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• W2076333776 abstract "Purpose/Objective(s)Ipsilateral radiation therapy is established for patients with well-lateralized tonsil cancer. Fewer studies report results in the context of concurrent chemoradiation therapy (CRT). The aim of our study was to evaluate the efficacy and toxicity for patients undergoing ipsilateral irradiation and concurrent chemotherapy.Materials/MethodsRetrospective, IRB approved review of patients undergoing definitive CRT for squamous cell tonsil cancer from 1990- 2011 at Duke University. Toxicity was graded according to RTOG grading for mucositis and CTCAE ver. 4. Outcomes were calculated from the last day of radiation therapy to death, recurrence or last follow up.Results137 patients were identified. 23 patients received radiation to the ipsilateral neck only. All were treated between 2005-11 and were stages T1N1(1), T1-T2N2A(4) or T1-T2N2b(18). All patients received 2 cycles of concurrent cisplatin; all but one received standard fractionation IMRT to 70 Gy. One hundred and fourteen patients were treated bilaterally; (stages T1N1 to T4bN2c). 28 patients with T1N1- T2N2b received bilateral treatment from 1998-2011 and provided the subgroup for comparison with the ipsilaterally treated patients. In patients treated ipsilaterally, the rate of hospitalization was less (17% vs 61%, p =<0.01). Mean weight loss was also less (6.3% vs 8.4%, p=.08). However, the rate of feeding tube placement was similar (17% vs 27%; p=0.33) as was grade 3 mucositis (52% vs 66%; p=0.19). Hospitalization (17% vs 62%, p=0.01) was higher for the bilateral patients. The rate of feeding tube placement was similar between these two groups (17% vs 29%, p=0.23). One ipsilaterally patient developed carotid stenosis requiring endarterectomy. For the early stage bilateral group, there were no late toxicities. 3-yr freedom from severe toxicity was similar (90% vs 85%, p=0.55). There was no difference in the 3-yr freedom from late toxicity between the two groups (90% vs 100%, p = 0.17). All ipsilaterally treated patients are alive (median f/u 30 months). Local control rates between the ipsilaterally treated and bilaterally treated patients were similar (100% LC at 3 and 5 years for ipsilateral cases vs 82% for bilateral cases at 3 and 5 years, p=0.25). 5-yr OS was better for the ipsilateral group but was no different when comparing the ipsilateral group to the early stage bilateral cases (5-yr OS 100% unilateral vs 82% bilateral, p=0.02 and 5-year OS 100% ispilateral vs 84% early stage bilateral, p=0.45).ConclusionsIpsilateral radiation for lateralized tonsil cancer appears to reduce short and long-term toxicities and even in patients with N2b disease this strategy provides good local regional control. Purpose/Objective(s)Ipsilateral radiation therapy is established for patients with well-lateralized tonsil cancer. Fewer studies report results in the context of concurrent chemoradiation therapy (CRT). The aim of our study was to evaluate the efficacy and toxicity for patients undergoing ipsilateral irradiation and concurrent chemotherapy. Ipsilateral radiation therapy is established for patients with well-lateralized tonsil cancer. Fewer studies report results in the context of concurrent chemoradiation therapy (CRT). The aim of our study was to evaluate the efficacy and toxicity for patients undergoing ipsilateral irradiation and concurrent chemotherapy. Materials/MethodsRetrospective, IRB approved review of patients undergoing definitive CRT for squamous cell tonsil cancer from 1990- 2011 at Duke University. Toxicity was graded according to RTOG grading for mucositis and CTCAE ver. 4. Outcomes were calculated from the last day of radiation therapy to death, recurrence or last follow up. Retrospective, IRB approved review of patients undergoing definitive CRT for squamous cell tonsil cancer from 1990- 2011 at Duke University. Toxicity was graded according to RTOG grading for mucositis and CTCAE ver. 4. Outcomes were calculated from the last day of radiation therapy to death, recurrence or last follow up. Results137 patients were identified. 23 patients received radiation to the ipsilateral neck only. All were treated between 2005-11 and were stages T1N1(1), T1-T2N2A(4) or T1-T2N2b(18). All patients received 2 cycles of concurrent cisplatin; all but one received standard fractionation IMRT to 70 Gy. One hundred and fourteen patients were treated bilaterally; (stages T1N1 to T4bN2c). 28 patients with T1N1- T2N2b received bilateral treatment from 1998-2011 and provided the subgroup for comparison with the ipsilaterally treated patients. In patients treated ipsilaterally, the rate of hospitalization was less (17% vs 61%, p =<0.01). Mean weight loss was also less (6.3% vs 8.4%, p=.08). However, the rate of feeding tube placement was similar (17% vs 27%; p=0.33) as was grade 3 mucositis (52% vs 66%; p=0.19). Hospitalization (17% vs 62%, p=0.01) was higher for the bilateral patients. The rate of feeding tube placement was similar between these two groups (17% vs 29%, p=0.23). One ipsilaterally patient developed carotid stenosis requiring endarterectomy. For the early stage bilateral group, there were no late toxicities. 3-yr freedom from severe toxicity was similar (90% vs 85%, p=0.55). There was no difference in the 3-yr freedom from late toxicity between the two groups (90% vs 100%, p = 0.17). All ipsilaterally treated patients are alive (median f/u 30 months). Local control rates between the ipsilaterally treated and bilaterally treated patients were similar (100% LC at 3 and 5 years for ipsilateral cases vs 82% for bilateral cases at 3 and 5 years, p=0.25). 5-yr OS was better for the ipsilateral group but was no different when comparing the ipsilateral group to the early stage bilateral cases (5-yr OS 100% unilateral vs 82% bilateral, p=0.02 and 5-year OS 100% ispilateral vs 84% early stage bilateral, p=0.45). 137 patients were identified. 23 patients received radiation to the ipsilateral neck only. All were treated between 2005-11 and were stages T1N1(1), T1-T2N2A(4) or T1-T2N2b(18). All patients received 2 cycles of concurrent cisplatin; all but one received standard fractionation IMRT to 70 Gy. One hundred and fourteen patients were treated bilaterally; (stages T1N1 to T4bN2c). 28 patients with T1N1- T2N2b received bilateral treatment from 1998-2011 and provided the subgroup for comparison with the ipsilaterally treated patients. In patients treated ipsilaterally, the rate of hospitalization was less (17% vs 61%, p =<0.01). Mean weight loss was also less (6.3% vs 8.4%, p=.08). However, the rate of feeding tube placement was similar (17% vs 27%; p=0.33) as was grade 3 mucositis (52% vs 66%; p=0.19). Hospitalization (17% vs 62%, p=0.01) was higher for the bilateral patients. The rate of feeding tube placement was similar between these two groups (17% vs 29%, p=0.23). One ipsilaterally patient developed carotid stenosis requiring endarterectomy. For the early stage bilateral group, there were no late toxicities. 3-yr freedom from severe toxicity was similar (90% vs 85%, p=0.55). There was no difference in the 3-yr freedom from late toxicity between the two groups (90% vs 100%, p = 0.17). All ipsilaterally treated patients are alive (median f/u 30 months). Local control rates between the ipsilaterally treated and bilaterally treated patients were similar (100% LC at 3 and 5 years for ipsilateral cases vs 82% for bilateral cases at 3 and 5 years, p=0.25). 5-yr OS was better for the ipsilateral group but was no different when comparing the ipsilateral group to the early stage bilateral cases (5-yr OS 100% unilateral vs 82% bilateral, p=0.02 and 5-year OS 100% ispilateral vs 84% early stage bilateral, p=0.45). ConclusionsIpsilateral radiation for lateralized tonsil cancer appears to reduce short and long-term toxicities and even in patients with N2b disease this strategy provides good local regional control. Ipsilateral radiation for lateralized tonsil cancer appears to reduce short and long-term toxicities and even in patients with N2b disease this strategy provides good local regional control." @default.
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• W2076333776 title "Ipsilateral Tonsil Chemoradiation: Improved Toxicity Compared to Bilateral Radiation and Effective Rates of Local-Regional Control" @default.
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