Proceedings of the 51st Annual ASTRO Meeting S433

region were significantly associated with the occurrence of oral ulcers. Then mean V50 in the 18 patients without oral ulcers was36%, while that of the 6 patients with oral ulcers was 55% (p = 0.06); the mean V60 was 18% and 39%, respectively (p = 0.02); themean V70 was 5% and 14%, respectively (p = 0.03); and the mean radiation dose to the oral region was 41 Gy and 49 Gy, respec-tively (p = 0.2).

Conclusions: The observed dose-volume-effects suggest that the V60 and V70 of the oral region should be reduced as much aspossible during the initial IMRT optimization to reduce the incidence of oral ulcers after treatment.

Author Disclosure: R. Yoshimura, None; Y. Kagami, None; Y. Ito, None; H. Okamoto, None; N. Murakami, None; M. Morota,None; H. Mayahara, None; M. Sumi, None; J. Itami, None.

2560 Sequential Intensity Modulation Radiation Therapy for Head and Neck Cancer: The Northwestern

University Experience

A. D. Bhate, N. S. Koneru, T. Thomas, J. A. Logemann, M. Gopalakrishnan, A. Rademaker, H. Pelzer, M. Agulnik, A. Mellott,B. B. Mittal

Northwestern University Memorial Hospital, Chicago, IL

Purpose/Objective(s): To review the Northwestern University experience with sequential intensity-modulated radiotherapy(IMRT) for the treatment of head and neck cancer.

Materials/Methods: From August 2002 to December 2008, 83 patients with head and neck cancer were treated with IMRT usinga sequential technique for curative intent. 13% of patients had Stage III disease and 74% had Stage IV disease. 8 patients receivedpostoperative radiation; 6 received radiation alone; 49 received radiation and chemotherapy; 20 received surgery, radiation andchemotherapy. Sites included were larynx (14), nasopharynx (7), oral cavity (5), oropharynx (45), hypopharynx (5) and unknownprimary (7). Toxicities were categorized into acute toxicity CTC, chronic worst toxicity RTOG and at last follow-up toxicityRTOG. Toxicities included skin, mucosa, dysphagia, salivary gland, mandible, larynx, pain and weight loss. Other variables in-cluded G-tube placement and esophageal stricture formation.

Results: The median follow-up was 14 months. The estimated 2 year local progression free survival, distant disease free survivaland overall tumor progression free survival was 91%, 85% and 82%, respectively. Acutely there was one Grade 4 mucositis and oneGrade 4 pain toxicity. There was no other acute or chronic Grade 4 or 5 toxicities. Acute Grade 3 toxicities included skin 43%,mucositis 75%, dysphagia 39%, salivary gland 1%, pain 1% and weight loss 10%. Grade 3 worst chronic toxicities includedskin 8%, dysphagia 18%, salivary gland 32% and weight loss 26%. Grade 3 last follow-up chronic toxicities included skin 8%,dysphagia 8%, salivary gland 13% and weight loss 18%. 17 of 83 patients (21%) had esophageal stricture of which 16 occurredprior to August 2006. We then started to reduce doses to the laryngo-pharyngeal-esophageal axis (LPEA) and since then only 1 of42 patients had a stricture. 48% of patients required a G-tube during radiation.

Conclusions: Currently in the US, IMRT using a Simultaneous Integrated Boost (SIB) technique to treat head and neck cancers ismost widely used. We have used a sequential technique in order to decrease hotspots and maintain a constant fraction size. Thesequential technique offers excellent tumor progression free survival with comparable toxicities to the published SIB technique.The treatment technique and dose volume histogram data on 24 normal structures contoured for each patient will be presentedand correlated to the toxicity. Reduced doses to the LPEA decreased the incidence of esophageal stricture. This data supportsthat IMRT using a sequential technique is an option for head and neck cancer treatment.

Author Disclosure: A.D. Bhate, None; N.S. Koneru, None; T. Thomas, None; J.A. Logemann, None; M. Gopalakrishnan, None; A.Rademaker, None; H. Pelzer, None; M. Agulnik, None; A. Mellott, None; B.B. Mittal, None.

2561 Accelerated Hypofractionated Radiation vs. Standard Fractionated Radiation Concurrent with

Cetuximab Chemotherapy in Locally Advanced Head and Neck Cancer (LAHNC)

S. L. Galper1, H. Deshpande2, M. G. Rose3, J. Colasanto4, R. Decker1

1Yale University School of Medicine, New Haven, CT, 2Yale Cancer Center, New Haven, CT, 3VA Cancer Center, West Haven,CT, 4St Francis Hospital, Hartford, CT

Purpose/Objective(s): Concurrent chemoradiation with cetuximab improves survival with acceptable toxicity in patients beingtreated for LAHNC. Accelerated fractionation has been shown to improve local-regional control (LRC), but is associated with in-creased toxicity. The purpose of this study is to compare our experience with accelerated hypofractionation with concurrent cetux-imab (HFRT) to standard fractionation with cetuximab (SFRT).

Materials/Methods: We reviewed the records for patients treated with curative chemoradiation therapy between January 2005 andDecember 2008. During that period, cetuximab concurrent chemoradiotherapy was administered in 14 patients whose age or co-morbidities precluded cisplatin-based chemotherapy. 8 received HFRT with greater than 2 Gy/day (median 2.2 Gy/day) and 6 re-ceived SFRT with 2 Gy/day. Patient charts and Tumor Registry data were reviewed for acute and late toxicity, which were scoredby RTOG criteria, and for local/regional failure (LRF), distant metastases and death.

Results: The cohorts were balanced for age (median age 71 vs. 66, p = 0.18) and AJCC stage. The hypofractionated cohorthad more oropharynx primaries (25% vs. 0%) and fewer larynx/hypopharynx primaries (38% vs. 50%). 2 patients in eachgroup received postoperative radiation instead of definitive radiation. Median follow-up times for the HFRT and SFRTcohorts were 10 and 16 months, respectively (p = 0.08). Overall treatment time in the HFRT cohort patients was shorter(45 days vs. 52 days, p = 0.002). Acneiform rash was reported in 50% and 67% of the HFRT and SFRT cohorts, respec-tively. Average weight loss was similar, 13lbs in the HFRT cohort and 10 lb in the SFRT cohort (p = NS). Grade 3 acutetoxicity was observed in 3/8 patients in HFRT arm, and 3/6 patients in SFRT arm (p = NS). No Grade 4 or greater acutetoxicities occurred in either arm. No Grade 3 or greater late toxicities were reported in either cohort. There was no sig-nificant difference in 2 year LRC (36% and 40%) or 2 year overall survival (80% in the HFRT cohort and 75% in theSFRT cohort).

S434 I. J. Radiation Oncology d Biology d Physics Volume 75, Number 3, Supplement, 2009

Conclusions: In this small series, HFRT with concurrent cetuximab was well-tolerated and not significantly more toxic than SFRTwith cetuximab. Given the known improvement in LRC with accelerated fractionation, HFRT concurrent with cetuximab repre-sents a reasonable treatment strategy.

Author Disclosure: S.L. Galper, None; H. Deshpande, None; M.G. Rose, None; J. Colasanto, None; R. Decker, None.

2562 Organ Preservation using HDR Brachytherapy for Locally Advanced Head and Neck Cancers: A Single

Center Experience

M. Duclos1, A. Al-Hamad1, H. Al-Halabi1, A. Alsuhaibani1, K. Kost1, A. Zeitouni1, M. Hier2, G. Shenouda1, M. Black2

1Montreal General Hospital, Montreal, Qc, Canada, 2jewish General Hospital, Montreal, Qc, Canada

Purpose/Objective(s): Head and neck cancer treatment is challenging. The ultimate goal is to offer loco-regional control with theminimal long-term toxicity. HDR brachytherapy as a boost or single treatment modality can be used in a primary setting or as a sal-vage modality treatment.

Materials/Methods: Between June 1994 and December 2006, 71 patients underwent conservative surgery followed by HDR bra-chytherapy treatment as part of their initial treatment. The dose varies from 30–36 Gy/10–12 fx BID, for solo adjuvant treatment, to15–21 Gy/5–7 tx BID for a boost. The oral cavity represent 77% of our patients (55): oral tongue (35), floor of mouth (11) andgingiva (9). The remaining patients presented with base of tongue primary (16). 44 patients received HDR brachytherapy as a boost(13) or single modality adjuvant treatment (31). 27 were treated in a salvage manner either as a boost (6) or single treatment (21).The TNM staging revealed that 28.2% were Stage 2, 64.7% Stage 3 and 7% Stage 4. Chemotherapy was given in all patients withbase of tongue primaries.

Results: With a median follow-up of 48 months (24 to 120) and a median age of 67 years, 5 patients died (2 from disease pro-gression). The overall local control rate was 60.5%: 70.5% for patients treated as part of their primary treatment and 40.7% in re-current setting. 5.6% developed acute toxicity. 29.6% developed G1–2 and 7.1% G3 late toxicity.

Conclusions: Treatment of head and neck cancer implies a multidisciplinary approach. Adjuvant HDR brachytherapy increase thelocal control with minimal toxicity.

Author Disclosure: M. Duclos, None; A. Al-Hamad, None; H. Al-Halabi, None; A. Alsuhaibani, None; K. Kost, None; A. Zeitouni,None; M. Hier, None; G. Shenouda, None; M. Black, None.

2563 Results of Radiotherapy for Esthesioneuroblastoma: Is Elective Nodal Irradiation Warranted?

O. Noh, S. Yoon, S. Kim, B. Lee, C. Kim, K. Jo, E. Choi, J. Kim, S. Ahn, S. Lee, et al.

Asan Medical Center, Seoul, Republic of Korea

Purpose/Objective(s): The role of elective nodal irradiation (ENI) in radiotherapy for esthesioneuroblastoma (ENB) is not clearlydefined. In our institution, ENI has not been performed routinely in radiotherapy (RT) of ENB. We analyzed the treatment outcomeof the ENB and the rate of the cervical nodal failure in the absence of the ENI.

Materials/Methods: Between August 1996 and December 2007, 19 patients with ENB were consulted for RT. Fourteen patients(74%) were male and median age was 40 years (range, 5–70). The modified Kadish Stage was A in 1, B in 4, C in 6, and D in 8.Initial treatment included surgery alone in 3, surgery and postoperative RT in 4, surgery and adjuvant chemotherapy in 1, surgery,postoperative RT and chemotherapy in 3, chemotherapy followed by RT or CCRT in 5. Three patients did not receive the plannedtreatment due to disease progression. Including 2 patients with salvage RT, 14 patients received radiotherapy. ENI was performedin 4 patients in high-risk patients. Of theses, 3 patients had cervical lymph node metastasis at presentation.

Results: Fourteen patients were analyzable and median follow-up time was 24 months (range, 7–64). Overall survival rate at 3 yearwas 64.9%. Local failure was shown in 3 (21%), regional cervical failure in 3 (21%) and distant failure in 2 (14%). No cervicalfailure occurred in patients with combined chemotherapy regardless of ENI. Three cervical failures occurred in 4 patients withENI or neck dissection (75%) and all these patients did not received combined chemotherapy.

Conclusions: Elective nodal irradiation in RT for ENB seems to be ineffective to prevent cervical failure in patients treated withchemotherapy combined multimodality therapy.

Author Disclosure: O. Noh, None; S. Yoon, None; S. Kim, None; B. Lee, None; C. Kim, None; K. Jo, None; E. Choi, None; J. Kim,None; S. Ahn, None; S. Lee, None.

2564 A Century of Total Body Irradiation (TBI)

C. A. Barker, A. Rimner, J. Yahalom

Memorial Sloan-Kettering Cancer Center, New York, NY

Purpose/Objective(s): To review the world literature and experience with TBI over the last century, summarizing major contri-butions, advances and controversies involving the technique.

Materials/Methods: The ISI Web of Knowledge electronic database was searched for the terms ‘‘total body irradiation’’ or‘‘whole body irradiation.’’ Bibliographic references from the oldest and most highly cited studies were used to create a timelinedetailing the development of the technique over the last 100 years.

Results: The literature search revealed 16,636 studies. In 1905, Friedrich Dessauer first described TBI using 3 simultaneously ac-tive low voltage X-ray sources to treat a supine patient, and later that year, Aladar Elfer reported the first clinical data using thetechnique. In 1925, Werner Teschendorf began a TBI program in Cologne for the treatment of lymphoid and hematopoietic