T.J. Carpenter

Tolerability, Toxicity, and Temporal Implications of Transoral Robotic Surgery (TORS) on Adjuvant Radiation Therapy in Carcinoma of the Head and Neck

Objectives: Overall treatment package time (from surgery to radiotherapy [RT] completion) > 100 days can portend poor outcomes in head and neck cancer. Faster postoperative recovery seen with transoral robotic surgery may decrease treatment duration and toxicity for adjuvant RT and chemoradiation. Methods: We retrospectively reviewed all patients treated with transoral robotic surgery (n = 124) and adjuvant RT and chemoradiation (n = 33) at our institution for head and neck cancer from April 2007 to December 2011 to determine treatment duration, acute toxicity, and long-term percutaneous gastric tube rates. Results: The median overall treatment time was 86 days and from surgery to RT start was 41 days; median RT duration was 44 days. No wound breakdown or infection occurred during or after RT. Two-year actuarial locoregional control, distant metastasis–free survival, and overall survival rates were 93%, 96%, and 97%, respectively. Conclusions: Adjuvant RT after transoral robotic surgery for head and neck cancer can be completed safely and in a timely fashion. Longer follow-up and a larger cohort will be needed to determine if this regimen is more effective than traditional surgery followed by adjuvant RT.

MP05-18 PROSTATE FIDUCIAL MARKER PLACEMENT IN PATIENTS WHILE ON ANTICOAGULATION: FEASIBILITY PRIOR TO PROSTATE SBRT

Objectives: Fiducial marker placement is required in patients undergoing robotic-based Stereotactic Body Radiotherapy (SBRT) for prostate cancer in order to track the six degrees of prostate motion that occur intrafractionally, during treatment. Many patients take anticoagulant medication due to other comorbidities. Anticoagulation therapy can cause patients to bleed during procedures and, in general practice, are often temporarily discontinued prior to invasive medical procedures to reduce that risk. However, some patients may not be able to temporarily discontinue anticoagulation therapy due to an increased risk of a thromboembolic event from their comorbid medical conditions. We looked at a series of our patients who were unable to discontinue anticoagulation therapy prior to fiducial marker placement and report on their outcomes to assess whether they experienced bleeding complications from the procedure. Methods: From August, 2015 to January, 2016, 16 consecutive patients on chronic anticoagulation therapy and who were not cleared to stop these medications underwent fiducial marker placement into the prostate for treatment and planning purposes. The most common indications for uninterrupted anticoagulation therapy in this cohort included: recent stent placement (6=number); myocardial infarction (6=number); pulmonary embolus (2=number); and atrial fibrillation (2=number.) Anticoagulation therapy included Aspirin (7=number); Plavix (5=number); Coumadin (3=number); Lovenox (2=number); Eliquis (1=number); Brillinta (1=number); Pradaxa (1=number); and Effient (1=number). 6 patients were on more than one of these agents at the time of fiducial marker placement. All patients had Emla cream placed on the perineum and lidocaine gel placed into the rectum prior to the procedure for numbing purposes. A transrectal ultrasound was placed for visualization of the prostate and normal anatomy as well as to provide real time image guidance of marker placement during the procedure. 2 needles with 2 fiducial markers and a spacer in each were placed transperineally into the prostate under ultrasound guidance using a brachytherapy grid. The needles were then removed after the fiducial markers were placed and gentle pressure was applied to the perineum by the nursing staff. All patients were monitored for bleeding afterwards by a registered nurse. Results: All 16 consecutive patients who were on anticoagulation and underwent fiducial marker placement were discharged home the same day of the procedure. No patient experienced significant bleeding. Conclusions: Transperineal fiducial marker placement in patients who are unable to Open Access Abstract