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Vienna, Austria

ESTRO 2023

Session Item

Saturday
May 13
10:30 - 11:30
Hall A
Head & neck
Boguslaw Maciejewski, Poland;
Sandra Nuyts, Belgium
Proffered Papers
Clinical
10:50 - 11:00
Target and failure pattern in SCC-HNCUP: a prospective phase-4 study from DAHANCA
Signe Bergliot Nielsen, Denmark
OC-0107

Abstract

Target and failure pattern in SCC-HNCUP: a prospective phase-4 study from DAHANCA
Authors:

Signe Bergliot Nielsen1, Nina Munk Lyhne2, Maria Andersen3, Jørgen Johansen4, Christian Godballe5, Hanne Primdahl6, Elo Andersen7, Mohammad Farhadi8, Anita Gothelf9, Christina Caroline Plaschke10, Thomas Kjærgaard11, Jens Overgaard12

1Aarhus University Hospital, Department of Experimental Clinical Oncology & Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus, Denmark; 2Aalborg University Hospital, Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Aalborg, Denmark; 3Aalborg University Hospital, Department of Oncology, Aalborg, Denmark; 4Odense University Hospital, Department of Oncology, Odense, Denmark; 5Odense University Hospital, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Odense, Denmark; 6Aarhus University Hospital, Department of Oncology, Aarhus, Denmark; 7Herlev Hospital, Department of Oncology, Herlev, Denmark; 8Zealand University Hospital, Department of Oncology, Næstved, Denmark; 9Rigshospitalet, Department of Oncology, Copenhagen, Denmark; 10Rigshospitalet, Department of Otorhino­laryngology, Head and Neck Surgery & Audiology, Copenhagen, Denmark; 11Aarhus University Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus, Denmark; 12Aarhus University Hospital, Department of Experimental Clinical Oncology, Aarhus, Denmark

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Purpose or Objective

The Danish national guidelines for head and neck squamous cell carcinoma of unknown primary (SCC-HNCUP) is from 2013. The guideline recommends bilateral elective neck irradiation. Elective mucosal areas typically include pharynx and larynx. Depending on affected neck node levels, nasopharynx is omitted in some cases and in other cases, only the oral cavity and oropharynx are irradiated. Trends towards a more individualized treatment approach with unilateral irradiation are emerging.
Aiming to assess compliance to treatment guidelines, a comparative matching of radiation treatment (RT) plans with guidelines was performed. Regional failures were described in relation to planned CTV’s (unilateral/bilateral) to evaluate whether the recurrences occurred in prophylactic irradiated areas.

Material and Methods

All patients who received RT as part of treatment for SCC-HNCUP in Denmark between 2014 and 2020 were included. Elective mucosal clinical target and elective nodal clinical target volumes from RT plans were obtained and compared with the topography of any ipsilateral or contralateral loco-regional failures.

Results

A total of 193 patients received curative radiotherapy as part of their treatment; 80 with primary (C)RT and 113 with adjuvant (C)RT. Concomitant chemotherapy was cisplatin (40 mg/m2 weekly). Seventy percent of patients treated with primary (C)RT received concurrent nimorazole. Patients were predominantly treated with IMRT (97%). A subfraction (17%) received elective neck irradiation unilaterally for unilateral neck disease. After a median (IQR) follow-up time of 3.1 (1.4 to 5.1) years, 10% had an in-field recurrence on the irradiated side of the neck. No patients treated unilaterally had a recurrence contralaterally. Seven percent had bilateral neck node disease. All of these were treated with bilateral RT, and 7% of these had regional in-field recurrence. Sixty-seven percent of mucosal failures occurred within the elective target volume. 5-year loco-regional failure rate was 19%.

Conclusion

We present the largest failure pattern analysis on a complete national cohort of SCC-HNCUP patients to date. Loco-regional failures are described in relation to planned CTVs. The loco-regional control was acceptable and comparable to primary head and neck SCC in other sites.