E368
28.6%  14.6%, 26.6%  17.1%, 12.3%  11.3% and 40.6%  12.4%,
38.9%  14.9%, 16.3%  14.3%, respectively. For the parotid and SMG, the
volume loss per treatment day decreased from 1.7%, 1.6% in the first week to
0.5%, 0.6% in the last week, and that of thyroid was of 0.4% - 0.5% after the
2nd week. The center of mass displacement of parotid gland shifted medially
2.0 mm - 2.6 mm, SMG and thyroid did medially 0.1 mm - 0.5 mm. In
addition, the displacement in anterior-posterior and cranial-caudal direction
were < 0.6 mm. The 3-demensional vector displacements of the parotid and
SMG were 2.2 mm e 2.9 mm and that of thyroid were 4.0 mm - 4.3 mm. The
DSCs of parotid, SMG and thyroid showed the decreased time-trend. For the
parotid, SMG, thyroid, the SD of SPDs increased from 1.5 mm e 1.8 mm in
the first week to 2.1 mm e 2.5 mm. The variations among the different weeks
were statistically different (P < 0.05) and there was no difference between
the left- and right-sided OARs (P> 0.05).
Conclusion: For NPC, the volume, position and shape of parotid, SMG,
thyroid occurred in quantifiable variations and these geometrical changes
have their time-trend, which suggests the necessity of re-planning for the
further sparing of OAR further during IMRT.
Author Disclosure: W. Tan: None. X. Li: None. R. Xu: None. X. Wang:
None. Y. Li: None. D. HU: None.
2907
Reirradiation for Recurrent Nasopharyngeal Carcinoma: Outcomes
and Complications
Y. LI, Y.L. Soong, M.L.K. Chua, T.W.K. Tan, J. Wee, and K.W. Fong;
National Cancer Centre Singapore, Singapore
Purpose/Objective(s): Patients with recurrent nasopharyngeal carcinoma
(NPC) often have a poor prognosis due to limited treatment options.
Reirradiation can be used for salvage treatment, but it is also limited by the
extent of disease at recurrence and treatment-related toxicities. Highly
conformal radiation therapy techniques, including: Intensity-modulated
radiation therapy (IMRT), a 3DCRT and IMRT system and Volumetric-
modulated arc therapy (VMAT), could improve the therapeutic ratio by
reducing the dose to normal tissue. Here, we review our institutional
experience in the management of previously irradiated recurrent NPC.
Materials/Methods: From January 2002 to December 2013, 111 patients
with pathologically proven local-regional recurrent NPC were reirradiated
using IMRT (n Z 98), 3DCRT and IMRT system (n Z 11), or VMAT (n
Z 2). 92 patients received primary radiation therapy or chemoradiation, 19
patients were treated as adjuvant (n Z 6) or salvage radiation therapy (n Z
13) after upfront curative intent surgery. Median dose was 66Gy (range 48-
70) and median volume of rGTV was 31.5 cm3 (range 0.97-158.59). Four
patients received fractionated stereotactic radiation (6Gy x8 or 8Gyx6),
whereas the mean dose per fraction for the rest was 2.08(range 1.88-2.75).
Concomitant chemotherapy was given to 51 patients (45.9%).
Results: With a median follow-up of 37.3 months, 3- and 5- year overall
survival, local regional control rates, local regional recurrence free survival
were 54.6%, 64.5%, 35.3% and 30.7%, 53.5%, 21.0%, respectively. Time
between radiation treatments and use of concomitant chemotherapy were
not associated with OS or local control. Patients treated for rT3-rT4 dis-
ease had a significantly worse overall survival and local regional recur-
rence free survival than rT1-rT2. (3-year overall survival 42.4% Vs 68.6%,
P Z 0.001; 3- year local regional recurrence free survival 21.2% Vs
52.2%, P Z 0.002). Higher 3-year OS was significant in patients with the
volume of rGTV < 40 cm3 than those with rGTV > 40 cm3 (75.5% versus
26.2%, P < 0.01). Patients less than 55 years old had better overall survival
than those above 55 (3-year overall survival 61.9% Vs 42.5%, P Z 0.043).
73 patients (66.4%) had at least one grade 3 and above late toxicity
following treatment. The common toxicities included cranial neuropathy
(34.2%, n Z 38), hearing impairment (33.3%, n Z 37), tube feeding
(26.2%, n Z 29) and radiological temporal lobe necrosis (18.9%, n Z 21).
Eight treatment-related deaths were observed, five (4.5%) were due to
severe epistaxis and three (2.7%) were secondary to carotid blowout.
Conclusion: Reirradiation for recurrent NPC resulted in promising survival
and local control outcomes in select patients. However, treatment related
toxicity is still significant even with the improvements of radiation
International Journal of Radiation Oncology  Biology  Physics
techniques. Further investigations on optimizing treatment strategies, are
warranted for advanced recurrent disease to improve survival and mini-
mize late toxicity.
Author Disclosure: Y. LI: None. Y. Soong: None. M. Chua: None. T.W.
Tan: None. J. Wee: None. K. Fong: None.
2908
Irradiation for Regionally Only Recurrent, Never-Irradiated Oral
Cavity Cancers
B.H. Lok, X. Cai, N. Riaz, J.E. Leeman, C.J. Tsai, S.M. McBride,
D.S. Higginson, S.S. Baxi, E.J. Sherman, B.R. Roman, R.J. Wong,
and N. Lee; Memorial Sloan Kettering Cancer Center, New York, NY
Purpose/Objective(s): The outcomes of patients (pts) after salvage ra-
diation therapy (RT) for neck only recurrences of oral cavity cancers
(OCC) are not well characterized. Therefore, we seek to report the treat-
ment results and prognostic factors of pts who received RT as part of their
salvage treatment for neck only recurrent disease (rT0 rN1-3) of initially
node negative (T1-2 N0) OCC without upfront adjuvant RT.
Materials/Methods: The records of consecutive pts who received salvage
RT as part of their treatment for neck only recurrent OCC (rOCC) at our
institution from 1989-2008 were reviewed. The Kaplan-Meier method was
for overall survival (OS), disease specific survival (DSS), freedom from
neck/regional failure (FFRF) and freedom from distant metastasis
(FFDM). The Cox proportional hazards regression model was used to
examine prognostic factors in univariate (UVA) and multivariate analysis
(MVA). Time to event was calculated from start of RT.
Results: Out of 123 pts with rOCC treated with salvage RT, 44 pts were
identified with neck only rOCC and compromised the study cohort. The
median time to neck only recurrence from primary diagnosis was 15 mo.
(range: 2 to 211 mos). From start of salvage RT, median follow-up for
living pts was 125 mo. (range: 8 to 310 mo) and 24 mo. for all pts (4 to 310
mo). Thirty-nine pts (89%) had salvage neck dissection followed by RT,
while the remaining 5 pts received definitive RT. Three pts who underwent
salvage neck dissection had grossly invasive recurrent neck disease (e.g.
large neck mass invading surrounding soft tissue/skeletal muscle, salivary
gland, jugular vein, etc.) resulting in positive soft tissue margins on the
nodal specimen. Fifteen pts (34%) received chemotherapy as part of their
salvage therapy including 3 pts treated with definitive RT. Recurrent N
stage was rN1, rN2, and rN3 in 17 (39%), 25 (57%), 2 (4%) pts, respec-
tively. The 5-year OS, DSS, FFRF and FFDM were 32%, 52%, 80%, and
73%, respectively. On MVA of the entire cohort, disease resulting in a
positive soft tissue margin after salvage neck dissection was independently
associated with worse OS (HR 6.17, P Z 0.009) as was lack of salvage
surgery (HR: 3.45, P Z 0.022). Disease resulting in positive margins was
also independently associated with worse DSS (HR: 6.52, P Z 0.005)
while greater rN-stage (rN2/N3 vs. rN1) was independently associated
with worse FFRF (HR: 8.2, P Z 0.045). On MVA of the surgical pts
subset, only negative surgical margin was independently associated with
improved OS (HR: 4.97, P Z 0.02) and DSS (HR: 4.92, P Z 0.021).
Conclusion: Neck only rOCC is a difficult to treat disease with poor
outcomes. Pts who are able to undergo salvage neck dissection with dis-
ease amenable to achieving negative surgical margins attain the best
clinical outcomes. We advocate for appropriate risk stratified treatment of
initial disease to improve outcomes.
Author Disclosure: B.H. Lok: None. X. Cai: None. N. Riaz: None. J.E.
Leeman: None. C. Tsai: None. S.M. McBride: None. D.S. Higginson:
None. S.S. Baxi: None. E.J. Sherman: None. B.R. Roman: None. R.J.
Wong: None. N. Lee: None.
2909
Evaluating the Impact of Node-Specific Growth in Patients With
Node-Positive Oropharyngeal Cancer
M. Dziemianowicz,1 C.T. Murphy,2 K. Devarajan,2 R. Mehra,2
J.A. Ridge,2 C. Fundakowski,2 and T.J. Galloway2; 1Temple University
School of Medicine, Philadelphia, PA, 2Fox Chase Cancer Center,
Philadelphia, PA