Purpose/Objective(s) Patients with advanced head and neck cancers (HNC) that present with resectable disease but are not candidates for post-operative external beam radiation pose a unique challenge. Reasons for ineligibility may include poor-performance status, prior-radiation therapy, or patient choice. We report an interim report of toxicity and outcomes of our institutional prospective study using Cesium-131 (Cs-131) brachytherapy at the time of surgery. Materials/Methods This is an IRB approved prospective single arm study. Eligibility includes operable advanced HNC needing post-operative external beam radiation (EBRT). Reasons for deciding against EBRT post-operatively included prior full course RT, patient choice, and performance status. Surgery includes gross total resection followed by Cs-131 implantation of the tumor bed, seeds 1 cm apart. Immediate reconstruction was performed if necessary. All patients were evaluated every 2-4 months for the first 12 months, followed by evaluation every 3-6 months. Recurrence was evaluated by clinical examination, contrast CT and/or FDG-PET. Toxicity was assessed using CTCAE v.5 criteria. Survival estimates were performed using the Kaplan-Meier method. Local control was defined as no recurrence within 0.5cm of the implant site. Results Eleven patients have been accrued till date in this study. Median age is 73 (Range 60-95). There were 3 females (27%) and 8 males (73%). Primary tumor sites are 7 (63%) oral cavity, 2 (18%) oropharynx, 1 larynx and 1 salivary gland. Nine patients had Cs-131 neck implant while 2 patients primary site implanted. Median prescription dose was 80Gy (Range:70-80Gy). Six patients had prior RT to the implanted site. Seven (63%) patients were treated for recurrent disease. With a median follow-up of 8 months (Range 1-19),11/11 (100%) patients had local control at the implanted site, 4/7 (37%) patients developed regional recurrence, 2 patients developed distant recurrence. At the last follow-up 8/11 (72%) are alive. There were four patients with grade 2 toxicity including abscess formation, flap dehiscence, skin breakdown, fistula (not ascribed to seeds) all of which were managed conservatively, and fistula was repaired. One patient had a short follow up of 3 months and was reported to have expired although the cause could not be ascertained. Conclusion This is an interim report of a prospective study using Cs-131 in HNC that were not candidates for curative post-operative EBRT. The high local control rates and limited toxicity are encouraging. We continue to accrue patients in this study and will report longer term outcomes of this prospective study soon.

Purpose/Objective(s) Radiotherapy (RT) is a mainstay of management of head and neck cancer (HNC) but is associated with high rates of severe toxicity. Currently there is a lack of objective criteria that can predict premature RT termination or delayed RT treatment completion. This study aims to evaluate objective criteria that can be used to identify patients who are less likely to tolerate an extended course of RT treatment. Materials/Methods A RT completion scoring system was developed based on patient characteristics (Table 1), which was used to assign patients with a total score. For validation of the scoring, patients with HNC treated with curative intent with RT at our tertiary care center from 2017 to 2023 were reviewed from a large departmental database (IRB approved). Patients were included if they had a diagnosis of primary HNC and were prescribed curative RT, either as primary treatment or post-operatively. Individual variables were scored and a total score was calculated for each patient. Early termination (ET) was defined as any non-completion of full radiation course. Prolonged treatment (PT) was defined as any radiation course >50 days. Chi-squares test / Fisher's exact test was used for categorical data. Univariable logistic regression was used for continuous data. Significance level was 0.05 for all tests unless otherwise specified. Data analysis was performed using SAS Version 9.4. Results Of 301 patients included, 182 (60%) were male and 119 (40%) were female. Median age was 66.9 years (range 20.3-96.0 years). 267 (89%) were treated with IMRT and 34 (11%) with SBRT. 150 (50%) had primary cancer in the oral cavity, 53 (18%) in the salivary glands, 45 (14%) in the oropharynx, 53 (18%) in the nasal cavity, sinuses, nasopharynx, larynx, hypopharynx and thyroid. 40 patients (13.3%) had PT and 14 (4.7%) had ET. For each unit increase in total score, there was significant increased risk of ET/PT (p value 0.002; odds ratio 1.17, 95% CI = 1.06-1.28). On multivariable analysis considering these covariates, patients with ECOG score 2-4 had higher risk of ET/PT than patients with ECOG score of 0-1 (odds ratio 3.63, 95% CI = 1.74-7.54, p value <0.001). Patients receiving >30 fractions had higher risk of ET/PT than those receiving <5 fractions (odds ratio 5.60, 95% CI = 1.09-28.71, p value = 0.039). Patients receiving concurrent chemotherapy had higher risk of ET/PT than patients receiving no systemic therapy (odds ratio 2.16, 95% CI = 1.08-4.34, p value = 0.030). Conclusion This novel radiation treatment score predicted ET/PT in RT treatment of HNC. Total score, ECOG score, total fractions and associated therapy were significantly associated with ET/PT. We plan to validate this score prospectively in patients with HNC being treated with RT.

SBRT provided comparable control and grade > / = 3 toxicity in the oropharynx and oral cavity, with numerically superior control in the oropharynx. No clear relationships were shown between volume of disease, mucosal surface radiation doses, retreatment, control and toxicity, though this analysis is limited by our sample size.

Survivors of head-and-neck cancers (HNC) grapple with long-term effects of treatment that impact their quality of life. Patient-reported outcome (PRO) measurement has been shown to improve clinical management and disease outcomes. We created a mobile application, LogPAL, where HNC survivors can track their symptoms, access educational tips, and find support services. The purpose of this pilot study was to test the usability and feasibility of LogPAL for PRO measurement among HNC survivors repeatedly over an eight week period. We hypothesized that the engaging application design would lead to successful data collection.

Purpose Management of head and neck cancers (HNC) in older adults is a common but challenging clinical scenario. We assess the impact of Stereotactic Body Radiation Therapy (SBRT) on survival utilizing the Geriatric-8 (G8) questionnaire. Materials and methods 171 HNC patients, deemed medically unfit for definitive treatment, were treated with SBRT ± systemic therapy. G8 questionnaires were collected at baseline, at 4–6 weeks, and at 2–3 months post-treatment. Patients were stratified according to their baseline G8 score: <11 as 'vulnerable', 11–14 as 'intermediate', and >14 as 'fit'. Overall survival (OS) was assessed through univariate Kaplan Meier analysis. Repeated measures ANOVA was used to determine if baseline characteristics affected G8 score changes. Results Median follow-up was seventeen months. 60% of patients presented with recurrent HNC, 30% with untreated HNC primaries, and 10% with metastatic non-HNC primaries. Median age was 75 years. Median Charlson Comorbidity Index score was 2. 51% of patients were 'vulnerable', 37% were 'intermediate', and 12% were 'fit' at baseline, with median survival of 13.2, 24.3, and 41.0 months, respectively (p = .004). Patients who saw a decrease in their follow-up G8 score (n = 69) had significantly lower survival than patients who had stable or increased follow-up G8 scores (n = 102), with median survival of 8.6 vs 36.0 months (p < .001). Conclusion The G8 questionnaire may be a useful tool in upfront treatment decision-making to predict prognosis and prevent older patients from receiving inappropriate anti-cancer treatment. Decline in follow-up G8 scores may also predict worse survival and aid in goals of care following treatment.

Tobacco use is the most significant risk factor associated with oral cavity squamous cell carcinoma (OCSCC). However, there is a subset of OCSCC that occurs in non-smokers (NS) for unclear reasons. We retrospectively described a population of NS with OCSCC to report overall survival (OS) and factors associated with tumor recurrence after initial surgery.

Adenoid cystic carcinoma (ACC) is a rare tumor, with variable growth pattern and propensity for distant metastasis. Factors affecting prognosis are under-studied. In this retrospective study, we describe a population of ACC patients (pts) treated at our institution and identify factors associated with survival.

Osteoradionecrosis (ORN) is a debilitating complication of chemoradiation therapy for head and neck cancer. ORN is difficult to differentiate from recurrent or progressive cancer, as they may share clinical and imaging characteristics. It is crucial, however, to distinguish between these two conditions, because management is quite different and outcomes depend on timely intervention. We performed a retrospective chart review with the goal of identifying potential clinical and radiological factors helpful in differentiating ORN from recurrent cancer. This retrospective case series examined 10 patients (pts) treated for oral squamous cell carcinoma in the last 2 years who were clinically suspected to have ORN based on physical exam, CT and/or PET imaging. Clinical details, tobacco and alcohol history, cumulative dose of radiation, chemotherapy, radiological appearance, histopathology, final diagnosis, treatment received and outcome were collected. Of the 10 patients, 9 had locally advanced disease at presentation. Six pts were male, and 4 female. Median age was 66 years (range 22-90). Five were ultimately diagnosed with ORN (cohort A) and the rest had progressive/recurrent disease (cohort B). In both cohorts, 3 pts had mandibular involvement, and 2 maxillary. Predominant symptoms were trismus (2 pts each in A and B), oral pain (4 pts each in A and B), spontaneous teeth loss (1 pt each in A and B), and exposed bone or fistula formation (2 pts each in A and B). Median cumulative radiation dose was 6000 cGy in cohort A and 6600 cGy in cohort B. The radiation technique (SBRT, IMRT) did not appear to be associated with either outcome. Time interval between RT and suspicion of ORN was longer in cohort A (13.8 months vs. 7 months). Radiologic features were also similar in cohort A and B, with soft tissue thickening and enhancement being seen in the majority of both ORN and cancer cases. Sclerosis was noted in 1 pt in A, and 2 pts in B. Median Standardized uptake value in the bone suspected to have ORN was 6.95 in cohort A and 6.3 in cohort B. Two pts in cohort B had initial biopsies that were negative for malignancy, but were positive on subsequent biopsies. All 5 pts with ORN are alive with stable or improving clinical status but all 5 pts with recurrent cancer have expired. ORN and recurrent cancer share common clinical and radiologic features. ORN symptoms occurring within a year of completion of radiation should prompt additional work up to rule out recurrence. While biopsy demonstrating malignancy can clearly help differentiate between the 2, a negative result does not rule out recurrence due to sampling issues. Repeated biopsies should be considered in pts who fail to improve with supportive care. It should be noted however that pts can have concurrent ORN and cancer and prioritization of management should be based on a discussion amongst multidisciplinary teams.