fibrous histiocytoma (20%). The surgical resection was performed in 25 of the 30 patients (83%). Negative surgical margins could be achieved only in 9 of 25 patients (36%). Ten patients had marginal resection (40%) and 6 patients (24%) had gross residual disease after the surgery. All patients in the surgical resection arm received postoperative radiotherapy except two patients. Results: Five-year local control rates for patients with negative surgical margins (n=9), microscopically positives (n=10), gross residual disease (n=6) and inoperable (n=5) cases were 64%, 70%, 20% and 0% respectively. The median disease free survivals were 26.6 months, 17.7 months, 8.4 and 5.5 months. However, there was no significant difference in local control between patients with negative or microscopically positive disease who receive postoperative radiotherapy (71% vs 70%). The higher dose of radiotherapy (= 60Gy) was found to be associated with a longer local control (p=0.048). The local control rates were lower in patients with grade 2–3 tumors as compared with grade 1 tumors (44% vs. 83%). The median overall survival of whole group was 31 months. Median survivals of patients receiving both surgery and radiotherapy with negative and microscopically positive margins were significantly better than patients who were not treated with surgery (34.8 and 36 months vs. 13.3 months). In univariate analysis grade 1–2 vs. 3, had statistically significant 5-year survival difference (64% vs. 14%, p=0.003). The presence of local relapse had clear negative effect on survival (absent vs. present 66% vs. 7%, p=0.0003). Conclusions: Our results and the findings in the literature confirm that the optimal treatment of head and neck soft tissue sarcomas is complete surgical excision. Postoperative adjuvant radiotherapy clearly improves local control however the high locoregional failure rates still indicate the need for improved treatment strategies. No significant financial relationships to disclose.

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Effectiveness of surface mould brachytherapy in electron era.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e21562 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e21562-e21562

Author(s):

Jyoti Mehta

Keyword(s):

Head And Neck ◽

Local Control ◽

Medical Condition ◽

External Beam Radiotherapy ◽

Surgical Margin ◽

Neck Region ◽

Complete Response ◽

Median Surface ◽

Head And Neck Region ◽

Grade 3

e21562 Background: In India, skin cancers constitute about 1-2% of all diagnosed cancers.Surgery stays main modality of treatment with adequate surgical margin shown excellent local control rates - generally 95%.However, conditions where surgery is not feasible, brachytherapy is alternative approach.Advanced technology improved the ability to deliver safe and effective radiotherapy, resulting in renewed interest in this modality.Brachytherapy has many advantages: they can deposit a significantly higher dose within a tumor, with better sparing of adjacent normal structures over external beam radiotherapy or electron therapy, which sometimes require irradiating a large volume of tissue in order to provide adequately coverage, which in term increase toxicity. The purpose of our paper is to find out the clinical outcomes of skin tumors and superficial tumours of head and neck region treated with Surface mould brachytherapy (SMB), in terms of survival and toxicity.We report on our institution’s experience with using Co-60 based HDR SMB for the treatment of skin and head and neck superficial malignancies. Methods: A retrospective review of all patients treated with surface mould Co-60-based HDR brachytherapy at our center.A total of 23 patients, with 23 lesions, were treated during this period, and included in the analysis. A total of three of these lesions were treated with a palliative intent, and were included. The most common fractionation scheme was 35 Gy in 10 fractions given daily (52%, n = 12), though a range of doses were used, from 8/2 fractions to 36 Gy/12 fractions. Results: Median age at diagnosis was 52 (range = 28-91). The majority were Squamous cell (43%, n = 10) or Basal cell carcinomas (34%, n = 8). Most lesions were located in the head and neck region. The most commonly used RT dose was 3GyX10 fractions; all patients had individualized CT-based planning.The 5-year overall survival (OS) was 86 %( twenty patients). Three patients were died. Most deaths were from unrelated causes. Response was assessed in OPD 2-4 months post-treatment. Our complete response (CR) rate was 73.9% (seventeen patients), with partial response in three patients; two patients could not be assessed for response and one patient died due to other medical condition. We report a 2-year local control (LC) rate of 91.3%, and local recurrence was found in two patients. The procedure was well tolerated, with no grade 3 or more acute or late toxicities. There was one case of grade 3 ulcer (CTCAE). The 100% isodose line median depth was 0.5 cm, and median surface dose = 126.5%. The median V90 = 92.3%. Conclusions: Surface mould brachytherapy is a safe, effective modality for treatment of skin malignancies or tumors. Brachytherapy was overall well tolerated, with no grade 3-5 acute or late toxicities. This treatment is a good alternative option for those patients unwilling or unable to undergo surgery for their skin malignancies

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