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i lé iè 0/ 4 Session plénière: 0/ 4 1 atelier de contourage 5 « Educational session » 2 « Poster discussion » 2 « Poster discussion » 2 « Scientific session » d’ORL purs 4 « scientific session » avec

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5 « Educational session »5 « Educational session »2 H d d k t ti ( 2 Head and neck presentations(cas clinique)

IMRT: Clinical updates in IMRT and pIGRT for Head and Neck cancer

Concurrent CT/RT and post op Concurrent CT/RT and post op radiotherapy for head and neck cancer

HPV: HPV cervical and head and neck HPV: HPV cervical and head and neck cancer

Poster(21 abstracts)Poster(21 abstracts) IMRT: Head and neck: target

delineation; normal tissue tolerance and outcomes after IMRT

TTT et pathologies rares: Head and neck particle therap rare t morsneck: particle therapy, rare tumors, pathology and MISC

Scientific session (16 abstracts) HPV: Finding the optimal therapeutic

ratio for oropharynx cancers in the Era of human papilloma virus

Prevention de la radiotoxicité: Strategies to preser e organ f nction after headto preserve organ function after head and neck radiotherapy

Scientific session (10 abstracts) Clinical trials(1 abstract) IMRT IGRT(1 abstract)( ) Novel approaches integrating targeted

biologics and imaging with radiotherapybiologics and imaging with radiotherapy (6 abstracts)

Treatment response monitoring and modeling (2 abstracts)

Scientific session clinical trialsScientific session clinical trials C it t Ci l ti d Concomitant Cisplatin and

Hyperfractionated Radiotherapy in Locally Advanced Head and Neck Cancer: Ten-Advanced Head and Neck Cancer: Tenyear Follow-up of a Randomized Phase III Trial (SAKK 10/94)

P Gh dj t lP. Ghadjar et al

224 patients 74,4 Gy fractionné en 1,2Gy deux fois par jour associé ou non au , y , y p j

CDDP 20mg/m² jour pendant 5 jours a S1 et S5

Augmentation de contrôle loco regional, survie sans recidive et survie specifique, sans augmentation de survie globale; pas d augmentationspecifique, sans augmentation de survie globale; pas d augmentation de toxicité

Une des seules phase 3 présentées phase 3

Poster discussion: Head and k t t d li tineck: target delineation;

normal tissue tolerance andnormal tissue tolerance and outcomes after IMRT Dose response of dysphagia in oropharynx cancer patients IMRT for oropharyngeal carcinoma: superior midline sparing with the clinical

implementation of biological based planning reduces dysphagia during definitive chemo radiationchemo radiation

Comparative study of IMRT Vs conventional radiotherapy with amifostine for preservation of parotid function in patients with head and neck cancer

Prospective clinical-dosimetric evaluation of normal tissue tolerance of the brachial plexus among patients treated by intensity modulated radiotherapy forbrachial plexus among patients treated by intensity modulated radiotherapy for head and neck cancer

Dose response relationships for lhermitte’s sign following chemoradiation for oropharyngeal cancer

Osteoradionecrosis and radiation dose to the mandiblein oropharyngeal cancerp y g Is conventional dose and fractionation required to prophylactically treat neck

lymphatics for head and neck cancer treated with IMRT Intensity modulated radiation therapy for oropharyngeal carcinoma: clinical

outcomes and longitudinal analysis of late effects IMRT combined with concurrent but not adjuvant chemotherapy in primary

nasopharyngeal cancer- outcome and long term toxicity

Comparative study of IMRT Vs conventional radiotherapy with amifostine for preservation py pof parotid function in patients with head and neck cancerneck cancer

Vyas et aly

Novembre 2008 a février 2009, 50 patients

Dose 66Gy en 33 séances Dose 66Gy en 33 séances Evaluation de la quantité de salive

I té êt d 2 t it t Intérêt des 2 traitements Avantage de l IMRT si on respecte g p

certaines doses mal spécifiées

Poster discussion: Head and neck: target delineation; normal tissue tolerance andnormal tissue tolerance and outcomes after IMRTou co es a e Mesure de la dose médiane sur les différents

muscles constricteurs en fonction de lamuscles constricteurs en fonction de la dysphagie; dose au constrictor inferieur<65 Gy

Avantage de l IMRT si on respecte certaines doses(3eme abstract) mais dose totale de 66 Gydoses(3eme abstract) mais dose totale de 66 Gy

Utilisation de la Dmax et V74 pour prédire la neuropathie plexiquep p q

Lésion de la moelle plus fréquente si plus grand volume de moelle a plus de 40GyP l dib l b ti d l V50 Pour la mandibule, observation de la V50 pour réduire l osteonecrose (med V50 a 31 Gy Vs 44Gy)

conclusionconclusion FAIRE de l’IMRT Moins de complicationp Meilleure distribution de dose

Poster discussion:Head and neck: particle therapy rare tumorsparticle therapy, rare tumors, pathology and MISCpat o ogy a d SC Evaluation of induction chemotherapy in patients undergoing concurrent chemo radiotherapy

for advanced laryngeal cancer Patient demographics and socio economic status on laryngeal cancer survival: a population Patient demographics and socio economic status on laryngeal cancer survival: a population

based study of 28715 patients Carbon ion radiotherapy for malignant head and neck tumors invading the skull base Should hypopharynx cancer continue to be inluded in multi head and neck trials within the

RTOGSki i f th h d d k ith i l i i Skin carcinoma of the head and neck with merineural invasion

AJCC/UICC staging system for nasopharyngeal carcinoma- changing from the 5th to the 7th edition and future improvement

Skin culture and treatment results in head and neck cancer patients with severe radiation dermatitis and potential suprainfection

Radiation therapy after chemoreduction in retinoblastoma and outcomes A comparison of definitive with postoperative proton beam therapy for locally advanced

sinonasal squamous cell carcinoma Seventy five percent of extrapharyngeal larynx respect the thyroid cartilage: a modern

clinicopahtologic review of 89 total laryngectomy specimens show new patterns of spreadclinicopahtologic review of 89 total laryngectomy specimens show new patterns of spread Basaloid squamous cell carcinoma is not an independent adverse prognostic factor in head

and neck cancer Photon IMRT adenoid cystic carcinoma with or without carbon ion boost: results in 116

patients from a single institution

Should hypopharynx cancer continue to be inluded in multi co t ue to be uded u thead and neck trials within the RTOGRTOG

Den et al Choix d une population avec tabagisme Choix d une population avec tabagisme

>10 ans Comparaison 108 hypopharynx avec Comparaison 108 hypopharynx avec

605 oropharynxRé lt t éj tif l Résultats péjoratifs pour les hypopharynx

Pronostics plus proche de celui des larynx

Traitement par induction?

Skin culture and treatment results in head and neck cancer patients withhead and neck cancer patients with severe radiation dermatitis and

t ti l i f tipotential suprainfectionGunn et alGunn et al

De 2007 a 2010; revue des mises en cultureculture

48 patients Staph chez 40 patients; 24 S aureus, 3

MR 29 traitements antibiotiques Conclusion: impossibilité de distinguer Conclusion: impossibilité de distinguer

infection de colonisation

A comparison of definitive with postoperative proton beam therapy for locally advanced p py ysinonasal squamous cell carcinoma

Wang et al

De 1991 a 2008; 62 patients De 1991 a 2008; 62 patients Carcinome sinusien localement avancé

43 hi t V 19 t hi i 43 chir + protons Vs 19 protons-chimio Autant de chimio ds les deux groupes(50%) Même taux de contrôle local a 2 ans: 80% Même survie globale(69 Vs 61%) a 2 ansg ( ) Tox grade 3: 17% Vs 0% NS Attente tox tardive Attente tox tardive

Poster discussion:Head and neck: particle therapy, rare

SCtumors, pathology and MISC

Essai indien: pas d apport de l induction ds le larynx avant p pp yARCC(mais pas de TPF)

Etude démographique Faisabilité des ions carbonesa sab té des o s ca bo es Hypopharynx a considéré plutôt comme des larynx que

des pharynx Invasion perineurale: mauvais pronostic Invasion perineurale: mauvais pronostic Pas de modification majeure de la nouvelle TNM du

cavum Importence de la culture bacterio en cas de doute si Importence de la culture bacterio en cas de doute si

infection epidermique Resultats equivalents pr les K sinusiens de chir Vs proto

therapie seule

ConclusionConclusion Pas de nouveauté

Scientific session Finding the optimal therapeutic ratio foroptimal therapeutic ratio for oropharynx cancers in the Era of p yhuman papilloma virus

Analysis of predictive factors of outcomes for patient with locally advanced unresectable pharyngeal squamous cell carcinoma treated with hyperfractionated twice dailypharyngeal squamous cell carcinoma treated with hyperfractionated twice daily radiotherapy +/- Cisplatin/FU

Survival and toxicity outcomes in base of tongue cancer treated with brachytherapy boost combined with 2D or IMRT: a ten year experience

Treatment of base of tongue cancer: conventional external beam radiotherapy alone Vs ea e o base o o gue ca ce co e o a e e a bea ad o e apy a o e sEBRT+brachy Vs IMRT

Treatment failure is uncommon in the modern era for squamous cell carcinoma of the tonsil treated with primary radiotherapy

Outcome of radiotherapy alone in HPV associated oropharyngeal cancerpy p y g CDDP and RT versus cetuximab and RT in the context of HPV and P16 in the treatment

of locally advanced head and neck cancer Outcomes of p16 positive oropharyngeal squamous cell carcinoma treated with post

operative adjuvant IMRT +/-chemotherapy Prognostic value of p16 expression in laryngeal cancer patients treated with radiation

Treatment of base of tongue cancer: conventional external beam radiotherapy alone Vs EBRT+brachy Vs IMRTVs IMRT

Setton et al 374 patients de 1985 a 2009 105 EBRT(70 Gy), 68 EBRT et boost en 105 EBRT(70 Gy), 68 EBRT et boost en

curie(54+25), 201 IMRT(70 Gy) Survie sans recidive a 5 ans: 85 89 93% Survie sans recidive a 5 ans: 85, 89, 93% Pas de difference significative en contrôle

local ou en survielocal ou en survie Xerostomie gr >2: 62%, 61%, 28% p=0,0003 Dysphagie gr 2: 30 11 17% significatif Dysphagie gr 2: 30, 11, 17% significatif

Scientific session Finding the optimal therapeutic ratio for oropharynxtherapeutic ratio for oropharynx cancers in the Era of human papilloma virus Facteur predictif pr les K pharyngés non operables traités par

ARCC bi frac: reponse objective a 6 mois et niveau median d EGFR, PSEGFR, PS

Base de langue: efficacité et faible morbidité de la curietherapie; pas de difference entre IMRT, EBRT et curie en terme d efficacitée cac té

2 articles de curiethérapie Meilleur pronostic des HPV+; interet de tester des desescalades

therapeutiquestherapeutiques Meme constat pour les patients p16+ (augmentation du contrôle

local par la radiotherapie)

ConclusionConclusion Interet des facteurs predictifs HPV et

p16 pour tenter une selection de patients et une desescalade de dose

Scientific session: Strategies to preserve organ function after head and neck radiotherapyhead and neck radiotherapy RTOG 0537 phase 2/3 study comparing acupuncture like transcutaneous

electrical nerve stimulation versus pilocarpine in treating early radiation induced xerostomia

Importance of sparing submandibular gland function to improve patient reported xerostomiaxerostomia

A phase 2 study of submandibular salivary gland transfer to the submental space prior to start of radiation treatment for prevention of radiation induced xerostomia in head and neck cancer patients

Predictors of xerostomia after head and neck IMRT: beyond the parotid glands Predictors of xerostomia after head and neck IMRT: beyond the parotid glands Isolation of human salivary gland stem cells from submandibular glands Phase 1 trial on adaptative dose painting by numbers for head and neck cancer:

what is the maximum tolerated dose? Predictors of worsening dysphagia following chemoradiation for oropharyngeal Predictors of worsening dysphagia following chemoradiation for oropharyngeal

cancer: results from a two years prospective longitudinal study Relationship between radiation treatment parameters and overall survival

following induction chemotherapy in a sequential regimen for locally advanced head and neck carcinoma

RTOG 0537 phase 2/3 study comparing acupuncture like transcutaneous electrical nerve pstimulation versus pilocarpine in treating early radiation induced xerostomia

Wong et al

Sept 2008 a oct 2009; 48 patientsSept 2008 a oct 2009; 48 patients

Acupuncture 24 seances; 38 patients

21% recevaient de la pilocarpine avant traitement

85 % de reduction de la xerostomie(amelioration de (35 % du score d impact sur la qualité de vie

A phase 2 study of submandibular salivary gland transfer to the submental space prior to start of radiation treatment for prevention of radiation pinduced xerostomia in head and neck cancer patients

Jha et alet al 49 patients

P d IMRT d th l d Pas d IMRT, pes d ethyol, pas de pilocarpine

26% de xerostomie aigue Technique faisable te reproductible Technique faisable te reproductible

Relationship between radiation treatment parameters and overall survival following induction h th i ti l i f l llchemotherapy in a sequential regimen for locally

advanced head and neck carcinomaSher et alSher et al

Essai TAX 324; phase3; 350 patients Analyse de l OS en fonction de la

radiothérapiep Univariée: type d induction, PS, site

primitif, T, N, durée de la radiothérapieprimitif, T, N, durée de la radiothérapie Multivariée: meme chose Apres 8 semaines de RT baisse de 4% Apres 8 semaines de RT, baisse de 4%

de l OS a chaque jour supplémentaire

Scientific session: Strategies to preserve organ functionto preserve organ function after head and neck radiotherapy Efficacité de l acupuncture; a tester en phase 3 Vs

pilocarpine Possibilité de translocation en submental des glandes Possibilité de translocation en submental des glandes

submandibulaires(reproductible en phase 2) Importance d epargner la cavité buccale saine dans la

xerostomiexerostomie Difficulté d isoler les cellules souches de glande

submandibulaire Confirmation de la superiorité de TPF Vs PF(TAX) Confirmation de la superiorité de TPF Vs PF(TAX)

ConclusionConclusion Différentes techniques en cours d etude

pour diminuer la xerostomie radio induite

Importance de la répartition de dose Importance de la répartition de dose

Scientific session: Treatment it i dresponse monitoring and

modelingmodeling Longitudinal monitoring of functional Longitudinal monitoring of functional

changes in irradiated head and neck t i ti l ttumors using optical spectroscopy

Prospective pharmacokinetic and diffusion IRM measurement of normaldiffusion IRM measurement of normal tissue response to head and neck IMRT

ConclusionConclusion Deux moyens en cours d etude pour

tenter d observer les reponses aux thérapeutiques

Scientific session: Novel approaches integrating targeted biologics and imaging with radiotherapyimaging with radiotherapy

Phase 2 study of concurrent and adjuvant Phase 2 study of concurrent and adjuvant chemotherapy with IMRT or 3DCT + bevacizumab for locally or regionally advanced y g ynasopharyngeal cancer RTOG 0615

Phase 1 trial of bevacizumab followed by concurrent radiation bevacizumab andconcurrent radiation, bevacizumab and cisplatin for locoregionally advanced SCC

Efficacity and toxicity of tyrosine kinase y y yinhibitor along with platinum based concurrent chemoirradiation in locally advanced squamous cell carcinoma of head and necksquamous cell carcinoma of head and neck

Efficacity and toxicity of tyrosine kinase inhibitor along with platinum based concurrent chemoirradiation in locally advanced squamous cell carcinoma of head and neck

Nandwani et lal

100 K ORL localement avancés exceptés 100 K ORL localement avancés exceptés cavum et sinus

RT 70 Gy RT 70 Gy RT + CDDP Vs RT + CDDP + gefitinib 250 mg OS: 56 Vs 68% OS: 56 Vs 68% PFS: 44 Vs 64% Pas de différence de toxicité de radiothérapie Pas de différence de toxicité de radiothérapie 20% d acne et 12% de diarrhée sous TKI

Scientific session: Novel approaches integrating targetedapproaches integrating targeted biologics and imaging with g g gradiotherapy

Pas d augmentation de saignement sous avastin

Avastin: semblerait efficace meme en Avastin: semblerait efficace meme en mono therapie

Gefitinib(iressa): 86% de reponse Gefitinib(iressa): 86% de reponse complete; augmentation de l acné

DONCDONC Pas de changement des pratiques IMRT= grand gagnantg g g Nouvelles molécules à

développer(avastin iressa)développer(avastin, iressa) Poursuite des investigations pour la

preservation salivaire