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Copenhagen, Denmark
Onsite/Online

ESTRO 2022

Session Item

Sunday
May 08
14:15 - 15:15
Mini-Oral Theatre 2
12: Head and neck
Hanene OUESLATI MAHJOUBI, France;
Johannes Kaanders, The Netherlands
Mini-Oral
Clinical
Risk of acute mucositis following an increase in high dose CTV1 in HNSCC patients
Ruta Zukauskaite, Denmark
MO-0480

Abstract

Risk of acute mucositis following an increase in high dose CTV1 in HNSCC patients
Authors:

Ruta Zukauskaite1,2, Jesper Grau Eriksen3,4, Elo Andersen5, Jorgen Johansen1, Eva Samsøe5,6, Simon Long Krogh7, Jens Overgaard4, Cai Grau3,8, Christian Rønn Hansen8,9,10

1Odense University Hospital, Department of Oncology, Odense, Denmark; 2University of Southern Denmark, Odense, Department of Clinical Research, Odense , Denmark; 3Aarhus University Hospital, Department of Oncology, Aarhus, Denmark; 4Aarhus University Hospital, Department of Experimental Clinical Oncology, Aarhus, Denmark; 5Copenhagen University Hospital Herlev, Department of Oncology, Copenhagen, Denmark; 6Zealand University Hospital, Department of Oncology, Naestved, Denmark; 7Odense University Hospital, Laboratory of Radiation Physics, Odense , Denmark; 8Aarhus University Hospital, Danish Centre for Particle Therapy, Aarhus, Denmark; 9University of Southern Denmark, Department of Clinical Research, Odense , Denmark; 10Laboratory of Radiation Physics, Odense University Hospital, Odense , Denmark

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Purpose or Objective

Radiotherapy (RT) in the head and neck region bears a risk of adverse effects due to often relatively large treatment volumes in a narrow anatomical region. According to the latest DAHANCA RT guidelines, there are at least 24 organs at risk that can be considered during RT planning because of a risk for toxicities. The current study aimed to investigate if the high dose clinical target volumes (CTV1) and planning target volume (PTV1) affected the risk and severity of acute mucositis (AM) for patients treated for head and neck squamous cell carcinomas (HNSCC) at three centres.   

Material and Methods

The cohort consisted of patients treated for squamous cell carcinomas of the oropharynx, hypopharynx, and larynx (except T1 glottis) according to DAHANCA radiotherapy guidelines using accelerated (66-68 Gy/33-34fx, 6 fx/week) or hyperfractionated (76-78 Gy/56-fx, 10 fx/week) RT ± systemic treatment and/or radiosensitiser in three DAHANCA centres between 2010 and 2015. Mucosal reactions were scored weekly during RT, as well as 2 weeks after RT as 0: none, 1: erythema, 2: patchy mucositis, 3: confluent mucositis, 4: ulceration. The highest observed score was used as the endpoint. Acute mucositis dependence was tested using ordinal logistic regression analysis, hence, all grades of AM were used. Predictors available for the model were: sex (male/female), age, smoking status (never/former/current/missing), primary tumour site (oropharynx/ hypopharynx/larynx), stage (1-2/3-4), systemic treatment (+/-), RT dose (66,68/76,78 Gy), radiosensitiser (+/-), and CTV1 volume (cm3) as continuous variable. The analysis was also performed with the same parameters where CTV1 was replaced by PTV1. Parameter selection was done through backward selection.

Results

A total of 1,623 patients received treatment. The median CTV1 volume was 55 cm3 (IQR 34-92 cm3) ; and PTV1 - 120 cm3 (IQR 79-186 cm3). Twenty-one patients had no AM recorded, and the majority (n=1,479 (91.2%)) had grade 2 or 3 AM. Statistically significant factors related to acute mucositis were: CTV1 (OR 1.003 per cm3 [95%CI 1.001-1.005]), female (OR 1.5[1.1-2.0]), oropharyngeal cancers (OR 3.0[2.3-4.0]), higher RT doses (OR 2.5 [1.6-4.0] and the use of systemic therapy (OR 1.4 [1.1-1.8] (Figure). Age, smoking status, stage, and radiosensitiser were not found to influence the risk of AM. A very similar result was found when CTV1 volume was substituted with PTV1.



Conclusion

AM is directly dependant on the CTV1 target volume. An increase in high dose radiotherapy treatment volumes for HNSCC patients will result in an increased risk of acute mucositis.