Proceedings of the 52nd Annual ASTRO Meeting S477

Materials/Methods: From 3/2008 to 9/2009 we investigated 25 patients (pts.) with a carcinoma of the oropharynx, hypopharynx,or larynx that were not eligible for function-preserving surgical intervention. The patients received 75 mg/m2 docetaxel on day 1,and 30 mg/ m2 cisplatin on days 1 to 3 (n = 23), or carboplatin AUC 1 on days 1 to 3 (n = 2). Responders (more than 30% of tumorshrinking evaluated by endoscopy and a SUV decrease of more than 20% in FDG-PET) received a CRT with a dose of 2.0 Gy ODup to 30 Gy and 1.4 Gy BID up to 69.2 Gy or 72.0 Gy together with paclitaxel 20 mg/m2 on days 1, 5, 8, 11, 25, 29, 33, 36 withcisplatin 20 mg/m2 or carboplatin AUC1 on days 1 to 4 and 29 to 32.

Results: Induction chemotherapy was feasible in all 25 pts with acceptable toxicity (leucopenia grade IV in one patient). Remissionwas observed in 88% of the pts. (n = 22). The 22 pts and one non-responder (refusal of surgical treatment) received a CRT withoutany delay due to toxicity of iCT. The two non-responders had partial laryngectomy and pharyngectomy. Radiotherapy in all otherscould be performed completely and 56% of the pts received more than 80% of the scheduled chemotherapy. There was no grade IVand V toxicity. Grade III toxicity was observed in some pts, i.e., infection: 9/23 (39%); dermatitis: 3/23 (13%); leucopenia: 7/23(30%); thrombopenia: 1/23 (4%). Oral feeding was unproblematic in 52% of the pts (11 of 21 pts. with available data) at least6 weeks after CRT, and feeding tube was still necessary in the remaining pts (48%, 10 of 21 pts). The iCT and CRT resulted incomplete remission (ycT0) in 22/23 pts (95%). One pt had salvage-laryngectomy after CRT (4%) due to local tumor persistence.Lymph node clearance (yc/pN0) was observed in 15 of 17 pts (88%) with initial suspicious lymph nodes. After a median follow-upof 11 mo (5-24 mo) one local and one distant recurrence had been observed. Three pts died during the follow-up, two of them due totumor related causes and one patient due to other causes. Local tumor control at 12 mo. was 84.6 ± 8.5%, overall survival was 89.6± 7.2%.

Conclusions: Short-term iCT and subsequent CRT with a taxane and a platinum compound is feasible with little toxicity andeffective concerning initial tumor remission. It should be investigated with respect to response-prediction and long term tumorcontrol.

Author Disclosure: S. Semrau, None; F. Waldfahrer, None; R. Linke, None; M. Lell, None; G. Klautke, None; T. Kuwert, None; H.Iro, None; R. Fietkau, None.

2613 Risk-stratified Treatment for Patients with Locally Advanced Oropharyngeal Carcinoma (OPC)

R. R. Boutrus, J. Wang, L. Wirth, J. McIntyre, J. R. Clark, A. W. Chan

Massachusetts General Hospital, Boston, MA

Purpose/Objective(s): To compare the treatment outcomes for patients with locally advanced OPC treated with different chemo-therapy regimens based on risk factors.

Materials/Methods: Between 1998 and 2009, 111 patients with Stage III and IVA/B squamous cell carcinoma were treated withdefinitive radiation therapy at the Massachusetts General Hospital. Sixty nine percent of the patients had positive smoking history.Patients were treated with either intensity modulated radiation therapy (n = 63) or conformal radiation therapy (n = 48). The mediandose to the gross tumor volume was 70 Gy. The median overall radiation treatment time was 47 days. Systemic treatment was givento 94% of patients. Our general treatment policy was to tailor the type of systemic agents according to the individual patient’s risk iffeasible. Patients with minimal disease (Group A, n = 32) were treated with radiation alone, weekly carboplatin, or weekly cetux-imab. Patients with intermediate risk (Group B, n = 68) were treated with concurrent cisplatin-based or carboplatin/paclitaxel-basedagents. Patients with advanced T- and N-stage (Group C, n = 11) were treated with cisplatin/paclitaxel/5-fluorouracil-based sequen-tial chemotherapy if feasible. The T4- and N3-stage distribution was: 3% and 3% in Group A, 16% and 13% in Group B, and 36%and 27% in Group C, respectively.

Results: At a median follow-up of 41 months, a total of 3 local, 3 regional, and 9 distant failures were observed. The actuarial localcontrol, regional control, and freedom from distant metastasis (FDM) rates at 2 years were 97%, 97%, and 91%, respectively. Thelocoregional control rates at 2 years were 96%, 94%, and 100% for Group A, B, and C, respectively (p = 0.61). The FDM at 2 yearswere 96%, 90%, and 89% for Group A, B, and C, respectively (p = 0.5). Eighty percent of patients who failed locoregionallyreceived Group B chemotherapy, and the majority had T4 disease. In univariate analysis, only T4 disease was predictive for de-creased local control (p\0.001), regional control (p = 0.007), and FDM rates (p = 0.04). The rates of locoregional control at 2 yearswere 99% and 75% for patients with T1-3 and T4 disease, respectively (p\0.001). The rates of FDM at 2 years were 94% and 80%for patients with T1-3 and T4 disease, respectively (p = 0.04). In multivariate analysis, only T4 disease was predictive for decreasedoverall survival rate (p = 0.002). N-stage was not predictive of locoregional recurrences, distant metastasis, and overall survival.For patients with available HPV status, HPV status did not predict for overall survival.

Conclusions: Our data suggests that risk-stratified treatment results in excellent outcome in patients with locally advanced OPC.This should be investigated in prospective settings, particularly patients with T4 disease should be considered for sequentialchemotherapy.

Author Disclosure: R.R. Boutrus, None; J. Wang, None; L. Wirth, None; J. McIntyre, None; J.R. Clark, None; A.W. Chan, None.

2614 Phase I/II Study of SMART-IMRT Plus Chemotherapy in Locoregionally Advanced

Nasopharyngeal Cancer

T. Fan, J. Li, T. Liu

Shandong Tumor Hospital, Jinan, China

Purpose/Objective(s): To evaluate the efficacy, toxicity, and tolerability of simultaneous modulated accelerated radiation therapy(SMART) intensity modulated radiotherapy (IMRT) plus cisplatin and 5-FU chemotherapy for patients with advanced nasopharyngealcancer.

Materials/Methods: From 2006 Mar through 2009 Jan, 45 patients with American Joint Committee on Cancer stage II-IV naso-pharyngeal carcinoma were treated with prescribed doses of 72 Gy (2.2 Gy/day*30fractions, 2 Gy/day*3 fractions) to the gross tu-mor volume, 60 Gy (2 Gy/day*30 fractions) to the clinical target volume and metastatic nodal station, and 54 Gy (1.8Gy/day*30fractions) to the clinically negative neck region. Before radiotherapy two cycles of concurrent cisplatin (30 mg/m2 day on days