Advanced Head Neck Cancer Research Articles

Spatially fractionated radiotherapy (Lattice SFRT) in the palliative treatment of locally advanced bulky unresectable head and neck cancer

ObjectivesLocally advanced bulky unresectable head neck cancer causes significant tumor mass effects, leading to severe symptoms. This study aims to report the safety and outcomes in patients undergoing Lattice spatially fractionated radiotherapy (Lattice SFRT) for locally advanced bulky unresectable head and neck cancer. MethodsPatients with bulky head and neck cancer received Lattice SFRT between June 2022 and June 2023. Lattice SFRT was administered in 2–3 fractions of 12 Gy (Gy) using 6-megavolt (MV) photon beams through a multileaf collimator (MLC) based on VMAT technology. The primary endpoints were symptomatic and tumor response rates. Secondary endpoints were overall survival, local control, and acute and late toxicity rates. Results19 consecutive patients meeting the study criteria were identified, predominantly with squamous cell carcinoma histology. The median patient age was 62 years (range 39–79 years), and the median tumor volume was 208 cc (cc) (range 48–701 cc). All patients completed radiotherapy. Among all investigated patients, 16 of 19 (84.2 %) patients achieved an objective response, including 10 individuals achieved a partial response (PR), with 3 of them exhibiting regression exceeding 75 %. 17 patients showed symptom improvement to varying degrees. Acute toxicity of Radiation Therapy Oncology Group (RTOG) grade 1 or higher occurred in 5 patients, while no grade 3 adverse events was observed. ConclusionsLattice SFRT proves to be a viable treatment option for the palliative management of bulky head and neck cancer. In the palliative setting, Lattice SFRT offers timely symptom relief, enhancing patient quality of life. Treatment toxicity remains within an acceptable range. Continued optimization of Lattice SFRT delivery and patient selection can benefit from further data on the feasibility and efficacy of this radiation modality.

End of life and palliative care decisions in advanced head neck cancer

The complexity of care for patients with advanced head and neck cancer is a significant issue, and current healthcare systems must focus on appropriate referral criteria, increased integration and coordination of care, and robust evaluation of specific care components. Linkage between research and service design delivery across teams, disciplines, and care settings is also important. Palliative care needs of patients with advanced head and neck cancer pose unique complexities due to the impact the illness has on eating, speaking, appearance, and breathing. Specialty palliative care consultation by trained experts helps primary teams facilitate goals of care discussions, symptom management, and medical resource navigation for the terminally ill patient. Early initiation of palliative care results in less invasive and more cost-effective patient-centered care. There is little literature on care practices in this population, and hospital-based care may increase towards the end of life to address potentially reversible conditions or uncertain prognosis. Early advanced care planning and end-of-life care options should be supported alongside continuation of therapy lines.

Evaluating the Response of Hypofractionated Radiotherapy verses Conventional Radiotherapy with Concurrent Cisplatin in Advanced Fixed Node Head and Neck Carcinoma

Background: The evolution of radiotherapy over recent decades has reintroduced the hypofractionation for many tumour sites with similar outcomes to those of conventional fractionated radiotherapy. The use of hypofractionation in locally advanced head and neck cancer (LAHNC) has been already used, however, its use has been restricted to only a few countries. The aim of this trial was to evaluate the safety and feasibility of moderate hypofractionated radiotherapy (HYP-RT) with concomitant cisplatin (CDDP). Objectives: To evaluate the efficacy of hypofractionated radiotherapy in advanced unresectable head neck cancer, in terms of response rate and evaluate the local and systemic toxicities of hypofractionated regimen with symptomatic improvement of radiotherapy and treatment compliance. Methods: A total of 50 cases of locally advanced head and neck cancer (stage cT4b and/or N3) without any evidence of distant metastasis were included in this study. These 50 cases were randomly distributed into study and control group containing 25 each. Radiotherapy consists of a single fraction of 6 Gy Per week for a total of 6 weeks. If the patient received less than 6weeks of treatment, he/she was excluded from study. Total dose given was 36 Gy in 6 fractions. All the patients were treated by unilateral or bilateral portal till 24 Gy and then off cord planning was done. Patients with complete disease regression after initially planned 36 Gy (BED-57.6Gy, considering alpha/beta of 10 and corresponding EQD2-48Gy) were offered further dose escalation depending upon tumour regression status, tolerability and toxicity according to institutional guidelines. Partial responders are given no treatment up to end of treatment period. Results: Among the study and control group, incidence of carcinoma of tonsil was 12% and 20%, carcinoma of base of tongue was 24% and 16%, carcinoma larynx 16% and 24%, respectively and Hematological toxicities (reference to blood hemoglobin level), Renal (reference to blood urea) were assessed according to WHO toxicity criteria in all cases weekly up to six weeks Among the study and control group, 8% and 12% had no acute hematologic reactions (χ2 = 0.22, p > 0.05), 56% and 48% had grade I hematologic reactions (χ2 = 0.32 p > 0.05,), 28% and 36% had grade II hematologic reactions (χ2 = 0.36, p > 0.05) and 8% and 4% had grade III hematologic reactions (χ2 = 0.35, p > 0.05) respectively. No patient had had grade IV hematological toxicity. Among the study and control group, 80% and76% had no acute renal toxicity. (χ2 = 0.11, p > 0.05), 20% and 24% had grade I hematologic reactions (χ2= 0.11 p > 0.05). No patients from either group develop grade II, III and IV renal toxicity. Conclusions: HYP-RT with concomitant CDDP was considered feasible for LAHNC, and the rate of acute toxicity was comparable to that of standard concomitant chemoradiation. A feeding tube was necessary for most patients during treatment. Further investigation of this strategy is warranted.

Comparative evaluation of oral mucositis in oral cancer patients undergoing 3-dimensional conformal radiation therapy and intensity modulated radiation therapy with or without chemotherapy.

Oral cancer is a significant cause of death across the world. A combined multimodal approach integrating surgery and radiation therapy (RT) with or without chemotherapy (CT) is commonly employed in advanced oral cancer to prevent recurrences and locoregional spread. Oral mucositis is a common acute toxicity reported in patients undergoing RT and CT. The delivery of optimal cancer therapy protocols is compromised due to morbidity caused by oral mucositis. To compare the severity of oral mucositis in oral cancer patients undergoing 3-Dimensional Conformal Radiation Therapy (3DCRT) and Intensity Modulated Radiation Therapy (IMRT) with or without concomitant CT. This was a prospective, unicentric and longitudinal study conducted in a cancer centre. One hundred four patients with locally advanced oral cancer were enrolled in this study. Fifty-two patients were treated with IMRT and 52 patients with 3DCRT to a dose of >60 Gy, along with concurrent cisplatin weekly CT. Mucositis was recorded before the start, in the end, 1 month, and 3 months post-chemoradiotherapy treatment. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software (v. 21.0, Chicago. 2012). Descriptive and frequency statistics were performed for different parameters assessed in 3DCRT and IMRT group. Grade 3 mucositis was the most predominant grade observed in both groups at the end of treatment. Thirty-six patients (69.3%) versus 24 patients (46.1%) developed grade 3 mucositis in 3DCRT and IMRT group, respectively (P = 0.013). Healing was better with IMRT group when compared to 3DCRT group 1 month and 3 months post-RT. Mucositis was severe in patients undergoing concomitant CT. IMRT reduced the incidence of severe mucositis and also improved the treatment-compliance compared to 3DCRT in locally advanced head neck cancer patients treated by chemoradiotherapy.

A Machine Learning Approach to Real‐World Time to Treatment Discontinuation Prediction

Real‐world time to treatment discontinuation (rwTTD) is an important endpoint measurement of drug efficacy evaluated using real‐world observational data. rwTTD, represented as a set of metrics calculated from a population‐wise curve, cannot be predicted by existing machine learning approaches. Herein, a methodology that enables predicting rwTTD is developed. First, the robust performance of the model in predicting rwTTD across populations of similar or distinct properties with simulated data using a variety of commonly used base learners in machine learning is demonstrated. Then, the robust performance of the approach both within‐cohort and cross‐disease using real‐world observational data of pembrolizumab for advanced lung cancer and head neck cancer is demonstrated. This study establishes a generic pipeline for real‐world time on treatment prediction, which can be extended to any base machine learners and drugs. Currently, there is no existing machine learning approach established for predicting population‐wise rwTTD, despite that it is an essential metric to report real‐world drug efficacy. Therefore, we believe our study opens a new investigation area of rwTTD prediction, and provides an innovative approach to probe this problem and other problems involving population‐wise predictions. An interactive preprint version of the article can be found at: https://doi.org/10.22541/au.166065465.59798123/v1.

How I Treat Advanced Head Neck Cancer

In India, head and neck cancer including all sites is the most common cancer in terms of incidence and mortality among both sexes combined as per GLOBOCAN 2018, with lip and oral cavity being the most common site.[1] Squamous cell cancer of head neck (HNSCC) constitutes the majority of all head and neck malignancies.[2] Most of the patients present in the advanced stage.[3] Even localized HNSCC are notorious for high rates of recurrence in spite of curative modalities of treatment.[4] Treatment for advanced recurrent HNSCC is palliative systemic therapy provided that patients have a good Eastern Cooperative Oncology Group (ECOG) performance score (PS) with normal organ function.

ОЦЕНКА ЭФФЕКТИВНОСТИ ЛУЧЕВОЙ ТЕРАПИИ РАКА ГОЛОВЫ-ШЕИ НА ОСНОВЕ МОДЕЛИ ЛОКАЛЬНОГО КОНТРОЛЯ ОПУХОЛИ

Purpose: Evaluation of the expected effectiveness of radiation therapy based on models of the local tumor control probability (Tumor Control Probability – TCP) for the head-neck cancer. 
 Material and methods: The study used data from 11 patients with locally advanced head-neck cancer (larynx, oropharynx, and oral cavity). For each patient two dosimetric treatment plans have been prepared: SIB-VMAT (70 Gy per tumor, 50 Gy per lymph nodes, 25 fractions) and SEQ-VMAT (70 Gy per tumor, 50 Gy per lymph nodes, 35 fractions). The developed plans were analyzed using A. Niemierko's TCP model with parameters obtained by B. Maciejewski (TCD50 = 70.26 Gy with a 49-day total treatment time), taking into account the dose–volume histograms and the total treatment time.
 Results: The developed plans ensured a high level of coverage (98–98 %) of the Clinical treatment volume (CTV) in all but one patient. The average TCP SIB-VMAT is 99.9 % due to the very short total treatment time. The average TCP for SEQ-VMAT is 61.0%. For one patient, both SIB-VMAT and SEQ-VMAT showed zero expected efficacy due to 95–95 % CTV coverage.
 Conclusion: The use of TCP model allows analyzing personalized treatment plans for patients and developing adaptive treatment regimens with an increase in the total dose, dose per fraction, and a decrease in the total treatment time.

Is Locally Advanced Head-Neck Cancer One More Candidate for Accelerated Hypofractionation?

Hypofractionated accelerated radiotherapy (HypoAR) is widely applied for the treatment of early laryngeal cancer. Its role in locally advanced head-neck cancer (LA-HNC) is unexplored. We present results of a prospective trial on 124 patients with LA-HNC, treated with radio-chemotherapy with three different HypoAR fractionations (3.5 Gy/day × 14-15 fractions, 2.7 Gy/day × 20-21 fractions, and 2.5 Gy/day × 21-22 fractions). Protraction of the overall treatment time due to oropharyngeal mucositis was enforced in 18/57 laryngeal, 6/19 nasopharyngeal, and 15/48 cancer patients with other tumors. Regarding late toxicities, laryngeal edema grade 3 was noted in 5/57 patients with laryngeal cancer, while severe dysphagia was noted in 4/124 and tracheoesophageal fistula formation in 1/124 patients. The complete response rates obtained were 73%, 84%, and 67% in patients with laryngeal, nasopharyngeal, and other tumors, respectively. The 3-year locoregional progression-free survival was 58%, 73%, and 55%, respectively. HypoAR chemoradiotherapy is feasible, with acceptable early and late radiotherapy toxicities, response rates and LPFS.

Head-neck cancer under concurrent chemoradiotherapy: does weight loss affect disease progression and treatment efficacy?

Rationale: Concurrent chemoradiotherapy(CCRT) in locally advanced head-neck cancer(HNC) may deteriorate already wasted body compartments. Weight loss(WL) may result in dose reduction or interruption of scheduled treatment, and poor prognosis. We aimed to analyze WL in HNC pts submitted to CCRT, to assess its potential impact on therapy response.

A prospective, comparative analysis of acute toxicity profile between three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) in locally advanced head and neck cancer patients

IntroductionThe advances of modern radiotherapy have emerged with the development of conformal radiotherapy techniques, such as the three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT). We prospectively compared acute toxicities and treatment-compliance between IMRT and 3DCRT in patients with locally advanced head and neck carcinoma. Method80 patients were enrolled in this comparative prospective non-randomized study. Inclusion criteria were patients with locally advanced carcinoma of hypopharynx, oropharynx and larynx. 40 patients were treated with IMRT and 40 patients with 3DCRT to dose of 70 Gy in 35 fractions, along with concurrent cisplatin weekly chemotherapy. All patients were assessed weekly during chemoradiotherapy treatment and after 3 months of the treatment. Results15 patients (38.4%) versus 8 patients (20.51%) developed grade 3 mucositis in the 3DCRT and IMRT group respectively (p= <0.001). At three months post chemo-radiotherapy treatment, 17 patients (43.6%) versus 7 patients (17.9%) had grade 2 dysphagia in 3DCRT and IMRT group respectively (p = 0.029). At three months post radiotherapy, grade 3 xerostomia was seen in 3 patients (7.6%) in 3DCRT group versus no patient (0%) in IMRT group (p = 0.006). IMRT group had lower incidence of grade 3 dermatitis (p = 0.043), weight loss of the patients during the treatment (p = 0.126), lesser requirement of nasogastric intubation (p = 0.003) and better treatment-compliance (p = 0.336) compared to 3DCRT. ConclusionIMRT reduced the incidence of severe mucositis, dysphagia, xerostomia, weight-loss of the patients, requirements for nasogastric tube and it improved the treatment-compliance compared to 3DCRT in locally advanced head neck cancer patients treated by chemo-radiotherapy.

Significant Dose Reduction to Central Neck Structures While Maintaining Locoregional Control in Patients with Advanced Head Neck Cancer Treated with Half-Beam-IMRT and AP Low Neck (HB-IMRT/AP) Radiotherapy Technique

Significant Dose Reduction to Central Neck Structures While Maintaining Locoregional Control in Patients with Advanced Head Neck Cancer Treated with Half-Beam-IMRT and AP Low Neck (HB-IMRT/AP) Radiotherapy Technique

The role of PET CT in the management of advanced nodal head neck cancer post chemoradiotherapy

We would like to thank the authors for their balanced and informative editorial on our PET NECK study (1).

L11 - Prognostic impact of weight loss variation and nutritional parameters in patients affected by locally advanced or metastatic Head Neck Cancer (HNC)

L11 - Prognostic impact of weight loss variation and nutritional parameters in patients affected by locally advanced or metastatic Head Neck Cancer (HNC)

Long term results of comparison of concurrent low-dose daily cisplatin versus the standard weekly cisplatin with six fractions per week radiotherapy in locally advanced head neck cancer.

Aim and Objective:Weekly administration of cisplatin (cis-diamminedichloroplatinum [CDDP]) appears more feasible and substantially more popular than the 3 weekly schedules due to better compliance. Different concurrent cisplatin schedules have been attempted including a daily schedule. We did a comparison of two consecutive single arm studies, i.e., use of weekly cisplatin versus daily cisplatin when used with concurrently with a moderately accelerated radiotherapy (RT) schedule.Patients and Methods:Two prospective feasibility, safety and efficacy studies were carried out consecutively within the department. The weekly CDDP study was done from August 2003 to August 2005 and daily CDDP study was conducted from November 2005 to June 2007. Both studies included locally advanced stage III and IV squamous cell carcinoma of the head and neck region with RT dose of 70 Gy. Concurrent single-agent cisplatin was administered weekly (35 mg/m2) in the first and daily (6 mg/m2) in the second study.Results:Weekly cisplatin study had 68 and daily CDDP study had 52 patients. The median follow-up in the two studies was 93 and 63 months, respectively. Compliance in the two studies was comparable. Acute Grade III/IV mucositis and dysphagia were significantly higher in weekly cisplatin study. Late Grade II/III toxicities such as xerostomia, dysphagia, ototoxicity and nephrotoxicity were similar. The 5 years locoregional control was 18% and 25% and 5 years overall survival rate was 32% and 31% in weekly and daily cisplatin studies, respectively.Conclusions:Modest acceleration along with either weekly or daily cisplatin, whichever is possible in one's setup, is do-able, provided due attention is paid to patient selection and supportive care.

Gefitinib with concurrent chemoradiation in locally advanced head neck cancer

Abstract Background Chemoradiation is standard treatment in locally advanced oropharyngeal and hypopharyngeal cancer but only few surviving for long term. Novel therapeutic agents targeting EGFR receptors demonstrated survival benefit in palliative setting and radiosensitization in preclinical studies. We compared cisplatin based concurrent chemoradiation with cisplatin and gefitinib based chemoradiation in patients with locoregionally advanced oro-hypo pharyngeal cancer. Methods Patients of oro-hypo pharyngeal squamous cell carcinoma with age between 18 and 70 and with locally advanced (stage III and IV, M0) were randomly assigned to receive either radiation with cisplatin 100 mg 2 on d1, 23 and 43 or radiation with cisplatin in same dose plus gefitinib 250 mg daily started two week before commencing radiotherapy till the end of radiation treatment. Primary and secondary end points were progression free and overall survival, respectively. Results Out of total 67 patients randomized, 32 received cisplatin with radiation (arm I) and 35 received cisplatin plus gefitinib with radiation (arm II). Overall response rates (complete and partial) were 62% and 71.42% in arm I and arm II, respectively, with no statistically significant difference ( P = 0.605). The median progression free survival was 24 months for arm I while it was 35 months for arm II ( P = 0.2877, hazard ratio [HR] = 0.688, 95% CI 0.3346–1.4150). The median overall survival was 31 months for arm I and 37 months for arm II ( P = 0.4344, hazard ratio [HR] = 0.7542 95% CI 0.3661–1.5539). Proliferative disease showed trend towards significance in terms of response but could not reach the level of significance ( P = 0.086). No statistically significant difference was found in toxicity profile of two arms. Conclusion Gefitinib and cisplatin combination is well tolerated concurrently with radiation but does not have impressive effect on response rate, progression free survival and overall survival, but encouraging result was seen in response rate in proliferative morphology.

Single Institute Experience with the Use of ConPaS Technique for the Treatment of Head and Neck Cancer

Aim: In the complex therapy of head neck cancers modern 3D based radiotherapy plays an important role. The parotid sparing effect of intensity modulated radiotherapy is proven, but in many patients the conventional 3D based techniques are still being used. Since 2006 the “Conpas” technique has been routinely used in our institution for the treatment of locally advanced head neck tumor patients. The aim of our study was to analyze the dosimetry, survival and side effect profile of this 3D based treatment modality. Patient and Methods: Between 01.07.2006 and 31.11.2008 a total of 83 patients were treated using this technique. An elective dose of 50,4 Gy was prescribed to the primary tumor and the bilateral neck node regions, followed by a simple two field boost to the primary tumor region (up to 70Gy). We retrospectively analyzed the following factors related to this method: dosimetry profile (PTV and OR doses, focusing on parotid gland doses), clinical responses, local and distant progression free survival profile, acute and late side effects. Results: The mean dose of primary tumors was 71.98 Gy, the elective region dose of 50.4 Gy was achieved in all cases. Following the treatment in 37 patients complete clinical response in 25 cases partial response in 5 cases stable disease and in 16 cases progressive disease was registered. The mean overall survival was 30,06 months, the mean disease free survival was 25,82 months. When reporting the superficial lobe volumes in “lower” tumor locations good mean parotid doses were achieved (25.3 Gy and 23.4 Gy). Comparing the acute side effect profiles in the “upper” localized group higher rate of Grade III xerostomia (21% vs. 2%, p?0.05) and dermatitis (27% vs. 6%, p?0.05) were observed compared to “lower” localization group. In the “upper” localized group the late xerostomia (grade 2-3) rate was also higher (8% vs. 0%, p?0.05). Conclusion: Based on our experience Conpas technique is feasible technique for treatment of advanced head neck cancer patients. Our clinical outcome, dosimetry and follow up results show that this technique should be used successfully in patients with ”lower” localized primer tumor sites. High attention should be addressed when reporting parotid doses.

Evaluation of depression, anxiety, and stress in nonmetastatic locally advanced head neck cancer patients: Prospective study in a tertiary medical center of India.

e20707 Background: Head neck cancer is one of the prevalent cancers in India. The diagnosis, treatment and the treatment outcome affect various psychological issues of the patients. The aim of the study is to assess depression, anxiety and stress of locally advanced head neck cancer patients, receiving concurrent chemoradiation. Methods: It was a prospective study done in the department of Radiotherapy, Medical College &amp; Hospital, Kolkata from July 2012 to January 2013. Depression Anxiety Stress Scale (DASS) was used to assess the Depression, Anxiety and Stress of the locally advanced non metastatic head neck carcinoma patients. The assessment of the psychological factors was done by the DASS questionnaire in Bengali Version. Each patient was assessed by this scale after 1) breaking bad news, 2) 3 wks after starting the concurrent chemoradiation, 3) on completion of the treatment and 4) 6 weeks after completion ,assessing the response. In each time it was compared with the baseline values using paired t test. Results: Study was carried out with 45 locally advanced non metastatic head neck carcinoma patients. Among them majority are male (77.78%). It was seen that after “breaking bad news” 68.89% of patient are significantly depressed (p &lt; .05). Depression was more among Male population, having age less than 60 years. After 3 weeks of treatment and on completion - in both scenario depression decreased but anxiety and stress increased. There was a significant positive correlation between various toxicities (eg. Mucositis, Dysphagia) on Anxiety and Stress during the course of treatment. Depression after 6weeks on completion was significantly (p &lt; .05) depends on the type of response. Conclusions: The psychological factors of the patients suffering from locally advanced head neck cancer should be taken in consideration right after diagnosis, assessed regularly during the course of management and appropriate care may be taken accordingly.

PP132: The role of early percutaneus endoscopic gastrostomy placement in patients with head and neck cancer treated by combined radiotherapy–chemotherapy

Purpose This study evaluates the outcome of early percutaneous endoscopic gastrostomy (PEG) placement in patients treated with concurrent chemoradiotherapy for advanced head neck cancer. Materials and methods From January 2010 until May 2012 a series of consecutive patients with advanced squamous cell head and neck cancer planned for radical treatment with long course or hypofractionated radiation therapy, underwent PEG placement. We retrospectively analyzed their records to determine the effect of early PEG placement on treatment completion without interruption. It is well known that combined chemoradiotherapy increases mucosal toxicity leading to decreased nutritional intake, weight loss and treatment interruption. Patients had a planning CT scan using individual immobilization with a thermoplastic device and were treated with 3D conformal radiotherapy to a total dose of 36 Gy in thirteen fractions ( hypofractionation schedule) or 66 Gy in 33 fractions (long course).They received concomitantly weekly platinum-based chemotherapy. Results Early percutaneous endoscopic gastrostomy (PEG) was correlated with fewer interruptions of treatment and a better nutritional status. Conclusions The results showed that patients with locally advanced head and neck carcinoma undergoing radiotherapy with curative intent and concomitant chemotherapy, had significant clinical benefit from the early placement of PEG. Prophylactic PEG maintains a sufficient nutritional status and reduces the incidence of treatment interruption due to therapy toxicity.

A matched-pair comparison of intensity-modulated radiation therapy with cetuximab versus intensity-modulated radiation therapy with platinum-based chemotherapy for locally advanced head neck cancer

We retrospectively compared the efficacy of intensity-modulated radiotherapy (IMRT) and cetuximab (IMRT/cetuximab) versus IMRT and platinum-based chemotherapy (IMRT/platinum) for locally advanced head neck squamous cell carcinoma (LAHNSCC). Thirty-one IMRT/cetuximab patients were matched 1:2 with 62 IMRT/platinum patients according to primary site and clinical stage. The primary endpoint was locoregional recurrence (LRR), and secondary endpoints included distant metastasis (DM), cause-specific survival (CSS), and overall survival (OS). Because of inherent selection bias, the IMRT/cetuximab cohort was significantly older and with a higher Charlson Comorbidity Index. IMRT/cetuximab and IMRT/platinum did not have significantly different LRR and DM (33 vs. 23 % at 2 years, P = 0.22; 17 vs. 11 % at 2 years, P = 0.40; respectively). IMRT/cetuximab had significantly worse CSS and OS (67 vs. 84 %, P = 0.04; 58 vs. 83 %, P = 0.001; respectively). However, for the subset of elderly patients ≥65 years old, there is no difference between the two cohorts for all endpoints (all P = NS). IMRT/platinum should remain the preferred choice of chemoradiotherapy for LAHNSCC, but IMRT/cetuximab may be a reasonable alternative for elderly patients.

OC-0142: Conventional radiotherapy vs. chemoradiotherapy vs. accelerated radiotherapy in advanced head neck cancer

OC-0142: Conventional radiotherapy vs. chemoradiotherapy vs. accelerated radiotherapy in advanced head neck cancer