J. MENARD. Post Astro

Transcription

1 J. MENARD Post Astro ORL

2 ORL Session plénière: 0/ 4 1 atelier de contourage 5 «Educational session» 2«Poster discussion» 2 «Scientific session» d ORL purs 4 «scientific session» avec présentation ORL

3 5«Educational session» 2H Head and neck presentations(cas ti clinique) IMRT: Clinical updates in IMRT and IGRT for Head and Neck cancer Concurrent CT/RT and post op radiotherapy for head and neck cancer HPV: HPV cervical and head and neck cancer

4 Poster(21 abstracts) IMRT: Head and neck: target delineation; normal tissue tolerance and outcomes after IMRT TTT et pathologies rares: Head and neck: particle therapy, rare tumors, pathology and MISC

5 Scientific session (16 abstracts) HPV: Finding the optimal therapeutic ratio for oropharynx cancers in the Era of human papilloma virus Prevention de la radiotoxicité: Strategies to preserve e organ function after head and neck radiotherapy

6 Scientific session (10 abstracts) Clinical trials(1 abstract) IMRT IGRT(1 abstract) Novel approaches integrating targeted biologics and imaging with radiotherapy (6 abstracts) Treatment response monitoring and modeling (2 abstracts)

7 Scientific session clinical trials Concomitant t Cisplatin and Hyperfractionated Radiotherapy in Locally Advanced Head and Neck Cancer: Ten- year Follow-up of a Randomized Phase III Trial (SAKK 10/94) PGhdj P. Ghadjar et al 224 patients 74,4 Gy fractionné en 1,2Gy deux fois par jour associé ou non au CDDP 20mg/m² jour pendant 5 jours a S1 et S5 Augmentation de contrôle loco regional, survie sans recidive et survie specifique, sans augmentation de survie globale; pas d augmentation de toxicité Une des seules phase 3 présentées phase 3

8 Poster discussion: Head and neck: target t delineation; normal tissue tolerance and outcomes after IMRT Dose response of dysphagia in oropharynx cancer patients IMRT for oropharyngeal carcinoma: superior midline sparing with the clinical implementation of biological based planning reduces dysphagia during definitive chemo radiation Comparative study of IMRT Vs conventional radiotherapy with amifostine for preservation of parotid function in patients with head and neck cancer Prospective clinical-dosimetric evaluation of normal tissue tolerance of the brachial plexus among patients treated by intensity modulated radiotherapy for head and neck cancer Dose response relationships for lhermitte s sign following chemoradiation for oropharyngeal cancer Osteoradionecrosis and radiation dose to the mandiblein oropharyngeal cancer Is conventional dose and fractionation required to prophylactically treat neck lymphatics for head and neck cancer treated with IMRT Intensity modulated radiation therapy for oropharyngeal carcinoma: clinical outcomes and longitudinal analysis of late effects IMRT combined with concurrent but not adjuvant chemotherapy in primary nasopharyngeal cancer- outcome and long term toxicity

9 Comparative study of IMRT Vs conventional radiotherapy with amifostine for preservation of parotid function in patients with head and neck cancer Novembre 2008 a février 2009, 50 patients Dose 66Gy en 33 séances Evaluation de la quantité de salive Intérêt des 2 traitements t Avantage de l IMRT si on respecte certaines doses mal spécifiées Vyas et al

10 Poster discussion: Head and neck: target delineation; normal tissue tolerance and outcomes after IMRT Mesure de la dose médiane sur les différents muscles constricteurs en fonction de la dysphagie; dose au constrictor inferieur<65 Gy Avantage de l IMRT si on respecte certaines doses(3eme abstract) mais dose totale de 66 Gy Utilisation de la Dmax et V74 pour prédire la neuropathie plexique Lésion de la moelle plus fréquente si plus grand volume de moelle a plus de 40Gy Pour la mandibule, observation de la V50 pour réduire l osteonecrose (med V50 a 31 Gy Vs 44Gy)

11 conclusion FAIRE de l IMRT Moins de complication Meilleure distribution de dose

12 Poster discussion:head and neck: particle therapy, rare tumors, pathology ogy and MISC Evaluation of induction chemotherapy in patients undergoing concurrent chemo radiotherapy for advanced laryngeal cancer Patient demographics and socio economic status on laryngeal cancer survival: a population based study of patients Carbon ion radiotherapy for malignant head and neck tumors invading the skull base Should hypopharynx cancer continue to be inluded in multi head and neck trials within the RTOG Skin carcinoma of the head and neck with merineural invasioni AJCC/UICC staging system for nasopharyngeal carcinoma- changing from the 5th to the 7th edition and future improvement Skin culture and treatment results in head and neck cancer patients with severe radiation dermatitis and potential suprainfection Radiation therapy after chemoreduction in retinoblastoma and outcomes A comparison of definitive with postoperative proton beam therapy for locally advanced sinonasal squamous cell carcinoma Seventy five percent of extrapharyngeal larynx respect the thyroid cartilage: a modern clinicopahtologic review of 89 total laryngectomy specimens show new patterns of spread Basaloid squamous cell carcinoma is not an independent adverse prognostic factor in head and neck cancer Photon IMRT adenoid cystic carcinoma with or without carbon ion boost: results in 116 patients from a single institution

13 Should hypopharynx cancer continue to be inluded in multi head and neck trials within the RTOG Den et al Choix d une population avec tabagisme >10 ans Comparaison 108 hypopharynx avec 605 oropharynx Résultats t péjoratifs pour les hypopharynx Pronostics plus proche de celui des larynx Traitement par induction?

14 Skin culture and treatment results in head and neck cancer patients with severe radiation dermatitis and potential ti suprainfection Gunn et al De 2007 a 2010; revue des mises en culture 48 patients Staph chez 40 patients; 24 S aureus, 3 MR 29 traitements antibiotiques Conclusion: impossibilité de distinguer infection de colonisation

15 A comparison of definitive with postoperative proton beam therapy for locally advanced sinonasal squamous cell carcinoma Wang et al De 1991 a 2008; 62 patients Carcinome sinusien localement avancé 43 chir + protons Vs 19 protons-chimio i Autant de chimio ds les deux groupes(50%) Même taux de contrôle local a 2 ans: 80% Même survie globale(69 Vs 61%) a 2 ans Tox grade 3: 17% Vs 0% NS Attente tox tardive

16 Poster discussion:head and neck: particle therapy, rare tumors, pathology and MISC Essai indien: pas d apport de l induction ds le larynx avant ARCC(mais pas de TPF) Etude démographique Faisabilité des ions carbones Hypopharynx a considéré plutôt comme des larynx que des pharynx Invasion perineurale: mauvais pronostic Pas de modification majeure de la nouvelle TNM du cavum Importence de la culture bacterio en cas de doute si infection epidermique Resultats equivalents pr les K sinusiens de chir Vs proto therapie seule

17 Conclusion Pas de nouveauté

18 Scientific session Finding the optimal therapeutic ratio for oropharynx cancers in the Era of human papilloma virus Analysis of predictive factors of outcomes for patient with locally advanced unresectable pharyngeal squamous cell carcinoma treated with hyperfractionated twice daily radiotherapy +/- Cisplatin/FU Survival and toxicity outcomes in base of tongue cancer treated with brachytherapy boost combined with 2D or IMRT: a ten year experience Treatment e of base of tongue cancer: ce conventional o external e beam radiotherapy apy alone Vs EBRT+brachy Vs IMRT Treatment failure is uncommon in the modern era for squamous cell carcinoma of the tonsil treated with primary radiotherapy Outcome of radiotherapy alone in HPV associated oropharyngeal cancer CDDP and RT versus cetuximab and RT in the context of HPV and P16 in the treatment of locally advanced head and neck cancer Outcomes of p16 positive oropharyngeal squamous cell carcinoma treated with post operative adjuvant IMRT +/-chemotherapy Prognostic value of p16 expression in laryngeal cancer patients treated with radiation

19 Treatment of base of tongue cancer: conventional external beam radiotherapy alone Vs EBRT+brachy Vs IMRT al Setton et 374 patients de 1985 a EBRT(70 Gy), 68 EBRT et boost en curie(54+25), 201 IMRT(70 Gy) Survie sans recidive a 5 ans: 85, 89, 93% Pas de difference significative en contrôle localouensurvie ou Xerostomie gr >2: 62%, 61%, 28% p=0,0003 Dysphagie gr 2: 30, 11, 17% significatif

20 Scientific session Finding the optimal therapeutic ratio for oropharynx cancers in the Era of human papilloma virus Facteur predictif pr les K pharyngés non operables traités par ARCC bi frac: reponse objective a 6 mois et niveau median d EGFR, PS Base de langue: efficacité et faible morbidité de la curietherapie; pas de difference entre IMRT, EBRT et curie en terme d efficacité cacté 2 articles de curiethérapie Meilleur pronostic des HPV+; interet de tester des desescalades therapeutiques Meme constat pour les patients p16+ (augmentation du contrôle local par la radiotherapie)

21 Conclusion Interet des facteurs predictifs HPV et p16 pour tenter une selection de patients et une desescalade de dose

22 Scientific session: Strategies to preserve organ function after head and neck radiotherapy RTOG 0537 phase 2/3 study comparing acupuncture like transcutaneous electrical nerve stimulation versus pilocarpine in treating early radiation induced xerostomia Importance of sparing submandibular gland function to improve patient reported xerostomia A phase 2 study of submandibular salivary gland transfer to the submental space prior to start of radiation treatment for prevention of radiation induced xerostomia in head and neck cancer patients Predictors of xerostomia after head and neck IMRT: beyond the parotid glands Isolation of human salivary gland stem cells from submandibular glands Phase 1 trial on adaptative dose painting by numbers for head and neck cancer: what is the maximum tolerated dose? Predictors of worsening dysphagia following chemoradiation for oropharyngeal cancer: results from a two years prospective longitudinal study Relationship between radiation treatment parameters and overall survival following induction chemotherapy in a sequential regimen for locally advanced head and neck carcinoma

23 RTOG 0537 phase 2/3 study comparing acupuncture like transcutaneous electrical nerve stimulation versus pilocarpine in treating early radiation induced xerostomia Wong et al Sept 2008 a oct 2009; 48 patients Acupuncture 24 seances; 38 patients 21% recevaient de la pilocarpine avant traitement 85 % de reduction de la xerostomie(amelioration de ( 35 % du score d impact sur la qualité de vie

24 A phase 2 study of submandibular salivary gland transfer to the submental space prior to start of radiation treatment for prevention of radiation induced xerostomia in head and neck cancer patients et al 49 patients Pas d IMRT, pes d ethyol, pas de pilocarpine 26% de xerostomie aigue Technique faisable te reproductible Jha

25 Relationship between radiation treatment parameters and overall survival following induction chemotherapy in a sequential regimen for locally ll advanced head and neck carcinoma Sher et al Essai TAX 324; phase3; 350 patients Analyse de l OS en fonction de la radiothérapie Univariée: type d induction, PS, site primitif, T, N, durée de la radiothérapie Multivariée: meme chose Apres 8 semaines de RT, baisse de 4% de l OS a chaque jour supplémentaire

26 Scientific session: Strategies to preserve organ function after head and neck radiotherapy Efficacité de l acupuncture; a tester en phase 3 Vs pilocarpine Possibilité de translocation en submental des glandes submandibulaires(reproductible en phase 2) Importance d epargner la cavité buccale saine dans la xerostomie Difficulté d isoler les cellules souches de glande submandibulaire Confirmation de la superiorité de TPF Vs PF(TAX)

27 Conclusion Différentes techniques en cours d etude pour diminuer la xerostomie radio induite Importance de la répartition de dose

28 Scientific session: Treatment response monitoring i and modeling Longitudinal monitoring of functional changes in irradiated head and neck tumors using optical spectroscopy Prospective pharmacokinetic and diffusion IRM measurement of normal tissue response to head and neck IMRT

29 Conclusion Deux moyens en cours d etude pour tenter d observer les reponses aux thérapeutiques

30 Scientific session: Novel approaches integrating targeted biologics and imaging with radiotherapy Phase 2 study of concurrent and adjuvant chemotherapy with IMRT or 3DCT + bevacizumab for locally or regionally advanced nasopharyngeal cancer RTOG 0615 Phase 1 trial of bevacizumab followed by concurrent radiation, bevacizumab and cisplatin for locoregionally advanced SCC Efficacity and toxicity of tyrosine kinase inhibitor along with platinum based concurrent chemoirradiation in locally advanced squamous cell carcinoma of head and neck

31 Efficacity and toxicity of tyrosine kinase inhibitor along with platinum based concurrent chemoirradiation in locally advanced squamous cell carcinoma of head and neck al Nandwani et 100 K ORL localement avancés exceptés cavum et sinus RT 70 Gy RT + CDDP Vs RT + CDDP + gefitinib 250 mg OS: 56 Vs 68% PFS: 44 Vs 64% Pas de différence de toxicité de radiothérapie 20% d acne et 12% de diarrhée sous TKI

32 Scientific session: Novel approaches integrating targeted biologics and imaging g with radiotherapy Pas d augmentation de saignement sous avastin Avastin: semblerait efficace meme en mono therapie Gefitinib(iressa): 86% de reponse complete; augmentation de l acné

33 DONC Pas de changement des pratiques IMRT= grand gagnantg Nouvelles molécules à développer(avastin, iressa) Poursuite des investigations pour la preservation salivaire