M. Conson

Predictors of Hypothyroidism in Hodgkin Lymphoma Survivors after Intensity-Modulated versus 3-Dimensional Radiation Therapy

PURPOSEnTo identify predictors of hypothyroidism after chemoradiation therapy for Hodgkin lymphoma (HL) and to compare outcomes after intensity modulated radiation therapy (IMRT) with those after 3-dimensional (3D) conformal radiation therapy (CRT).nnnMETHODS AND MATERIALSnNinety patients who underwent involved-site IMRT in 2009 through 2014 were evaluated for treatment-induced hypothyroidism, defined as elevated thyroid-stimulating hormone or decreased free thyroxine levels (or both). Receiver operating characteristic curve analysis identified individuals at low versus high risk based on dosimetric variables. Dosimetric cutoff points were verified with an external data set of 50 patients who underwent 3D-CRT.nnnRESULTSnIn the IMRT group, most patients (75 [83%]) had stage II HL, and the median prescribed dose was 30.6xa0Gy; in the 3D-CRT group, 32 patients (64%) had stage II HL, and the median prescribed dose was 32.0xa0Gy. No differences were found in the proportions of patients with bilateral (Pxa0=xa0.982) or unilateral (Pxa0=xa0.074) neck involvement between the 2 groups.xa0Hypothyroidism rates were marginally higher in the IMRT group, with estimated 3-year rates of freedom from hypothyroidism of 56.1% in the 3D-CRT group and 40% in the IMRT group (Pxa0=xa0.057). Univariate analysis showed that smaller thyroid volume and higher thyroid dose were associated with hypothyroidism in both groups (Pxa0<xa0.05). In the IMRT group, the percentage of the thyroid gland volume receiving ≥25xa0Gy (V25) and the absolute volume of the thyroid gland spared from 25xa0Gy (VS25Gy) were the strongest predictors of hypothyroidism (Pxa0=xa0.001 and Pxa0<xa0.001, respectively).xa0Cutoff points of 63.5% (V25) and 2.2xa0mL (VS25Gy) classified patients as high risk (80%-82%) or low risk (37%-44%) (Pxa0<xa0.001). Use of a thyroid avoidance structure reduced the incidence of hypothyroidism (Pxa0<xa0.05) in the IMRT group.nnnCONCLUSIONSnThe percentage of the thyroid receiving 25xa0Gy and the volume of the thyroid spared from 25xa0Gy predicted the risk of hypothyroidism after either IMRT or 3D-CRT for HL. IMRT may confer a higher risk than 3D-CRT unless a treatment avoidance structure is used during planning.

Locally advanced paranasal sinus carcinoma: A study of 30 patients

Sinonasal carcinomas (SNcs) are rare neoplasms arising from the paranasal sinuses and nasal cavity. Although these tumours have a heterogeneous histology, they are commonly diagnosed as a locally advanced disease and are associated with a poor prognosis. The present retrospective study reviewed 30 patients with locally advanced SNc, who were treated with surgery followed by chemoradiotherapy or radiotherapy, or radiotherapy with or without concomitant chemotherapy between January 1999 and January 2013 at the Department of Radiation Therapy, University of Naples Federico II (Naples, Italy). A total of 19 patients were treated with upfront surgery followed by adjuvant radio- or chemoradiotherapy (group A), while the remaining 11 patients received exclusive radiotherapy with or without concomitant chemotherapy (group B). Concurrent cisplatin-based chemotherapy (100 mg/m2, days 1, 22 and 43 for 3 cycles) was administered to 34% of patients in group A and 55% of patients in group B. At a median follow-up of 31 months, 33.3% of patients were alive. Cause-specific survival (CSS) and progression-free survival (PFS) times were 32 and 12 months, respectively. No difference in CSS rate was observed between the two treatment groups. Univariate analysis determined that disease stage was the only factor that significantly affected CSS (P=0.002) and PFS (P=0.0001) rates. Acute and chronic toxicities were mild, with only 23.3% of patients reporting G1-2 side effects and no treatment-related blindness. The present study reported moderate activity and efficacy of surgery followed by adjuvant radio- or chemoradiotherapy, and exclusive radiotherapy with or without chemotherapy in this poor prognosis category of patients.

Optimal multidisciplinary treatment of oral cavity mucosal melanoma: Outcome analysis in a case series

Oral cavity mucosal melanomas (OCMM) represent only 3% of all malignant melanomas. Surgery is the mainstay of treatments and it is often followed by adjuvant radiotherapy. The role of adjuvant immunotherapy and/or chemotherapy is still debated and to date neither treatment is routinely used. From January 1990 to January 2010, we have collected from our database data of 20 patients with a histologically proven diagnosis of OCMM. Upfront surgery, followed by adjuvant radiotherapy was performed in 16/20 (80%) patients. Immunohistochemical analysis was carried out on all tissue samples and the following markers were assessed: Ki-67, HMG-45, Melan-A, S-100, CD31, CD35, CD20, CD21, and CD3. Although Ki-67, HMG-45, Melan-A, and S-100 were assessed in tumor cells, the analysis of CD31, CD21, CD20, CD3, and CD35 was carried out on the tumor-infiltrating lymphocytes. Patient outcome was analyzed and associated with clinical and Immunohistochemical tumor characteristics. The median overall survival (OS) was 12 months, with a 2-year OS rate of 30%. The median progression-free survival (PFS) was 9 months, with a 2-year PFS rate of 25%. Grade of lymphocyte infiltration (CD20 and CD3 expression) correlated strongly with prognosis. Interestingly, overexpression of CD21 along with downregulation of CD31 was significantly associated with better OS and PFS, whereas the reversal features correlated with a poor prognosis. Our report shows that patients affected by OCMM have a poor prognosis despite the administration of multimodal treatments. Moreover, our analysis suggests that the evaluation of several biomarkers, especially in tumor-infiltrating lymphocytes, may identify categories of patients with distinct immune response against the tumor and possibly different treatment response and prognosis.

EP-1375: Non linear response of TLD-100 irradiated by an Intra Operative Radiation Therapy accelerator

EP-1375 Non linear response of TLD-100 irradiated by an Intra Operative Radiation Therapy accelerator V. DAvino, F. Savino, M. Conson, M. Pugliese, R. Pacelli, L. Cella, R. Liuzzi Institute of Biostructure and Bioimaging, National Council of Research (CNR), Naples, Italy Federico II University School of Medicine, Department of Advanced Biomedical Sciences, Naples, Italy Federico II University, Department of Physics, Naples, Italy