POSTERS

1. REIRRADIATION FOR RECURRENT HEAD AND NECK SQUAMOUS CELL CARCINOMA: CLINICAL

OUTCOMES

Agarwal Sharmila Jaslok Hospital and Research Centre, Mumbai

Mukherjee Prattusha1, Patel Malhar1, Kulkarni Rupali2, Qazi Mahiya2, Goswami Bibhash Chandra1, Kalyani Nikhil1 1Jaslok Hospital and Research Centre, Mumbai 2Bethany Hospital, Thane

2. EVALUATING THE DIAGNOSTIC AND PROGNOSTIC IMPACT OF THE PET/CT IMAGING IN LOCALLY

ADVANCED OROPHARYNX CANCER PATIENTS

Alarza Cano Marina Hospital Universitario 12 De Octubre. Madrid. Spain

Ruiz Alonso Ana1, Nenclares Peña Pablo1, Hernández Martínez Ana Cristina1, Iglesias Docampo Lara1, Gutiérrez Díaz Ramón1, Sánchez Aniceto Gregorio1

1Hospital Universitario 12 De Octubre. Madrid. Spain

3. ANTERO MEDIAL TIGHT (AMT) FREE FLAP FOR THE RECONSTRUCTION IN HEAD AND NECK

SURGERY: PRELIMINARY EXPERIENCE

Almadori Giovanni Institute of Otolaryngology Head & Neck Surgery, Catholic University of the Sacred Heart, A. Gemelli University Hospital Foundation, Rome-Italy

Visconti Giuseppe, Parrilla Claudio, Salonna Giampiero, Romanello Matteo, Di Cintio Giovanni, Paludetti Gaetano, Salgarello Marzia

4. MINICHROMOSOME MAINTENANCE PROTEIN 7 (MCM7) AND GEMININ EXPRESSION:

PROGNOSTIC VALUE IN LARYNGEAL SQUAMOUS CELL CARCINOMA IN PATIENTS TREATED WITH

RADIOTHERAPY AND CETUXIMAB

Almadori Giovanni Institute of Otolaryngology Head & Neck Surgery, Catholic University of the Sacred Heart, A. Gemelli University Hospital Foundation, Rome, Italy

Lauriola Libero, De Corso Eugenio, Bussu Francesco, Valentini Vincenzo, Di Cesare Tiziana, Mele Dario, Salonna Gianpiero, Di Cintio Giovanni, Paludetti Gaetano, Carey Thomas, Ranelletti Franco

5. SUPERFICIAL CIRCUMFLEX ILIAC ARTERY PERFORATOR (SCIP) FREE FLAP FOR THE

RECONSTRUCTION IN HEAD AND NECK SURGERY: PRELIMINARY EXPERIENCE

Almadori Giovanni Institute of Otolaryngology Head & Neck Surgery, Catholic University of the Sacred Heart, A. Gemelli University Hospital Foundation, Rome, Italy

Visconti Giuseppe, Rigante Mario, Romanello Matteo, Salonna Giampiero, Di Cintio Giovanni, Paludetti Gaetano, Salgarello Marzia

6. MIXED BEAM (PHOTONS-PROTONS) RADIOTHERAPY FOR LOCALLY ADVANCED (T3-T4) NON-

ENDEMIC NASOPHARYNGEAL CARCINOMA: PRELIMINARY RESULTS

Alterio Daniela European Institute of Oncology, Milan

D'Ippolito Emma1, Fossati Piero1, Ricotti Rosalinda2, Gandini Sara2, Vischioni Barbara1, Vitolo Viviana1, Bonora Maria1, Mastella Edoardo1, Magro Giuseppe1, Franco Pierfrancesco3, Krengli Marco4, Comi Stefania2, Tagliabue Marta2, Verri Elena2, Valvo Francesca1, Jereczek-Fossa Barbara Alicja5,6, Orecchia Roberto7,8

1National Center for Oncological Hadrontherapy, CNAO, Pavia 2European Institute of Oncology, Milan 3University of Turin, Turin 4University of Piemonte Orientale, Novara 5University of Milan, Milan; 6European Institute of Oncology, Milan 7Scientific Directorate, European Institute of Oncology, Milan 8Scientific Directorate National Center for Oncological Hadrontherapy, CNAO, Pavia

7. SOFT TISSUE NECROSIS (STN) IN OROPHARYNGEAL CANCER PATIENTS TREATED WITH

TRANSORAL ROBOTIC SURGERY (TORS) FOLLOWED BY POSTOPERATIVE RADIOTHERAPY: THE

EUROPEAN INSTITUTE OF ONCOLOGY EXPERIENCE

Alterio Daniela European Institute of Oncology, Head and Neck Program, Dept Radiation Oncology, Milan, Italy

Tagliabue Marta1, Muto Matteo2, Zorzi Stefano1, Sibio Daniela2, Bayir Omer3, Marvaso Giulia4, Ferrari Annamaria4, Verri Elena5, Ansarin Mohssen1, Jereczek Fossa Barbara Alicja2,4

1European Institute of Oncology- Head and Neck Program, Division of Ototalryngology and Head and Neck Surgery, Milan, Italy 2Dept Oncology and Hemato-Oncology, University of Milan, Italy 3dokun EyuL Universitesi Hastanesi 4European Institute of Oncology, Head and Neck Program, Dept Radiation Oncology, Milan, Italy 5European institute of Oncology- Head and Neck Program, Division of Urogenital and Head and Neck Medical Oncology, Milan, Italy

8. PERCEPTION, KNOWLEDGE, AND AWARENESS OF HEAD AND NECK CANCER: A CROSS-SECTIONAL

STUDY OF THE GENERAL POPULATION

Althobaiti Awwadh King Abdulaziz University, Jeddah, Saudi Arabia

Merdad Mazin1, Marzouki Hani1, Mosli Mahmoud1, Alwassia Rolina1, Al-Hajeili Marwan1, Majdili Ahad1, Aser Khulod1

1King Abdulaziz University, Jeddah, Saudi Arabia

9. DIAGNOSTIC TIMELINE AND DETERMINANTS OF TREATMENT DELAYS IN ORAL AND

OROPHARYNGEAL CANCER PATIENTS IN BRAZIL

Arantes Soares Joao Marcos Universidade Federal de São Joao Del Rey, Divinopolis

Tiburcio Jaqueline1, Belligoli Leonardo1, Bigodeiro Viviane1, Bretas Pedro1, Nunes Louise1, Prado Neto Severino1, Waldolato Gustavo1, Freitas Chaves Aline Lauda1

1Universidade Federal de São Joao Del Rey, Divinopolis

10. LOCAL RECURRENCE OF LARYNGEAL CANCER TREATED WITH INTENSITY-MODULATED

RADIOTHERAPY AND ASSOCIATED TOXICITIES: THE BEATSON EXPERIENCE

Begbie Finn Beatson West of Scotland Cancer Centre, Glasgow, Scotland

Thomson Maureen1, Paterson Clare1 1Beatson West of Scotland Cancer Centre, Glasgow, Scotland

11. UNCOMMON CERVICAL NODE METASTASES FROM NON HEAD AND NECK PRIMARY TUMOUR

Bejarano-Panadés Natàlia Hospital Mateu Orfila, Mahón

Martínez de Castro Ana María1, Muñoz Proto Fernanda1, Barrio M.Mar1 1Hospital Mateu Orfila, Mahón

12. MULTIDISCIPLINARY NETWORK BETWEEN NAVIGATION-ASSISTED PLATFORM AND COMPUTER-

AIDED DESIGN AND MANUFACTURING PLATFORM

Bescós Atín Coro Hospital Universitari Vall d'Hebron, Barcelona (Spain)

13. VALIDATION OF THE 8TH AJCC TNM CLASSIFICATION IN A WELL-DEFINED RETROSPECTIVE T1-T2

ORAL SQUAMOUS CELL CARCINOMA COHORT

Boeve Koos Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

Melchers L.J.1, Schuuring E.2, Roodenburg J.L.N.1, Halmos G.B.3, van Dijk B.A.C.4, van der Vegt B.2, Witjes M.J.H.1 1Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands 2Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands 3Department of Otorhinolaryngology / Head & Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands 4Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

14. DISSECTING HETEROGENEITY AND MOLECULAR MECHANISMS INVOLVED IN PARANASAL SINUS

CANCER

Bossi Paolo Fondazione IRCCS Istituto Nazionale Tumori, Milan

Granata Roberta, Orlandi Ester, Fallai Carlo, Licitra Lisa, Perrone Federica, Quattrone Pasquale, Facco Carla, Sessa Fausto, Turri Zanoni Mario, Battaglia Paolo, Castelnuovo Paolo, Paielli Nicholas, Serafini Serena Mara, De Cecco Loris

15. HEALTH AND ECONOMIC OUTCOMES OF TWO DIFFERENT FOLLOW UP STRATEGIES IN

EFFECTIVELY CURED ADVANCED HEAD AND NECK CANCER – TRIAL IN PROGRESS

Bossi Paolo Fondazione IRCCS Istituto Nazionale Tumori, Milan

Granata Roberta, Orlandi Ester, Piazza Cesare, Meregaglia Michela, Rognoni Carla, Quaglini Silvana, Pulice Iolanda, Giolitto Serena, Calareso Giuseppina, Lorizzo Alessandro, Licitra Lisa

16. SEEKING FOR PROGNOSTIC FACTORS IN NON-ENDEMIC, RECURRENT/METASTATIC

NASOPHARYNGEAL CANCER THROUGH A WEB-BASED DATA REGISTRATION: A FIRST STEP INTO

THE REAL-WORLD DATA ANALYSIS

Bossi Paolo Fondazione IRCCS Istituto Nazionale Tumori, Milan

Berruti Alfredo, Alberti Andrea, Alfieri Salvatore, Ferrari Vittorio, Mirabile Aurora, Licitra Lisa, Grisanti Salvatore

17. CO2 TRANSORAL MICROSURGERY FOR SUPRAGLOTTIC SQUAMOUS CELL CARCINOMA

Carta Filippo University of Cagliari

Quartu Daniela1, Marrosu Valeria1, Sambiagio Giovanni B. 1, Puxeddu Roberto1, Mariani Cinzia1 1University of Cagliari

18. AN ONLY NAVIGATION-ASSISTED PLATFORM FOR A MULTIDISCIPLINARY ONCOLOGICAL

NETWORK

Catanzaro Susanna Operative Unit of Maxillo-Facial Surgery, Otolaryngology and Dentistry, Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo (Fg), Italy

Copelli Chiara, Corsa Pietro, Manfuso Alfonso, Tewfik Hanna Karim, Pederneschi Nicola, Cassano Lazzaro, Mastromatteo Annalisa, Cocchi Roberto

19. EXPERIENCE OF SCAPULAR TIP FREE FLAP RECONSTRUCTION IN HEAD&NECK SURGERY: A SUPINE

HARVEST TECHNIQUE

Chalmers Richard Department of Head & Neck Surgery, Guy’s and St Thomas’ Hospital, London

Cascarini Luke1, Fry Alastair1, Townley William2 1Department of Head & Neck Surgery, Guy’s and St Thomas’ Hospital, London 2Department of Plastic & Reconstructive Surgery, Guy’s and St Thomas’ Hospital, London

20. INTRA-ORAL ANASTOMOSIS FOR FREE FLAP RECONSTRUCTION OF INTR-ORAL TUMOUR DEFECTS.

TECHNIQUE AND LEARNING POINTS

Chalmers Richard Department of Head & Neck Surgery, Guy’s and St Thomas’ Hospital, London

Cascarini Luke1, Fry Alastair1 1Department of Head & Neck Surgery, Guy’s and St Thomas’ Hospital, London

21. THE MICROBIOME OF HEAD AND NECK SQUAMOUS CELL CARCINOMA PATIENTS IN HONG KONG

Chan Jason Chinese University of Hong Kong

Ng Cherrie1, Chan Paul1, Yeung Zenon1, Wong Eddy1, Vlantis Alexander1, Chen Zigui1 1Chinese University of Hong Kong

22. RADICAL RADIOTHERAPY FOR NASOPHARYNGEAL CARCINOMA IN PATIENTS WITH CONNECTIVE

TISSUE DISEASE - OUTCOMES IN THE ERA OF IMRT

Cheung Ka Wai Alice Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong SAR

Chan Po Chung1, Ng Wan Ying Alice1, Tung Yuk1 1Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong SAR

23. INVESTIGATING THE PROGNOSTIC ROLE OF NEUTROPHIL-LYMPHOCYTE RATIO IN HEAD AND

NECK PATIENTS WITH RECURRENT AND/OR METASTATIC SQUAMOUS CELL CARCINOMA

Cossu Rocca Maria European institute of Oncology- Head and Neck Program, Division of Urogenital and Head and Neck Medical Oncology, Milan

Verri Elena1, Ansarin Mohssen2, Alterio Daniela3, Gandini Sara4, Cullurà Daniela1, Marvaso Giulia5, Aurilio Gaetano1, Tagliabue Marta2, Mascia Roberta1, Lombardi Francesca6, Nolè Franco1

1European Institute of Oncology- Head and Neck Program, Division of Urogenital and Head and Neck Medical Oncology, Milan 2European Institute of Oncology- Head and Neck Program, Division of Head and Neck Surgery, Milan 3European Institute of Oncology-Head and Neck Program, Dpt of Radiotherapy, Milan 4European Institute of Oncology, Division of Epidemiology and Biostatistic, Milan 5European Institute of Milan-Head and Neck Program, Dpt of Radiotherapy, Milan 6European Institute of Oncology-Data management, Milan

24. THE 3D EXOSCOPE IN TRANSORAL RESECTION OF OROPHARYNGEAL TUMORS: PRELIMINARY

RESULTS

Crosetti Erika Head and Neck Oncology Service, Oncology Dept., University of Turin, Candiolo Cancer Institute - FPO, IRCCS, Turin, Italy

Succo Giovanni1, Arrigoni Giulia1 1Head and Neck Oncology Service, Oncology Dept., University of Turin, Candiolo Cancer Institute - FPO, IRCCS, Turin, Italy

25. ORAL SQUAMOUS CELL CARCINOMA AND FANCONI ANEMIA

de Pablo García-Cuenca Alba Hospital Vall d´Hebron

26. ASSESSING THE QUALITY OF LIFE IN TOTAL LARYNGECTOMY PATIENTS: A REVISION OF

LITERATURE

De Rossi Stefano AOUI Verona Borgo Trento

Molteni Gabriele1, Veronese Sheila1, Gazzini Luca1, Pierotello Luca1, Veneri Antonio1, Marchioni Daniele1 1AOUI Verona Borgo Trento

27. THE PREDICTIVE ROLE OF THE PI3K PATHWAY IN STAGE III AND STAGE IV HEAD AND NECK

CANCER PATIENTS TREATED WITH CONCOMITANT RADIOTHERAPY AND CISPLATIN OR

CETUXIMAB

de Ruiter Emma J. University Medical Center, Utrecht

Terhaard Chris H. J.1, de Bree Remco1, Willems Stefan M.1 1University Medical Center, Utrecht

28. THREE-DIMENSIONAL HIGH-DEFINITION EXOSCOPY SYSTEM FOR TRANSORAL LARYNGEAL

SURGERY

Deganello Alberto University of Brescia, Italy

Paderno Alberto1, Del Bon Francesca1, Nicolai Piero1 1University of Brescia, Italy

29. INVESTIGATION OF B-CELL CLL/LYMPHOMA 2 (BCL2) AND BCL2 ASSOCIATED X (BAX) GENE

EXPRESSION STATUS IN TURKISH PATIENTS WITH LARYNGEAL SQUAMOUS CELL CARCINOMA

Demokan Semra Department of Basic Oncology, Oncology Institute, Istanbul University, Istanbul

Sen Sena1, Eryilmaz Onder1, Cömert Sevde1, Suoglu Yusufhan2, Ulusan Murat2, Ak Gülsüm3, Dalay Nejat1 1Department of Basic Oncology, Oncology Institute, Istanbul University, Istanbul 2Department of Otorhinolaryngology, Faculty of Medicine, Istanbul University, Istanbul 3Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul

30. SENTINEL LYMPH NODE BIOPSY AND DEPTH OF INVASION OF THE PRIMARY TUMOR IN EARLY

STAGE ORAL CANCER

den Toom Inne Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, The Netherlands & Department of Otolaryngology-Head and Neck Surgery, VU University Medical

Janssen L.M.1, van Es R.J.J.1, van Weert S.2, Willems S.M.3, Bloemena E.4, Leemans C.R.2, de Bree R.1 1Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, The Netherlands 2Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands 3Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands 4Department of Oral and Maxillofacial Surgery / Oral Pathology, VU University Medical Center/Academic Centre for Dentistry (ACTA) Amsterdam, The Netherlands & Department of Pathology, VU University Med

31. BENEFIT OF VOLUMETRIC-MODULATED ARC THERAPY IN SINONASAL SQUAMOCELLULAR

CARCINOMA: SINGLE INSTITUTION EXPERIENCE

Djan Igor Oncology institute of Vojvodina, Faculty of Medicine, University of Novi Sad

Rutonjski Laza1, Nikolin Borislava2, Petrović Borislava2, Baucal Milutin3, Cudic Ozren3 1Oncology Institute of Vojvodina, Faculty of Science, University of Novi Sad 2Oncology institute of Vojvodina, Faculty of Medicine, University of Novi Sad 3Oncology Institute of Vojvodina, Sremska Kamenica

32. EXAMINATION OF PROMOTER METHYLATION OF ZINC FINGER PROTEIN 238 (ZNF238) GENE IN

ORAL SQUAMOUS CELL CARCINOMA

Eryilmaz Onder Department of Basic Oncology, Oncology Institute, Istanbul University, Istanbul

Sen Sena1, Doruk Can2, Ulusan Murat2, Demokan Semra1 1Department of Basic Oncology, Oncology Institute, Istanbul University, Istanbul 2Department of Otorhinolaryngology, Faculty of Medicine, Istanbul University, Istanbul

33. TREATMENT COMPLIANCE AND OUTCOME OF PATIENTS AGED ≥65 YEARS WITH LOCALLY

ADVANCED OROPHARYNGEAL SQUAMOUS CELL CARCINOMA (OC) TREATED WITH

RADIOTHERAPY CONCURRENT TO CISPLATIN OR CETUXIMAB

Espeli Vittoria IOSI

Martucci Francesco1, Richetti Antonella1, Siano Marco2 1IOSI 2KSSG

34. ETIOLOGY, TREATMENT AND PROGNOSIS OF ORAL SQUAMOUS CELL CARCINOMA IN

INDIVIDUALS AT DIFFERENT AGES

Feng Zhien Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China

35. TIR3: A NEVER-ENDING STORY. ARE TIR3A AND TIR3B SUFFICIENT IN SURGEON’S DECISION-

MAKING? CYTO-ULTRASONOGRAPHIC CORRELATION CAN HELP PREDICTING MALIGNANCY RISK

Feroci Francesco Nuovo Ospedale S. Stefano, Prato

Sarno Antonio1, Garotta Matteo1, Zaccari Dario1, Perini Davina1, Fagni Niccolò1, Guagni Tommaso1 1Nuovo Ospedale S. Stefano, Prato

36. TRANSIENT HYPOCALCEMIA AFTER TOTAL-THYROIDECTOMY: COULD VITAMIN 25-(OH)D

INSUFFICIENCY AND MALIGNANCY INFLUENCE ITS OCCURRENCE?

Galli Andrea IRCCS San Raffaele, Milan

Lira Luce Francesca1, Di Filippo Luigi1, Manzoni Marco1, Bussi Mario1 1IRCCS San Raffaele, Milan

37. VOICE PROSTHESIS REHABILITATION AFTER TOTAL LARYNGECTOMY: ARE SATISFACTION AND

QUALITY OF LIFE MAINTAINED OVER TIME?

Galli Andrea IRCCS San Raffale

Giordano Leone1, Biafora Matteo1, Tulli Michele1, Bussi Mario1 1IRCCS San Raffale

38. PREVENTION OF PHARYNGOCUTANEOUS FISTULA AFTER TOTAL LARINGECTOMY, USING ADIPOSE

TISSUE AND MESENCHYMAL STEN CELLS: PILOT STUDY

Garotta Matteo Nuovo Ospedale S. Stefano, Prato

Sarno Antonio1, Zaccari Dario1, Giani Iacopo1 1Nuovo Ospedale S. Stefano, Prato

39. DUAL ENERGY CT AND SPECTRAL HOUNSFIELD UNIT CURVES TO DIFFERENTIATE NON-OSSIFIED

THYROID CARTILAGE FROM INFILTRATED THYROID CARTILAGE BY SQUAMOUS CELL CARCINOMA

IN LARYNGEAL CANCER: PRELIMINARY RESULTS

Giannitto Caterina European Institute of Oncology- Head and Neck Program, Division of Radiology, Milan, Italy

Preda Lorenzo1, Zorzi Stefano2, Tofanelli Laura1, Cattaneo Augusto2, De Benedetto Luigi2, Ansarin Mohssen2, Bellomi Massimo1

1European Institute of Oncology- Head and Neck Program, Division of Radiology, Milan, Italy 2European Institute of Oncology- Head and Neck Program, Division of Ototalryngology and Head and Neck Surgery, Milan, Italy

40. TISSUE AND SERUM MICRORNA PROFILE OF ORAL SQUAMOUS CELL CARCINOMA PATIENTS

Golusinski Pawel Department of Head and Neck Surgery, Greater Poland Cancer Centre, Poznan University of Medical Sciences

Head and Neck Cancer Biology Lab Department of Biology and Environmental Studies, Poznan

Schneider Augusto1, Masternak Michal2 1Faculdade de Nutrição, Universidade Federal de Pelotas, Pelotas, RS, Brazil 2College of Medicine, Burnett School of Biomedical Sciences, University of Central Florida

41. NON-LIVING ANIMAL MODELS FOR THE HEAD AND NECK ONCOLOGY AND RECONSTRUCTIVE

SURGEON

Gonzalez Gimeno Maria Jose ENT Department. Universidad Complutense de Madrid

Martin Villares Cristina1, Gonzalo-Orden JM2, Valor Cristina3, Diaz Gonzalez Laura4, Hernandez Maria1 1Hospital El Bierzo, Ponferrada 2Animal Surgery Department. Universidad de Leon 3Hospital Infanta Sofia, Madrid 4Hospital de Palencia

42. EVALUATION OF PERIOPERATIVE EXAMINATION AND MANAGEMENT OF THYROID NEOPLASM IN

CHILDREN AND ADOLESCENTS

Grachev Nickolay Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow

Vorozhtsov Igor1, Babaskina Natalya1, Iaremenko Ekaterina1 1Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow

43. NUANCES IN PAROTID REGION SURGERY IN PEDIATRIC POPULATION

Grachev Nickolay Dmitriy Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia

Kalinina Margarita, Babaskina Natalia, Vorozhtsov Igor, Polev Georgiy

44. THE ACCURACY OF ACR TI-RADS CLASSIFICATION OF NECK ULTRASOUND AS A FIRST-LINE

DIAGNOSTIC APPROACH FOR THYROID NEOPLASMS IN PEDIATRIC PATIENTS: A FIVE-YEAR

RETROSPECTIVE STUDY

Grachev Nickolay Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow

Vorozhtsov Igor1, Babaskina Natalya1, Iaremenko Ekaterina1 1Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow

45. RISK OF MALIGNANCY IN THYROID NODULE IN 1505 PATIENTS WITH BENIGN OR WITHOUT FINE-

NEEDLE ASPIRATION

Gram Signe Buhl Rigshospitalet, Copenhagen

Holst Hahn Christoffer1, Rasmussen Jacob1 1Rigshospitalet, Copenhagen

46. COMPARTMENTAL SURGERY FOR ORAL TONGUE - FLOOR OF MOUTH CANCER: ONCOLOGIC AND

FUNCTIONAL OUTCOMES

Grammatica Alberto Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy

Piazza Cesare1, Montalto Nausica2, Del Bon Francesca2, Paderno Alberto2, Frittoli Barbara3, Nicolai Piero2 1Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS - National Cancer Institute of Milan, University of Milan, Milan, Italy 2Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy 3Department of Radiology, University of Brescia, Brescia, Italy

47. A RANDOMIZED PHASE II STUDY FOR TERTIARY PREVENTION OF SQUAMOCELLULAR CANCER OF

HEAD AND NECK (SCCHN) WITH A DIETARY INTERVENTION (DIETINT)

Granata Roberta IRCCS Istituto Nazionale Tumori Milano

48. THE APPLICATION VALUE OF THE MODIFIED CONTINUOUS RESECTION IN MIDDLE-STAGE ORAL

TONGUE SQUAMOUS CELL CARCINOMA: A RETROSPECTIVE STUDY OF 406 CASES

Han Zhengxue Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China

49. NBTXR3, AN INNOVATIVE TREATMENT OPTION FOR ELDERLY, FRAIL, HEAD AND NECK

SQUAMOUS CELL CARCINOMA PATIENTS: A PHASE I TRIAL

Hoffmann Caroline Institut Curie

Moreno Victor1, Calugaru Valentin2, Jouffroy Thomas2, Rodriguez José2, Calvo Emiliano1, Dodger Bernard1, Chilles Annes2, Khrili Samar2, Badois Nathalie2, Lesnik Maria2, Le Tourneau Christophe2

1START Madrid- FJD Fundación Jiménez Díaz 2Institut Curie

50. INCREASING INCIDENCE AND SURVIVAL OF HEAD AND NECK CANCER IN DENMARK: A NATION-

WIDE STUDY FROM 1980-2014

Jakobsen Kathrine Kronberg Rigshospitalet

51. MULTIFOCALITY AS A PROGNOSTIC FACTOR IN THYROID CANCER

Joseph Kyle University of Sydney

Eslick Guy1, Edirimanne Senarath1 1University of Sydney

52. RISK FACTORS FOR HUMAN PAPILLOMA VIRUS INFECTION AND HEAD AND NECK CANCER

Karavelia Aspasia General Hospital of Chania “St George”, Chania Greece

53. OPTIMIZATION OF COMBINED TREATMENT IN PATIENTS WITH SQUAMOUS CELL CARCINOMA OF

THE HEAD AND NECK

Kurochkina Iuliia First Moscow State Medical University

Reshetov Igor, Sukorceva Natalya, Bykov Igor, Shevalgin Alexandr

54. MEDULLARY CARCINOMA OF THYROID WITH ISOLATED HEPATIC METASTASIS IN NEWLY SETUP

RURAL CANCER CENTRE OF INDIA

Kansal Latika Homi Bhabha Cancer Hospital, Sangrur

Sumit Gupta1, Debashish Chaudhary1, Tapas Dora1, Mehul Bupkari1 1Homi Bhabha Cancer Hospital, Sangrur

55. AN EXTENDED HYPOFRACTIONATED PALLIATIVE RADIOTHERAPY REGIMEN FOR HEAD AND NECK

CARCINOMAS

Laursen Michael Department of Oncology, National University Hospital, Rigshospitalet, Copenhagen, Denmark

Friborg Jeppe, Specht Lena, Kristensen Claus, Gothelf Anita, Bernsdorf Mogens, Vogelius Ivan

56. PROGNOSTIC VALUE OF ADIPOSE TISSUE VOLUME FOR PREDICTING DISEASE PROGRESSION IN

PATIENTS WITH HEAD AND NECK CANCER

Lee Jeong Won Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon, Korea

Ban Myung Jin1, Park Jae Hong1, Yoo Ik Dong1, Lee Sang Mi1 1Soonchunhyang University Cheonan Hospital, Cheonan, Chungcheongnam-do, Korea

57. MOLECULAR PROFILING OF MAMMARY ANALOGUE SECRETORY CARCINOMA AND ACINIC CELL

CARCINOMA FACILITATING PRECISION DIAGNOSIS AND TARGETED THERAPY

Licitra Lisa Medical Oncology Head and Neck Cancer Department, Istituto Nazionale dei Tumori, Milan, Italy

Michal Michal1, Christiansen Jason2, Potts Steven2, Trama Annalisa3, Skalova Alena4 1Biopticka lab, ltd., Plzen, Czech Republic 2Ignyta, Inc. San Diego, CA, USA 3Evaluative Epidemiology Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy 4Department of Pathology, Charles University and Faculty of Medicine in Plzen, Prague, Czech Republic

58. PEMBROLIZUMAB PLUS CHEMORADIATION (CRT) VS CRT ALONE FOR LOCALLY ADVANCED HEAD

AND NECK SQUAMOUS CELL CARCINOMA (LA-HNSCC): KEYNOTE-412

Licitra Lisa Fondazione IRCCS Istituto Nazionale dei Tumori, Milan

Machiels Jean-Pascal1, Yen Chia-Jui2, Rischin Danny3, Waldron John4, Burtness Barbara5, Gregoire Vincent1, Tao Yun Gan6, Yorio Jeffrey7, Aksoy Sercan8, Ikeda Sadakatsu9, Hong Ruey-Long10, Ge Joy Yang11, Brown Holly11, Bidadi Behzad11, Siu Lillian L.12

1Cliniques Universitaires Saint-Luc, Brussels 2National Cheng Kung University Hospital, Tainan 3Peter MacCallum Cancer Centre, East Melbourne 4Princess Margaret Cancer Centre, Toronto 5Yale University School of Medicine, New Haven 6Institut Gustave Roussy, Villejuif 7Texas Oncology–Austin Central, Austin 8Hacettepe Universitesi Tip Fakultesi, Ankara 9Medical Hospital, Tokyo Medical and Dental University, Tokyo 10 National Taiwan University Hospital, Taipei 11Merck & Co., Inc., Kenilworth 12Princess Margaret Cancer Centre, Toronto

59. PHASE 2 TRIAL OF PEMBROLIZUMAB IN PATIENTS (PTS) WITH RECURRENT OR METASTATIC

CUTANEOUS SQUAMOUS CELL CARCINOMA (CSCC): KEYNOTE-629

Licitra Lisa Fondazione IRCCS Istituto Nazionale dei Tumori, Milan

Siu Lillian L.1, Cohen Ezra2, Zhang Pingye (Eric)3, Gumuscu Burak3, Swaby Ramona3, Harrington Kevin4 1Princess Margaret Cancer Centre, Toronto 2Moores Cancer Center at UC San Diego Health, La Jolla 3Merck & Co., Inc., Kenilworth 4Head and Neck/Skin Units, The Institute of Cancer Research, London

60. ODONTOGENIC DEEP NECK ABSCESSES

Lim Richmond Quan Qing Tan Tock Seng Hospital, Singapore

Chong Yaw Khian Tan Tock Seng Hospital, Singapore

61. NODAL STAGE: IS IT A PROGNOSTIC FACTOR FOR SUBMANDIBULAR GLAND CANCER?

Liu Yanbin Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China

Qin Lizheng

62. HOPE FOR SALIVARY GLAND CANCER (SGC): EORTC HNCG/UKCRN 1206 RANDOMIZED PHASE II

STUDY TO EVALUATE THE EFFICACY AND SAFETY OF CHEMOTHERAPY (CT) VS ANDROGEN

DEPRIVATION THERAPY (ADT) IN PATIENTS WITH RECURRENT AND/OR METASTATIC ANDROGEN

RECEPTOR (AR) EXPRESSING SGC

Locati Laura Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy

Caballero Carmela1, Fortpied Catherine1, Perrone Federica2, Quattrone Pasquale3, Harrington Kevin4, Grégoire Vincent5, Licitra Lisa6

1Medical and Statistics, EORTC, Brussels, Belgium 2Molecular Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy 3Pathology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy 4Radiotherapy and Imaging, Royal Marsden Foundation Trust/ The Institute of Cancer Research, London, Great Britain 5Dept. Radiation Oncology, Cliniques Universitaires St. Luc, Brussels, Belgium 6Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy - University of Milan, Italy

63. PHASE II TRIAL OF ABIRATERONE ACETATE IN PATIENTS WITH RELAPSED AND/OR METASTATIC,

CASTRATION RESISTANT AR EXPRESSING SALIVARY GLANDS CARCINOMAS (SGCS)

Locati Laura Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy

Bossi Paolo1, Bergamini Cristiana1, Calareso Giuseppina2, Granata Roberta1, Alfieri Salvatore1, Resteghini Carlo1, Galbiati Donata1, Cavalieri Stefano1, Platini Francesca1, Licitra Lisa1

1Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy - University of Milan, Italy 2Radiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy

64. OUR EXPERIENCE IN THE MANAGEMENT OF HEAD AND NECK CANCER IN ELDERLY PATIENTS

Magnano Mauro Division of Otorhinolaryngology, Pinerolo and Rivoli Hospitals, Pinerolo, Italy

Bertone Fabio, Andreis Marco, Boffano Paolo, Machetta Giacomo

65. PROGNOSTIC FACTORS AFFECTING SURVIVAL IN T4 BUCCAL MUCOSA CANCERS: COMPARISON

BETWEEN BONE EROSION AND SKIN INVOLVEMENT

Mair Manish Tata Memorial Hospital, Mumbai, India

Mathur Yash1, Chaturvedi Pankaj1, Nair Deepa1 1Tata Memorial Hospital, Mumbai, India

66. THE EFFECTIVENESS OF 18F-FDG PET/CT IN HEAD AND NECK SQUAMOUS CELL CANCER

Majchrzak Ewa Department of Head and Neck Cancer, University of Medical Sciences in Poznan, Poland, The Greater Poland Cancer Centre

67. SLOW-MOHS SURGERY. REPORT OF 6 CASES

Malet Contreras Albert Cirugía Oral y Maxilofacial, Hospital La Paz, Madrid

Cebrián Carretero José Luis, Gonzalez Martín-Moro Javier, Losa Muñoz Pedro, Ruiz Elena, Burgueño García Miguel

68. DIAGNOSIS, TREATMENT AND PROGNOSIS OF PRIMARY LYMPHOMA OF THE MAJOR SALIVARY

GLANDS

Mao Minghui Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China

69. NUTRITIONAL STATUS IN HEAD AND NECK CANCER PATIENTS: THE IMPACT ON THE PROGNOSES

Martin Villares Cristina Hospital El Bierzo, Ponferrada

Gonzalez Gimeno Maria Jose1, Tapia Risueño Manuel2, Hernandez Maria2, Rodriguez Prado Nuria2, San Roman Carbajo Jesus2, Lourido Diana2

1ENT Department. Universidad Complutense. Madrid 2Hospital El Bierzo, Ponferrada

70. THE RABBIT MODEL FOR ONCOLOGIC LARYNGEAL RECONSTRUCTION RESEARCH. PRELIMINARY

RESULTS

Martin Villares Cristina Hospital El Bierzo, Ponferrada

Gonzalez Gimeno Maria Jose1, Gonzalo-Orden JM2, Carvajal Urureña Ana3, Valor Cristina4, Dominguez Calvo jesus5 1ENT Department. Universidad Complutense de Madrid 2Animal Surgery Department. Universidad de Leon 3Animal Health. University of Leon 4Hospital Infanta Sofia. San Sebastian. Madrid 5Hospital El Bierzo

71. TRAINING IN AIRWAY EMERGENCIES FOR LARYNGECTOMY PATIENTS IN A NEW SIMULATION

MODEL: THE “NECK-BREATHER” SIMULATOR

Martin Villares Cristina Hospital El Bierzo, Ponferrada

Gonzalez Gimeno Maria Jose1, Rodriguez Prado Nuria2, Hernandez Maria2, Valor Cristina3, Diez Gonzalez Laura4 1ENT Departmanet. Universidad Complutense de Madrid 2Hospital El Bierzo, Ponferrada 3Hospital Infante Sofia, San Sebastian, Madrid 4Hospital de Palencia

72. TARGETABLE DRUGS IN SALIVARY DUCT CARCINOMA

Martinez de Castro Ana Maria Hospital General Mateu Orfila, Menorca

Bejarano-Panadés N.1, Afonzo Y.1, Ferri J.1, Diaz P.1, Baste Rotllan N.2 1Hospital General Mateu Orfila, Menorca 2Hospital Universitario Vall d'Hebrón

73. EWING SARCOMA OF THE MANDIBLE IN A PEDIATRIC PATIENT: FROM SEGMENTAL RESECTION

TO IMPLANT-SUPPORTED ORAL REHABILITATION

Martorell Pau Oral and Maxillofacial Surgery-Hospital Universitario Vall Hebrón Barcelona

Sierra Nicolas E.1, Munill Montserrat1, Bescós M.S.1 1Oral and Maxillofacial Surgery-Hospital Universitario Vall Hebrón Barcelona

74. TRANSORAL ROBOTIC SURGERY (TORS) WITH THE FLEX ROBOTIC SYSTEM IN PATIENTS WITH

HYPOPHARYNGEAL AND LARYNGEAL TUMORS

Mattheis Stefan Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Germany

75. IMMUNOHISTOCHEMICAL DETECTION OF A LOSS OF SMARCB1 IN POORLY DIFFERENTIATED

ADENOCARCINOMAS OF THE SINONASAL TRACT

McHugh Alison Beaumont Hospital, Dublin

O'Cathain Eadaoin1, Fitzgerald Conall1, O'Neill Prof. J. P. 1, O'Sullivan Barry1, McNally Stephen1 1Beaumont Hospital, Dublin

76. PERCUTANEOUS ENDOSCOPIC GASTROSTOMY DEPENDANCE IN HEAD AND NECK CANCER

McNamara Kate Shrewsbury & Telford NHS Trust

77. 3D MICROVASCULAR ANASTOMOSIS: PRELIMINARY STUDY IN HEAD AND NECK PATIENTS

Molteni Gabriele Department of Otolaryngology, University of Verona, Verona

Procacci Pasquale1, Fior Andrea1, Veneri Antonio2, Nocini Pier Francesco1, Marchioni Daniele2 1Department of Maxillofacial Surgery, University of Verona, Verona 2Department of Otolaryngology, University of Verona, Verona

78. ONCOLOGICAL OUTCOMES OF PAROTID GLAND MALIGNANCIES: A RETROSPECTIVE ANALYSIS OF

74 PATIENTS

Molteni Gabriele AOUI Brogo Trento, Verona

Molinari Giulia1, Ghirelli Michael1, Marchioni Daniele1, Presutti Livio1 1AOU Policlinico di Modena, Modena

79. RECONSTRUCTION OF COMPLEX ORO-MANDIBULAR DEFECTS IN HEAD AND NECK CANCER: THE

CHIMERIC SUBSCAPULAR FLAP

Molteni Gabriele Università degli studi di Verona

Gazzini Luca1, Fior Andrea1, Procacci Pasquale1, Plotegher Cristina1, Nocini Pier Francesco1, Marchioni Daniele1 1Università degli Studi di Verona

80. AURORA KINASE EXPRESSION PREDICTS OVERALL SURVIVAL FOR ORAL TONGUE SQUAMOUS

CELL CARCINOMA

Nenclares Peña Pablo Hospital Universitario 12 de Octubre, Madrid, Spain

Ruíz Alonso Ana1, Alonso Riaño Marina1, Ballestín Caravilla Claudio1, Pérez-Regadera Gómez José Fermín1 1Hospital Universitario 12 de Octubre, Madrid, Spain

81. NEUROENDOCRINE CARCINOMA OF THE OROPHARYNX: A REPORT OF 2 CASES AND REVIEW OF

THE LITERATURE

Omakobia Eugene Bradford Royal Infirmary, Bradford, United Kingdom

Sood Salil1, Sood Sanjai1, Gouldesbrough David1, Cardale Kate2, Dyker Karen2, Sutton David1, Glore Raad John1 1Bradford Royal Infirmary, Bradford, United Kingdom 2St James's University Hospital, Leeds, United Kingdom

82. THE ROLE OF FINE NEEDLE ASPIRATION CYTOLOGY AND FROZEN SECTION HISTOPATHOLOGY IN

THE MANAGEMENT OF PAROTID GLAND TUMOURS: A 5 YEAR EXPERIENCE IN A UK TEACHING

HOSPITAL

Omakobia Eugene Bradford Royal Infirmary, Bradford, UK

Sood Salil1, Glore Raad John1, Gouldesbrough David1, Sood Sanjai1 1Bradford Royal Infirmary, Bradford, UK

83. THE EXISTENCE AND LEVEL INVESTIGATION OF ENDOCANNABINOIDS AND CANNA-BINOID

RECEPTORS IN HUMAN LARYNGEAL SQUAMOUS CELL CARCINOMA CELL LINE

Önay Övsen Hacettepe University Faculty of Medicine Department of ENT

Süslü Nilda1, Korkusuz Petek2, Köse Sevil2, Hoşal Şefik3 1Hacettepe University Faculty of Medicine Department of ENT 2Hacettepe University Faculty of Medicine Department of Histology and Embryology 3Liv Hospital, ENT Department, Ankara

84. HEAD AND NECK CANCER IN ELDER NEGLECT

Pagliari Angelo Virgilio U.O. ORL - Ospedale Maggiore di Crema - ASST Crema

Blotta Pasquale U.O. ORL - Ospedale Maggiore di Crema - ASST Crema

85. LIPOFILLING IN HEAD AND NECK RECONSTRUCTION

Pagliari Angelo Virgilio U.O. ORL - Ospedale Maggiore di Crema - ASST di Crema

86. PREOPERATIVE EMBOLIZATION OF THYROID ARTERIES IN LARGE CERVICO-MEDIASTINAL GOITER

AND PAPILLARY CARCINOMA

Pagliari Angelo Virgilio U.O. ORL - Ospedale Maggiore - ASST Crema

Blotta Pasquale1, Spinazzola Angelo2, Benelli GianPaolo2 1U.O. ORL - Ospedale Maggiore di Crema - ASST Crema 2U.O. Radiologia - Ospedale Maggiore - ASST Crema

87. ASSESSMENT OF INCIDENCE OF HYPOTHYROIDISM AS A SEQUELAE FOLLOWING THERAPEUTIC

EXTERNAL BEAM RADIATION THERAPY IN HEAD AND NECK MALIGNANCIES WITH DOSE- VOLUME

PREDICTORS

Pareek Vibhay Jupiter Hospital Thane

88. V LEVEL DISSECTION IN ORAL SCC N+: IS IT REALLY NECESSARY?

Pierotello Luca ENT department University Hospital of Verona

Molteni Gabriele1, Giampaoli Giorgio2, Procacci Pasquale2, Fior Andrea2, Nocini Pier Francesco2, Marchioni Daniele1

1ENT department University Hospital of Verona 2Maxillofacial Surgery Department University Hospital of Verona

89. MANAGEMENT OF PHARYNGOCUTANEOUS FISTULAE AFTER SALVAGE TOTAL LARYNGECTOMY

Pop Sever "Iuliu Hatieganu" University of Medicine and Pharmacy, ENT Department, Cluj-Napoca, Romania

Bucin Rareș1, Vereș Ștefana1, Tomuș Mihai1, Bud Diana1, Fodor Lucian2, Fodor Marius3 1"Iuliu Hatieganu" University of Medicine and Pharmacy, ENT Department, Cluj-Napoca, Romania 2Plastic and Reconstructive Surgery Department, Emergency Clinical County Hospital Cluj-Napoca 3 Vascular Surgery Department, Emergency Clinical County Hospital Cluj-Napoca

90. RECURRENT AND PERSISTENT DIFFERENTIATED THYROID CANCER: ULTRASOUND DYE-ASSISTED

SURGERY (USDAS) FOR LYMPHADENECTOMY IN THE NECK

Proh Michele European Institute of Oncology - Head & Neck Program - Division of Otolaryngology Head & Neck Surgery, Milan, Italy

Giugliano Gioacchino, Ciccone Daniele, Scelsi Daniele, Grosso Enrica, De Fiori Elvio, Ansarin Mohssen

91. MIXED MEDULLARY AND PAPILLARY CARCINOMA OF THYROID: A RARE CASE REPORT AND

REVIEW OF LITERATURE

Punamiya Aditya P.D. Hinduja Hospital and Medical Research Centre, Mumbai

Nandu Bharat1, Lala Murad1 1P.D. Hinduja Hospital and Medical Research Centre, Mumbai

92. SELECTING THE RIGHT PATIENTS FOR FUTURE TRIALS - MULTIPLE ENDPOINTS MODEL IN 1244

PATIENTS WITH OSCC AND KNOWN HPV AND P16 STATUS

Rasmussen Jacob H. Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Denmark

Larsen Christian G.1, Håkansson Katrin E.2, Friborg Jeppe2, Vogelius Ivan R.2, Buchwald Christian von1 1Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Denmark 2Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Denmark

93. CYTOLOGICAL PRESENTATION OF THYROID CARCINOMA – THE IMPACT OF MDT

Rovira Aleix Guy's and St Thomas Fundation Trust

Volpini Luigi1, Nixon Iain1, Jeannon JP1, Karan Kapoor1, Ash Chandra1, Muffadal Moonin1, Edward Odell1, Rose Ngu1, Ricard Simo1

1Guy's and St Thomas Fundation Trust

94. OUTCOMES FOLLOWING INITIAL PRESENTATION AND DIAGNOSIS OF HEAD AND NECK CANCER

Rovira Aleix Guy's and St Thomas NHS Fundation trust

Volpini Luigi1, Tornari Christotomos1, Oakley Richard1, Arora Asit1, Jeannon JP1, Simo Ricard1 1Guy's and St Thomas NHS Fundation trust

95. PATIENT AND TUMOR CHARACTERISTICS IN RELATION TO VITAL STATE IN LARYNGEAL CANCER

PATIENTS

Ruiter Lilian UMC Utrecht

van Gils C., Bruggink A., Terhaard C.H.J., de Bree R., Willems S., van Dijk B.A.C.

96. INCIDENCE AND SURVIVAL OF OROPHARYNGEAL CANCER IN DENMARK: A NATION-WIDE,

POPULATION-BASED STUDY FROM 1980-2014

Schmidt Jensen Jakob Rigshospitalet, University of Copenhagen

Hebbelstrup Jensen David, Grønhøj Christian, Kim Schmidt Karnov Kirstine, Nørregaard Cecilie, Klitmøller Agander Tina, Specht Lena, von Buchwald Christian

97. HTERT PROMOTER METHYLATION PATTERN IS ALTERED IN BLOOD LEUKOCYTES OF HEAD AND

NECK CANCER PATIENTS

Sobecka Agnieszka Department of Head and Neck Surgery, Poznan University of Medical Sciences, The Greater Poland Cancer Centre, Poznan, Poland

Radiobiology Lab, The Greater Poland Cancer Centre, Poznan, Poland

Barczak Wojciech1,2, Blaszczak Wiktoria2, Golusinski Pawel1, Rubis Blazej3, Masternak Michal M.1,4, Suchorska Wiktoria M.2,5, Golusinski Wojciech1

1Department of Head and Neck Surgery, Poznan University of Medical Sciences, The Greater Poland Cancer Centre, Poznan, Poland 2Radiobiology Lab, The Greater Poland Cancer Centre, Poznan, Poland 3Department of Clinical Chemistry and Molecular Diagnostics, Poznan University of Medical Sciences, Poznan, Poland 4University of Central Florida, Burnett School of Biomedical Sciences 5Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland

98. THREE-DIMENSIONAL PRINTING OF PATIENT-SPECIFIC SURGICAL PLATES IN HEAD AND NECK

RECONSTRUCTION: A PROSPECTIVE STUDY

Su Richard Yuxiong The University of Hong Kong, Hong Kong

Yang Weifa1, Choi Wing Shan1, Leung Yiu Yan1, Du Ruxu1, Curtin Justin Paul1 1The University of Hong Kong, Hong Kong

99. OPEN PARTIAL HORIZONTAL LARYNGECTOMY BY CO2 FIBER LASER RESECTION: PRELIMINARY

RESULTS

Succo Giovanni Head and Neck Oncology Service, Oncology Dept., University of Turin, Candiolo Cancer Institute - FPO, IRCCS, Turin, Italy

Crosetti Erika1, Caracciolo Alessandra1, Maldi Elena2 1Head and Neck Oncology Service, Oncology Dept., University of Turin, Candiolo Cancer Institute - FPO, IRCCS, Turin, Italy 2Pathology Unit, Candiolo Cancer Institute - FPO, IRCCS, Turin, Italy

100. ANTEROLATERAL THIGH FLAP PERFORATOR VARIABILITY AND SPLIT FLAP STRATEGIES

Sudirman Siti Radhziah E-da hospital, Kaohsiung, Taiwan

Shih Hsiang-Shun E-da Hospital, Kaohsiung, Taiwan

101. COMPLICATIONS AND DIFFICULTIES IN PATIENTS DURING SURGERY AND POST OPERATIVE

PERIOD FOR LOCALLY ADVANCED THYROID CANCERS IN A NEWLY SETUP CANCER CENTRE

Sumit Gupta Homi Bhabha Cancer Hospital, Sangrur

Latika Kansal1, Debashish Chaudhary1, Tapas Dora1 1Homi Bhabha Cancer Hospital, Sangrur

102. THE SURVIVAL OF PATIENTS UNDERWENT SALVAGE NECK DISSECTION WITH NECK RECURRENCE

OF HEAD NECK CANCER: ONE CANCER CENTER EXPERIENCE

Süslü Nilda Hacettepe University Faculty of Medicine Ankara

Kuşçu Oğuz1, Yazıcı Gözde1, Cengiz Mustafa1, Aksoy Sercan1, Güllü İbrahim1, Dolgun Anıl1, Hoşal Şeifk2 1Hacettepe University Faculty of Medicine Ankara 2Ankara Liv Hospital Ankara

103. POSITIVE FRESH FROZEN SECTION MARGINS AS AN ADVERSE INDEPENDENT PROGNOSTIC

FACTOR FOR LOCAL RECURRENCE IN ORAL CANCER PATIENTS

Szewczyk Mateusz Department of Head and Neck Surgery Poznan University of Medical Sciences, The Greater Poland Cancer Centre

Golusinski Wojciech1, Pazdrowski Jakub1, Masternak Michal1,2, Golusinski Pawel1,3 1Department of Head and Neck Surgery Poznan University of Medical Sciences, The Greater Poland Cancer Centre 2College of Medicine, Burnett School of Biomedical Sciences, University of Central Florida, Orlando 3Head and Neck Cancer Biology Lab, Department of Biology and Environmental Sciences

104. THE ROLE OF EXTENDED HISTOLOGICAL EVALUATION IN ORAL CANCER PATIENTS WITH LOCAL

RECURRENCES

Szybiak Bartosz Department of Head and Neck Surgery; Greater Poland Cancer Centre

105. PIGMENTED EPITHELIOID MELANOCYTOMA WITH NODAL MELANOSIS - A RARE CAUSE OF CYSTIC

CERVICAL LYMPHADENOPATHY

Tan Hiang Jin Singapore General Hospital, Singapore

Tan Choon Chieh Sengkang General Hospital, Singapore

106. PRE-DISPOSING FACTORS AND COMPLICATION RATES ACROSS A DECADE OF TOTAL

LARYNGECTOMY

Thompson Christopher NHS Lothian, Edinburgh

107. CLINICAL OUTCOMES FOR T1N0 ORAL TONGUE CANCER PATIENTS, UNDERWENT SURGERY WITH

AND WITHOUT POSTOPERATIVE RADIOTHERAPY

Toprani Rajendra HCG Cancer Center, Ahmedabad, India

108. OUTCOMES OF MICROVASCULAR FREE FLAP RECONSTRUCTION OF HEAD AND NECK DEFECTS

AFTER MAJOR ABLATIVE SURGERY: AN EXPERIENCE OF 891 CASES AT A SINGLE INSTITUTE

Toprani Rajendra HCG cancer centre, Ahmedabad, India

109. THE IMPACT OF ENHANCED RECOVERY PATHWAYS ON OUTCOMES AFTER SALVAGE SURGERY

FOR RECURRENT/ PERSISTENT HEAD AND NECK CANCERS IN ELDERLY PATIENTS: SINGLE

TERTIARY CENTRE REVIEW

Tornari Chrysostomos Guy's and St Thomas' NHS Foundation Trust

Volpini Luigi1, Rovira-Casas Aleix1, Jeannon Jean-Pierre1, Simo Ricard1, Oakley Richard1 1Guy's and St Thomas' NHS Foundation Trust

110. PROGNOSTIC ROLE OF EXTRACAPSULAR SPREAD IN PLANNED NECK DISSECTION AFTER

CHEMORADIOTHERAPY

Valero Cristina Hospital de la Santa Creu i Sant Pau (Barcelona)

León Xavier1, Pardo Laura1, Sansa Aina1, Rodriguez Camilo1, Rovira Carlota1, Casasayas Maria1, Gutierrez Alfons1, Neumann Eduard1, Quer Miquel1

1Hospital de la Santa Creu i Sant Pau (Barcelona)

111. PATIENT AND TUMOR CHARACTERISTICS OF PATIENTS WITH EPITHELIAL HEAD AND NECK

CANCER BY REFERRAL STATUS TO A HEAD AND NECK ONCOLOGY CENTER IN A NATIONALLY

CENTRALIZED SETTING

van Dijk Boukje Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht

Campschroer Gaby1, Halmos Gyuri2, Merkx Matthias (Thijs)3 1Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht 2University of Groningen, University Medical Center Groningen, Groningen 3Radboud University Medical Center, Nijmegen

112. UP-FRONT AND SALVAGE TRANSORAL LASER MICROSURGERY (TLM) FOR GLOTTIC SQUAMOUS

CELL CARCINOMA: A SINGLE CENTRE RETROSPECTIVE CASE SERIES

Vander Poorten Vincent UZ Leuven, Leuven, Belgium

Bijnens Jacqueline1, Delaere Pierre1, Nuyts Sandra1, Clement Paul1, Meulemans Jeroen1 1UZ Leuven, Leuven, Belgium

113. ENDOSCOPIC APPROACHES FOR MALIGNANT TUMORS OF SINONASAL TRACT AND ANTERIOR

SKULL BASE: OUR EXPERIENCE

Veneri Antonio AOUI Verona

Molteni Gabriele1, Marchioni Daniele1 1AOUI Verona

114. MANAGEMENT OF THYROID CANCER WITH GROSS ANGIOINVASION - SURGICAL TECHNIQUE AND

OUTCOME

Volpini Luigi Guy's and St Thomas' NHS Foundation Trust

Rovira-Casas Aleix1, Tornari Chrysostoms1, Odell Eddy1, Mohan H1, Harrison-Phipps K1, Panuschka C1, Jeannon Jean-Pierre1, Oakley Richard1, Simo Ricard1

1Guy's and St Thomas' NHS Foundation Trust

115. DETECTION OF SEROLOGICAL HPV16 STATUS IN THE COURSE OF THERAPY IN PATIENTS WITH

OROPHARYNGEAL CARCINOMA

Weiland Thomas HNO-Univ.Klinik Graz

Wolf Axel1, Vasicek Sarah1, Pondorfer Prisca1, Holzmeister Clemens1, Moser Ulrich1, Brcic Luka2, Thurnher Dietmar2

1HNO-Univ.Klinik Graz 2Institut für Pathologie der Medizinischen Universität Graz

116. LYMPH NODES METASTASIS OF PAPILLARY THYROID CARCINOMA TO THE NECK WITH ABSENCE

OF TUMOR IN THE THYROID GLAND

Weinstein Omri The Baruch Padeh Medical Center, Poria, Israel affiliated with Bar-Ilan University, Faculty of Medicine

Goshen Sivan1, Merchavy Shlomo1 1The Baruch Padeh Medical Center, Poria, Israel affiliated with Bar-Ilan University, Faculty of Medicine

117. USE OF SUBMANDIBULAR GLAND FLAP FOR REPAIRING DEFECTS AFTER TUMOR RESECTION IN

THE PAROTID REGION

Yang Bin Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China

1. Reirradiation for recurrent Head and Neck Squamous Cell Carcinoma: clinical outcomes

Agarwal Sharmila

Jaslok Hospital and Research Centre, Mumbai

Mukherjee Prattusha1, Patel Malhar1, Kulkarni Rupali2, Qazi Mahiya2, Goswami Bibhash Chandra1,

Kalyani Nikhil1 1Jaslok Hospital and Research Centre, Mumbai 2Bethany Hospital, Thane

Rationale: Locally advanced head & neck cancers are the commonest cancers in India. Loco-regional

recurrence is a predominant pattern of failure occurring in about 40% of the patients. Few of these

patients may be offered curative intent reirrdiation (Definitive / Adjuvant). With an aim to analyze the

clinical outcomes with reirradiation for recurrent LAHNSCC, the following retrospective analysis was

done.

Materials and methods: Between January 2007 to May 2017, 84 patients were treated with curative

intent reirradiation to face and neck at our institutes. All the enrolled patients had biopsy proven

evidence of recurrent and/or new primary locally advanced carcinoma of the head and neck. Patients

were treated with either definitive or post-operative adjuvant irradiation. Target volume included gross

disease with margin / tumour bed with involved nodal region. Patients were treated with IMRT / 3DCRT

for reirradiation. Patients were followed up every 3 monthly after completion of treatment for tumour

control and toxicity evaluation.

Results: We included 84 patients in the analysis. There were 67 males. The median duration between

two courses of radiation was 34 months (range: 6-180 months). Forty two patients each had received

definitive and adjuvant treatment after surgery. The median dose for reirradiation was 60 Gy (Range 40-

66 Gy). Eighty patients completed planned treatment. Six patients developed grade III mucositis. Two

patients developed grade 3 skin toxicity resulting in unplanned treatment termination. One patient was

dependent on Ryles tube feeding post radiation for 6 months. At median follow up of 17 months, 63

patients were alive (49 disease free). Thirty four patients had recurrent / residual loco-regional disease.

One patient had second primary disease. One and Two year OS post reirradiation were 70% and 51%

respectively. There was no difference in OS between adjuvant reirradiation as compared to definitive

reirradiation.

Conclusions: Curative intent reirradiation is a feasible treatment option with acceptable toxicities. A

reasonable DFS and OS can be offered for selected group of patients. Reirradiation may be considered

as a viable option for management of recurrent head and neck cancers.

2. Evaluating the Diagnostic and Prognostic Impact of the PET/CT Imaging in Locally Advanced

Oropharynx Cancer Patients

Alarza Cano Marina

Hospital Universitario 12 De Octubre. Madrid. Spain

Ruiz Alonso Ana1, Nenclares Peña Pablo1, Hernández Martínez Ana Cristina1, Iglesias Docampo Lara1,

Gutiérrez Díaz Ramón1, Sánchez Aniceto Gregorio1 1Hospital Universitario 12 De Octubre. Madrid. Spain

Rationale: 18-FDG-PET/TC molecular imaging plays a critical role in radiation treatment planning of head

and neck cancer, transforming both primary tumour delineation and cervical nodal staging. The aims of

this study were to compare the differences in tumour staging between CT and 18-FDG-PET/TC and to

determine whether SUVmax functions as a prognostic factor in patients with locally advanced

oropharynx cancer.

Materials and methods: From October 2009 through May 2016, 29 patients with locally advanced

squamous cell oropharynx carcinoma who underwent 18-FDG-PET/TC in simulation conditions with

thermoplastic mask before radical Chemo-radiotherapy treatment were enrolled and reviewed

retrospectively. We analysed changes in tumour staging (AJCC, 7ª Ed. TNM classification) of 18-FDG-

PET/TC in comparison to CT. SUVmax was analysed for association with disease-free survival (DFS) and

overall survival (OS).

Results: Of the 29 patients, most of them (28 patients, 96.55%) were diagnosed with stage IVa-IVb, and

one was staged as III. None of them had metastasis in 18-FDG-PET/TC. All of them were treated with

chemo-radiotherapy (10 patients previously received induction chemotherapy with TPF regimen) with

radical intention. Concurrent chemotherapy used was Cetuximab in 10 patients and Cisplatin in 19

patients.

In comparison with CT, 18-FDG-PET/CT changes T stage in 24% (16% increase, 8% decrease) of cases, N

stage in 32% (24% increase, 8% decrease) and overall stage in 36% (28% increase, 8% decrease) of

patients. Mean tumour and lymph node SUVmax were 21.6 (±9.5) and 14.9 (±7.7), respectively. With a

median follow-up of 26 months, 2-year OS and DFS were 58% and 56%, respectively. Cox regression

analysis showed no correlation between SUVmax value and DFS, neither OS.

Conclusions: The results of this study indicate that 18-FDG-PET/TC is useful in tumour staging locally

advanced oropharynx cancer, varying the clinical stage in a considerable percentage from the initial CT

stage. Moreover, this has an implication in modifying the radiotherapy planning delineation.

We could not stablish a statistically significant relationship between SUVmax and prognosis, but these

could be influenced by the fact that mostly all were stage IVa-IVb patients, and all of them received

chemo-radiotherapy treatment.

3. Antero medial tight (AMT) free flap for the reconstruction in head and neck surgery:

preliminary experience

Almadori Giovanni

Institute of Otolaryngology Head & Neck Surgery, Catholic University of the Sacred Heart, A. Gemelli

University Hospital Foundation, Rome-Italy

Visconti Giuseppe, Parrilla Claudio, Salonna Giampiero, Romanello Matteo, Di Cintio Giovanni, Paludetti

Gaetano, Salgarello Marzia

Rationale: Thigh represents a good donor site for the preparation of free and pedicled flaps, to repair

local and distant tissue deficits. Variability and reliability of this donor site made it as the first choice for

the harvest of flaps for the reconstruction of massive tissue loss in Head & Neck surgery.

Because of poor clinical experience and anatomical variability, it’s impossible to evaluate the real

potentiality of AMT (anteromedial thigh flap) although low donor site’s morbility and the large

possibilities of utilization. The aim of this study is to present our experience with AMT flap, as an

intraoperative choice during dissection of ALT flap, because it represents the best reconstructive option

for its pedicle features and perforating artery’s course. Moreover our study wants to assess clinical

applicability, pros and cons of this versatile and “unexpected” flap.

Materials and methods: We considered 3 patients (two males and a female) who underwent complex

reconstruction with AMT flap for Head and Neck Cancer. Two surgical teams (one for demolitive surgery

and one for the flap preparation) work together to reduce operation time.

Results: The average lenght of skin paddle was of 10 cm; the average strength was 7 cm. We hadn’t

postoperative complications; donor sites were closed without skin grafts. No complications was found

at six months Follow up.

Conclusions: AMT adipocutaneous flap represents a good surgical option for complex Head&Neck

reconstructions. It has demonstrated to be a surgical possibility with high versatility and poor morbility.

4. Minichromosome maintenance protein 7 (MCM7) and geminin expression: Prognostic value

in laryngeal squamous cell carcinoma in patients treated with radiotherapy and cetuximab

Almadori Giovanni

Institute of Otolaryngology Head & Neck Surgery, Catholic University of the Sacred Heart, A. Gemelli

University Hospital Foundation, Rome, Italy

Lauriola Libero, De Corso Eugenio, Bussu Francesco, Valentini Vincenzo, Di Cesare Tiziana, Mele Dario,

Salonna Gianpiero, Di Cintio Giovanni, Paludetti Gaetano, Carey Thomas, Ranelletti Franco

Rationale: Minichromosome maintenance protein 7 (MCM7) is a downstream of human epidermal

growth receptor (HER1) signaling. We examined MCM7, geminin, and HER1 expression in patients with

laryngeal squamous cell carcinoma (SCC) treated with radiotherapy and cetuximab.

Materials and methods: MCM7, geminin, and HER1 were evaluated by immunohistochemistry on 61

patients with laryngeal SCC. The follow-up (median, 32.1 months; range, 2-139 months) went from the

beginning of therapy to tumor progression-free survival (PFS) and death (overall survival [OS]).

Results: MCM7, but not geminin, was associated only with HER1 expression, whereas no association

was found with other clinicopathological characteristics. Patients with MCM7 high - geminin high and

MCM7 high - geminin low tumor status had a risk of progression 3.1 times and 17.7 times greater,

respectively, than patients with MCM7 low - geminin high tumor status. Tumor site, MCM7, and geminin

were independent determinants of PFS, whereas MCM7 was an independent prognostic marker of OS.

Conclusions: At present there is no clear evidence that HER1 expression correlate with sensitivity to

cetuximab. MCM7-geminin tumor status, as a prognostic marker independent from HER1 expression,

may provide information to identify subgroups of patients with different local response to cetuximab

and radiotherapy.

5. Superficial circumflex iliac artery perforator (SCIP) free flap for the reconstruction in Head

and Neck Surgery: preliminary experience

Almadori Giovanni

Institute of Otolaryngology Head & Neck Surgery, Catholic University of the Sacred Heart, A. Gemelli

University Hospital Foundation, Rome, Italy

Visconti Giuseppe, Rigante Mario, Romanello Matteo, Salonna Giampiero, Di Cintio Giovanni, Paludetti

Gaetano, Salgarello Marzia

Rationale: Nowadays using of free microvascular flaps is the gold standard for the oncological

reconstruction in the head and neck surgery with. ALT (anterolateral thigh) flap is the most used flap for

soft tissue reconstructions, as it provides versatility in terms of constructions, even chimera, and

reliability. However, the ALT flap exhibits some disadvantages in terms of quality of reconstruction,

especially for the resurfacing of the face, pharynx, tongue and mouth floor because it is not easily pliable

even if thinned, and it leaves scarred stigmata on the lateral anterior surface of the thigh, that are not

be easily accepted by female patients.

Materials and methods: We report the preliminary cases of the use of the SCIP flap for the

reconstruction of the pharynx, for the reconstruction of a wide defect in the lower third of the face, and

for the reconstruction of a tongue and mouth floor. After the preoperative study with doppler, the SCIP

flap was removed by first studying the flap vascular anatomy through an explorative cutting and then

drawing the flap according to the reconstructive needs. The donor site was closed with negative pressure

therapy.

Results: The SCIP flap exhibits vascular anatomical variability and can be based on SCIA's deep or

superficial branch dpending on its dominance. Venous drainage is guaranteed by the SCIV rather than

other veins that are smaller.

Vascular anastomoses require the use of intraoperative microscopy and sometimes supermicro

technique as the artery gauge at the femoral origin is usually 1mm.

Complications have not been reported and we have verified a superior pliability of this flap then that of

the ALT flap. The donor site is particularly acceptable and very much appreciated by the patients.

Conclusions: Despite of the length of the pedicle and the vessels gauge, the SCIP flap is a viable

alternative in head and neck reconstruction especially in areas where there is no need for volume or

resurfacing.

6. Mixed beam (photons-protons) radiotherapy for locally advanced (T3-T4) non-endemic

nasopharyngeal carcinoma: preliminary results

Alterio Daniela

European Institute of Oncology, Milan

D'Ippolito Emma1, Fossati Piero1, Ricotti Rosalinda2, Gandini Sara2, Vischioni Barbara1, Vitolo Viviana1,

Bonora Maria1, Mastella Edoardo1, Magro Giuseppe1, Franco Pierfrancesco3, Krengli Marco4, Comi

Stefania2, Tagliabue Marta2, Verri Elena2, Valvo Francesca1, Jereczek-Fossa Barbara Alicja5,6, Orecchia

Roberto7,8 1National Center for Oncological Hadrontherapy, CNAO, Pavia 2European Institute of Oncology, Milan 3University of Turin, Turin 4University of Piemonte Orientale, Novara 5University of Milan, Milan; 6European Institute of Oncology, Milan 7Scientific Directorate, European Institute of Oncology, Milan 8Scientific Directorate National Center for Oncological Hadrontherapy, CNAO, Pavia

Rationale: Local control of locally advanced (cT3-T4, cN0-N3, M0) nasopharyngeal cancer (LANPC)

remains a challenge. Purpose of the present analysis was to evaluate outcome of patients (pts) with

LANPC treated using a sequential mixed beam (MB) approach (Intensity Modulated Radiotherapy -IMRT-

followed by proton therapy) and to compare results to those obtained in a similar retrospective cohort

of pts treated with only IMRT.

Materials and methods: 17 consecutive pts with LANPC treated with MB approach were evaluated. First

phase of treatment consisted in IMRT up to a total dose of 54-60 Gy (elective irradiation of the neck and

macroscopic disease). Second phase consisted in proton therapy boost on the pre-treatment

macroscopic disease (with pencil beam scanning, up to a total dose of 70-74 Gy RBE). 17 pts with LANPC

treated with only IMRT (up to a total dose of 70 Gy, 2-2.12 Gy/die, Simultaneous Integrated Boost

technique) were also analyzed. Clinical outcome (local control -LC-, 3-year local relapse free- -LRFS-,

distant metastases free- survival -DMFS-) and toxicity profile were evaluated. For the purpose of the

study the response to treatment, LC and LRFS was considered only for the primary tumor in the

nasopharynx.

Results: Pts treated with IMB and IMRT had a median follow-up of 31 and 51 months, respectively. LC,

3-year LRFS and DMFS were 93%,93%,64% and 81%,85% and 81% for MB and IMRT group, respectively.

Although cT4 represented 71% and 41% of cases in MB and IMRT cohort of pts, LC control was not

statistically different between the two groups (p=0.60). No G4 acute and late toxicity was found. The

most frequent acute toxicities were: G2-G3 mucositis and dysphagia found in 71%, 88% and 53%, 53%

in MB and IMRT group, respectively. Grade 2-3 late xerostomia was found in 33% and 19% for MB and

IMRT group, respectively. Long term endocrine disorders were found in 7% and 6% of pts treated with

MB and IMRT, respectively. Although a significant higher total dose was prescribed to pts treated with

a MB approach (p=0.02) the toxicity profile were similar between the 2 groups.

Conclusions: Results showed excellent short-term outcome and limited radiation-related side effects in

pts treated with a MB approach. A longer follow-up is required to confirm these promising preliminary

results.

7. Soft tissue necrosis (STN) in oropharyngeal cancer patients treated with Transoral robotic

surgery (TORS) followed by postoperative radiotherapy: the European Institute of Oncology

experience

Alterio Daniela

European Institute of Oncology, Head and Neck Program, Dept Radiation Oncology, Milan, Italy

Tagliabue Marta1, Muto Matteo2, Zorzi Stefano1, Sibio Daniela2, Bayir Omer3, Marvaso Giulia4, Ferrari

Annamaria4, Verri Elena5, Ansarin Mohssen1, Jereczek Fossa Barbara Alicja2,4 1European Institute of Oncology- Head and Neck Program, Division of Ototalryngology and Head and

Neck Surgery, Milan, Italy 2Dept Oncology and Hemato-Oncology, University of Milan, Italy 3dokun EyuL Universitesi Hastanesi 4European Institute of Oncology, Head and Neck Program, Dept Radiation Oncology, Milan, Italy 5European institute of Oncology- Head and Neck Program, Division of Urogenital and Head and Neck

Medical Oncology, Milan, Italy

Rationale: Soft tissue necrosis (STN) represents a peculiar side effects in patients (pts) treated with

transoral robotic surgery (TORS) followed by postoperative radiotherapy (PORT). Aim of this analysis

was to evaluate incidence and risk factors of STN in pts treated for oropharyngeal cancer (OPC) at our

Institute

Materials and methods: Between November 2009 and June 2017, 23 pts were treated with TORS and

PORT for OPC. Four pts were excluded (two pts lost at follow up and two pts with a follow up shorter

than 3 months). Therefore, 19 pts (14 male, median age 60 years) represented the study cohort for the

present analysis. Two pts received tonsillectomy while 17 patients were treated with a complete

oropharyngectomy. Surgical margins were negative, close and positive in 9, 6 and 4 pts, respectively.

Most pts (84%) had pathologic stage III and IV. The median total dose of PORT was 66 Gy (range 60-

70Gy). For 15 pts the radiotherapy treatment plan was available and analysed. According to available

literature data, we considered the following risk factors for STN: depth of surgical resection, pathological

tumour size, grade of acute mucositis, radiation doses (total, mean and maximum dose and

dose/fraction) prescribed to the surgical tumor bed

Results: After a median follow up of 25 months (mean 26, range 3-77 months), all pts were alive without

disease. STN occurred in 4 (21%) pts. For all pts STN healed spontaneously. The median depths of

surgical resection and pathological tumor sizes were 1cm, 1cm and 2.2cm, 2.1cm for pts who

experienced and those who experienced not STN, respectively. Radiation doses were similar between

the two groups: median values of dose prescription to the surgical bed was 66 Gy, mean dose/fraction

was 2Gy/die, median value of the maximum and mean dose to the surgical tumor bed were 69 and 63

Gy, respectively. Median acute mucositis was grade 2 for both groups of pts

Conclusions: The present analysis confirms that STN represents a common event in pts treated by TORS

and PORT. No correlation between STN and suggested risk factors was found but this is probably due to

the limited number of analysed pts. In case of PORT after TORS we therefore suggest to contour the

tumor surgical bed in order to carefully evaluate the absorbed dose in that region.

8. Perception, Knowledge, And Awareness of Head and Neck Cancer: A Cross-Sectional Study of

The General Population

Althobaiti Awwadh

King Abdulaziz University, Jeddah, Saudi Arabia

Merdad Mazin1, Marzouki Hani1, Mosli Mahmoud1, Alwassia Rolina1, Al-Hajeili Marwan1, Majdili Ahad1,

Aser Khulod1 1King Abdulaziz University, Jeddah, Saudi Arabia

Rationale: Head and neck cancer (HNC) is responsible for substantial morbidity, mortality, and cost

worldwide. HNC is the 3rd most common cancer in Saudi Arabia and believed to be a growing public

health concern. Early identification and modification of lifestyle risk factors related to HNC are believed

to significantly influence disease burden and outcomes. Knowledge of the society’s level of awareness

of HNC is needed prior to introducing interventions on the level of the public. Therefore, we aimed to

assess public awareness, perception, and knowledge of HNC among Saudis.

Materials and methods: Adults aged 18 and above were surveyed using a self-administered

questionnaire during a head and neck awareness campaign. Knowledge of HNC symptoms and risk

factors and predictors of time to seeking medical advice were considered the main outcomes.

Results: 713 adults were surveyed. The majority of patients were males (66%), in the 21-40 age category

(68%), and held a bachelor degree of education (58%). 48% had never smoked and 61% had never

received counseling about risks of smoking. Only 34% were healthcare providers. 71%, 78%, and 64% of

surveyed individuals recognized at least one alarming symptom of oral cavity, laryngeal, and thyroid

cancer, respectively. 88% recognized at least one risk factor of HNC. The most common method of

delivering awareness was social media (38%). Only 50% reported that they would seek medical advice

immediately if symptoms of HNC were recognized. The most commonly reported barrier to seeking

medical advice was difficulty finding an appointment with a specialist (35%). On linear regression age

(coefficient = -1.54, 95% confidence interval (CI) = -0.27 ‒ -0.40, p = 0.012) and awareness method

(coefficient = 0.22, 95%CI = 0.23 ‒ 0.10, p = 0.04) were significant predictors of delay in seeking medical

advise.

Conclusions: The vast majority of the population appears to be aware of symptoms and risk factors of

HNC but only half would expedite medical advice. Symptomatic young individuals exposed to social

media appear to be more likely to seek urgent medical advice.

9. Diagnostic timeline and determinants of treatment delays in oral and oropharyngeal cancer

patients in Brazil

Arantes Soares Joao Marcos

Universidade Federal de São Joao Del Rey, Divinopolis

Tiburcio Jaqueline1, Belligoli Leonardo1, Bigodeiro Viviane1, Bretas Pedro1, Nunes Louise1, Prado Neto

Severino1, Waldolato Gustavo1, Freitas Chaves Aline Lauda1 1Universidade Federal de São Joao Del Rey, Divinopolis

Rationale: Oral/oropharyngeal cancer (OOC) is the most common malignant tumor among head and

neck cancer (HNC) patients in Brazil. They are often diagnosed at advanced stages with high morbidity

for the patients. Understanding the diagnosis and treatment timeline of these tumors is essential. The

aim of this study is to measure the time spent since the first symptom to the treatment initiation and

point out variables associated with delay in the treatment of OOC.

Materials and methods: One hundred patients were interviewed using a structured questionnaire that

addressed socioeconomic, demographic issues and clinical characteristics. Time (T) was divided between

first symptoms until treatment in four intervals: T1: time between first symptom to the first

appointment with a doctor; T2: time between this appointment until the arrival to the Reference Center;

T3: time from the arrival in Reference Center until the pre treatment tests are done; T4: from patient

eligible for to be treated until the treatment.

Results: Nine patients (9%) died before treatment. 72% of patients were diagnosed at an advanced

stage, showing significant association with gender (female), alcohol, smoking and type of

treatment(surgical versus non surgical). The average time from first symptom to treatment was 216.66

days, the highest medians were found in T1 and T2 (respectively 62.8 and 94.1 days). T1: Tobacco and

alcohol addicted patients and positive cancer familiar history of HNC are statistically associated with

delay in diagnosis more than 30 days. T2: Patients evaluated by a HNC expert and who don´t used

antibiotics are statistically NOT associated with delay of the treatment. Patients living in the reference

center city had a greater T3. Patients submitted to non surgical treatment had a shorter T4.

Conclusions: Delays in the treatment beginning are statistically associated with tobacco e alcohol

addicted patients, antibiotics use, general practitioner evaluation instead of HNC expert and surgical

treatment. Public policies should be directed to these variables to timely treatment of HNC in Brazil.

10. Local recurrence of laryngeal cancer treated with intensity-modulated radiotherapy and

associated toxicities: the Beatson experience

Begbie Finn

Beatson West of Scotland Cancer Centre, Glasgow, Scotland

Thomson Maureen1, Paterson Clare1 1Beatson West of Scotland Cancer Centre, Glasgow, Scotland

Rationale: Intensity-modulated radiotherapy (IMRT) in the treatment of laryngeal cancer is now

common practice. Its use has been shown to reduce the toxicity of treatment in the short and long-

term. However, there is concern that the

conformity of this technique increases the risk of geographic miss. This study sought to determine

outcome in terms of recurrence and its associated toxicity in patients with laryngeal cancer treated with

IMRT.

Materials and methods: Patients who had received radical IMRT using RapidArc® between 01/2011 and

02/2014 at the Beatson West of Scotland Cancer Centre were identified retrospectively. Clinical records

were reviewed to determine outcome post-

treatment. Patients were followed-up for at least 1 year. Toxicity data were gathered using a patient-

reported scoring system at 3, 6, 9, 12, 18, 24 and 36 months post-treatment.

Results: 55 patients were eligible for the study: 18 females and 37 males. Mean age 62 (range:39-80).

Median follow-up 18 months (range:2-44). Median disease-free survival 16 months (range:1-43).

Overall recurrence rate for the cohort was 14.55% (n= 8). 4 patients had salvage laryngectomy

performed with histopathological confirmation of recurrence. Xerostomia was the most prevalent

toxicity at all time points. Toxicity was higher in the early stages and diminished as time progressed with

minimal late toxicities.

Conclusions: IMRT for laryngeal cancer shows good control rates comparable with other treatment

modalities. Xerostomia is the commonest toxicity and may last for years. Late toxicities are minimal

and acceptable but data is lacking. Overall, IMRT is an effective treatment for laryngeal cancer with

acceptable outcomes.

11. Uncommon cervical node metastases from non head and neck primary tumour

Bejarano-Panadés Natàlia

Hospital Mateu Orfila, Mahón

Martínez de Castro Ana María1, Muñoz Proto Fernanda1, Barrio M.Mar1 1Hospital Mateu Orfila, Mahón

Rationale: Cervical lymph node is a common site of metastases for malignant tumors of the head and

neck. However, about 1% of all malignancies that present with cervical adenopathy have their primary

tumor in another remote site. Primary tumors that may be associated with cervical adenopathy without

visible primary from head and neck tumour are breast, lung, gastrointestinal tract, genitourinary tract

and, exceptionally, the central nervous system.

The main objective of this study, is the clinical relevance of knowing which tumors have a propensity to

nest in cervical territory, without objectifying primary tumor in the head and neck area.

Materials and methods: Review of patients with malignant cervical lymph node excluding lymphoma,

melanoma and squamous cell carcinoma from non primary sites in the head and neck. Period analyzed

between 2013-2017. Number, primary tumor, histologic type and location neck metastases are

presented.

Results: With a sample of 9 patients, 3 of them (33%) with lung cancer (non-small cell lung cancer), 2/3

patients in supraclavicular fossa and 1/3 in the left III neck area; 2 patients (22%) with breast cancer

(ductal carcinoma) 1/2 in left side IV level and 1/2 in supraclavicular fossa; 1 patient (11%) with

testicular cancer (seminomatous germ cell tumor) on IV right neck level; 1 patient (11%) with renal cell

carcinoma on thyroid gland; 1 patient (11%) with intestinal adenocarcinoma on IV left neck; and 1

patient (11%) with prostate cancer (adenocarcinoma) on right III level neck.

Conclusions: This sample of cases illustrates the difficulty of the differential diagnosis of cervical lymph

node involvement without known primary tumor. To be able to establish the clinical history, the

diagnosis and the therapeutic strategy with a multidisciplinary assessment of oncologists,

otorhinolaryngologists and pathologists, allows to reach the correct management of the patient. A

search for the primary tumour includes information gained by histology, immunohistochemistry, and

evaluation of molecular markers that may be unique to the primary tumor site In addition, 18F-fluoro-

2-deoxyglocose positron emission tomography combined with CT (FDG-PET/CT) has greatly improved

the ability to detect the location of an unknown primary tumor.

12. Multidisciplinary network between navigation-assisted platform and computer-aided design

and manufacturing platform

Bescós Atín Coro

Hospital Universitari Vall d'Hebron, Barcelona (Spain)

Rationale: The treatment of malignant tumors of the maxillofacial area requires an interdisciplinary

approach in order to obtain an optimal balance between tumor control and quality of life of the affected

patients.

Materials and methods: Although the primary intended outcome of surgery to treat head-and-neck

malignancies continues to be the disease-free survival of the patient, health-related quality of life

(HRQOL) is now seen as an essential secondary outcome.

A multidisciplinary network in assisted navigation has been well described. The advantages offered

include improving the interface between different specialists −surgeon, radiologist, radiation oncologist

and pathologist− in the field of head and neck cancer and allowing feedback between them that could

be useful in critical points such as the definition of the resection margins by the pathologist and

subsequent radiotherapy treatment planning.

On the other hand, the quality of live in head and neck cancer patients who were treated surgically

largely depends on the quality of the reconstruction.

The aforementioned quality is increased by the application of digital technology through virtual planning

and development of customized plates and prostheses that allow greater accuracy of reconstruction and

therefore an improvement in the functional and aesthetic results.

Results: The aim of our presentation is to describe the interconnection between the navigation-assisted

platform and a platform of computer-aided design and manufacturing by introducing 5 clinical cases.

Conclusions: We believe that this new complex network between digital platforms can improve the

transfer of information as well as the quality of the treatment given to our patients.

13. Validation of the 8th AJCC TNM classification in a well-defined retrospective T1-T2 oral

squamous cell carcinoma cohort

Boeve Koos

Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center

Groningen, Groningen, The Netherlands

Melchers L.J.1, Schuuring E.2, Roodenburg J.L.N.1, Halmos G.B.3, van Dijk B.A.C.4, van der Vegt B.2, Witjes

M.J.H.1 1Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center

Groningen, Groningen, The Netherlands 2Department of Pathology and Medical Biology, University of Groningen, University Medical Center

Groningen, Groningen, The Netherlands 3Department of Otorhinolaryngology / Head & Neck Surgery, University of Groningen, University

Medical Center Groningen, Groningen, The Netherlands 4Department of Epidemiology, University of Groningen, University Medical Center Groningen,

Groningen, The Netherlands

Rationale: In the 8th edition of the American Joint Committee on Cancer (AJCC) TNM staging Manual

(8th ed.), tumor infiltration depth and extranodal extension (ENE) are added to the classification of oral

squamous cell carcinoma (OSCC). The 8th ed. TNM classification was validated on three independent

cohorts, however not at the level of disease specific survival. The aim of this study was to validate the

8th ed., with independent well-defined data, on three endpoints: overall survival (OS), disease specific

survival (DSS) and disease free survival (DFS).

Materials and methods: A retrospective cohort of 211 oral squamous cell carcinoma patients with a

median follow-up of 64 months was selected of which 173 patients, treated by primary resection

combined with neck dissection. In all cases, tumor infiltration depth was reassesed. OS, DSS and DFS

were calculated for both the 7th and 8th ed. using Kaplan-Meier functions.

Results: With the 8th ed., 75 patients (36%) were upstaged because of tumor infiltration depth and 21

of the 173 neck treated patients (12%) were upstaged because of extranodal extension. With the 8th

ed. criteria, T3 staged showed a trend of shorter OS compared to T2 staged patients (66% vs. 50%, p =

0.082) and N3 patients had shorter OS compared to N2 staged patients (44% vs. 13%, p = 0.006). DFS

and DSS were comparable with OS.

Conclusions: Upstaging according to the 8th edition of the AJCC TNM classification could better identify

patients with worse prognosis, resulting in more accurate prediction of survival endpoints.

14. Dissecting heterogeneity and molecular mechanisms involved in paranasal sinus cancer

Bossi Paolo

Fondazione IRCCS Istituto Nazionale Tumori, Milan

Granata Roberta, Orlandi Ester, Fallai Carlo, Licitra Lisa, Perrone Federica, Quattrone Pasquale, Facco

Carla, Sessa Fausto, Turri Zanoni Mario, Battaglia Paolo, Castelnuovo Paolo, Paielli Nicholas, Serafini

Serena Mara, De Cecco Loris

Rationale: Epithelial, non-glandular paranasal sinus cancer is a rare disease, with a global dismal

prognosis. Dissecting the heterogeneity of paranasal sinus cancers and providing valuable information

on the biology of the malignancy is eagerly needed to improve therapeutic approaches.

Materials and methods: We selected a retrospective cohort of 47 paranasal sinus cancer cases including

the following histologies: i) sinonasal undifferentiated cancer (SNUC; n=13); ii) sinonasal neuroendocrine

cancer (SNEC; n=13); iii) non keratinizing squamous cell cancer (NKSCC; n=21). Treatment consisted in

different combinations of surgery, radiation and systemic therapies. Whole-transcriptome profiling was

performed by microarray analysis using the DASL assay and BeadArray Chips (Illumina). Supervised

analysis was performed by sPLS-DA to disclose the molecular patterns associated to histologies. We

explored the potential biological processes differentiating the subtypes through Gene Set Enrichment

Analysis (GSEA). Functional pathway analysis was performed interrogating gene sets belonging to

Hallmark Gene Set Collection.

Results: Class prediction analysis based on gene-expression data showed a misclassification rate of 19%

compared to pathological revision. We defined a neuroendocrine signature able: i) to differentiate SNEC

from SNUC and NKSCC; ii) to stratify patients based on overall survival (Log-rank p-value <.001).

Functional analysis disclosed pathways related to inflammatory/ interferon-alpha response networks as

enriched in SNUC cases, while NKSCC is characterized by proliferation and mTOR pathways. As further

attempt to disclose the biology behind paranasal sinus cancer, consensus unsupervised clustering was

applied to the gene-expression data matrix and revealed the presence of four stable clusters of samples.

These clusters showed a significant enrichment of: i) proliferation pathways and gene-sets associated

with G2/M checkpoint; ii) MYC, mTOR signalling; iii) inflammation pathways; iv) extracellular matrix and

WNT signalling.

Conclusions: The present preliminary report is the first in-deep molecular analysis of paranasal sinus

cancer that proves the capability of transcriptomic profiling to capture molecules and functional

pathways deregulated in this disease. The identification of gene-expression patterns associated across

the different histologies and to clinical outcome is ongoing.

15. Health and economic outcomes of two different follow up strategies in effectively cured

advanced head and neck cancer – trial in progress

Bossi Paolo

Fondazione IRCCS Istituto Nazionale Tumori, Milan

Granata Roberta, Orlandi Ester, Piazza Cesare, Meregaglia Michela, Rognoni Carla, Quaglini Silvana,

Pulice Iolanda, Giolitto Serena, Calareso Giuseppina, Lorizzo Alessandro, Licitra Lisa

Rationale: No consensus has been reached till now on the optimal timing and type of examinations to

be adopted during the follow up (FUP) of head and neck squamous cell cancer (HNSCC) patients. There

is also a need to find out which is the most cost-effective FUP program in this population. The present

trial is aimed to assess the superiority of a more intensive radiologic FUP approach compared with a less

intensive, symptom-driven one; their economic impact on the healthcare system is also evaluated.

Materials and methods: This is a randomized, phase II, multicenter trial. Patients with stage III-IV SCC

of oral cavity, oropharynx, larynx or hypopharynx having already received radiation therapy as curative

treatment or in postoperative setting, in complete remission at six months, are randomized into two

arms representing alternative FUP approaches. The non-intensive FUP (ARM A), designed according to

the National Comprehensive Cancer Network (NCCN) guidelines, implies a radiologic evaluation (loco-

regional CT scan or MRI) within 6 months since treatment end and subsequently only at signs or

symptoms occurrence. Conversely, the intensive FUP (ARM B) consists of a number of scheduled

radiologic evaluations over time.

The timing of FUP visits for each patient is tailored according to the head and neck subsite as per NCCN

and AIOCC (Italian Association of Cervical Facial Oncology) guidelines. The accrual started in May 2015

and 110 patients of the planned 330 have been enrolled so far.

Results: The cost-effectiveness of ARM B compared to ARM A will be assessed in terms of incremental

cost per life year and quality-adjusted life year (QALY) gained. Moreover, the percentage of potentially

salvageable recurrences or second primaries, the cause-specific survival and the overall survival of

recurring patients will be evaluated in both study groups.

Conclusions: The trial is currently open to accrual. It has the ambition to define the state of the art in

the radiological exams needed after curative treatment of HNSCC patients.

The trial is supported by the Swiss Bridge Association.

Presented on behalf of the HETECO team of investigators.

16. Seeking for prognostic factors in non-endemic, recurrent/metastatic nasopharyngeal cancer

through a web-based data registration: a first step into the real-world data analysis

Bossi Paolo

Fondazione IRCCS Istituto Nazionale Tumori, Milan

Berruti Alfredo, Alberti Andrea, Alfieri Salvatore, Ferrari Vittorio, Mirabile Aurora, Licitra Lisa, Grisanti

Salvatore

Rationale: Patients (pts) with recurrent (r) and/or metastatic (m) nasopharyngeal cancer (NPC) form a

heterogeneous group, with no recognized prognostic factors in geographical areas where the disease is

not endemic. We conducted a retrospective pilot study to analyse the patterns of clinical presentation

and the prognostic factors of r/m NPC pts treated at two referral centers in Northern Italy.

Materials and methods: Clinical data were collected in a web-based platform as part of a wider project

to create a large database of NPC pts from lower incidence countries (www.npcportal.org). Statistical

analysis included Kaplan Meier estimates, parametric test and Cox models for hazard ratio

determination.

Results: We analysed 118 pts consecutively treated from 1/2006 to 12/2016 at the departments of

medical oncology of the Istituto Nazionale Tumori Milano (nr 104) and Spedali Civili Brescia (nr 14).

Twenty-two (19%) pts had metastasis at diagnosis. Of the remaining 96 pts relapsing after first-line

treatment, 41 (43%), 36 (37%) and 19 (20%) had loco-regional relapse, distant metastases or both,

respectively. Bone was the most frequent metastatic site (62%) followed by liver (42%), distant lymph

nodes (36%) and lung (34%). The median disease-free interval in relapsing pts was 14 months. Patients

with loco-regional relapse received re-irradiation combined with chemotherapy (CT) or CT alone in 54%

and 32% of cases, respectively. The combination treatment resulted in a survival advantage (51 vs 17

months, p .005). R/m pts received up to 5 lines of CT (median 3) and the most frequently adopted

schedules were platinum-based, combined with paclitaxel (19%), gemcitabine (16%) and fluorouracil

(15%). Negative prognostic factors for PFS were the short disease-free interval and the following factors

collected at baseline (before starting therapy for r/m NPC): ECOG PS ≥1, anaemia (haemoglobin level

less than 9 g/dL), LDH (above 350 UI/L) and presence of circulating EBV-DNA. After therapy start, the

reduction of circulating EBV-DNA from baseline levels mirrored a clinical benefit.

Conclusions: The present analysis helps defining prognostic factors for r/m NPC in non-endemic regions.

Increasing the number of analysed pts through a web-based platform will refine the prognostic model

and will help in evaluating the impact of different treatments in such a disease.

17. CO2 Transoral Microsurgery for Supraglottic Squamous Cell Carcinoma

Carta Filippo

University of Cagliari

Quartu Daniela1, Marrosu Valeria1, Sambiagio Giovanni B. 1, Puxeddu Roberto1, Mariani Cinzia1 1University of Cagliari

Rationale: The main advantage of CO2 laser endoscopic supraglottic laryngectomy is the tailoring the

resection on the basis of the tumor extension by sparing all possible anatomical structures not involved

by the tumor. We performed a retrospective clinical study on the functional and oncologic results after

endoscopic supraglottic laryngectomy.

Materials and methods: Forty-three patients (34 males, 9 females, mean age of 61.7 years - range of

43-84 years) were treated for supraglottic squamous cell carcinoma by transoral approach with CO2

laser, from November 2010 to November 2017. Surgical procedures were classified according to the

European Laryngological Society. Swallowing was evaluated according to the Multinational Association

of Supportive Care in Cancer/International Society of Oral Oncology. Statistical analyses were performed

using GraphPad Prism software (GraphPad, San Diego, CA, USA).

Results: Patients underwent 2 type I, 3 type IIa, 2 type IIb, 3 type IIIa, 12 type IIIb, 13 type IVa, 2 type

IVb modified, and 6 type IVb supraglottic laryngectomies. Twenty-one patients (49%) underwent

primary neck dissection (16 simultaneously, and 5 within 30 days after the transoral procedure). In 23

patients (53.5%) temporary trachesotomy was performed. At 3 months, patients who underwent

resections without removal of the arytenoid showed better swallowing compared to patients who

underwent standard type IVb resection (p=0.016395). Nine patients (21%) underwent adjuvant

radiotherapy. During the follow-up 11 patients died for other causes and 2 patients died for the disease.

Nine patients (21%) experienced recurrence of the disease (4 on ipsilateral neck, 1 on contralateral neck,

1 on ipsilateral neck and after 1 year on primary, and 3 on primary), and underwent total laryngectomy

(3 cases), neck dissection (6 cases), and neck dissection and open horizontal laryngectomy (1 case). Four

patients underwent adjuvant radiotherapy after rescue therapy. Kaplan-Meier analysis revealed 5-years

disease-specific-survival, local-relapse-free-survival, nodal-relapse-free-survival, overall-laryngeal-

preservation and overall-survival of 93.1%, 82.9%, 79%, 90.6%, and 64.8%.

Conclusions: Transoral CO2 laser supraglottic laryngectomy is an oncologic sound alternative to

traditional open neck surgery, and chemo-radiotherapy. Recovery of swallowing is significatively

worsened after total resection to the arytenoid.

18. An only navigation-assisted platform for a multidisciplinary oncological network

Catanzaro Susanna

Operative Unit of Maxillo-Facial Surgery, Otolaryngology and Dentistry, Hospital Casa Sollievo della

Sofferenza, San Giovanni Rotondo (Fg), Italy

Copelli Chiara, Corsa Pietro, Manfuso Alfonso, Tewfik Hanna Karim, Pederneschi Nicola, Cassano Lazzaro,

Mastromatteo Annalisa, Cocchi Roberto

Rationale: An optimal treatment of head and neck malignant tumours requires an interdisciplinary

approach between radiology, surgery, radiotherapy, and pathology, often afflicted by some problems

such as: the anatomical complexity of the head and neck area, the complexity of the three-dimensional

resections and reconstructions, the difficulty of orienting the specimen by the pathologist and the non-

standardized transfer of detailed information among medical specialists. The technological innovations

achieved in recent years have provided an important aid to address the above-listed issues and

improved the accuracy and quality of oncological treatments performances, starting from the pre-

surgical planning till to the adjuvant radiotherapic planning.

Materials and methods: In the first phase, the DICOM data of CT/MRI are imported in planning software

iPlan Cranial 3.0 (Brainlab AG, Germany) in order to carry out a surgical planning and define the resection

volume. The second phase consists in the intraoperative transposition of surgical planning and in the

identification, on the three-dimensional navigation image, of “reference landmarks”, related both to

resection margins and to intraoperative biopsies and to suspected areas for residual involvement that

cannot be excised due to the proximity to important structures. The surgical treatment planning with

landmarks is used by the pathologist for properly orienting the surgical specimen and to have a better

histological definition of resection margins and critical areas. Finally, the pathologist integrates the

histological information into the system with specific coordinates in order to perform a correct adjuvant

radiation planning, minimizing the irradiation of adjacent healthy structures.

Results: In this study, we found unchanged operative times, a reduced rate of errors in the surgical

specimen orientation and an increased distance of the tumor from the margins of resection, an optimal

definition of irradiation volume.

Conclusions: An only navigation-assisted platform allows the interactive exchange of data in ready-to-

use formats by radiological examinations, surgical planning, intraoperative navigation, as well as

radiotherapy planning software.

19. Experience of scapular tip free flap reconstruction in Head&Neck surgery: a supine harvest

technique

Chalmers Richard

Department of Head & Neck Surgery, Guy’s and St Thomas’ Hospital, London

Cascarini Luke1, Fry Alastair1, Townley William2 1Department of Head & Neck Surgery, Guy’s and St Thomas’ Hospital, London 2Department of Plastic & Reconstructive Surgery, Guy’s and St Thomas’ Hospital, London

Rationale: The scapular tip free flap has an important role in head and neck reconstruction. It’s use is

often limited by the need to reposition the patient on their side for harvest, preventing 2-teams from

operating simultaneously. We present a series where harvest is in the supine position allowing a 2-team

approach.

Materials and methods: The scapular tip chimeric flap has been used in our Head and Neck unit since

2016. Patient demographics and operative details have been collected prospectively over this time and

our experience with this harvest technique will be presented. Complications and length of stay details

have also been recorded.

Results: Over a 14-month period there were 12 patients that underwent head and neck bony

reconstruction with a scapular tip free flap harvested in the supine position with shoulder abducted and

a rolled towel medial to the ipsilateral scaplar. Nine patients were male whilst 3 were female with an

average age of 70 years (Range: 51-85 years). The tumour types included 10 SCC (3 recurrent and one

post treatment osteoradionecrosis), one neuroendocrine tumour and one adenoid cystic carcinoma. The

bony defect involved the maxilla in 7 cases – of which 3 included the orbital floor. The remaining cases

required reconstruction of the mandible. Due to the complexity of the compound defects, a variety of

flaps were used supplied by the subscapular axis. Six cases used the scapular tip with a covering of teres

major over the periosteum, 4 included the latissimus dorsi muscle whilst 3 included a skin component

either the TDAP or the parascapular flap. Of these cases, one used 3 flap components, scapular tip, LD

and TDAP skin island.

All cases were harvested in the supine position and there were no flap losses. There were 3 minor

complications with some areas of soft tissue debridement required at week 7 for the ORN case,

superficial skin loss from the parascapular flap and loss of part of the LD component of the chimeric flap

at 2-weeks post operation. Length of stay was 16 days on average (Range: 10-31 days) including post-op

recovery, rehabilitation, nutrition training and speech and language input.

Conclusions: We present a series of complex reconstructions using the scapular tip free flap. It can be

harvested successfully in the supine position allowing for a 2-team approach.

20. Intra-oral anastomosis for free flap reconstruction of intr-oral tumour defects. Technique and

learning points

Chalmers Richard

Department of Head & Neck Surgery, Guy’s and St Thomas’ Hospital, London

Cascarini Luke1, Fry Alastair1 1Department of Head & Neck Surgery, Guy’s and St Thomas’ Hospital, London

Rationale: Microvascular head and neck reconstruction is challenging and comes with varying degrees

of morbidity depending upon the case. We are constantly aiming to reduce morbidity for our patients.

In some cases where access to the neck vessels by way of an access neck dissection is not needed, then

patient morbidity can be reduced by performing intra-oral anastomoses to the facial vessels in the cheek

rather than to vessels in the neck.

Materials and methods: We present our experience, technique and learning points on 5 patients

undergoing free flap intraoral reconstruction using an intraoral microvascular technique. Data was

collected prospectively and all cases had been discussed at the multidisciplinary team meeting prior to

surgery.

Results: Five cases underwent intraoral free flap anastomosis. All cases required maxillary

reconstruction. Three free fibular and two radial forearm flaps were used. The tumours comprised of 2

benign odontogenic myxomas, one mucoepidermoid carcinoma, one low grade sarcoma and one

previously completely excised maxillary SCC. This last case was treated with wide local excision and

obturator at the patients’ request. She later wanted a free flap reconstruction to correct the oronasal

fistula. In one case the facial vein calibre was too small so a small incision in the neck was made to

identify the EJV. The average length of stay was 11 days.

Conclusions: There is a learning curve when performing intraoral anastomoses. The right set up is

essential comprising of various retractors and experienced assistance. Pre-operative planning to identify

and gain access to the facial vessels, as well as techniques to access other vessels for anastomoses is

required. In addition, consideration should be made for the length of pedicle needed when

anastomosing in the cheek. In appropriately selected patients, intraoral anastomosis can reduce the

morbidity of free flap reconstructive procedures.

21. The microbiome of head and neck squamous cell carcinoma patients in Hong Kong

Chan Jason

Chinese University of Hong Kong

Ng Cherrie1, Chan Paul1, Yeung Zenon1, Wong Eddy1, Vlantis Alexander1, Chen Zigui1 1Chinese University of Hong Kong

Rationale: The microbiota has been shown to be related to a variety of carcinomas. However, there has

not been an extensive evaluation of the microbiota and its role in head and neck squamous cell

carcinoma. Here we evaluate the microbial dynamics associated with HNSCC.

Materials and methods: Prospectively collected HNSCC patient tumor tissues and paired normal control

tissues were analyzed with NGS 16S rRNA V1-V2 region for bacteria. Bioinformatic and statistical analysis

was performed with R.

Results: Forty-four HNSCC patients with paired tumor and adjacent normal tissues >5cm from the tumor

were evaluated. The bacterial diversity was significantly depressed in the tumor tissues when compared

with that of normal controls (p<0.004). The overall oral bacterial community was commonly represented

by Fusobacterium (mean abundance of 9.6%) and Prevotella (9.2%), with Streptococcus, Haemophilus

and Leptotrichia constituting 5.9%, 5.6% and 5.3%, respectively. A linear discriminant analysis (LDA) for

effect size (LEfSe) determined 18 “core” bacterial taxa (>1% mean abundance) were tissue-type

discriminative. Among them, Fusobacterium was significantly predominant in tumor tissues when

compared with normal controls (mean abundance of 12.9% vs 6.3%, p<0.001). Other dominant bacteria

in tumor tissues include Peptostreptococcus, Parvimonas, Catonella, Johnsonella,

Peptostreptococcaceae (family) and Staphylococcus. In contrast, Streptococcus and another 10 genera

were more common in normal tissues.

Conclusions: Our early results show that there is a reduced diversity of the microbiome and an increased

abundance of fusobacterium in HNSCC. However, the species and relationship with the pathogenesis of

HNSCC still needs to be investigated as these findings may provide essential information for further

preventative or management strategies to control HNSCC.

22. Radical Radiotherapy for Nasopharyngeal Carcinoma in Patients with Connective Tissue

Disease - Outcomes in the Era of IMRT

Cheung Ka Wai Alice

Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong SAR

Chan Po Chung1, Ng Wan Ying Alice1, Tung Yuk1 1Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong SAR

Rationale: Connective tissue disease (CTD) has historically been considered to be associated with a

greater risk of severe radiotherapy (RT)-related acute and late toxicities. RT is the mainstay of treatment

for nasopharyngeal carcinoma (NPC). So far, there have been limited studies focusing on patients with

CTD receiving RT to head and neck region, but severe complications were reported. With IMRT and

VMAT, it is of interest to know about the tolerance and outcomes of patients with CTD who are treated

with radical RT for NPC.

Materials and methods: Patients with a diagnosis of CTD and having undergone radical IMRT or VMAT

for NPC between 2005 and 2016 were retrospectively identified and reviewed. RT-related acute and late

toxicities were the primary outcomes, 3-year survival rates were the secondary outcomes.

Results: Of the 19 patients (mean [range] age, 54.7 [35-69] years; 11 [57.9%] men) treated during the

review period, all had undifferentiated carcinoma. Median follow-up was 38.2 months (interquartile

range 13.3-59.8). As for disease stage (AJCC 7th edition), 10.5% had stage I, 26.3% stage II, 36.8% stage

III, 21.1% stage IVA, and 5.3% stage IVB. The commonest CTDs were malignancy-related

dermatomyositis (42.1%), rheumatoid arthritis (26.3%) and systemic sclerosis (10.5%). Chemotherapy

was used as induction in 31.6% of patients and concurrent in 63.2%. Frequencies of grade 3 mucositis

and dermatitis were both 5.3%. Grade 3 dysphagia was evident in 4 patients (21.1%), while tube feeding

was indicated in 5 (26.3%); notably, 3 of them (all had dermatomyositis) already presented with

dysphagia upon diagnosis. Upon follow-up, 10.5% of patients experienced grade 3 hearing impairment,

and 10.5% had grade 3 dysphagia necessitating tube feeding. There were no grade 4 acute or late

toxicities. Three-year local failure-free survival, regional failure-free survival, distant failure-free survival

and disease-free survival were 100%, 87%, 77% and 77% respectively, 3-year overall survival was 60.3%

while 3-year cancer-specific survival was 80%. Persistence of dermatomyositis was observed in 87.5% of

those having malignancy-related dermatomyositis after documentation of complete remission (CR) of

NPC.

Conclusions: Our data suggest that radical RT for NPC is tolerable in patients with a diagnosis of CTD,

without excessive severe acute and late toxicities, while comparable cancer-specific survival outcomes

are achieved.

23. Investigating the prognostic role of neutrophil-lymphocyte ratio in head and neck patients

with recurrent and/or metastatic squamous cell carcinoma

Cossu Rocca Maria

European institute of Oncology- Head and Neck Program, Division of Urogenital and Head and Neck

Medical Oncology, Milan

Verri Elena1, Ansarin Mohssen2, Alterio Daniela3, Gandini Sara4, Cullurà Daniela1, Marvaso Giulia5, Aurilio

Gaetano1, Tagliabue Marta2, Mascia Roberta1, Lombardi Francesca6, Nolè Franco1 1European Institute of Oncology- Head and Neck Program, Division of Urogenital and Head and Neck

Medical Oncology, Milan 2European Institute of Oncology- Head and Neck Program, Division of Head and Neck Surgery, Milan 3European Institute of Oncology-Head and Neck Program, Dpt of Radiotherapy, Milan 4European Institute of Oncology, Division of Epidemiology and Biostatistic, Milan 5European Institute of Milan-Head and Neck Program, Dpt of Radiotherapy, Milan 6European Institute of Oncology-Data management, Milan

Rationale: Standard first line sistemic treatment for recurrent-metastatic (R/M) head and neck

squamous cell carcinoma (SCCHN) patients (pts) still shows unsatisfactory efficacy profile mainly due to

the lack of recognized prognostic or predictive factors in these pts. Neutrophil-to-lymphocyte ratio (NLR)

seems to represent an independent predictor of poor outcome in pts with cancer. The purpose of this

study was to investigate the association between overall survival (OS) and the basal NLR in pts with R/M

SCCHN.

Materials and methods: From January 2010 to December 2016, 52 R/M SCCHN pts were retrospectively

evaluated. All pts received a first line platinum based chemotherapy associated with cetuximab. For all

pts neutrophil and lymphocyte count was available at the start of treatment. Overall survival (OS) was

calculated from date of chemotherapy to death or last follow-up. OS curve was estimated with the

Kaplan-Meier method. Associations of NLR with OS was tested with the Log-rank test. Multivariate Cox

proportional hazard models, adjusted for confounders and prognostic factors, were used to assess

independent prognostic values of NLR, for OS.

Results: From January 2010 to December 2016, 52 R/M SCCHN pts were finally evaluated. Median age

was 61years (range 25-81), 27% were female, 48% were grading 1 or 2 SCCHN, 38% were PS ECOG zero,

13% had positive HPVOPSCC. Median basal NLR value was 5.5 (range: 0.9-15). Median follow-up after

completion of first line platinum based + cetuximab treatment was 16 months. Median OS was 14

months. Multivariate analysis showed that adjusting for previous radiotherapy, number of cycles of

chemotherapy, maintenance of treatment and ECOG PS, NLR was significantly associated with OS

(P=0.03).

Conclusions: In our retrospective series, basal NLR seems to correlate with overall survival. Although

further validation are needed on more robust series, NLR seems to confirm its value in supporting

decision making process and allowing us to identify pts for whom platinum-based chemotherapy and

cetuximab would be likely ineffective.

24. The 3D exoscope in transoral resection of oropharyngeal tumors: preliminary results

Crosetti Erika

Head and Neck Oncology Service, Oncology Dept., University of Turin, Candiolo Cancer Institute - FPO,

IRCCS, Turin, Italy

Succo Giovanni1, Arrigoni Giulia1 1Head and Neck Oncology Service, Oncology Dept., University of Turin, Candiolo Cancer Institute - FPO,

IRCCS, Turin, Italy

Rationale: The treatment of oropharyngeal tumors (OTs) is particularly challenging because this site is

involved in various crucial functions (breathing, swallowing, speech).

The trend of human papilloma virus (HPV)-positive patients with OTs having better outcomes and overall

survival (OS) rates than patients with HPV-negative tumors, led to a progressive de-escalation of

treatment approaches, especially in HPV-related and early stage carcinoma, in order to minimize the

morbidity outcomes and late complications of traditional therapies. Transoral laser oropharyngectomy

(TLO) emerged as a potentially effective de-escalation approach, with safe oncologic outcomes. The

primary disadvantages of TLO are related to exposure, because of the need for direct line of sight and

the poor maneuverability of surgical instruments. A possible alternative method could be the use of an

intraoperative microscope.

In recent years, transoral robotic surgery (TORS) has been shown to be an effective alternative to open

surgery, yielding good results in terms of disease control and survival rates. TORS may overcome some

limitations in exposure through a direct visualization of the operating field in TLO with its use of an

angled binocular endoscope.

Unfortunately, TORS is a very expensive technique. Exposure can be a problem and can result in visual

obstruction and instrument collision. Based on these considerations, our Institute has recently adopted

the VITOM 3D Exoscope System (Karl Storz, Tuttlingen, Germany) as an excellent alternative to the

operating microscope and TORS.

Materials and methods: We compared the results of 10 consecutive transoral lateral

oropharyngectomies (TLAO) performed with the VITOM 3D Exoscope System, and 10 TLAO performed

with an operating microscope, analyzing their efficacy and safety.

Results: No acute complications occurred. The exoscope is a versatile and slim optical instrument. The

cost is modest when compared to the TORS. Anatomical details are more relevant, and fine

vascularization and irregularities of the mucosa become perfectly visible.

Conclusions: The VITOM optical exoscope can be considered to be an excellent alternative to the

operating microscope and TORS, with its excellent handling in visual translation, depth of field,

magnification, image contrast and color, as well as being an excellent teaching device for residents.

25. Oral Squamous Cell Carcinoma and Fanconi Anemia

de Pablo García-Cuenca Alba

Hospital Vall d´Hebron

Rationale: Fanconi Anemia (FA) patients are characterized by specific factors that may influence oral

SCC treatment outcome and evolution. Surgery can be challenging, associated with higher risk, and

adjuvant treatment can cause high toxicities. Our objective is to revise our experience in oral SCC in

patients with FA.

Materials and methods: We retrospectively reviewed FA patients treated from oral SCC by our

department from 2005-2017. Patient and tumour characteristics, surgery and reconstruction

performed, pTNM and margin status were retrieved. Postoperative complications, adjuvant treatment

and toxicities were described. Chronology of recurrence and secondary tumours was also collected.

Results: Four patients were treated at a mean age of 33yo. Two patients had oral tongue SCC (pT1N0),

one had an upper alveolar ridge SCC (pT4N1), and the last had 2 primaries in the lower alveolar ridge

(pT4N0) and in the upper (pT1N0). Surgery was performed in all, and reconstruction was done with an

ALT, Fibular and temporal flap. Adjuvant radiation was delivered to one patient, and chemoradiation to

another. Full dose radiotherapy was achieved in both, but chemotherapy had to be suspended due to

fungal mucositis grade 3 and hypertransaminemia. One patient had locoregional recurrence after 4

years, followed by another local recurrence 1,5 months after surgery and another unresectable

locoregional recurrence 1,5 months after that. A second patient developed metastases at 5 months, and

a third had local recurrence at 3 years. In 5 surgeries there was a positive margin. Three patients required

blood transfusions perioperatively. One patient presented an infected orocervical fistula. Two patients

are still alive, the other 2 died at 9 and at 5 years after diagnosis.

Conclusions: Treating FA patients is challenging. They present with diffuse tumours with difficult margin

assessment due to field cancerization, have a high risk of early tumour recurrence in spite of aggressive

surgery and also have increased risk of developing secondary cancers. Administration of adjuvant

therapy should be carefully assessed as they may develop severe toxicity that may jeopardize treatment

finalization. Eventually, these patients seem to have a bad prognosis, with early recurrence and high

mortality at young age.

26. Assessing the quality of life in total laryngectomy patients: a revision of literature

De Rossi Stefano

AOUI Verona Borgo Trento

Molteni Gabriele1, Veronese Sheila1, Gazzini Luca1, Pierotello Luca1, Veneri Antonio1, Marchioni Daniele1 1AOUI Verona Borgo Trento

Rationale: In head and neck cancer patients, the impact caused by the disease and its treatments makes

the assessment of quality of life (QoL) particularly important. For these reasons, specific questionnaires

have been elaborated for such patients over the years. The aim of this study is to confront the tools used

to evaluate the QoL of patients treated with total laryngectomy for head and neck cancer, in order to

better understand how this surgery affects patients' QoL.

Materials and methods: A systematic review of literature was carried out to evaluate QoL of patients

undergoing total laryngectomy (TL) for head and neck cancer. The research was performed in PubMed

database, using the key words “quality of life” and “laryngectomy”. The inclusion criteria for articles

were: articles published from 2005 to February 2016; articles in English; articles concerning patients

undergoing total laryngectomy; articles published in journals with impact factor at the time of

publication or at the time of the analysis.

Results: 51 articles have been identified and selected. The contents of these articles varied widely, as

the authors focused on different aspects of health in evaluating the QoL of patients. For this reason, the

comparison between the articles was performed by a confrontation of the tests used to evaluate QoL.

In particular, a total of 35 different questionnaires were identified. The scores achieved by TL patients

in the different categories considered in the questionnaires were confronted with those obtained by

different subgroups of patients, though different questionnaires took into account different features

making it very difficult to effectively identify a better tool for analyzing the QoL.

Conclusions: QoL is an extremely important issue, suggesting the necessity to assess QoL in order to

better understand the patients needs and to standardize and improve treatment options. Nonetheless,

it appears as if it is as much difficult to assess QoL as it is to test it. This study reveals the need for a

standardized instrument for analyzing the QoL of TL patients, so as to define the standards that need to

be used to understand the course of the QoL of the individual new patients, in order to give those people

presenting results below expectations a prompt and efficacious response and guarantee them the best

QoL possible.

27. The predictive role of the PI3K pathway in stage III and stage IV head and neck cancer patients

treated with concomitant radiotherapy and cisplatin or cetuximab

de Ruiter Emma J.

University Medical Center, Utrecht

Terhaard Chris H. J.1, de Bree Remco1, Willems Stefan M.1 1University Medical Center, Utrecht

Rationale: 40% of head and neck cancer patients treated with concomitant radiotherapy and cisplatin

(chemoradiation) or cetuximab (immunoradiation) face recurrent disease. Accurate biomarkers to

predict treatment outcome are still lacking. This study aims to investigate the predictive role of

activation of the PI3K-pathway, by assessing the activation of PI3K downstream targets mTOR and AKT,

and the expression of inhibitor PTEN.

Materials and methods: p-mTOR, p-AKT and PTEN expression was immunohistochemically assessed in

pre-treatment biopsies of 91 patients with stage III or IV hypopharyngeal, laryngeal or HPV-negative

oropharyngeal cancer (66 treated with chemoradiation, 25 with immunoradiation) and correlated with

locoregional control, disease-free survival and overall survival.

Results: An association was found between mTOR activation and worse overall survival in our total

patient cohort (p=0.035). No difference was observed between chemoradiation and immunoradiation

patients. PTEN overexpression was associated with worse overall survival in chemoradiation patients

(p=0.004), but not in immunoradiation patients (p=0.25). No association between AKT activation and

treatment outcome was observed.

Conclusions: mTOR activation and PTEN overexpression are associated with treatment outcome in head

and neck cancer patients treated with chemoradiation or immunoradiation. This suggests that activation

of PI3K-pathway might be a predictive biomarker for treatment outcome in head and neck cancer.

28. Three-dimensional high-definition exoscopy system for transoral laryngeal surgery

Deganello Alberto

University of Brescia, Italy

Paderno Alberto1, Del Bon Francesca1, Nicolai Piero1 1University of Brescia, Italy

Rationale: In transoral laryngeal surgery, the particularly small and relatively distant surgical field results

in the need for long instruments that are manipulated from an even greater distance, leading to well-

known drawbacks in terms of ergonomics and manual dexterity.

Materials and methods: Following laryngeal exposure with a conventional laryngoscope we obtained a

complete visualization of the larynx with a 3D high-definition exoscopic system (VITOM® 3D, Karl Storz,

Tuttlingen, Germany) that was placed at approximately 20 cm from the entrance of the laryngoscope

using a custom holding system (VERSACRANE, Karl Storz). Three transoral laryngeal surgeries (debulking

of a supraglottic lesion, reconstruction of the false vocal fold after resection of a voluminous laryngocele,

and excision of a vocal fold leukoplakia) were performed in order to assess their feasibility using this

instrument and its advantages over the operative microscope.

Results: All three surgeries were easily completed without the need to shift to an operative microscope

and with no complications. The surgeon was in close contact with the laryngoscope inlet, looking at the

surgical field in a 3D high-definition screen, without bulky instruments obstructing the space of

maneuver. This improved the surgeon’s comfort and ergonomics, favoring bi-manual tissue

manipulation, while maintaining an optimal magnified stereoscopic visualization of the larynx. The

significant magnification capability proved to be particularly useful to approach the glottic plane.

Conclusions: Three-dimensional high-definition exoscopic systems proved to have an interesting

potential for transoral laryngeal surgery. Future developments may lead to adjunctive refinements with

the potential to add new useful tools in the laryngeal surgeon’s armamentarium.

29. Investigation of B-Cell CLL/Lymphoma 2 (BCL2) and BCL2 Associated X (BAX) Gene Expression

Status in Turkish Patients with Laryngeal Squamous Cell Carcinoma

Demokan Semra

Department of Basic Oncology, Oncology Institute, Istanbul University, Istanbul

Sen Sena1, Eryilmaz Onder1, Cömert Sevde1, Suoglu Yusufhan2, Ulusan Murat2, Ak Gülsüm3, Dalay Nejat1 1Department of Basic Oncology, Oncology Institute, Istanbul University, Istanbul 2Department of Otorhinolaryngology, Faculty of Medicine, Istanbul University, Istanbul 3Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul

Rationale: Recent studies indicate that status of proapoptotic and antiapoptotic genes may play a

significant role in larynx carcinogenesis (LC). BCL2 and BAX genes are located on chromosome 18q21

and 19, respectively. B-Cell CLL/Lymphoma 2 (BCL2) is antiapoptotic and BCL2 associated X (BAX) is

proapoptotic gene and this large protein family and all members contain at least one of four Bcl-2

homology domains. They play important roles to programmed cell death. LC is estimated to be the

second most common malignancy of the head and neck region. Aberrant genetic/epigenetic changes

tobacco and alcohol habits, age, ethnic group, life style and diet have been associated with LC

development. However, there are a lot of studies investigating the expression levels of the BCL2 and

BAX genes in many cancers including laryngeal cancer, in the literature, there was no study evaluating

these genes’ expression levels in Turkish patients. In our study, we investigated the association of

differentially expressed levels of BCL2/BAX genes with Turkish LC patients.

Materials and methods: The expression status of BCL2 and BAX genes were analyzed in tumor and

matched-normal tissue samples of 50 patients by the quantitative real-time polymerase chain reaction

method (QRT-PCR) in LightCycler 480.

Results: BCL2, BAX and the reference genes’ expression status were analyzed by calculating the

threshold cycle numbers (Ct) as fold changes using the 2-ΔΔCt method. After evaluation of the

expression levels, we selected the ratio of >=2 as the threshold for differentially expressed BCL2 and

BAX. The decreased expression levels of BCL2 and the increased levels of BAX were observed as 38%

(19/50) and 32% (16/50), respectively, in tumor tissue samples according to normal tissues. In 18%

(9/50) of larynx cancer patients, the increased anti-apoptotic BCL2 expression levels were observed

whereas pro-apoptotic BAX gene expression levels were increased in tumor samples.

Conclusions: Our study suggests that there is an association between increased expression levels of BAX

and decreased expression levels of BCL2 in LC. Our results are consistent with the other studies in

literature. It is still in progress to include a larger cohort of patients.

*This work was supported by Scientific Research Projects Coordination Unit of Istanbul University.

Project number: I.U.BAP-ONAP-42152.

30. Sentinel lymph node biopsy and depth of invasion of the primary tumor in early stage oral

cancer

den Toom Inne

Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical

Center Utrecht, The Netherlands & Department of Otolaryngology-Head and Neck Surgery, VU

University Medical

Janssen L.M.1, van Es R.J.J.1, van Weert S.2, Willems S.M.3, Bloemena E.4, Leemans C.R.2, de Bree R.1 1Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical

Center Utrecht, The Netherlands 2Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam,

The Netherlands 3Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands 4Department of Oral and Maxillofacial Surgery / Oral Pathology, VU University Medical

Center/Academic Centre for Dentistry (ACTA) Amsterdam, The Netherlands & Department of

Pathology, VU University Med

Rationale: Sentinel lymph node biopsy (SLNB) allows to examine histopathologically the (sentinel) lymph

nodes with the highest risk of containing metastases, more precisely than routine examination of all

lymph nodes in an elective neck dissection. Therefore, SLNB with observation of the neck in negative

SLNB patients can serve as a more accurate reference standard than END for the evaluation of tests

predicting the presence of lymph node metastases. This study investigates if depth of invasion of the

primary tumor can predict occult nodal disease in patients diagnosed with a cT1-2N0 (according to 7th

TNM classification) oral squamous cell carcinoma (OSCC) who underwent SNLB.

Materials and methods: In two Dutch Head and Neck centers SNLB was performed in 199 OSCC patients

and retrospectively analyzed. Depth of invasion of the primary tumor was considered to be the actual

mass beneath the mucosal surface, or in case of ulceration or exophytic lesions the theoretical

reconstruction of the mucosal surface. Histopathological examination of the sentinel lymph nodes (SLNs)

included step-serial sectioning with additional keratin immunohistochemical staining. Patients with a

positive SLN and patients with regional metastasis during follow-up in case of a negative SLNB (false-

negatives), were considered as patients with metastases.

Results: Metastases were found in 64 of 199 patients (32%). Of these 64 patients, the mean depth of

invasion was 6.58 mm compared to 4.69 mm in patients without metastases (P=0.003). In univariate

logistic regression analysis, depth of invasion showed an odds ratio of 1.15 (95% CI 1.05 – 1.26)

progressive per 1 mm (P= 0.002). The ROC-curve showed an area under the curve of 0.65 with a most

optimal cut-off point of 3.4 mm depth of invasion (sensitivity 83%, specificity 45%). Regional metastases

were found in 15% of patients with depth of invasion ≤ 3.4 mm. Median follow-up was 19 months (range

1-104).

Conclusions: Depth of invasion seems to be a moderate predictor for regional metastasis in patients

with cT1-2N0 OSCC. Staging of the neck using SLNB is useful also in early oral cancers with limited depth

of invasion.

31. Benefit of volumetric-modulated arc therapy in sinonasal squamocellular carcinoma: single

institution experience

Djan Igor

Oncology institute of Vojvodina, Faculty of Medicine, University of Novi Sad

Rutonjski Laza1, Nikolin Borislava2, Petrović Borislava2, Baucal Milutin3, Cudic Ozren3 1Oncology Institute of Vojvodina, Faculty of Science, University of Novi Sad 2Oncology institute of Vojvodina, Faculty of Medicine, University of Novi Sad 3Oncology Institute of Vojvodina, Sremska Kamenica

Rationale: The purpose of this study was to evaluate the treatment plan adequacy and delivery

efficiency among volumetric-modulated arc therapy (VMAT) with two arcs for patients with sinonasal

SCC. Our aim was to show new institutional experience with VMAT technique.

Materials and methods: All patients were planned with Elekta's Monaco 5.11.02 treatment planning

system and treated at Elekta's Versa HD linear accelerator. Ten patients with sinonasal SCC (ethmoidal

sinus 2, frontal sinus with intracranial extension 3, nasal cavity with spread in ethmoidal sinus3 and

sphenoidal sinus 2) were treated with VMAT. The target area received two or three dose levels (70, 66,

and 54Gy or 66 and 54Gy) in 30-33 fractions using simultaneous integrated boosts (SIB) technique. We

analysed maximal and mean doses on the target and organ at risk (OAR).

Results: The patients planned with VMAT had PTV coverage with an average of more than 98%. The

VMAT plan showed Dmax and Dmean on PTV, 74.15Gy with SD 4.8Gy and 67.37Gy with SD 2.05Gy

respectively; lacrimial gland left and right Dmax11.25Gy and Dmean 5.24Gy, Dmax13.72Gy and Dmean

7.12Gy respectively. Regarding right and left ophthalmic nerves: Dmax 46.69Gy with SD 5.7Gy and

Dmean 26.94Gy with SD 5.76; Dmax35.86Gy with SD 11.11Gy and Dmean 21.23 with SD 10.37Gy

respectively. Also max and mean doses at other OAR (lenses, optic chiasma, brain stem and spinal cord)

were in good range. This results in PTV coverage and OAR sparing cannot be achieve in 3D conformal

technique even in lesser target doses e.g. for PTV of 50Gy. However, our results for PTV dose coverage

and coverage of OAR was similar or even better in comparison with some published data for VMAT

technique.

Conclusions: VMAT reduced MU/fx and shortened delivery time remarkably compared with other

techniques especially with 3D conformal RT. Our results demonstrated that for sinonasal SCC without

VMAT technique we cannot achieve superior target coverage and normal tissue sparing, as well as a

significant reduction in treatment time. So we can conclude that VMAT represent strong and powerful

tool against sinonasal SCC especially because this region has lower response on chemotherapy.

32. Examination of promoter methylation of Zinc Finger Protein 238 (ZNF238) gene in oral

squamous cell carcinoma

Eryilmaz Onder

Department of Basic Oncology, Oncology Institute, Istanbul University, Istanbul

Sen Sena1, Doruk Can2, Ulusan Murat2, Demokan Semra1 1Department of Basic Oncology, Oncology Institute, Istanbul University, Istanbul 2Department of Otorhinolaryngology, Faculty of Medicine, Istanbul University, Istanbul

Rationale: Oral squamous cell carcinoma (OSCC) constitutes half of head and neck cancer. Epigenetic

changes as well as genetic changes are known to play important roles in cancer development.

Methylation of CpG islands in the promoter regions of genes acts as a significant mechanism of

epigenetic gene silencing. Professor Dr. Semra Demokan and her colleagues observed that the

expression of ZNF238 (Zinc Finger Protein 238) gene was reduced by promoter methylation in OSCC

patients’ tumor tissues performed by methylation and gene expression arrays reported in her project

“TUBITAK-SBAG-114S497”. It has been reported in literature that the ZNF238 gene regulates the genes

involved in cell development transcriptionally. There was no study investigated the methylation levels

of the ZNF238 gene in the OSCC patients in literature. In our study, we evaluated methylation levels of

this gene in larger cohort of Turkish OSCC patients and healty individuals’ tissues/ body fluids.

Materials and methods: We investigated the quantitative methylation levels of the ZNF238 gene in 50

OSCC patients’ tumor and matched normal tissues and serum samples and 10 healthy individuals’ tissue

and serum samples by Quantitative Methylation Specific PCR (QMSP). In addition, the receiver operator

charecteristics curve (ROC) analysis method was used to test the biomarker potential of this gene.

Results: In our study, ZNF238 gene promoter methylation was present in 42% (21/50) of tumor samples

and 18% (9/50) of matched normal tissues from patients with OSCC while %10 (1/10) of healthy

individuals tissues. Methylation was observed in 75% (6/8) of the floor of mouth and this ratio was higher

than methylation levels of other anatomical subgroups. On the other hand, no methylation was

observed in serum samples of patients and healthy individuals. ZNF238 gene methylation status was

associated with poor prognosis, metastasis and differentiation. There was a significant correlation

between disease state and methylation status (p=0,05, Mann Whitney U test).

Conclusions: Our study suggests that there is an association between promoter methylation status of

the ZNF238 and OSCC. ZNF238 gene methylation may have an epigenetic biomarker potential in a special

subset of OSCC-diagnosed subtypes.

*The present work was supported by the Research Fund of Istanbul University. Project No. İÜ-BAP-TYL-

2017-26789.

33. Treatment compliance and outcome of patients aged ≥65 years with locally advanced

oropharyngeal squamous cell carcinoma (OC) treated with radiotherapy concurrent to

cisplatin or cetuximab

Espeli Vittoria

IOSI

Martucci Francesco1, Richetti Antonella1, Siano Marco2 1IOSI 2KSSG

Rationale: The pivotal meta-analysis about concurrent chemo-radiation and the phase 3 study with

cetuximab added to loco regional treatment for head and neck squamous-cell carcinoma showed only a

small benefit in favor of chemotherapy for patients older than 70 years and for cetuximab in patients

older than 65 years, respectively.

Materials and methods: We analyzed retrospectively elderly patients with histologically proven OC who

received definitive IMRT/RapidArc concurrent with cisplatin or cetuximab. 3-weekly cisplatin and weekly

cetuximab were considered standard treatments. Weekly cisplatin and no systemic treatment were

considered non-standard treatments.

Results: A total of 51 patients was included with a median age of 70 years (range 65-82 years). 24

patients (47%) were younger and 27 (53%) patients were older than 70 years, respectively. All patients

received the IMRT/RapidArc prescribed dose. Standard treatment was proposed to 24 (47%) patients

and it was completed in 11 (45%) cases. For patients younger than 70 years, standard treatment was

proposed to 12 (50%) patients and completed in 8 (66.6%) cases. For patients older than 70 years,

standard treatment was proposed to 12 (44.5%) patients and completed in 3 (25%) cases. 78.5% of all

patients, 66.6% of patients <70 years and 88.8% of ≥70 years were treated not according to the

recommended standard of care. Median PFS was similar between both subgroups.

Conclusions: In clinical practice, both, standard and non-standard treatment is difficult to perform in

elderly patients with advanced loco-regional oropharyngeal cancer. This may be an explanation for the

small survival benefit in this setting for elderly patients.

34. Etiology, treatment and prognosis of oral squamous cell carcinoma in individuals at different

ages

Feng Zhien

Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital

Medical University, Beijing 100050, China

Rationale: The purposes of this study were to explore the etiology, treatment and prognosis of OSCC

patients with different ages and sought to analyze the reasons that may contribute to this difference.

Materials and methods: This study included a retrospective cohort enrolled 2443 patients from June

1999 to December 2014 and a prospective cohort enrolled 217 patients (ClinicalTrial.gov number:

NCT02395367) from January 2015 to March 2017. All patients were diagnosed as oral squamous cell

carcinoma and were surgically treated in our hospital. Chi square test, Kaplan-Meier analysis and Cox

proportional-hazards regression model were performed for statistical analysis.

Results: The history of smoking (p<0.001) and drinking (p<0.001) were related to age. Further

exploration showed that younger patients started smoking (p=0.004) and drinking (p=0.041) earlier than

the older patients and also consumed more tobacco (p=0.002) and alcohol (p=0.118). Patients with

advanced age had worse outcomes in both DFS (p=0.002) and DSS (p<0.001). They also had more severe

comorbidity (p=0.007) and were more likely to receive a conservative treatment (p<0.001). Age was not

an independent risk factor for oral squamous cell carcinoma.

Conclusions: Early and heave smoking and drinking are important risk factors for the development of

oral squamous cell carcinoma in young adults. However, compared with young patients, older patients

had worse prognosis. That might be related with their more severe comorbidity and received more

conservative treatment.

35. TIR3: a Never-Ending Story. Are TIR3A and TIR3B Sufficient in Surgeon’s Decision-Making?

Cyto-Ultrasonographic Correlation Can Help Predicting Malignancy Risk

Feroci Francesco

Nuovo Ospedale S. Stefano, Prato

Sarno Antonio1, Garotta Matteo1, Zaccari Dario1, Perini Davina1, Fagni Niccolò1, Guagni Tommaso1 1Nuovo Ospedale S. Stefano, Prato

Rationale: The 2014 SIAPEC-IAP classification of thyroid nodules divided the previous TIR3 category in

two new classes (TIR3A and TIR3B), in order to reduce the rate of surgery for benign diseases. However,

the management of indeterminate thyroid nodules is still controversial and a more accurate diagnostic

tool is needed.

The aim of this study was to assess whether the combination of cytology and TIRADS-based US

characteristics can stratify indeterminate thyroid nodules, better predicting their malignancy risk.

Materials and methods: This is a single-center study designed on a prospectively-collected database of

66 cases (TIR3A and TIR3B), that underwent surgery for histological diagnosis between April 2016 and

November 2017. Overall, TIR3A and TIR3B malignancy rates were determined. Then cytology and TIRADS

score were combined and malignancy rates of these combinations were compared. According to results,

nodules were stratified in three groups: low, intermediate and high risk of malignancy.

Results: This is a single-center study designed on a prospectively-collected database of 66 cases (TIR3A

and TIR3B), that underwent surgery for histological diagnosis between April 2016 and November 2017.

Overall, TIR3A and TIR3B malignancy rates were determined. Then cytology and TIRADS score were

combined and malignancy rates of these combinations were compared. According to results, nodules

were stratified in three groups: low, intermediate and high risk of malignancy.

Conclusions: The 2014 SIAPEC-IAP classification has improved diagnostic accuracy of indeterminate

thyroid nodules. Its combination with TIRADS is a feasible and reliable diagnostic tool and it offers a

better stratification for malignancy risk.

According to these results, surgery should be strongly recommended in high-risk patients and carefully

evaluated in intermediate-risk; whereas conservative approach could be adopted in low-risk patients,

thus reducing the rate of overtreatment.

36. Transient hypocalcemia after total-thyroidectomy: could vitamin 25-(OH)D insufficiency and

malignancy influence its occurrence?

Galli Andrea

IRCCS San Raffaele, Milan

Lira Luce Francesca1, Di Filippo Luigi1, Manzoni Marco1, Bussi Mario1 1IRCCS San Raffaele, Milan

Rationale: Transient hypocalcemia (TH) is the most frequent complication after total thyroidectomy

(TT), ranging from 1.6 to 68% in different series: it develops approximately 24-48h after surgery and it

recovers spontaneously within 12 months. Despite its mild symptoms, TH can protract duration and

costs of hospital stay. Aim of the present study is to evaluate factors that could possibly affect the

incidence of TH after TT.

Materials and methods: This is a retrospective survey assessing 50 eucalcemic patients who

consecutively underwent TT between May 2015 and April 2016 at our institution. Main indications

included thyroid carcinoma and adenoma, multinodular goiter and large goiter with compressive

symptoms. None of the patients had a history of prior neck or thyroid surgery nor comorbidities

influencing calcium metabolism. AACE definition of biochemical hypocalcemia was used to stratify the

subjects (serum albumin-corrected total calcium levels less than 2.1 mmol/L - 8.5 mg/dL).

Results: TH occurred in 38/50 patients (76%). However using a corrected total calcium levels of < 2.0

mmol/L (8 mg/dL), which is the threshold mostly employed in literature, the incidence of TH moved to

46%. 39/50 patients (78%) had Vitamin 25-(OH)D levels < 30ng/mL. Histopathological evaluation

detected benign thyroid lesions in 28/50 cases (56%) and malignant ones in 22/50 (44%). No significant

associations were found between the incidence of TH and sex, age, mean operative time, concurrent

neck dissection and rate of intraoperative incidental parathyroidectomy. Postoperative TH was

significantly more frequent within patients with preoperative Vitamin 25-(OH)D levels < 30 ng/mL (p =

0.01), and, similarly, with a malignant histopathological diagnosis (p = 0.04).

Conclusions: Our findings suggest that Vitamin 25-(OH)D insufficiency and malignant disease are

significantly associated with an higher incidence of postoperative TH. We advise to routinely assess

preoperative Vitamin 25-(OH)D levels in order to identify patients at risk for postoperative TH in an

earlier phase. As a consequence, preoperative supplementation in Vitamin 25-(OH)D insufficient

patients could be considered to minimize the risk of postsurgical TH.

37. Voice prosthesis rehabilitation after total laryngectomy: are satisfaction and quality of life

maintained over time?

Galli Andrea

IRCCS San Raffale

Giordano Leone1, Biafora Matteo1, Tulli Michele1, Bussi Mario1 1IRCCS San Raffale

Rationale: Total laryngectomy (TL) is still the standard of care for advanced laryngeal/hypopharyngeal

carcinoma, either as a primary procedure or as a salvage treatment after chemo-radiotherapy (CRT)

failure. Rapid, effective voice rehabilitation is always mandatory and trachea-esophageal speech (TES)

has gradually become the gold standard over esophageal speech (ES) or electro-larynx. We previously

(2011) evaluated quality of life (QoL) and degree of satisfaction in TL patients after TES rehabilitation,

demonstrating its great efficacy in highly motivated subjects. Aim of the present study is to investigate

whether those results are maintained over time within the same selected cohort.

Materials and methods: Of the original cohort (24 subjects), there were 15 patients left with a minimum

follow-up of 10 years after voice prosthesis (VP) implantation. The analysis was conducted through the

same questionnaires, in order to obtain comparable results: Short Form 36-Item Health Survey (SF-36)

for QoL assessment and a study-specific structured questionnaire for evaluation of TES-related

satisfaction.

Results: We found a substantial increase in terms of QoL in many SF-36 areas in comparison with 2011

results. Also TES-related satisfaction improved over time as far as voice clarity, loudness, tone, fluency

and clarity on the telephone was concerned. We also noticed a significant lengthening in VP duration

(6.3 ± 3.1 months, against 3.5 ± 2.0 months in 2011). Interestingly a group of patients (26.7%, 4/15)

reported an increasing difficulty in cleaning VP and some subjects (20%, 3/15) would not choose the

same kind of voice restoration if they could turn back time. Patients who reported these two issues are

pretty the same and those more distant from our institution.

Conclusions: With the present work we highlighted how the striking results of TES in terms of QoL and

patient satisfaction can not only maintain over time, but also improve. An integrated, widespread

network of centres for VP management and replacement is needed to optimize patients’ follow-up and

allow larger series studies.

38. Prevention of Pharyngocutaneous Fistula after Total Laringectomy, using adipose tissue and

mesenchymal sten cells: pilot study

Garotta Matteo

Nuovo Ospedale S. Stefano, Prato

Sarno Antonio1, Zaccari Dario1, Giani Iacopo1 1Nuovo Ospedale S. Stefano, Prato

Rationale: Pharyngocutaneous fistula (PCF) are a common complication after total laryngectomy (TL), a

surgical procedure still crucial in the management of laryngeal cancer. PCF are associated with a longer

hospital stay, delay in starting adjuvant therapies, patient discomfort and loss in quality of life. The

percentages of these complications are reported from 3 to 65%, although a recent meta-analysis showed

a rate of 10-25%. A new strategy to avoid this complication is autotransplantation of autologous adipose

tissue containing pericytes, and progenitor cells including adult mesenchymal cells (MSCs). MSCs are

considered a promising therapeutic option in regenerative medicine for their immunomodulatory

capacity, their paracrine effects through trophic factors that exhibit antifibrotic, anti-apoptotic and pro-

angiogenic activity. It has recently been shown that MSCs derived from adipose tissue contain progenitor

cells able to differentiating into adult endothelial cells and participating in neoangiogenesis. The

therapeutic effect of MSCs in humans is supported by several experimental models of inflammatory

diseases and clinical trials in reconstructive and aesthetic surgery but also proctological, intestinal,

cardiac, vascular and endocrinological. Techniques for fatty tissue picking and processing have rapidly

evolved over the last few years, in literature there are both safety and efficacy related to use adipose

tissue derivatives.

Materials and methods: Lipogems® is a simple system designed to harvest, process, and transfer refined

adipose tissue and is associated with great regenerative potential and optimal handling ability. With the

help of this new technology, and without enzymes or other additives, fat tissue is microfragmented

gently and washed from proinflammatory oil and blood residues. The resulting product contains

pericytes retained within an intact stromal vascular niche and is ready to interact with the recipient

tissue after transplantation, thereby becoming activated as MSCs. The main goal of this study is to treat

every patient undergoing TL. At the end of demolition step, microfragmented fat tissue previously

obtained was injected at the level of the mucosal and submucosal layer of the neopharynx suture.

Results: Preliminary results exposure.

Conclusions: The preliminaries results obtained are very promising in use both in patients who have

never been treated and in previously treated patients.

39. Dual energy Ct and Spectral Hounsfield unit Curves to differentiate non-ossified thyroid

cartilage from infiltrated thyroid cartilage by squamous cell carcinoma in laryngeal cancer:

preliminary results

Giannitto Caterina

European Institute of Oncology- Head and Neck Program, Division of Radiology, Milan, Italy

Preda Lorenzo1, Zorzi Stefano2, Tofanelli Laura1, Cattaneo Augusto2, De Benedetto Luigi2, Ansarin

Mohssen2, Bellomi Massimo1 1European Institute of Oncology- Head and Neck Program, Division of Radiology, Milan, Italy 2European Institute of Oncology- Head and Neck Program, Division of Ototalryngology and Head and

Neck Surgery, Milan, Italy

Rationale: To evaluate the role of dual-energy CT spectral Hounsfield unit attenuation in differentiating

the attenuation of normal non-ossified thyroid cartilage from infiltrated thyroid cartilage by squamous

cell carcinoma in laryngeal cancer.

Materials and methods: We evaluated 20 dual-energy CT scans in patients with laryngeal cancer in

different stages and in 10 healthy patients. Dual-energy CT scans from 17 patients with histopathology-

proved laryngeal squamous cell carcinoma at different primary sites (laryngeal and nonlaryngeal) were

included. Patients were scanned with a 64-section single-source scanner with fast-kilovolt (peak)

switching, and scans were reconstructed at different virtual monochromatic energy levels ranging from

40 to 140 keV. Spectral attenuation curves of tumor, nonossified thyroid cartilage and infiltrated thyroid

cartilage were quantitatively evaluated and compared.

Results: Our preliminary data showed that normal nonossified thyroid cartilage had a characteristic,

predictable spectral attenuation curve that was different from that of tumors and infiltrated cartilage.

Conclusions: Head and neck squamous cell carcinoma and infiltrated cartilage could be differentiated

by nonossified thyroid cartilage with spectral attenuation curves but our data should be validate in a

larger cohort of patient.

40. Tissue and serum microRNA profile of oral squamous cell carcinoma patients

Golusinski Pawel

Department of Head and Neck Surgery, Greater Poland Cancer Centre, Poznan University of Medical

Sciences

Head and Neck Cancer Biology Lab Department of Biology and Environmental Studies, Poznan

Schneider Augusto1, Masternak Michal2 1Faculdade de Nutrição, Universidade Federal de Pelotas, Pelotas, RS, Brazil 2College of Medicine, Burnett School of Biomedical Sciences, University of Central Florida

Rationale: There is still need to better understand the biology and uncover novel biomarkers/predictors

of oral squamous cell carcinoma (OSCC) in order to improve response to therapy. MicroRNAs (miRNAs)

are well known for their roles in cell growth and proliferation, regulating pathways which are critical to

cancer development9. It is proposed that secreted miRNAs can have a role in intercellular

communication, where donor cells can affect gene expression in distant or adjacent target cells. This

suggests that serum miRNAs can act either in a hormone-like pattern or even as biomarkers for a variety

of pathological conditions. The pattern of circulating miRNAs has been proposed as a marker for several

types of cancer with high success and repeatability, including for the diagnosis of OSCC cases. Some

miRNAs have been shown to be directly involved in oncogenesis, acting as tumor suppressors 16) or

even oncogenes. Therefore the aim of the current work, was to identify miRNAs regulated in OSCC

cancerous tissue when compared to a healthy adjacent tissue and to verify the presence of the same

miRNAs in the circulation of these patients.

Materials and methods: The clinical material comprised the tumor tissue from five patients with

squamous cell carcinoma of the oral cavity.

Results: A total 255 miRNAs were identified in tissue and 381 different miRNAs were identified in serum

samples. When comparing the miRNA expression between tumor and healthy tissue we identified 48

miRNAs (25 down- and 23 up-regulated) that were differentially expressed (FDR<0.05). From these 48

differentially expressed miRNAs in tissue, 30 miRNAs were also found in the serum of the same patients.

hsa-miR-32-5p was up-regulated in tumor compared to healthy tissue in our study, and was previously

shown to be up-regulated in the serum of OSCC patients.

Conclusions: The findings of our study indicated that that miRNAs can be used as potential non-invasive

biomarkers of OSCC.

41. Non-living animal models for the Head and Neck oncology and reconstructive surgeon

Gonzalez Gimeno Maria Jose

ENT Department. Universidad Complutense de Madrid

Martin Villares Cristina1, Gonzalo-Orden JM2, Valor Cristina3, Diaz Gonzalez Laura4, Hernandez Maria1 1Hospital El Bierzo, Ponferrada 2Animal Surgery Department. Universidad de Leon 3Hospital Infanta Sofia, Madrid 4Hospital de Palencia

Rationale: Animal models can not replace surgical experience, but can improve our motor skills and

increase our confidence. Live animals as surgical models require laboratories, anesthesia and ethical

aprovals. There are definitive adventages for non-living animal models: easy accesible, cheap, no ethical

problems and they can be easily recreated at home. The aim of this study is to rewiew which non-living

animal models are suitable to training in Reconstructive Head and Neck Oncological Surgery and to

present our personal surgical experimental experience.

Materials and methods: First, we reviewed in PubMed in order to select the best experimental models

for Reconstructive Oncological Surgery for Head and Neck. In second stage, we practice standard surgical

techniques and new procedures in the experimental models with a high level of evidence and

recommendation from literature.

Results: For MICROVASCULAR TRAINING, the chicken was our first non-living model election: wings,

thigh, foot, aorta, trachea and esophagus was an excellent and easy created models in which we can

training our motor skills under microscope. For FACIAL RECOSTRUCTIVE SURGERY after wide tumoral

resections, sheep and pig heads can easily recreated surgical simulations with a high evidence level. For

FLAPS TRAINING, chicken and pig was our election.

Conclusions: Non-living animal models are the most effective option to recreate surgical problems to

resolve by the reconstructive oncological surgeon in head and neck tumors. Chicken, sheep and pig

permit easy training to increase our competence and shortening our learning curve in head and neck

reconstructive surgery.

42. Evaluation of perioperative examination and management of thyroid neoplasm in children

and adolescents

Grachev Nickolay

Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology,

Moscow

Vorozhtsov Igor1, Babaskina Natalya1, Iaremenko Ekaterina1 1Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology,

Moscow

Rationale: Evaluation the effectiveness of risk minimization measures during diagnosis, treatment and

follow-up of thyroid neoplasm and their effects on postoperative outcome in paediatrics.

Materials and methods: We examined 70 patients underwent thyroid surgery from 2012 to July 2017.

Median age was 15 years (range 3 months – 17,9 years). Perioperative management features consisted

of prevention of postoperative hypoparathyroidism in all patients, interpretation of US protocols

according to ACR TI-RADS system as the first line diagnostics. As a risk minimization tool, intraoperative

nerve monitoring (IONM) has been introduced to verify 71.4% (n=80) recurrent laryngeal nerves-at-risk.

The duration of catamnesis varied from 1 to 56 months. Health-related quality of life (HRQoL) after long-

term follow-up was performed in accordance with the protocol SF-36.

Results: Total thyroidectomy was performed in 58.6% (n=41) patients, lobectomy – in 41.4% (n=29).

Optionally selective neck dissection (VI) in 66.7% (n=28), unilateral modified radical neck dissection - in

19,1% (n=8) and bilateral - in 35,7% (n=15) patients with thyroid cancers were performed. Notably,

tumor size <10 mm was statistically signified risk factor for thyroid cancer (p=0,00005; p<0,05).

Unilateral recurrent laryngeal nerve injury (RLNI) and vocal cord palsy was performed in 2,9% (n=3)

patients. Recovery time for temporary RLNIs was stratified by injury type and ranged from 7 days to 6

months, but there was no permanent RLNI. Selective neck dissection (VI), malignant tumors,

extrathyroidal extension were not statistically identified risk factors for RLNI in contrast with thyroid

surgery without IONM (p<0,05). Use of the 1.1 mg/dl cut-off for deciding whether to start early

prophylaxis of hypocalcemia allowed most patients to avoid symptomatic hypocalcemia.

Conclusions: Analysis of long-term follow-up revealed a strong marked advantageous trend of our

perioperative examinations and intraoperative safety patterns. Two goals have been achieved by the

use of IONM: сlarification of RLN anatomy during the operation as a prerequisite for RLN protection,

especially for challenging anatomies and intraoperative, rather than postoperative, assessment of RLN

function to facilitate, even under difficult circumstances.

Thus, HRQoL in thyroid cancer patients was comparable to that in the general population.

43. Nuances in parotid region surgery in pediatric population

Grachev Nickolay

Dmitriy Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology,

Moscow, Russia

Kalinina Margarita, Babaskina Natalia, Vorozhtsov Igor, Polev Georgiy

Rationale: In pediatric population the incidence of benign lesions of parotid region reaches 65%, while

malignancies are faced in 35%. The most common malignancy of the parotid gland in childhood is

mucoepidermoid carcinoma. According to Owusu et al postoperative facial nerve palsy can develop in

21% of cases.

Materials and methods: In our Center 36 pediatric patients have been operated for parotid gland and

parotid region tumors between 2014 and 2017. The postoperative follow up ranged from 3 weeks to 34

months. Median age was 7 years and 4 months (min – 4 mo, max – 17 years 7 mo).

Results: The distribution of lesions was as follows: 72,2 % of benign tumors – lymphatic malformations

(n=16), vascular malformations (n=5), sialoadenitis (n=3), neurofibromas (n=2), lymphoid hyperplasia

(n=21). Malignant lesions encountered in 27,8% of cases: rhabdomiosarcoma – 4, mucoepidermoid

carcinoma – 4, neuroblastoma mts – 1, Berkytt lymphoma – 1 case. 39 surgeries have been conducted

including 7 biopsies, 6 superficial parotidectomies, 2 radical parotidectomies, 3 subtotal resections, 14

resections of lymphatic malformations, 4 resections of vascular malformations, 3 resections involving

parotidectomy as a surgical step. The following nuances of tumor spread were noticed: prominent

vessels inside the tumor in 5 cases, invasion of facial nerve in 4 cases, invasion of external acoustic

meatus – 3, bony destruction of mandible – 1, invasion of optic nerve in 1 case.

The median surgical time was 3 hours, median in-patient hospital stay – 10 days. The necessity of ICU

stay has arisen in 18% (n=7) of cases and was mainly connected with the patient’s age under 1 year

(n=3), simultaneous mandible resection in 1 case, simultaneous neck dissection in 3 cases and 2 cases

due to simultaneous reconstructive surgeries.

To prevent the facial nerve palsy in 15 (39%) neurophysiological monitoring (NPM) has been used. In

group of NPM postoperative facial nerve palsy took place in 13% of cases – 1 marginal branch palsy and

1 palsy of all 5 branches. In no-NPM group facial nerve palsy was faced in 19% of cases.

Conclusions: Almost one third of pediatric patients with parotid tumor have a malignancy. Almost one

half of surgeries of the parotid region in our center were re-operations in circumstances of scar tissue

and distorted anatomy. Implementation of neurophysiological monitoring allowed to lower the

incidence of facial nerve palsy.

44. The accuracy of ACR TI-RADS classification of neck ultrasound as a first-line diagnostic

approach for thyroid neoplasms in pediatric patients: a five-year retrospective study

Grachev Nickolay

Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology,

Moscow

Vorozhtsov Igor1, Babaskina Natalya1, Iaremenko Ekaterina1 1Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology,

Moscow

Rationale: Evaluation the effectiveness of ACR TI-RADS classification of neck ultrasound as a first-line

diagnostic approach for thyroid neoplasms in pediatric patients.

Materials and methods: A retrospective analysis was made of FNA and US protocols in 70 patients who

underwent the examination and treatment in Dmitry Rogachev National Research Center between

January 2012 and August 2017. In the retrospective series 70% (n=49) patients undergone FNA and

61,2% (n=30) of them undergone repeated FNA. All US protocols were interpreted according to ACR TI-

RADS system. The diagnostic accuracy of FNA and ACR TI-RADS was measured and intraobserver

concordance among two experts who independently interpreted US protocols according to ACR TI-RADS

classification was calculated.

Results: According histologic examination protocols, benign nodules reported greater multimorbidity

71,4% (n=20), compared with thyroid cancer 28,6% (n=12), complicating FNA procedure. A statistically

significant predictor of thyroid cancer with a tumor size <10mm (p <0.05) was revealed. At the same

time, invasive growth of the neoplasm was a significant predictor of both locoregional (p <0.05) and

distant metastases (p <0.05).

Comparison of the diagnostic accuracy of FNA and ACR TI-RADS showed a significant advantage of ACR

TI-RADS due to higher sensitivity (97.6% vs. 60%), specificity (78.6% vs. 53.8%), positive predictive value

(87.2%% vs. 71.4 %) and negative predictive value (95.7% vs. 41.2%). Concordance on the interpreted

US protocols according to ACR TI-RADS classification between two experts was high, excluding accidental

coincidence.

Conclusions: Our data supports the feasibility of US corresponding to the ACR TI-RADS classification as

a first-line diagnostic approach for thyroid neoplasm, reducing the number of unnecessary biopsies for

thyroid nodules.

45. Risk of malignancy in thyroid nodule in 1505 patients with benign or without fine-needle

aspiration

Gram Signe Buhl

Rigshospitalet, Copenhagen

Holst Hahn Christoffer1, Rasmussen Jacob1 1Rigshospitalet, Copenhagen

Rationale: Fine-needle aspiration (FNA) is currently the primary diagnostic procedure in diagnosing

thyroid malignancy and FNA can help discriminate between benign and malignant disease. However,

FNA cannot provide histology and the risk of malignancy in cases of benign FNA or in cases where FNA

are not performed (i.e. no clinical suspicion of malignancy) is therefore relevant in a clinical setting. The

aim of this study was to report the risk of malignancy in these cases and investigate possible predictive

factors.

Materials and methods: All patients treated in a tertiary referral centre from 2000-2016 and

prospectively registered in The Danish Thyroid Surgery Database (THYKIR) was included (N=3703).

Information about age, gender, trachea compression or dislocation, weight, scintigraphy, ultrasound,

medical treated thyrotoxicosis and serum stimulating thyroid hormone were retrieved and some

variables were dichotomized. Differences were tested with the chi2 or Mann-Whitney U test as

appropriate.

Patients with malignant FNA or suspicious FNA and or clinic were excluded up front leaving 1505 patients

available for further analysis. The patients were divided in two groups; 1.) with benign FNA (N=764) and

2.) FNA not performed (N=740).

Results: The risk of malignancy in group 1 was 7.6% (58/764=0.08) and the risk of malignancy in group

2 was 6.8% (50/740=0.07). Comparing malignant histology versus benign histology of patients within the

two groups, the study was unable to determine any predictive factors of malignancy (lowest p-

value=0.071). Ultrasound findings, however, shows a borderline significant trend in both groups (p-

value=0.063 and 0.067).

Conclusions: Even though the risk of malignancy was found to be only 7,6% and 6,8% respectively in

case of benign FNA or when FNA is not performed, such percentages should be considered high given

that patients with suspicious clinic were excluded. Unfortunately, however, no statistically significant

predictors could be identified.

46. Compartmental surgery for oral tongue - floor of mouth cancer: oncologic and functional

outcomes

Grammatica Alberto

Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy

Piazza Cesare1, Montalto Nausica2, Del Bon Francesca2, Paderno Alberto2, Frittoli Barbara3, Nicolai Piero2 1Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS - National Cancer

Institute of Milan, University of Milan, Milan, Italy 2Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy 3Department of Radiology, University of Brescia, Brescia, Italy

Rationale: Oral tongue/floor of mouth SCC (OSCC) with depth of infiltration (DOI) >10 mm invades

extrinsic muscles, the lingual vasculo-nervous bundle, hypoglossal nerve, and the lymphatic channels.

Oral ‘compartmental hemiglossopelvectomy’ (CHGP) removes “en bloc” the tumor and its potential

pathways of spreading to the neck: the aim of our study is to evaluate oncologic and functional outcomes

of CHGP for OSCC both in primary and salvage surgery.

Materials and methods: Retrospective study of 58 patients undergoing CHGP, neck dissection and

reconstruction with radial forearm or anterolateral thigh free flap for OSCC, with MRI/CT DOI >10 mm.

Patients were divided in 2 groups: A (primary surgery, n=48) and B (salvage surgery, n=10). We calculated

2-year overall (OS), disease-free survival (DFS), local (LC), loco-regional control (LRC), and functional

results (videofluoroscopy, speech intelligibility at telephone, EORTC QLQ-H&N35 and UW-QOL).

Results: Two-year OS, DSS, LC, and LRC for Group A and B were 77.1%, 88.8%, 97.7%, 91.1%, and 26.7%,

25.7%, 50%, and 36%, respectively. The aspiration rate was 22.7%. Vallecular and piriform sinus residue

were present in 70.4% and 52.2% of cases. Prolonged swallowing time was observed in 15.9% of

patients. Speech intelligibility was >80% in 54.6% of cases. Subjective scores >80 were observed in 38.6%

for swallowing and in 29.5% for speech intelligibility. A significant impact was found only for the pull-

through approach with better swallowing outcomes.

Conclusions: In Group A, compartmental surgery +/- adjuvant (chemo)-radiotherapy, was a reliable

oncologic approach. In contrast, in Group B the prognosis remains extremely poor even after such an

aggressive therapeutic approach. From a functional point of view, the entire resection of one anatomic

compartment does not seem to seriously affect speech intelligibility and swallowing functions.

47. A randomized phase II study for tertiary prevention of squamocellular cancer of head and

neck (SCCHN) with a dietary intervention (DietINT)

Granata Roberta

IRCCS Istituto Nazionale Tumori Milano

Rationale: There is a strong need for effective preventive approaches to reduce incidence of

recurrences, second tumors and treatment related late sequelae. In epidemiological studies, diet is

reported to play a major role as risk factor for head and neck squamous cell cancer development. Recent

studies have suggested that dietary and exercise interventions improve survival and quality of life in

patients with a previous diagnosis of cancer.

Materials and methods: We present an open-label randomized phase II multicenter trial in progress. An

estimated 120 patients with locally advanced squamocellular head and neck cancer (STAGE III-IV),

oropharynx cancer HPV positive with > 10 pack/year, are planned. These patients deemed to be in

complete remission at month 3 after curative treatment are considered for this trial. Two arms of

intervention are foreseen: the experimental arm (arm A) based on dietary intervention in addition to

standard recommendations and a control arm (arm B) including only standard recommendations. The

intervention strategy is based on the AICR/WCRF recommendations for cancer and recurrences

prevention and it is focused on decreasing inflammation, glycaemia and insulinaemia while promoting

nutrient-rich diet. The reduction in the incidence of tumor recurrence will be analyzed comparing EFS

curves between the two arms with the non-parametric Kaplan-Meier method. Secondary analyses will

describe the time trend in the prevalence of side effects and quality of life, as assessed by the EORTC

QLQ-H&N35 questionnaire. Translational analysis (cytokine, salivary and plasmatic miRNA) will be

performed. The trial is coordinated by Istituto Nazionale Tumori Milan and conducted in 6 European

countries; it was opened in 2016. To date a total of 64 patients has been enrolled, 33 patients in arm A

and 31 patients in arm B.

Results: Ongoing

Conclusions: The trial was awarded a grant in the Joint Transnational Call (JTC) 2013 context under the

theme of "Translational research on tertiary prevention in cancer patients".

48. The application value of the modified continuous resection in middle-stage oral tongue

squamous cell carcinoma: a retrospective study of 406 cases

Han Zhengxue

Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital,

Capital Medical University, Beijing 100050, China

Rationale: The aim of this study was to explore the application value of modified continuous resection

compared with the traditional continuous resection and discontinuous resection for patients with

middle stage oral tongue squamous cell carcinoma (OTSCC).

Materials and methods: This study enrolled 406 patients between January 2000 and May 2017 with

primary oral tongue squamous cell carcinoma (OTSCC) of T2N0M0 and all of them were surgically

treated in our department. Chi square test, Kaplan-Meier analysis and Cox proportional-hazards

regression model were performed for statistical analysis.

Results: Kaplan-Meier analysis showed that modified continuous resection group was better than

discontinuous resection in both 5-year intervening region recurrence (IRR) (6.3% vs 18.8%, p=0.004) and

5-year disease-specific survival (DSS) (88.6% vs 75.1%, p=0.003). In addition, modified continuous

resection group has lower postoperative complications rate than continuous resection group (3.8% vs

13.2%, p=0.044). Cox regression indicated that the surgical technique (p=0.002) was an independent

predictive factor for 5-year IRR and DSS.

Conclusions: Compared with continuous resection and discontinuous resection, modified continuous

resection has advantages in both prognosis and postoperative complications. It is valuable for

application in the clinical practice of middle-stage OTSCC.

49. NBTXR3, an innovative treatment option for elderly, frail, head and neck squamous cell

carcinoma patients: a phase I trial

Hoffmann Caroline

Institut Curie

Moreno Victor1, Calugaru Valentin2, Jouffroy Thomas2, Rodriguez José2, Calvo Emiliano1, Dodger

Bernard1, Chilles Annes2, Khrili Samar2, Badois Nathalie2, Lesnik Maria2, Le Tourneau Christophe2 1START Madrid- FJD Fundación Jiménez Díaz 2Institut Curie

Rationale: In the treatment of head and neck squamous cell carcinoma (HNSCC), elderly and frail

patients (pts) are ineligible for chemoradiation with cisplatin, the non-surgical standard of care.

Consequently, innovative research tends toward a new treatment option, NBTXR3. These first-in-class

hafnium oxide nanoparticles are activated by radiotherapy and physically destroy cancer cells. They are

currently evaluated in a phase I clinical trial [NCT01946867] for locally advanced HNSCC in the population

of interest.

Materials and methods: So far, 12 pts, aged over 70, with stage III or IV HNSCC of the oral cavity or

oropharynx, ineligible for surgery and for cisplatin, but eligible for exclusive radiotherapy were included.

NBTXR3 was injected on Day 1, as a single intratumoral (IT) injection, followed by IMRT (70 Gy / 35

fractions / 7 weeks) on Day 2, with a follow-up of 24 months. Tested dose levels were by a 3+3 design

at 5%, 10%, 15% and 22% of baseline tumor volume. Determination of the Recommended Doses and

the early Dose Limiting Toxicities (DLT) were the primary endpoints and secondary objectives included

IT residency (presence of leakage) and efficacy per RECIST 1.1 response.

Results: No grade 3 or 4 adverse events (AE) related to NBTXR3, nor DLT were observed for volume dose

levels 5% (3 pts), 10% (3 pts), 15% (5 pts), and 22% (1 pt). Two AE (tumor hemorrhage, grade 1, and oral

pain, grade 2) related to intra-tumoral injection were reported at 15% and 22%. CT scan comparison

between 24h post IT injection and post 7 weeks-radiation did not highlight any leakage of NBTXR3 in the

surrounding tissues, and confirmed its persistence over time. 7 complete responses (CR) out of 11 (1 pt

was not evaluable) were observed, mostly at the higher doses levels: 10% (2 pts), 15% (4 pts), 22% (1

pt). Among these 7 pts, at the data lock point, 6 CR persisted after 3 to 10 months of follow-up.

Conclusions: NBTXR3 is safe and well tolerated even at the highest tested doses. Preliminary efficacy

analysis suggests a promising perspective for the treatment of HNSCC in the elderly, with confirmed CR.

These findings are consistent with preliminary outcomes from clinical trials in other oncological

indications, supporting that NBTXR3 might be efficient at enhancing radiotherapy’s efficacy in many

types of solid tumors.

50. Increasing Incidence and Survival of Head and Neck Cancer in Denmark: A nation-wide study

from 1980-2014

Jakobsen Kathrine Kronberg

Rigshospitalet

Rationale: The purpose of the study was to determine trends in age-adjusted incidence rates (AAIR) and

survival probability in head and neck cancers (HNCs) in the Danish population from 1980 to 2014.

Materials and methods: All patients registered with HNC in the nationwide Danish Cancer Registry from

1980-2014 were included. We evaluated the AAIR per 100,000 and the average annual percent change

(AAPC). The relative survival probability at five-years was calculated in relation to gender, anatomical

location, and histology, and we constructed age-period-cohort models of incidence.

Results: 34,606 patients were included (64.7% men). The AAIR increased from 9.1 per 100,000 in 1980

to 17.4 per 100,000 in 2014 with an AAPC of 2.1%. The greatest incidence increase was observed in

oropharyngeal cancer (AAPC: 5.4%) followed by hypopharyngeal cancer (AAPC: 4.2%). Adenocarcinomas

had the highest AAPC (5.0%) followed by squamous cell carcinomas (AAPC: 2.0%). The AAPC was

significantly higher in women (2.4%) compared with men (1.6%). For all HNC patients, the relative

survival at 5-years rose significantly from 49.0% in 1980-1984 to 62.4% in 2010-2014. Women had a

significantly higher survival than men with a relative survival of 61.7% compared to 50.0% in men.

Laryngeal cancer had the best survival probability of cancers in the upper aerodigestive tract with

hypopharyngeal cancer having the poorest survival.

Conclusions: This nation-wide study showed a significant rise in incidence of HNC for men and women

along with a significant increase in relative survival. Oropharyngeal cancer had the highest increase in

incidence followed by hypopharyngeal cancer which showed the poorest survival of HNCs.

51. Multifocality as a prognostic factor in thyroid cancer

Joseph Kyle

University of Sydney

Eslick Guy1, Edirimanne Senarath1 1University of Sydney

Rationale: Thyroid cancer is one of the most common endocrine cancers whose incidence has been

steadily increasing. Previous studies have suggested that multifocality in thyroid cancer is associated

with poor prognosis. The present study aims to quantify the data on multifocality as a factor indicating

poor prognosis by meta-analysis.

Materials and methods: A systematic search was carried out using the electronic databases PubMed

and Medline. We searched for articles containing keywords of multifocality and thyroid cancer, as well

as risk factors and prognostic factors for thyroid cancer (Lymph node metastases, extrathyroidal

extension, distant metastases, disease recurrence, Age, tumour size. and gender). Data sets containing

hazard ratios and odds ratios were then compared.

Results: The meta-analysis was performed using a total of 21 articles, showed that multifocality is

associated with an increased risk of development of LNM (12 Studies: OR=1.87; 95% CI=1.51-2.32; I2 =

49.11; p-value = 0.03), Extrathyroidal extension (15 Studies: OR=3.18; 95% CI = 0.69-14.71; I2 = 95.62;

p-value <0.001), Tumour Size > 1cm (3 Studies: OR=2.75; 95% CI = 1.95-3.89; I2 = 0.00 and p-value =

0.88) and disease recurrence (5 Studies: HR=2.81; 95% CI = 1.07-7.36; I2 = 95.85; p-value < 0.001). Risk

factors that did not significantly contribute to a higher incidence of multifocality include Age >45, Male

Gender.

Conclusions: Multifocality in Thyroid cancer is a significant risk factor for disease progression and

increases the risk of disease recurrence. The present study suggests that patients who have multifocal

disease should therefore be managed more aggressively from an operative ad post-operative

perspective.

52. Risk factors for Human Papilloma Virus infection and Head and Neck Cancer

Karavelia Aspasia

General Hospital of Chania “St George”, Chania Greece

Rationale: Clinical, molecular and epidemiology data suggest a connection between Head and Neck

Cancer and HPV infection. A literature review focusing on specific factors that can be associated with

Head and Neck Cancer in patients with HPV infection is promising about future research on that field.

Materials and methods: Literature review among risk factors in HPV associated Head and Neck cancer

that last decade.

Results: Types of sexual beahaviour, smoking, alcohol, hygiene, marijuana, immunosuppression are

some of the most common risk factors that are associated with tumourigenesis in HPV positive patients.

Also the type of HPV gene infection and sex plays an important role.

Conclusions: Future studies focusing on specific risk factors for tumourigenesis in patients with HPV

infection will be very helpful in screening projects and predecting prognosis in patients.

53. Optimization of combined treatment in patients with squamous cell carcinoma of the head

and neck

Kurochkina Iuliia

First Moscow State Medical University

Reshetov Igor, Sukorceva Natalya, Bykov Igor, Shevalgin Alexandr

Rationale: The most common method of treating patients with squamous cell carcinoma of the oral

cavity and pharynx is a combined method. Nowadays the role of the induction chemotherapy in the

treatment of resectable and locally advanced tumors of the head and neck has not yet been clarified,

although the most effective regimen now is the triple combination of docetaxel, cisplatin, 5-fluorouracil.

Conducting chemotherapy prior to surgical treatment has become a particularly attractive strategy.

Materials and methods: In a single-center, randomized, open study, based on the First Medical

University, patients with squamous cell carcinoma of the oral cavity and pharynx were divided into two

groups. The control group of patients received neoadjuvant chemoradiotherapy at the first stage of

treatment, according to standard regimens. The main group, at the first stage of treatment received

neoadjuvant chemotherapy 2-4 courses of the TPF scheme. Further were analyzed the effectiveness of

treatment using radiation diagnostic methods according to RECIST criteria and evaluation of therapeutic

pathomorphosis was carried out. The second stage was surgical treatment for both groups. The

following treatment parameters were analyzed: the possibility of safe operative intervention, the

frequency of complications, the completion of reconstruction, general and disease-free survival, local

control.

Results: In the group of patients receiving induction chemotherapy, the number of preserved operations

was higher than in the chemoradiation group (13 of 20 in the baseline and 10 of 26 in the control group).

The number of complications is less in the control group. The frequency of therapeutic pathomorphosis

of grade 3-4 in the tumor was much higher in the group of patients receiving induction chemotherapy

at the first stage of treatment than in the chemoradiation group (13 of 20 in the main group and 12 of

26 in the control group). This was confirmed morphologically while evaluating postoperative material.

Conclusions: As already known, surgical treatment in combination with induction chemotherapy plays

a significant role in the fight against squamous cell carcinoma of the head and neck. Preliminary results

indicate the prospect of combined treatment with induction chemotherapy with the TPF scheme, and

in the second stage - surgical treatment.

54. Medullary Carcinoma of Thyroid with isolated hepatic metastasis in newly setup rural cancer

centre of India

Kansal Latika

Homi Bhabha Cancer Hospital, Sangrur

Sumit Gupta1, Debashish Chaudhary1, Tapas Dora1, Mehul Bupkari1 1Homi Bhabha Cancer Hospital, Sangrur

Rationale: How we managed a case of Medullary Carcinoma of Thyroid with isolated hepatic metastasis

in newly setup rural cancer centre of India.

Materials and methods: A 41 year old man presented to us with 3 x 2 cm non tender, mobile, firm node

in left level II neck. Hopkins 90 degree examination was normal. USG guided FNAC was done which was

suggestive of medullary carcinoma thyroid. Serum calcitonin value was 405pg/ml and urine VMA level

was 1.24mg/24hr and other routine investigation were normal. CECT neck showed there was ill defined

hypodense lesion measuring about 17x14mm arising from superior pole of left thyroid lobe margins of

lesions were ill defined with speck of calcification. Right lobe of thyroid was normal. Enlarged enhancing

level III, IV, VI lymph nodes were seen on left side, larger measuring approx 16x13mm.USG guided FNAC

from thyroid also shows medullary carcinoma of thyroid.As a metastatic work up ultrasound abdomen

was done which shows ill defined hypoechoic lesion 21x19mm seen in segment VI of liver with mild

internal vascularity. Then triphasic CECT scan of abdomen was done which showed ill defined lesion

measuring 27 x 26 mm in the segment VI within the liver parenchyma. There was no other focal lesion

and no dilatation of biliary tree. USG guided FNAC was done from segment VI of liver which was

suggestive of medullary carcinoma. Patient underwent total thyroidectomy with bilateral level ii- v neck

dissection and central compartment clearance. Histopathological report was consistent with medullary

carcinoma thyroid with extra thyroidal extension and lymphovascular invasion was seen. Nodes were

positive for medullary carcinoma of thyroid with extra capsular extension. For isolated hepatic

metastasis patient underwent radiofrequency ablation at Institute of Liver and Biliary Sciences, New

Delhi. After this Patient received external beam radiotherapy because extrathyroidal and perinodal

extension.

Results: Regular Postop 3 monthly follow-up done CECT neck and abdomen show no abnormality. His

serum calcitonin became normal. After 2 years patient is loco regionally with metastatic liver lesion is

controlled with normal calcitonin level.

Conclusions: Decision making and meticulous surgery has important role in this case. Hepatic Lesions

with 5 cm or less can be very well managed with radiofrequency ablation. This type case management

can be done in a rural area cancer setup.

55. An extended hypofractionated palliative Radiotherapy Regimen for Head and Neck

Carcinomas

Laursen Michael

Department of Oncology, National University Hospital, Rigshospitalet, Copenhagen, Denmark

Friborg Jeppe, Specht Lena, Kristensen Claus, Gothelf Anita, Bernsdorf Mogens, Vogelius Ivan

Rationale: Palliative radiotherapy to patients with head and neck cancer is often necessary, but there is

a substantial variation in the treatment regimens reported in the literature, and consensus on the most

appropriate schedules does not exist. In order to minimize acute toxicity while at the same time ensure

tumor control, hypofractionated treatment regimens are often used. In the current study we

retrospectively investigated the outcome in patients intended for palliative radiotherapy with a

prolonged hypofractionated regime routinely used in Denmark.

Materials and methods: Patients with newly diagnosed head and neck cancer treated with a specific

palliative radiotherapy regime of 52-56 Gy in 13-14 fractions twice-weekly from 2009 to 2014 at our

institution were included. Patients were excluded if they had previously received radiotherapy.

Data on disease location, stage, patient performance status, treatment response, acute skin and

mucosal toxicity, and late fibrosis were collected prospectively, and supplemented with information

from medical records.

Results: Eighty-one patients were included in the study and sixty patients (74 %) completed the intended

treatment. Rates of combined complete and partial response two months post-treatment in evaluated

patients were 78 % at tumor site and 75 % at nodal site. Median overall survival was 5.3 months and in

patients who completed the intended treatment 10.3 months. Performance status had a significant

influence on survival and on completing the intended treatment, while there was no clear influence of

stage, except in metastatic disease (table 1). Grade III or IV acute mucositis were observed in 23 %, and

grade III or IV acute dermatitis observed in 14 %. Moderate or severe fibrosis was recorded in 41 % of

evaluated patients.

Conclusions: Palliative hypofractionated radiotherapy with 52-56 Gy in 13-14 fractions given twice

weekly showed good treatment response and tolerability in a vulnerable patient population. However,

it may not be suited for patients in poor performance status.

56. Prognostic value of adipose tissue volume for predicting disease progression in patients with

head and neck cancer

Lee Jeong Won

Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon, Korea

Ban Myung Jin1, Park Jae Hong1, Yoo Ik Dong1, Lee Sang Mi1 1Soonchunhyang University Cheonan Hospital, Cheonan, Chungcheongnam-do, Korea

Rationale: The aim of the study was to assess the relationship between adipose tissue volume measured

on PET/CT images and survival in patients with head and neck cancer.

Materials and methods: A total of 107 head and neck cancer patients with no distant metastasis (16

nasopharyngeal cancer, 46 oropharyngeal cancer, and 45 hypopharyngeal cancer) who underwent F-18

fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for staging

work-up and subsequent surgical resection or chemoradiotherapy were retrospectively enrolled.

Maximum standardized uptake value (Tmax), metabolic tumor volume (MTV), and total lesion glycolysis

(TLG) of primary tumor were measured from PET/CT images. Volumes of subcutaneous (SAT) and

visceral (VAT) adipose tissue were measured from three consecutive CT images of PET/CT at the level of

the L4 spine. The prognostic values of volume of SAT and VAT for predicting disease progression-free

survival were assessed and compared with PET parameters and clinical factors.

Results: Of the 107 patients, 28 patients (26.2%) experienced disease progression during follow-up. On

univariate analysis, underweight (p=0.024), C-reactive protein/albumin ratio (p=0.006), platelet-to-

lymphocyte ratio (p=0.008), TNM stage (p=0.002), Tmax (p=0.016), MTV (p=0.044), TLG (p=0.036), SAT

volume (p<0.001), and VAT volume (p=0.044) were significant prognostic factors for predicting disease

progression. The patients with low SAT and VAT volumes had significantly worse disease progression-

free survival than those with high SAT and VAT volumes. On multivariate analysis with adjusting for age

and sex, only TNM stage (p=0.010; hazard ratio, 3.18; 95% confidence interval, 1.31-7.69 for stage III-IV)

and SAT volume (p=0.022; hazard ratio, 2.62; 95% confidence interval, 1.15-5.97 for SAT volume <25

cm3) were significantly associated with disease progression-free survival.

Conclusions: For patients with head and neck cancer, low SAT volume significantly associated with worse

disease progression-free survival.

57. Molecular Profiling of Mammary Analogue Secretory Carcinoma and Acinic Cell Carcinoma

Facilitating Precision Diagnosis and Targeted Therapy

Licitra Lisa

Medical Oncology Head and Neck Cancer Department, Istituto Nazionale dei Tumori, Milan, Italy

Michal Michal1, Christiansen Jason2, Potts Steven2, Trama Annalisa3, Skalova Alena4 1Biopticka lab, ltd., Plzen, Czech Republic 2Ignyta, Inc. San Diego, CA, USA 3Evaluative Epidemiology Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS,

Istituto Nazionale dei Tumori, Milan, Italy 4Department of Pathology, Charles University and Faculty of Medicine in Plzen, Prague, Czech Republic

Rationale: The STARTRK-2 is a potentially registration-enabling Phase-2 global basket trial of the

investigational tyrosine kinase inhibitor entrectinib (Ignyta) in patients with solid tumors harboring

NTRK1/2/3, ROS1, or ALK fusions. Phase-1 studies of entrectinib reported a 79% ORR targeting these

gene fusions across multiple histologies in patients naïve to inhibitors of these targets, received an

efficacious dose and had extracranial disease. Nearly all tumors of the rare salivary gland subtype

mammary analogue secretory carcinoma (MASC) will contain the ETV6-NTRK3 fusion, and it has been

estimated that up to 70% of extraparotid acinic cell carcinoma (AciCC) cases will also have this driving

fusion and may be misdiagnosed MASC. Applying epidemiological data from the RARECAREnet project

based on 94 population-based cancer registries covering 24 European countries from 2000 to 2007, the

expected new cases per annum of parotid and extraparotid AciCC cases (ICD-O3 code 8550/3) in the

EU28 is c.500 and c.100, respectively.

Materials and methods: MASCs represent locally invasive malignancies of the salivary glands with

microcystic architecture, low-grade nuclei, and granular pink vacuolated cytoplasm. The most important

differential diagnostic considerations are AciCC, low-grade cystadenocarcinoma, and mucoepidermoid

carcinoma. Molecular profiling, comprising a pan-TRK antibody IHC-prescreen and an RNA-based

anchored multiplex PCR NGS, was conducted.

Results: Molecular profiling resulted in pathologic reclassification of many AciCC cases to MASC. They

display strong mammaglobin and S100 positivity and harbor translocation t(12;15)(p13;q25) resulting in

ETV6-NTRK3 fusion, and leading to the considerations of entrectinib (pan-TRK inhibitor) as a targeted

investigational treatment option.

Conclusions: TRKC inhibition with a pan-TRK inhibitor entrectinib in a NTRK3-rearranged cancer

highlights the value of molecular profiling and targeted therapies for rare malignancies where

alternative therapies are lacking. We recommend that all suspected MASC neoplasms, including

zymogen-poor AciCC, and low-grade salivary carcinomas mimicking MASC, undergo molecular profiling.

58. Pembrolizumab Plus Chemoradiation (CRT) vs CRT Alone for Locally Advanced Head and Neck

Squamous Cell Carcinoma (LA-HNSCC): KEYNOTE-412

Licitra Lisa

Fondazione IRCCS Istituto Nazionale dei Tumori, Milan

Machiels Jean-Pascal1, Yen Chia-Jui2, Rischin Danny3, Waldron John4, Burtness Barbara5, Gregoire

Vincent1, Tao Yun Gan6, Yorio Jeffrey7, Aksoy Sercan8, Ikeda Sadakatsu9, Hong Ruey-Long10, Ge Joy Yang11,

Brown Holly11, Bidadi Behzad11, Siu Lillian L.12 1Cliniques Universitaires Saint-Luc, Brussels 2National Cheng Kung University Hospital, Tainan 3Peter MacCallum Cancer Centre, East Melbourne 4Princess Margaret Cancer Centre, Toronto 5Yale University School of Medicine, New Haven 6Institut Gustave Roussy, Villejuif 7Texas Oncology–Austin Central, Austin 8Hacettepe Universitesi Tip Fakultesi, Ankara 9Medical Hospital, Tokyo Medical and Dental University, Tokyo 10 National Taiwan University Hospital, Taipei 11Merck & Co., Inc., Kenilworth 12Princess Margaret Cancer Centre, Toronto

Rationale: CRT with cisplatin is the standard of care for patients with LA-HNSCC not treated by surgery.

Preclinical data in murine cancer models show improved tumor growth control and survival when RT is

combined with a PD-1 inhibitor. Pembrolizumab is effective for treatment of recurrent/metastatic

HNSCC, and initial results from a phase 1b study suggest that pembrolizumab plus CRT is tolerable in

patients with LA-HNSCC. KEYNOTE-412 (NCT03040999) is a phase 3, randomized, placebo-controlled,

double-blind trial to determine the efficacy and safety of pembrolizumab given with CRT and as

maintenance therapy versus placebo plus CRT in LA-HNSCC.

Materials and methods: Eligibility criteria include age ≥18 years; newly diagnosed, treatment-naive,

oropharyngeal p16 positive (any T4 or N3), oropharyngeal p16 negative (any T3-T4 or N2a-N3), or

larynx/hypopharynx/oral cavity (any T3-T4 or N2a-N3) SCC; evaluable tumor burden (RECIST v1.1); and

ECOG performance status 0-1. Patients will be randomly assigned (1:1) to receive pembrolizumab 200

mg every 3 weeks plus cisplatin-based CRT or placebo plus cisplatin-based CRT. Treatment will be

stratified by RT regimen (accelerated RT [56-70 Gy, 6 fractions/week for 6 weeks] or standard RT [56-70

Gy, 5 fractions/week for 7 weeks]), tumor site/p16 status (oropharynx p16 positive vs p16 negative or

larynx/hypopharynx/oral cavity), and disease stage (III vs IV). A priming dose of pembrolizumab or

placebo will be given 1 week before CRT, followed by 2 doses during CRT and an additional 14 doses

after CRT, for a total of 17 pembrolizumab or placebo infusions. Treatment will be discontinued at

centrally confirmed disease progression, unacceptable toxicity, or patient/physician decision to

withdraw. Response will be assessed by computed tomography or magnetic resonance imaging 12

weeks after CRT, every 3 months for 3 years, then every 6 months for years 4 and 5. Patients will be

evaluated to determine the necessity of neck dissection 12 weeks after completion of CRT; neck

dissection will be recommended in cases of persistent disease. Safety will be monitored throughout the

study and for 30 days after treatment end.

Results: The primary end point is event-free survival. Secondary end points include overall survival,

safety, and patient-reported outcomes.

Conclusions: Recruitment is ongoing in 21 countries and will continue until ~780 patients are enrolled.

59. Phase 2 Trial of Pembrolizumab in Patients (pts) With Recurrent or Metastatic Cutaneous

Squamous Cell Carcinoma (cSCC): KEYNOTE-629

Licitra Lisa

Fondazione IRCCS Istituto Nazionale dei Tumori, Milan

Siu Lillian L.1, Cohen Ezra2, Zhang Pingye (Eric)3, Gumuscu Burak3, Swaby Ramona3, Harrington Kevin4 1Princess Margaret Cancer Centre, Toronto 2Moores Cancer Center at UC San Diego Health, La Jolla 3Merck & Co., Inc., Kenilworth 4Head and Neck/Skin Units, The Institute of Cancer Research, London

Rationale: There are no approved treatments and no standard of care for recurrent or metastatic cSCC.

Regimens that are effective for squamous cell carcinoma of the head and neck (HNSCC) may also be

effective for cSCC. Cisplatin- and cetuximab-based regimens are commonly used in recurrent or

metastatic cSCC; however, evidence supporting their efficacy is limited. Pembrolizumab is a

programmed death 1 (PD-1) inhibitor that directly blocks the interaction between PD-1 and its ligands,

PD-L1 and PD-L2. Evidence has been shown of pembrolizumab efficacy and safety in patients with

recurrent or metastatic HNSCC in the phase 1b KEYNOTE-012 study. This single-arm, open-label phase 2

trial will be conducted to evaluate the efficacy and tolerability of pembrolizumab in pts with previously

treated recurrent or metastatic cSCC (NCT03284424).

Materials and methods: Key inclusion criteria are age ≥18 years; histologically confirmed cSCC as the

primary site of malignancy; metastatic disease or locally recurrent disease not curable by surgery,

radiation, or systemic therapy; previously treated with a platinum- or cetuximab-based regimen;

measurable disease per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1); and

Eastern Cooperative Oncology Group performance status 0-1. Pts will be treated with pembrolizumab

200 mg every 3 weeks by intravenous infusion, continued for 35 doses (~2 years) or until disease

progression, unacceptable toxicity, intercurrent illness, nonadherence, or investigator or pt decision to

withdraw. Radiographic imaging will be performed every 6 weeks for year 1 and every 9 weeks

thereafter. Adverse events will be monitored and graded according to National Cancer Institute

Common Terminology Criteria for Adverse Events, version 4.0.

Results: Primary end point is objective response rate per RECIST v1.1 assessed by blinded independent

central review. Secondary end points include duration of response, disease control rate (complete or

partial response or stable disease for ≥12 weeks), and progression-free survival per RECIST v1.1, and

overall survival, safety, and tolerability. Pharmacokinetics, biomarkers, and health-related quality of life

will be evaluated as exploratory end points.

Conclusions: Recruitment is ongoing in 10 countries and will continue until 120 pts are enrolled.

60. Odontogenic deep neck abscesses

Lim Richmond Quan Qing

Tan Tock Seng Hospital, Singapore

Chong Yaw Khian

Tan Tock Seng Hospital, Singapore

Rationale: 25-30% of deep neck space infections arise from an odontogenic source. Swelling of the

submandibular and deep neck spaces as a result of infection can lead to airway compromise. We aim to

provide an up to date review of the manifestation and management of such a condition.

Materials and methods: We describe a series of patients with odontogenic deep neck abscesses ranging

from simple (isolated mandibular space abscesses) to complex (submandibular space spreading to

parapharyngeal and visceral spaces). We then detail the anatomy of the spread of infections from the

oral cavity to the deep neck spaces. Finally, we review the approaches to the mandibular spaces, paying

particular attention to the feasibility of contemporary minimally invasive surgical approaches.

Results: The location of an odontogenic abscess depends on the location of the offending tooth and

tooth root. Tooth roots posterior to the mylohyoid attachment result in submandibular space infections

while tooth roots anterior to the mylohyoid attachment result in sublingual space infections. Further

spread to other deep neck spaces is possible. Surgical approaches include open transoral or external

incisions with or without the assistance of endoscopes. Completely endoscopic approaches via ports

have been described, although its real-world utility has been questioned due to the risk of hypercarbia

and subcutaneous emphysema while creating the working space in the neck.

Conclusions: An understanding of the anatomy and approaches to the submandibular spaces is crucial

to treat such a common yet potentially fatal condition.

61. Nodal stage: Is it a prognostic factor for submandibular gland cancer?

Liu Yanbin

Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, School

of Stomatology, Capital Medical University, Beijing, China

Qin Lizheng

Rationale: Submandibular gland cancer is relatively rare. The purpose of this study was to estimate 5-

year overall and disease-free survival and to identify prognostic factors associated with overall and

disease-free survival for submandibular cancer.

Materials and methods: The investigators implemented a retrospective cohort study and enrolled a

sample of patients with submandibular glad cancer. The predictor variables were age, gender, tumor

stage, nodal stage, margin status and extracapsular spread. The outcome variables were 5-year OS and

5-year DFS. Kaplan Meier methods were used to estimate survival and Cox hazards models were used

to identify prognostic variables.

Results: The sample was composed of 52 subjects with submandibular gland cancer with a mean age of

47.4 years and 51.9% male. The median follow-up was 81 months (range of 11–159 months). The 5-year

OS and DFS rates were 76.9% and 67.3%, respectively. Fixed mass, positive neck node and positive

margin status were significant predictors of OS and DFS. Nodal stage was the significant independent

predictor affecting the disease outcome of submandibular gland cancer.

Conclusions: Our results identified several important prognostic factors associated with survival rate in

patients with submandibular gland cancer. These prognostic variables include symptoms at

presentation, pathologic nodal status and margin status. These outcomes suggest that heightening

vigilance of clinical characteristics for this disease may provide the impetus for improving the survival

rate.

62. Hope for salivary gland cancer (SGC): EORTC HNCG/UKCRN 1206 randomized phase II study

to evaluate the efficacy and safety of Chemotherapy (CT) vs androgen deprivation therapy

(ADT) in patients with recurrent and/or metastatic androgen receptor (AR) expressing SGC

Locati Laura

Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy

Caballero Carmela1, Fortpied Catherine1, Perrone Federica2, Quattrone Pasquale3, Harrington Kevin4,

Grégoire Vincent5, Licitra Lisa6 1Medical and Statistics, EORTC, Brussels, Belgium 2Molecular Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy 3Pathology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy 4Radiotherapy and Imaging, Royal Marsden Foundation Trust/ The Institute of Cancer Research,

London, Great Britain 5Dept. Radiation Oncology, Cliniques Universitaires St. Luc, Brussels, Belgium 6Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy -

University of Milan, Italy

Rationale: SGCs are rare and heterogenous tumors (<1% of all malignancies in Europe). Among more

than 20 histotypes, only salivary duct carcinoma (SDC) and adenocarcinoma NOS expresses AR. These

variants are aggressive and associated with poor prognosis. Surgery is the main curative treatment but

upon relapse, patients are left with very few options. There is an urgent need to understand their biology

to enable progress in this rare disease. This study (NCT01969578) aims to evaluate the efficacy and

safety of ADT (experimental arm) vs chemotherapy (standard arm) in patients with recurrent and/or

metastatic, AR overexpressing SDC and adenocarcinoma, NOS by demonstrating a 15% improvement in

Progression Free Survival (PFS) rate at 6 months in favor of ADT.

Materials and methods: Trial design: In this multicenter, randomized, phase II intergroup study a total

of 76 treatment naïve patients (Cohort A) are planned to be randomized to receive ADT or platinum-

based chemotherapy. Previously treated patients will be enrolled in a separate Cohort B to receive ADT.

Patients from Cohort A randomized to chemotherapy can also enter Cohort B at disease progression.

The primary endpoint is PFS for Cohort A and best overall response for Cohort B. Central testing of AR

expression is based on staining intensity (0 = negative to 3 = strong) and percentage of positive nuclear

stained cells (0 = ≤10% to 3 = ≥70%). AR overexpression requires a maximum score of 3 on both scales.

Mechanisms of AR activation and resistance will be studied. This study is led by EORTC Head and Neck

Cancer Group with UNICANCER/REFCOR, International Rare Cancer Initiative UK Salivary Gland Cancer

Group and RARECARENet. It will run in 35 sites in 10 countries: Austria, Belgium, France, Germany,

Greece, Hungary, Italy, Portugal, The Netherlands, and United Kingdom. Sites from the EURACAN

European Reference Network are participating. Currently, 36 patients are registered; 20 have AR

overexpression, of which 16 have been randomized in Cohort A. Identification of AR as a treatment

target in SGC can be practice changing.

Results: NA

Conclusions:

Clinical trial identification: EORTC 1206 HNCG http://clinicaltrials.gov/ct/show/NCT01969578

Legal entity responsible for the study: European Organization for Research and Treatment of Cancer

Funding: EORTC ICR RARECAREnet Fondazione IRCCS Istituto Nazionale dei Tumori

63. Phase II trial of abiraterone acetate in patients with relapsed and/or metastatic, castration

resistant AR expressing salivary glands carcinomas (SGCs)

Locati Laura

Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy

Bossi Paolo1, Bergamini Cristiana1, Calareso Giuseppina2, Granata Roberta1, Alfieri Salvatore1, Resteghini

Carlo1, Galbiati Donata1, Cavalieri Stefano1, Platini Francesca1, Licitra Lisa1 1Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy -

University of Milan, Italy 2Radiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy

Rationale: Expression of androgen receptors (AR), is reported in more than 80% of salivary duct

carcinomas (SDC) and in 50% of adenocarcinomas, NOS. Similarly to prostate cancer (Pca), androgen

deprivation therapy (ADT) has been employed with success in patients with metastatic AR-expressing

SDC and adenocarcinoma, NOS in so much as an international randomized trial is ongoing to assess the

efficacy of ADT over chemotherapy as first line treatment in this setting of patients (NCT01969578).

Abiraterone acetate was approved in advanced, castration resistant Pca in 2011. We tested the activity

of abiraterone in two patients with AR-positive castration resistant adenocarcinoma, NOS obtaining two

partial responses (Locati LD, Cancer Biol Ther 2014).

Materials and methods: Trial design: This is a phase II trial (NCT02867852) aimed at assessing the

activity (CR+ PR) of abiraterone in castration resistant AR-positive SGCs. The drug will be considered

effective and worth of further evaluation if the response rate will be at least 20%. The null hypothesis

will be RR 5% versus the alternative RR20%. A 2-stage Simon design will be applied. Type I and type II

error rates are set at the 10% and 20% levels. If at least 1/9 response will be observed in the first step,

patients enrolment will go on up to a final overall sample size of 24 subjects. If at least 3/24 responses

will be recorded, the null hypothesis will be rejected in favor of the alternative and the drug considered

promising and worthy of further investigation. Objective tumor response and time to progression will

be measured according to RECIST criteria 1.1 and to PCWG2 recommendations for bone lesions.

Results:

Conclusions: Twenty four patients with AR-expressing SGC, progressed on ADT, will be enrolled over

two years. To date 11 subjects have been enrolled and 3 patients are still receiving the study drug. Four

250 mg tablets of abiraterone acetate will be administered daily to patients until progression of disease

or intolerable toxicity. Disease control rate, incidence of adverse events, overall survival and progression

free survival will be assessed as well. Tumor samples will be also collected for translational analyses

(e.g.CYP17 expression; PI3K mutations). Blood and saliva samples will be collected as well.

64. Our experience in the management of head and neck cancer in elderly patients

Magnano Mauro

Division of Otorhinolaryngology, Pinerolo and Rivoli Hospitals, Pinerolo, Italy

Bertone Fabio, Andreis Marco, Boffano Paolo, Machetta Giacomo

Rationale: The management of head-and-neck cancer in elderly patients is challenging. In fact, co-

morbidities, poor performance status, limited supportive care, and impaired mental status may be

frequent factors that determine deviations from the established standards of care. There is still no

consensus about the eventual need to administer less aggressive treatment in elderly patient. The aim

of this study was to assess our experience in the management of elderly patients with head and neck

cancer in comparison with younger patients.

Materials and methods: A retrospective review was conducted for all patients admitted and treated for

newly diagnosed head and neck cancer between January 2008 and December 2012. The clinical

characteristics and management approaches recorded prospectively were compared between the

elderly (aged ≥ 70 years) cohort and younger (aged <70 years) cohort. The following data were collected

and analyzed for each patient: age; sex; tumor site; tumor stage; performed treatment.

The outcome was classified according to the following categories: NED (No Evidence of Disease), DOD

(Dead of Other Diseases), DWD (Dead Because/with the tumor disease), LWD (Alive with Disease).

Results: A total of 316 head and neck cancer patients (232 males, 84 females) were identified: 203 (64%)

were in the young group (146 males; 57 females), whereas 113 patients (36%) were in the elderly group

(86 males; 27 females). No statistically significant differences between the younger and the elderly

groups was found for gender and site of tumor. Instead, statistical analysis confirmed that stage I was

statistically more frequently observed in younger patients and that stage IV was more commonly found

in elderly subjects. Treatment options were quite uniformly distributed within the two groups, with the

only exception being represented by radiotherapy alone that was more frequently administered in

elderly patients. On the whole, 151 younger patients and 67 elderly were alive at 2 year follow up with

no evidence of disease.

Conclusions: The results of the present retrospective study have confirmed that chronologic age should

not be a reason to deny appropriate treatments that could prevent death in elderly patients.

65. Prognostic factors affecting survival in T4 buccal mucosa cancers: comparison between bone

erosion and skin involvement

Mair Manish

Tata Memorial Hospital, Mumbai, India

Mathur Yash1, Chaturvedi Pankaj1, Nair Deepa1 1Tata Memorial Hospital, Mumbai, India

Rationale: Bone erosion or skin involvement upstages buccal mucosa cancers as T4 cancers. We did this

study to analyze which among skin involvement or bone involvement, is an indicator of aggressive

primary tumor.

Materials and methods: This is a retrospective chart review of 442 treatment naïve T4 buccal mucosa

cancers operated at a tertiary cancer center from January 2012 to February 2015. The tumors were

classified as T4 either because of bone erosion, skin involvement or both. Overall survival (OS) and

disease-free survival(DFS) estimations were calculated using log rank test and cox-regression analysis.

Results: The median age of the patients in the study group was 54 years with male to female ratio of

4.1:1. Skin involvement was seen in 65 (14.7 %), bone erosion was seen in 312(70.6%) and both were

involved in 65 (14.7 %) patients. Estimated 5-year overall survival of the study group was 51.4%. We

found bone involvement was an independent factor predicting DFS (5-year DFS 44.6% vs. 69.1%; p-

0.002) and OS(5-year OS :47.6% vs. 76%;p-0.005). However, involvement of skin did not impact DFS (5-

year DFS 44.8% vs. 55.4%) nor OS (5-year OS 47.2% vs. 56%) even on univariate analysis. It was also seen

that tumors with involvement of both had worst survival (5-year DFS:33%; OS: 38.5%). Other factors

influencing DFS were nodal metastasis p-0.000(2.7), Poorer grade of tumor p-0.012(1.5).

Conclusions: Bone involvement suggests aggressive behavior of the primary tumor as compared to skin

involvement. However, tumors with involvement of both have worst outcomes. There is a need to think

beyond the historic TNM staging.

66. The effectiveness of 18F-FDG PET/CT in head and neck squamous cell cancer

Majchrzak Ewa

Department of Head and Neck Cancer, University of Medical Sciences in Poznan, Poland, The Greater

Poland Cancer Centre

Rationale: The aim of the study was to evaluate the diagnostic performance of 18F-FDG-PET/CT for

detection of primary tumour in patients with CUP Syndrom and in the differentiation of residual tumor,

locoregional or distant recurrence in the follow-up of patients who underwent radical treatment of the

head and neck neoplasm.

Materials and methods: 261 patients treated for head and neck cancer were included in the study.

Patients were divided into two groups: patients with histologically confirmed metastatic cervical lymph

nodes from unknown primary tumour (44%) and patients diagnosed with head and neck neoplasm after

completion of oncological treatment (56%). The basic research methods such as regular ENT

examination with the endoscopy assessment of the upper aerodigestive tract, analysis of 18F-FDG-

PET/CT results based on clinical observations of patients, morphological imaging studies and

retrospective analysis of the medical history of each patient were performed.

Results: Based on the results of PET/CT in CUP Syndrom patients group, the detection rate for primary

tumour was 24.3% in total, 17.6% for head and neck region and 6.6% for other anatomical subsites. The

sensitivity of PET/CT was 47.14%, specificity 66.67%. PET/CT results contributed to a change in

treatment plan in approximately 50% of patients with CUPS. In the second study group the detection

rate of local recurrence based on PET/CT was 22%, of regional recurrence 10% and distant metastases

23%. The sensitivity of PET/CT was 91.57%, specificity 88.89%.

Conclusions: 18F-FDG-PET/CT is an effective method of diagnosis of locoregional and distant recurrence

in patients who completed radical oncological treatment of head and neck cancer. In addition, PET/CT

is useful in the detection of primary tumour as well as other unexpected pathologies, such as distant

metastases, in patients with CUP Syndrom.

67. Slow-Mohs Surgery. Report of 6 cases

Malet Contreras Albert

Cirugía Oral y Maxilofacial, Hospital La Paz, Madrid

Cebrián Carretero José Luis, Gonzalez Martín-Moro Javier, Losa Muñoz Pedro, Ruiz Elena, Burgueño

García Miguel

Rationale: Conventional Mohs Surgery (MS) has proven for decades its effectivity in the treatment of

facial skin cancer, assuring complete cancer removal, keeping as much healthy tissue as possible, and

resulting in lower local recurrences than simple wide excision. Some of its indications are basal cell

carcinoma (BCC), epithelial carcinoma, melanoma, dermatofibrosarcoma protuberans (DFSP), adnexal

carcinoma, and other skin cancer strains. MS is indicated in those tumors up to 1-2cm and when staining

tissue is not required, because tissue examination takes a lot of time. However, when wider skin areas

have to be removed or when immunostaining is required, histological studies lengthen and thus, it is not

possible to perform MS in one day. In this context, “Slow-Mohs” or “Staged Excision” surgery uses

another technique that lets more time to perform a careful examination by doing it in different stages,

and allowing the patient to avoid a long stay in the hospital.

Materials and methods: This is a retrospective observational study. 6 cases of skin cancer were treated

by Slow-Mohs between 2012 and 2017, in our Maxillofacial Department in collaboration with the

Dermatology Department, in H. La Paz of Madrid, SP.

Results: Six patients underwent six Slow-Mohs procedures for three DFSP, one adnexal carcinoma, one

lentigo maligna and one BCC. The most common sites were the forehead and the cheek. Ages raised

from 30 to 74 y.o. at diagnosis. 2 cases of DFSP had followed a neoadjuvant treatment with Imatimib.

Five from six patients required two phases of Mohs Surgery, and an average of one more surgery to

reconstruct. The minimal removal left a defect of 4x2x3cm, meanwhile the biggest extirpation had a

9x7x3,5 defect, until free margins were reached. No recurrence has been observed.

Conclusions: Slow-Mohs surgery is a good alternative to conventional MS in cases of wide lesions, and

cases in which tissue staining is required. The patient doesn’t have to stay for a long period of time in

the surgery room to complete the treatment, and reconstruction is performed later assuring free

margins. However, collaboration of the patient is required with frequent visits in order to keep the

bloody surgical bed clean, and secondary scarring can lead to retraction of surrounding tissues with

undesirable aesthetic results. Finally, the deferred technique can be more expensive than wide excision

or conventional MS.

68. Diagnosis, treatment and prognosis of primary lymphoma of the major salivary glands

Mao Minghui

Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital,

Capital Medical University, Beijing 100050, China

Rationale: The aim of the current study was to analyze the clinical features, diagnosis, treatment

outcomes and prognostic factors of primary lymphoma of the major salivary glands.

Materials and methods: From January 1999 to March 2015, a total of 26 patients with primary malignant

lymphoma of the major salivary glands who were treated at the Capital Medical University School of

Stomatology were included for analysis. The Kaplan–Meier test was used to assess overall survival (OS),

disease-free survival (DFS), disease-specific survival (DSS), and local control (LC). The factors associated

with prognosis were analyzed by univariate analysis.

Results: 15.4% (4/26) of the patients received adjuvant radiotherapy, 19.2% (5/26) received adjuvant

chemotherapy, 7.7% (2/26) received adjuvant radiochemotherapy, and 57.7% received no further

treatment after surgery. The 3-, 5- and 10-year OS was 96.2%, 86.5%, 86.5%, and the corresponding DSS

rates were 96.2%, 85.5%, 85.5%. International prognostic index (IPI), pathology, clinical manifestation

and Ann Arbor Stage, but not treatment regimen, were important prognostic factors.

Conclusions: Surgery alone may be an appropriate choice for patients with fully resectable MALT

lymphoma. High IPI score, diffuse swelling and advanced Ann Arbor Stage were associated with an

unfavorable prognosis. Diagnosis based on surgically resected specimens is more ideal than that based

on fine-needle aspiration cytology or intraoperative frozen-section analysis.

69. Nutritional status in head and neck cancer patients: the impact on the prognoses

Martin Villares Cristina

Hospital El Bierzo, Ponferrada

Gonzalez Gimeno Maria Jose1, Tapia Risueño Manuel2, Hernandez Maria2, Rodriguez Prado Nuria2, San

Roman Carbajo Jesus2, Lourido Diana2 1ENT Department. Universidad Complutense. Madrid 2Hospital El Bierzo, Ponferrada

Rationale: Malnutrition is reported to affect 30-50% of all patients with head and neck cancer. The

impact of malnutrition on surgical outcome is not clearly understood. The purpose of this study is to

determine if nutritional status is related to postoperative complications (pharyngostoma) or tumor

recurrence.

Materials and methods: One hundred patients with T2-4 head and neck carcinomas underwent surgery

were studied prospectively. We havestudied 100 pati. We studied serum albumin, protein serum level,

cholesterol and lymphocites in each patient. These variables underwent statistical analysis (p < 0.05).

Nutritional status was related to postoperative complications and 2-year survival.

Results: Twenty-seven patients present malnutrition (54%). Low serum albumin (< 3.5 g/dL) and a low

level of serum proteins (< 6.5g/dL) were predictive indicators of postlaryngectomy pharyngocutaneous

fistula (p < 0.05). We had 15 patients with pharyngostoma and 11 tumor recurrences. We did found

correlation between malnutrition and tumor recurrence (p < .05).

Conclusions: Malnutrition has negative impact on outcome of patients with head and neck carcinomas.

Our results suggest that a low-level of serum proteins and albumin are predictive clinical parameters of

postlaryngeal pharyngocutaneous fistula.

70. The rabbit model for oncologic laryngeal reconstruction research. Preliminary results

Martin Villares Cristina

Hospital El Bierzo, Ponferrada

Gonzalez Gimeno Maria Jose1, Gonzalo-Orden JM2, Carvajal Urureña Ana3, Valor Cristina4, Dominguez

Calvo jesus5 1ENT Department. Universidad Complutense de Madrid 2Animal Surgery Department. Universidad de Leon 3Animal Health. University of Leon 4Hospital Infanta Sofia. San Sebastian. Madrid 5Hospital El Bierzo

Rationale: Recostruction after wide partial laryngetomyies is the only alternative to total laryngetomy

in so many quimioradiated patients. But laryngeal raconstruction in humans has many unresolved

problems. The rabbit model is a versatile gold standard in thacheal transplantation reseach, so we

propose this biological model to explore solutions to the reconstruction of the surgical defect by extesive

malingnant laryngeal lesions to avoid permanent tracheostomy

Materials and methods: We propose an experimental study in a rabbit model for training and research

about wide partial laryngectomy reconstruction with aortic graft in two stages: in the first stage, 10

rabbits underwent an hemilaryngectomy by an standard surgical operative technique. Key points about

hemilaryngectomy, aortic graft desing and lateral thoracic flap disection are describe in the present

study. In a second stage, biological results of the aortic graft on the larynx aftet 6 months will be

searched

Results: Preliminary results about operative technique are described. We approached the larynx via a

vertical midline cervical incision. A defect of 1x2 cm was surgically created in one hemilarynx of the

rabbit. The defect was immediately reconstructed using an aortic graft as a laryngeal mucosa and

cartilage, and covered by a vascularized flap over the laryngo-aortic sutures. Key points in operative

technique are presented.

Conclusions: Thacheal recostruction by aortic graft evidences can be the key towards laryngeal

reconstruction. Our preliminary results with the use of aortic allograft for laryngeal reconstruction are

an aesy and reproductible model for training and explore the operative technique. Our model are limited

because the lack of biological results. We continue working in the second experimental biological

research part of the study.

71. Training in airway emergencies for laryngectomy patients in a new simulation model: the

“Neck-Breather” simulator

Martin Villares Cristina

Hospital El Bierzo, Ponferrada

Gonzalez Gimeno Maria Jose1, Rodriguez Prado Nuria2, Hernandez Maria2, Valor Cristina3, Diez Gonzalez

Laura4 1ENT Departmanet. Universidad Complutense de Madrid 2Hospital El Bierzo, Ponferrada 3Hospital Infante Sofia, San Sebastian, Madrid 4Hospital de Palencia

Rationale: Permanent tracheostomy after laryngectomy must be considered always a difficul airway.

Training is the key to improve tha safety of the difficult airway. There are many devices for learning and

training the "normal" difficult airway. But laryngectomy patients present a permanent alteration of their

upper airway: the trachea can not never conect to the mouth. Successfully managements of these

patients depends on the "undestanding" of the "new anatomy".

Materials and methods: We propose an artificial plastic anatomic model with removable parts for

simulation and training in emergency airway training in laryngectomy patients (neck-breather patients)

in order to increase confidence and competence. Varoius components of the device are easy removable

and replaceable, in order to mimics the normal upper airway and the anatomy of laryngectomy patient.

We trained the validated guidelines for management of these selected patients.

Results: For the purposes of understanding the new airway anatomy after total laryngectomy and to

train emergencies in these patients, we constructed a plastic simulator with normal upper airway

anatomy and a larynx easy removable, to illustrated the new anatomical scenario in these patientes.

Larynx is easy removable in such a way that in the new modificated anatomy, the trachea of the phanton

can not connected to the mouth, but it is connected to the cervical skin (a permanent tracheostoma).

Schemes and real photos are presented.

The new neck breather simulator, after removing the larynx and connectind, the trachea to the skin,

permit to training the algorithm of laryngectomy airway emergency (oxygenation, remove the inner

cannula, pass a suction catheter, deflate the cuff, remove the tube) and also, permit the learning of the

best practice in the care of the tracheostoma and in the insert of artificial devices into the stoma.

Conclusions: Patient with permanet tracheostoma may be considered always a difficult airway to

management. Simulated training is the key to improve the safety and the emergency management of

neck-breathing patients. In our knowledge, this is the first neck-brather simulator that mimic the total

laryngectomy anatomy for training and simulation.

72. Targetable drugs in salivary duct carcinoma

Martinez de Castro Ana Maria

Hospital General Mateu Orfila, Menorca

Bejarano-Panadés N.1, Afonzo Y.1, Ferri J.1, Diaz P.1, Baste Rotllan N.2 1Hospital General Mateu Orfila, Menorca 2Hospital Universitario Vall d'Hebrón

Rationale: Salivary Duct Carcinoma (SDC) is a distinctive and clinically aggressive adenocarcinoma of

salivary gland. It arises from the ductal epithelium, predominantly in the parotid gland. We present a

case report of SDC.

Materials and methods: We report a case of an extensive mass arising from the left parotid gland with

cervical lymph nodes in a 75-year-old male patient. A radical parotidectomy with modified neck

dissection was performed on febrery 2014. Pathological analysis showed a SDC with local infiltration,

perineural and lymphovascular involvement and 3 of 10 metastatic nodes with extracapsular spread .

The immunohistochemistry reveals androgen receptor expression (75%), non-amplified HER2, and ki67

38%. The molecular analysis by Next-generation sequencing (Amplicon-seq, 60 genes), showed HRAS

Q61R and PIK3CA E545K mutations.

Results: The therapeutic evolution of our patient, is based on the fact that after the surgery of the

primary tumor, it develops prematurely metastatic bone disease (D2 and D11). Carboplatin-paclitaxel

was started (from March to July 2014), with bone progression (D4). Considering poor response to

chemotherapy, radiotherapy treatment was performed on metastatic bone lesions (D2, D4 and D11),

with stabilization of disease as best response. At the same time, a molecular analysis was carried out.

Two mutations were detected in RAS and PI3K pathways, allowing enrollment on clinical trial with a PI3K

pan-inhibitor from October 2014 to January 2015. After that, bone progression was confirmed. With

the aim to block PI3K pathway, he started a combined treatment with an mTORC1/2 inhibitor and PI3K

alpha inhibitor in a clinical trial. He presented a stable disease during four months. After progression on

targeted therapy, hormonal treatment with LHRH agonist was considered which began on October 2015.

Nowadays he continues on treatment with stable disease.

Conclusions: Multiple agents have been studied as systemic therapy in malignant parotid tumors.

Androgen receptor, HER2 expression, and PIK3 oncogenic pathway are critical in the tumorogenesis of

SDC. This knowledge provides an opportunity to select and evaluate targetable therapies in SDC.

73. Ewing sarcoma of the mandible in a pediatric patient: from segmental resection to implant-

supported oral rehabilitation

Martorell Pau

Oral and Maxillofacial Surgery-Hospital Universitario Vall Hebrón Barcelona

Sierra Nicolas E.1, Munill Montserrat1, Bescós M.S.1 1Oral and Maxillofacial Surgery-Hospital Universitario Vall Hebrón Barcelona

Rationale: The current therapy for Ewing sarcoma of the head and neck territory in the pediatric patient

begins with systemic induction chemotherapy followed by local radical treatment with a combination of

surgery and radiotherapy.

Different reconstructive techniques have been described for segmental resections of the mandible in

the pediatric population. Nowadays, the free vascularized fibular graft has become the workhorse for

reconstructions of large mandibular defects in both, adults and children. However, the reduced height

of the fibula is suboptimal for achieving a simultaneous reconstruction of the facial contour and alveolar

height. In addition, the donor-site morbidity is a major concern in the growing patient.

Materials and methods: We report the comprehensive treatment of a 10-year-old girl with a non-

metastatic Ewing sarcoma involving the right body of the mandible. A new technique for pediatric

mandibular reconstruction is presented: the combination of a bone allograft segment covered with a

vascularized fibular periosteal flap (VFPF). This technique provides enough bone-stock to maintain the

facial contour while reducing the vertical distance to the occlusal plane, facilitating the implant-

supported oral rehabilitation and diminishing the donor-site morbidity.

Results: Nine years after diagnosis, and after local recurrence treated with chemo-radiotherapy, there

is no evidence of local or distant disease and the patient shows appropriate cosmetic and functional

outcomes with an implant-supported oral rehabilitation.

Conclusions: Despite being a unique-case report, this novel technique has showed promising results.

The combination of a bone allograft segment with the VFPF provided an anatomical and functional

reconstruction of the mandible, while the potential morbidity of the fibular resection has been avoided.

Further cases are needed to delineate the benefits and disadvantages of this reconstructive technique.

74. Transoral robotic surgery (TORS) with the Flex Robotic System in patients with

hypopharyngeal and laryngeal tumors

Mattheis Stefan

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Germany

Rationale: The Flex Robotic System is a flexible robotic device specifically developed for TORS. We

performed a prospective clinical study, assessing the efficacy of the Flex Robotic System in the surgery

of laryngeal and hypopharyneal head and neck tumors.

Materials and methods: From 2014 until 2017 a total of 24 patients required a surgical procedure for

malign lesions (T1 and T2 carcinoma) of the larynx (n=16) and hypopharynx (n=8). Access and

visualization of different anatomic subsites were individually graded by the surgeon. Set up times, access

and visualization times, surgical results as well as adverse events and system malfunctions were

documented intraoperatively. The mean follow up was one year.

Results: The lesions could be exposed and visualized properly in all patients. The surgical procedures

performed with the Flex® Robotic System were intraoperatively evaluated as successful. Especially in

anatomic regions difficult to reach such as aryepiglottic fold, postcricoid or piriform sinus, the system

provided a good surgical overview. No serious adverse events occurred. We observed two local

recurrences during follow-up.

Conclusions: Hypopharyngeal and laryngeal tumors in areas difficult to reach could be successfully

resected using the Flex® Robotic System thus making the system a safe and effective tool in transoral

robotic surgery.

75. Immunohistochemical detection of a loss of SMARCB1 in poorly differentiated

adenocarcinomas of the sinonasal tract

McHugh Alison

Beaumont Hospital, Dublin

O'Cathain Eadaoin1, Fitzgerald Conall1, O'Neill Prof. J. P. 1, O'Sullivan Barry1, McNally Stephen1 1Beaumont Hospital, Dublin

Rationale: SMARCB1 (or INI1) is a tumour suppressor gene on chromosome 22q, a deficiency of which

has been associated with the pathogenesis of a number of malignant neoplasms including poorly-

differentiated and locally-aggressive carcinomas of the sinonasal tract. Anatomically, these invasive

sinonasal carcinomas pose both a threat to a number of structures in close proximity, and a challenge

to the team involved in surgical planning.

Materials and methods: A literature review on SMARCB1 deficienct tumours of the sinonasal tract was

performed. We present a case from our tertiary referral centre of locally invasive sinonasal carcinoma

with features on histology in keeping with a poorly differentiated non-keratinising large cell carcinoma.

Immunohistochemistry staining was performed showing the absence of INI-1.

Results: 18 previous cases were identified in the literature: 7 male and 11 female. Presenting symptoms

were predominantly ocular symptoms, with pain and obstructive symptoms of the sinonasal tract. Half

of the cases identified had regional or distant metastases at presentation, and 44% had died from their

disease at the time of publication.

Case (with clinical imaging): A 55 year-old male presented with progressive ptosis, ophthalmoplegia and

deterioration in visual acuity. Cross-sectional imaging, including MRI with contrast, revealed an invasive

frontal sinus lesion with extension to the orbit, sinonasal cavity, scalp and pre-septal tissues anteriorly,

superiorly and posteriorly with dural involvement and intracranial extension. Bony destruction was

evident along the medial orbital wall and in areas of the left frontotemporal bone. Pre-operative biopsies

confirmed poorly differentiated adenocarcinoma. A multi-disciplinary surgical approach was adopted,

involving a craniotomy, complex sinonasal resection with orbital exenteration and fronto-temporal

reconstruction using an anterolateral thigh free-flap. The patient is currently receiving adjuvant chemo-

radiotherapy at our institution.

Conclusions: Advances in combined open and endoscopic techniques, as well as pre-operative

radiological assessment, allow management of these challenging cases. The identification of a loss of

SMARCB1 is easily identified on immunohistochemistry and allows for sub-categorization of these

aggressive tumours, providing a greater understanding of their unique behaviour and facilitating

advances in targeted therapies.

76. Percutaneous Endoscopic Gastrostomy Dependance in Head and Neck Cancer

McNamara Kate

Shrewsbury & Telford NHS Trust

Rationale: (Chemo) radiotherapy for head and neck cancer can cause oral mucositis, acute xerostomia

and dysphagia. This can lead reduced oral intake, and as a result, weight loss. The insertion of a

prophylactic percutaneous endoscopic gastrostomy (PEG) tube prior to radiotherapy to prevent weight

loss is widely recognised. Prolonged placement of a PEG tube can be associated with worsening swallow

function as a result of disuse.To assess duration of PEG tube placement and identify factors which

predict prolonged (≥9 months) dependence on PEG tube.

Materials and methods: A retrospective review of patients treated with (chemo) radiotherapy for head

and neck squamous cell cancers between January 2015 and December 2016 was undertaken. Data was

obtained from an online clinical portal and weights taken from dietician’s records. Multinominal analysis

was performed in SPSS (version 22) to ascertain which of the factors (sex, diabetes, site of tumor,

surgery, chemotherapy, alcohol and smoking status) were positive predictors of prolonged PEG tube.

Results: 45 patients were identified. Median age was 61 years. 38 patients (84.4%) were male and 7

(15.6%) female. Concomitant chemotherapy was given in 33 (73.3%) patients. Therapeutic surgery was

performed in 21 patients (46.7%) prior to radiotherapy. 35 patients (77.8%) had a history of smoking

including current smokers and ex- smoking. 4 (8.9%) of the patients were diabetics. 33 patients (73.3%)

underwent PEG tube insertion. Average length of PEG tube stay was 252.2 days and median length of

stay was 172 days.

None of the factors that we assessed were significantly related to prolonged duration of PEG. We did

however find that patients with tumours of the oropharynx were 3 times more likely to have a prolonged

PEG placement (P=0.53). Patients’ who didn’t undergo therapeutic surgery were almost 1.5 times more

likely to have a PEG tube inserted for >9 months (0.69).

Conclusions: Although not statistically significant, oropharyngeal primary cancers and those that didn’t

have surgery had a greater likelihood of prolonged PEG duration. We therefore believe that particularly

in these groups of people we should ensure early and intensive rehabilitation.

77. 3D microvascular anastomosis: preliminary study in head and neck patients

Molteni Gabriele

Department of Otolaryngology, University of Verona, Verona

Procacci Pasquale1, Fior Andrea1, Veneri Antonio2, Nocini Pier Francesco1, Marchioni Daniele2 1Department of Maxillofacial Surgery, University of Verona, Verona 2Department of Otolaryngology, University of Verona, Verona

Rationale: Advanced head and neck cancers and recurrence after radiation therapy are common in

tertiary referral centre. These patients often need wide resection with reconstruction and microvascular

free flap is the gold standard technique in this scenario. Vessels suture in microvascular reconstruction

is usually made with microscope and some surgeons use loupes. 3D technology is increasing day by day.

both in endoscopic and in open surgery with external 3D camera. We present a preliminary study of

microanastomosis and flap raising using 3D external camera (Vitom® 3D) in connection with a 3D HD

monitor, using special 3D glasses.

Materials and methods: 3 patients with head and neck squamous cell carcinoma underwent

microvascular reconstruction with 1 ALT, 1 radial forearm, 1 latissimus dorsi free flap. All flaps and all

microvascular anastomosis (both artery and vein) were raised and done using Vitom® 3D.

Results: No intraoperative or post-operative surgical complications were reported. The technique is easy

to learn in well-trained microvascular surgeons, because position is very similar to that used with

microscope. Position is more confortable and relaxed and at the end of surgery the surgeon felt less

tired. 3D microvascular anastomosis is possible and feasible to date, the vision is really nitid and 3D is

really helpful in microsurgery. Surgeon’s position is really comfortable. Video of the procedure will be

showed during the presentation.

Conclusions: This is a preliminary study and experience with few patients. To the best of our knowledge

this is the first reported experience with 3D microanastomosis in patients.

78. Oncological outcomes of parotid gland malignancies: a retrospective analysis of 74 patients

Molteni Gabriele

AOUI Brogo Trento, Verona

Molinari Giulia1, Ghirelli Michael1, Marchioni Daniele1, Presutti Livio1 1AOU Policlinico di Modena, Modena

Rationale: Salivary gland malignancies are rare neoplasms whose management has been extensively

evolving over the last two decades. Nevertheless, patient outcomes have not improved accordingly,

mainly due to their heterogeneous biological behavior.

Materials and methods: Based on chart data from 74 patients who underwent surgery for a tumor of

the parotid gland, this retrospective study analyzes the involvement of several factors and variables on

Overall, Disease-Specific, and Disease-Free Survival, as well as on Loco-Regional Control.

Results: As expected, advanced stage, high grade, or lymph nodes invasion greatly impaired patient

outcomes. Interestingly, in our cohort, the age at diagnosis ≥55 was a cause of poorer disease survival

likely due to a different distribution in tumor histotypes between older and younger patients. Despite

the two groups were homogeneous for the numerosity of squamous cell carcinomas (the worst

histotype in our analysis), older patients are more rarely affected by mucoepidermoid and acinic cell

carcinomas, which have generally better prognosis. Furthermore, patients aged ≥55 had a more

frequent pathological involvement of the deep lobe of the parotid gland if compared to the younger

counterpart.

Conclusions: Despite the numerosity of patients enrolled in our cohort, the rarity of some salivary gland

tumor histotypes requires high-number series randomized-controlled and prospective trials to be

analyzed. Thus, this paper further emphasizes the need to research in malignant tumors of the parotid

gland to improve the treatment management and survival of patients.

79. Reconstruction of complex oro-mandibular defects in head and neck cancer: the chimeric

subscapular flap

Molteni Gabriele

Università degli studi di Verona

Gazzini Luca1, Fior Andrea1, Procacci Pasquale1, Plotegher Cristina1, Nocini Pier Francesco1, Marchioni

Daniele1 1Università degli Studi di Verona

Rationale: Head and neck advanced cancers require difficult and aggressive surgery that may hesitate

in large composite defects of different soft tissues and bone. This topic is particularly challenging in

salvage surgery after radiation therapy. Reconstructive techniques in these cases are very complex and

sometimes require the use of multiple microvascular flaps. The chimeric free flaps based on the

subscapular system, allow complex reconstructions, providing both, soft tissue and bone on a single

vascular peduncle. The purpose of this study is to present this reconstructive choice and to show the

personal experience of the Authors.

Materials and methods: The regional anatomy of the subscapular system and the possible chimeric flaps

that can be harvest, the reconstructive surgical technique and the positioning of the patient will be

explained. 2 clinical cases of complex head and neck reconstructions after radiotherapy will be

presented. Data about preoperative condition, intraoperative pictures, radiological and clinical

documentation, were collected.

Results: A plenty of different flaps can be harvest based on the subscapular system as a chimeric flap.

These flaps can include different tissues (skin, bone, muscle) on a single vascular pedicle. This

characteristic is particularly useful in complex defects following large en-bloc resection of advanced

head and neck cancers. The only alternative in these cases is usually reconstruction with a double

microvascular flap, which means longer surgical time and higher percentage of flap loss. Another

advantage of this flap is that it is possible a two team approach: resecting and reconstructing teams can

work simultaneously placing the patient in a 30° semi-decubitus position.

Conclusions: Free flaps based on the subscapular system can be an excellent reconstructive choice in

complex head and neck tumour resection.

80. Aurora kinase expression predicts overall survival for oral tongue squamous cell carcinoma

Nenclares Peña Pablo

Hospital Universitario 12 de Octubre, Madrid, Spain

Ruíz Alonso Ana1, Alonso Riaño Marina1, Ballestín Caravilla Claudio1, Pérez-Regadera Gómez José

Fermín1 1Hospital Universitario 12 de Octubre, Madrid, Spain

Rationale: Identifying prognostic biomarkers for oral tongue squamous cell carcinoma (OTSCC) is

important for the prediction of tumour behaviour and for guiding treatment. Aurora kinases play a role

in human carcinogenesis and their overexpression is associated with poor histologic differentiation and

poor prognosis. The aim of this study was to determine whether expression of Aurora-A and Aurora-B

correlates with the OTSCC patient prognosis, measured as disease-free survival (DFS) and overall survival

(OS) following treatment (surgery or concurrent chemoradiation).

Materials and methods: Pretreatment tumour biopsies from 100 OTSCC patients were immunostained

for Aurora-A and Aurora-B. Survival was analysed by the Log rank test and the Kaplan Meier estimator.

A backward Cox regression strategy was used to include Aurora kinase expression and additional clinical

and pathological variables in the multivariate analysis (MVA).

Results: Of 89 patients who initially underwent surgery, 57 were diagnosed with Stage I OTSCC, 15 with

Stage II, 4 with Stage III, and 13 with StageIV. Eleven patients with clinical stage IV OTSCC initially

received chemoradiation. Over a median 75-month follow-up, the 5-year OS and DFS for all patients

were 57% and 50%, respectively. Of the 100 patients, 26 had Aurora-A-positive tumours, whereas 47

tumours expressed Aurora-B. Compared with patients with no Aurora expression, the median OS was

significantly shorter in patients with Aurora-A-positive tumours (105 months vs 27 months, p=0.019)

and Aurora-B-positive tumours (not reached vs 32 months, p=0.0037). No differences were detected in

DFS. The MVA identified Aurora-A expression, Aurora-B expression, age, and clinical stage as significant

predictors of OS. The magnitudes of the hazard ratios for OS associated with Aurora-A and Aurora-B

were 2.7 (95%CI 1.17-6.27, p=0.02) and 2.43 (95%CI 1.13-5.26, p=0.02), respectively.

Conclusions: Pretreatment Aurora-A and Aurora-B expression identifies a subset of OTSCC patients with

increased risk of death. These findings could help in patient selection and represent an encouraging step

toward the development of personalized therapeutic approaches.

81. Neuroendocrine Carcinoma of the Oropharynx: A report of 2 cases and review of the

literature

Omakobia Eugene

Bradford Royal Infirmary, Bradford, United Kingdom

Sood Salil1, Sood Sanjai1, Gouldesbrough David1, Cardale Kate2, Dyker Karen2, Sutton David1, Glore Raad

John1 1Bradford Royal Infirmary, Bradford, United Kingdom 2St James's University Hospital, Leeds, United Kingdom

Rationale: Neuroendocrine carcinoma (NEC) of the oropharynx is extremely rare. Only 42 cases have

been reported since it was first identified in 1972. Here we report 2 further cases occurring in a 62 year

old man and in a 53 year old man with an emphasis on diagnosis and management.

Materials and methods: Two cases of oropharyngeal NEC were identified at our institution affecting two

distinct subsites of the oropharynx; the left palatine tonsil in 62 year old man and the left soft palate in

a 53 year old man. For both cases, we reviewed the presenting features, radiological findings,

histological appearances, immunohistochemistry and management. We also reviewed the literature to

evaluate treatment and survival of patients with NEC of the oropharynx.

Results: The final diagnoses were confirmed to be T2 N1 M0 poorly differentiated NEC of the left palatine

tonsil and T2 N2c M0 large cell NEC of the left soft palate. Following discussion in our multidisciplinary

meeting, chemotherapy combined with radiotherapy was deemed the most appropriate treatment.

Conclusions: NEC of the oropharynx is a rare and aggressive condition with a poor prognosis. Due to its

rarity, standardised treatment guidelines have not yet been established. From review of the current

literature, the overriding opinion favours chemotherapy combined with radiotherapy as the

recommended treatment modality. For patients with locally advanced disease, surgery appears to have

little impact on overall survival.

82. The Role of Fine Needle Aspiration Cytology and Frozen Section Histopathology in the

Management of Parotid Gland Tumours: a 5 year experience in a UK teaching hospital

Omakobia Eugene

Bradford Royal Infirmary, Bradford, UK

Sood Salil1, Glore Raad John1, Gouldesbrough David1, Sood Sanjai1 1Bradford Royal Infirmary, Bradford, UK

Rationale: There are multiple studies outside the United Kingdom evaluating the utility of both fine

needle aspiration cytology (FNAC) and frozen section histopathology (FS) in the management of parotid

gland tumours. The overwhelming consensus from most studies is that FS may be slightly more accurate

than FNAC but the two investigations play a complementary role in operative decision-making. There is

some contention regarding the use of FS to base treatment decisions but it is generally agreed that the

expertise of the reporting histopathologist is a vital factor. We sought to clarify whether the findings

from our UK study are in agreement with the world literature.

Materials and methods: We conducted a retrospective review of all patients undergoing parotid surgery

by the same consultant ENT surgeon at our institution over a 5 year period from September 2012 to

September 2017. We collected data on age, gender, initial radiological imaging, FNAC, FS if performed

and final histological diagnosis. Both FNAC and FS findings were compared with final histology to

determine accuracy.

Results: 75 patients were identified over the 5 year period. The age range was 12 to 82 with a mean age

of 55. 34 patients were male and 41 patients were female. 75% of patients underwent ultrasound

imaging as part of their initial assessment. 55 patients had pre-operative FNAC and 17 patients had intra-

operative FS. The accuracy of pre-operative FNAC was 81% and concordance with final histology was

82% for benign lesions and 71% for malignant lesions. 21% of FNAC tests performed were non-

diagnostic. The accuracy of intra-operative FS was 88% and concordance with final histology was 92%

for benign lesions and 80% for malignant lesions.

Conclusions: Both FNAC and FS play a complementary role in the operative management of parotid

gland tumours. In our study, FS was more accurate than FNAC; particularly in detecting malignant

lesions. This is in agreement with the findings from other studies. Our findings tend to agree with UK

National Multidisciplinary Guidelines which suggest ultrasound guided FNAC for all salivary tumours.

However, in cases where pre-operative FNAC remains non-diagnostic, FS may help to detect the

presence of malignancy and guide decision-making with regard to the extent of surgery i.e. superficial

parotidectomy for benign lesions and total conservative parotidectomy +/- neck dissection for malignant

lesions.

83. The Existence and Level Investigation of Endocannabinoids and Canna-binoid Receptors in

Human Laryngeal Squamous Cell Carcinoma Cell Line

Önay Övsen

Hacettepe University Faculty of Medicine Department of ENT

Süslü Nilda1, Korkusuz Petek2, Köse Sevil2, Hoşal Şefik3 1Hacettepe University Faculty of Medicine Department of ENT 2Hacettepe University Faculty of Medicine Department of Histology and Embryology 3Liv Hospital, ENT Department, Ankara

Rationale: In cancer biology endocannabinoids have been shown to be antiproliferative, apoptotic and

inhibitor of migration. The major endocannabinoids being investigated are, Anandamide (AEA) and 2-

Arachidonoylglycerol (2-AG). Their receptors CB1 and CB2 are basically studied, as well. In vitro and in

vivo experiments on breast, colon and pancretic cancer cells showed that the level of AEA, 2-AG and CB

receptors were elevated. Additionally, agonists of CB receptors were shown to inhibit cancer

proliferation. According to these, we aimed to study the existence of endocannabinoids and their

receptors in human laryngeal squamous cell carcinoma. We also intended to invastigate the possible

antiproliferative effects of endocannabinoids in human laryngeal squamous cell carcinoma.

Materials and methods: We designed an in vitro observational cell line experiment. In methods, we

proliferated cells from a human laryngeal squamous cell carcinoma cell line: HEp-2. We quantified

endocannabinoids (AEA and 2-AG) by flow-cytometric methods, and investigated the existence of

cannabinoid receptors (CB1 and CB2) and measured their level by flow-cytometric methods and by using

PCR (Polimerase Chain Reaction). For the purpose of investigating if an antiproliferative effect of

endocannabinoids existed, we evaluated the cell viability after administiration of CB1-2 agonists and

antagonists to cell line.

Results: Our results showed the existence of AEA and 2-AG at increased levels in human laryngeal

squamous cell carcinoma cell line by using flow-cytometric methods, but failed to show the CB1-CB2

existence by flow-cytometric methods and by using PCR. Additionally, AEA and 2-AG showed an

antiproliferative effect on HEp-2 cell line, by a possible receptor independent pathway.

Conclusions: In the light of these data, the existence of endocannabinoids in human laryngeal squamous

cell carcinoma cell line was showed, and additionally at an increased level in comparison with the control

cell line. The major endo-cannabinoid in the human laryngeal squamous cell carcinoma was AEA.

Externally inserted 2-AG was a more potent antiproliferative agent than AEA and this effect could not

be blocked by selective receptor antagonism, suggesting us that it was a possible receptor independent

pathway.

84. Head and neck cancer in elder neglect

Pagliari Angelo Virgilio

U.O. ORL - Ospedale Maggiore di Crema - ASST Crema

Blotta Pasquale

U.O. ORL - Ospedale Maggiore di Crema - ASST Crema

Rationale: Elder neglect refers to elders who are unable to independently cope with the basic needs of

their life. The recent increasingly aging population and head and neck malignancies in aged patients

place new oncologic issue and question. Extended use of tobacco, comorbidity, cognitive function

impairment, low function of immunologic system, malnutrition, trasportaion problems, poor oral

hygiene and periodontal disease have a high incidence in elder neglect with head and neck cancer.

Materials and methods: We investigated retrospectively in our series of patients with head and neck

carcinoma the impact of limited social support on duration of symptoms, early diagnosis, therapy

discontinuation, survival and quality of life in elderly patients.

Results: The majority of elderly neglect presented with a period greater than six months of the

symptoms versus three months in elderly patients, advanced stage disease (T3-T4 versus T1-T2) was

significantly greater in elder neglect versus elderly and associated with worse survival. In elder neglect

significantly major was the need of plastic recontructive technique.

Conclusions: Screening program dedicated in elder neglect could be useful for early diagnosis and to

improve prognosis and quality of life. An adequate caregiver support in elder neglect could improve a

therapy continuation and increase survival.

85. Lipofilling in head and neck reconstruction

Pagliari Angelo Virgilio

U.O. ORL - Ospedale Maggiore di Crema - ASST di Crema

Rationale: In 1910 Eugene Hollander publishes the first report of fat injection into the areas of the face

requiring improvement in attempt to propose a new reconstructive procedure. Its use spread rapidly.

Equally soon appears the evidence of lose in weight and volume of large adipose graft estimate in about

45%. So fat grafting began to lose favour. In 1997 Sidney Coleman proposed the atraumatic techniques

for fat harvesting, purification and microinjections placement to improve fat survival. In 2001 Zuk

demonstrate that fat contain stem cells and in 2007 Rigotti reports regenerative effect of damage tissue

switch on again the interest on fat graft as a recontructive procedure.

Materials and methods: We review the medical literature regarding the use of fat grafting in

recontruction in head and neck cancer and present our experience relative to surgical technique. After

skin incision using No 11 blade a cannula with rounded-off tip is inserted in chosen area and infiltrate

100 ml of cold physiologic solution with 0,5 ml epinephrine 1:1000, 10 ml ropivacaine 10mg/ml and 10

ml lidocaine 20 mg/ml. Through the same incision fat is harvested using 2 to 3 mm cannulas of various

lenght 15 to 23 cm. Than the syringe is positioned in a centrifugal unit and spun at 3000 rpm for 3

minutes. The fraction of purified fat is than placed in receiving area.

Results: A lot of reports in literature are relative to volume restoration, reshaping contour, regeneration

of irradiated tissue and scar remodelling. In particular vocal fold augmentation, velopharyngeal

imcompetence and fistulas treatments are area of fat graft application in cervico-facial reconstruction.

Non significant complications are described. Our results are in according those of literature.

Conclusions: Lipofilling in head and neck reconstruction is a efficent and easy therapy, minimally

invasive, well tolerated with good and stable functional outcome.

86. Preoperative embolization of thyroid arteries in large cervico-mediastinal goiter and papillary

carcinoma

Pagliari Angelo Virgilio

U.O. ORL - Ospedale Maggiore - ASST Crema

Blotta Pasquale1, Spinazzola Angelo2, Benelli GianPaolo2 1U.O. ORL - Ospedale Maggiore di Crema - ASST Crema 2U.O. Radiologia - Ospedale Maggiore - ASST Crema

Rationale: Thyroid gland diseases remain one of the most widespread problems considering that almost

9% of women and 2% of men are affected by thyroid disorder. Embolization of vascular tumours of head

and neck become an important adjunct to treatment of these pathologies. Endovascular embolization

of thyroid arteries was first described by Gunther in 1984.

Materials and methods: We reviwed the literature on applications of selective embolization of thyroid

arteries and present our experience in preoperative embolization in large cervico-mediastinal

multinodular goiter and papillary carcinoma.

Results: The number of publications are rather limited and relative of thyrotoxicosis, thyroid cancer,

vascular lesions of thyroid arteries and metastases from thyroid carcinoma. In only four reports was

proposed embolization as preoperative treatment (Ramos 2004, Dedecjous 2007, Tarteaglia 2007, Rohr

2016). A women with a multinodular intrathoracic goiter reaching both spine and aortic arch displacing

the trachea and the esophagus was reffered to us for dyspnea and dysphagia. After thyroid ultrasound

and CT scanners patient was submitted to embolization using femoral approach and then a cervical

thyroidectomy avoiding difficult and hazardous manoveur with limited intraoperative bleeding. The only

side effect was a ligh transient hyperthyroidism attributed to cell necrosis.

Conclusions: Preoperative embolization of thyroid arteries in patients with voluminous goiter and

papilary carcinoma with extension to mediastinum permits to reduce intraoperative bleeding, to avoid

median sternotomy and to remove thyroid through a safe cervical approach alone. So embolization

technique, in selected cases, is useful and precious procedure that should join in options therapies in

thyroid gland pathologies treatment.

87. Assessment of incidence of hypothyroidism as a sequelae following therapeutic external

beam radiation therapy in Head and Neck malignancies with Dose- volume predictors

Pareek Vibhay

Jupiter Hospital Thane

Rationale: The objective of this study was to understand better the associated risk factors for

development of hypothyroidism, the onset period, association of patient and treatment related

parameters and also the dosimetric parameters leading to hypothyroidism in initial euthyroid head and

neck malignancies receiving radiation therapy.

Materials and methods: In our prospective study, during the period September 2015 to April 2017, a

total of 150 patients with histopathologically proven head and neck squamous cell cancer. The cohort

included 113 males and 37 females with a median age of 51.5 years (Range 22 – 68 years). The patients

received radiation therapy with a median dose of 60Gy (Range 60 - 66Gy) with either IMRT or 3DCRT

techniques. Thyroid function was assessed at baseline and thereafter at 6 and 12 months following the

completion of radiotherapy.

Results: After a median follow up of 12 months, the incidence of subclinical hypothyroidism at 6 months

of completion of treatment was 3.3% and incidence of clinical hypothyroidism was 1.3%. Subsequently,

the incidence at 12 months was 16.7% and 5.3% respectively. The disease was higher in hypopharyngeal

and oropharyngeal lesions. Among general parameters, nodal burden (p = 0.003), chemotherapy (p <

0.001) and tobacco addiction (p = 0.013) were found to be significant risk factors in subsequent

development of hypothyroidism. On multivariate analysis, V30 (p = 0.002), V40 (p = 0.0004) and V50 (p

= 0.0002) were the most statistically significant. IMRT was found to have much lower incidence of

development of hypothyroidism compared to 3DCRT (p = 0.0489). The dose parameters found in this

study were V30<68Gy, V40<52.5Gy and V50<28.3Gy for prevention of development of hypothyroidism.

Conclusions: In head and neck squamous cell carcinoma patients treated with radiation therapy, thyroid

minimum dose, V30, V40 and V50 and use of chemotherapy and initial nodal burden and tobacco

addiction are risk factors for development of subclinical or clinical hypothyroidism and can be used as

predictors for such outcomes.

88. V level dissection in oral SCC N+: is it really necessary?

Pierotello Luca

ENT department University Hospital of Verona

Molteni Gabriele1, Giampaoli Giorgio2, Procacci Pasquale2, Fior Andrea2, Nocini Pier Francesco2,

Marchioni Daniele1 1ENT department University Hospital of Verona 2Maxillofacial Surgery Department University Hospital of Verona

Rationale: To analyze the prevalence of nodal metastasis at level V in previously untreated oral cavity

squamous cell carcinoma who underwent neck dissection, in order to discuss the evidence for routine

level V dissection.

Materials and methods: We retrospectively analyze patients affected by oral cavity squamous cell

carcinoma, who underwent neck dissection at the ENT and Maxillofacial Surgery Department of the

University Hospital of Verona from 1997 to October 2017. All patients were affected by previously

untreated mucosal SCC of the oral cavity presenting with clinical nodal metastasis but level V was

clinically uninvolved. All neck levels were separated intraoperatively for histological examination.

Results: We describe the prevalence of nodal occult metastasis at level V in 172 neck dissection, focusing

on the correlation with clinical staging, presence of nodal metastasis in other levels and primitive tumor

subside. This work can be useful in the management of oral cavity SCCc to reduce the morbidity related

to the Spinal Accessory nerve.

Conclusions: The low prevalence of level V involvement in SCC of oral cavity do not support routine

dissection of level V even in cN+ patients. According to the literature more perspective studies are

needed to assess long term oncological outcome in order to suggest safer indications about neck

dissection.

89. Management of pharyngocutaneous fistulae after salvage total laryngectomy

Pop Sever

"Iuliu Hatieganu" University of Medicine and Pharmacy, ENT Department, Cluj-Napoca, Romania

Bucin Rareș1, Vereș Ștefana1, Tomuș Mihai1, Bud Diana1, Fodor Lucian2, Fodor Marius3

1"Iuliu Hatieganu" University of Medicine and Pharmacy, ENT Department, Cluj-Napoca, Romania 2Plastic and Reconstructive Surgery Department, Emergency Clinical County Hospital Cluj-Napoca 3 Vascular Surgery Department, Emergency Clinical County Hospital Cluj-Napoca

Rationale: The increased use of radiation and chemoradiation in the primary treatment of laryngeal

carcinoma has resulted in higher rates of pharyngocutaneous fistula (PCF) after salvage laryngectomy.

Management of these fistulae is a real challenge for the head and neck surgeon.

Materials and methods: We conducted a retrospective study of 28 patients who underwent a salvage

total laryngectomy in our department between 2010 - 2016. We reviewed the fistula rates and the

management strategies. Preoperative chemoradiotherapy and radiotherapy were analyzed as potential

risk factors. Fistulae were divided in minor and major, major fistulae requiring surgical repair.

Results: Of the 28 patients, fistulae occured in 13 (46,4%) patients. No significant differences have been

noted between the subgroup that received chemoradiotherapy, compared to radiotherapy alone. 6

patients (46 %) with minor fistulae were treated conservatively. Major fistulae required surgical repair.

Pectoralis major flap have been used in 3 patients (23%). Free flaps have been used in 4 patients (31%).

To reconstruct the pharynx in the free flap group we used a free jejunal flap, and for skin resurfacing we

used the lateral arm and the lateral thigh flap. All flaps survived. No major complications occured. The

mean hospitalization after PMF reconstruction was 26,6 (±3,2) days and after free flap reconstruction

was 10 (±1,9) days (p<0.05). All patients achieved 100% oral intake after surgery.

Conclusions: Pharyngocutaneous fistula remains a significant problem following salvage laryngectomy.

Major fistulae require surgical repair. The use of loco-regional or free flaps is a reliable method of

reconstruction in these cases.

90. Recurrent and Persistent Differentiated Thyroid Cancer: Ultrasound Dye-Assisted Surgery

(USDAS) for lymphadenectomy in the neck

Proh Michele

European Institute of Oncology - Head & Neck Program - Division of Otolaryngology Head & Neck

Surgery, Milan, Italy

Giugliano Gioacchino, Ciccone Daniele, Scelsi Daniele, Grosso Enrica, De Fiori Elvio, Ansarin Mohssen

Rationale: The treatment of recurrent Differentiated Thyroid Cancer (DTC) is challenging. The aim of this

study was to evaluate the disease free survival (DFS) in patients with DTC treated with Ultrasound Dye-

Assisted Surgery (USDAS).

Materials and methods: Data of 60 patients previously treated with surgery and radioiodine therapy

(RAI), who underwent USDAS for recurrent DTC, with a follow-up of 12 to 106 months were

retrospectively reviewed.

Results: Histology reports were positive for disease in all cases but one (previously treated with

alcoholization) 50 patients remained without evidence of disease during the follow-up, 2 patients

received RAI again for positive thyreoglobuline, 2 patients had distant recurrence 40 months after

USDAS, 6 patients underwent another surgical treatment. The technique showed only few

complications.

Conclusions: The USDAS is a simple, low morbidity, not-expensive and radiation-free localizing

technique that seems to improve DFS with promising results in lymphadenectomy of DTC local

recurrence.

91. Mixed medullary and papillary carcinoma of thyroid: A rare case report and review of

literature

Punamiya Aditya

P.D. Hinduja Hospital and Medical Research Centre, Mumbai

Nandu Bharat1, Lala Murad1 1P.D. Hinduja Hospital and Medical Research Centre, Mumbai

Rationale: Papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) are two distinct

types of thyroid carcinoma. The histogenetic origin and possible molecular mechanisms responsible for

the development of mixed medullary-papillary carcinoma of the thyroid are still unclear

Materials and methods: 59 year old male presented with insidious onset anterior neck swelling for 4

months. Examination showed it a multinodular goitre with right level 3 neck node. Ultrasonography and

CTScan neck confirmed these findings. FNAC of neck node was suggestive of metastatic

carcinoma.Serum calcitonin levels were 1277 pg/ml..Total thyroidectomy with central compartment

lymph node clearance and bilateral modified radical neck dissection was performed. Frozen section

showed medullary thyroid carcinoma.Postoperative course was uneventful. Final histopathology report

showed combined MTC and PTC in right lobe of thyroid with metastatic MTC in the neck nodes. Post

operative iodine scan showed residual functioning thyroid tissue in the thyroid bed.No adjuvant RAI

therapy was given. Postoperative calcitonin levels were 10.36pg/ml.Patient is on a regular follow up on

opd basis.

Results: The simultaneous, discrete, existence of PTC and MTC, separated by normal tissue, is

increasingly being identified. One of the explanation is the ‘common stem cell theory’ postulating a

common progenitor cell, possibly in the ultimobranchial body,with divergent differentiation giving rise

to both parafollicular and follicular cell lines. Another potential theory is a common tumorigenic stimulus

such as radiation exposure that promotes the malignant transformation of both endodermal and neural

crest-derived cell lines. The more appealing hypothesis, reported in most studies, refers to a potential

role of RET germline mutations in the development of both histological types.

Conclusions: Despite the limited number of patients, we may conclude that the majority of concurrent

MTC and PTC, might simply be coincidental, and related to a careful pathological examination. For the

clarification of the exact pathogenesis of this rare form of the tumor, more detailed and comprehensive

investigations based on a larger number of cases are needed.

92. Selecting the right patients for future trials - multiple endpoints model in 1244 patients with

OSCC and known HPV and p16 status

Rasmussen Jacob H.

Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of

Copenhagen, Denmark

Larsen Christian G.1, Håkansson Katrin E.2, Friborg Jeppe2, Vogelius Ivan R.2, Buchwald Christian von1 1Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University

of Copenhagen, Denmark 2Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen,

Denmark

Rationale: In the era of precision medicine and HPV related HNSCC it is relevant to assess the risk of not

only survival, but also the risk of loco-regional failure (LRF) and distant metastasis (DM). The UICC

classification is developed with overall survival as sole endpoint, but the risk of LRF and DM is important

to guide who might benefit from local or systemic treatment intensification or de-intensification. The

purpose of this study is to develop a multi endpoint model in a large population based patient cohort

with oropharyngeal squamous cell carcinoma (OSCC) and known p16 status.

Materials and methods: Patients diagnosed with OSCC and treated with curative radiotherapy with or

without platin based chemotherapy in eastern Denmark from 2000–2014 were included. Patient

characteristics including age, gender, UICC-, T-, N-stage, smoking habits and performance status (PS)

were retrieved and both p16 staining and HPV DNA-PCR were performed. The information was used to

develop a competing risk model, combining three cause specific Cox models with LRF, DM and death

with no evidence of disease (NED) as endpoints.

UICC 8th edition was used and in p16 negative patients N2a and N2b were merged to N2, and N2c and

N3 was merged to N3. The model is presented as an interactive online tool

https://rasmussen.shinyapps.io/Oropharynxmodel/)

Absolute risk of LRF, DM and death of NED after five years were estimated and the performance of the

model was compared to UICC classification with cross validation to test the performance in random

subsets of data.

Results: 1244 patients with OSCC were included. The median time to last follow up was 5.8 years.

In LRF Gender, Smoking, T-stage, N-stage and p16/HPV status were all significant predictors. For DM

smoking, T4-stage and N-stage were significant predictors. For death NED age, gender, PS, smoking,

p16/HPV status, and UICC stage were significant predictors.

The multi endpoint model performed better than UICC classification with a clinically relevant higher AUC

for all endpoints (AUCLRF =65.8% vs. 60.8%, p=0.08;AUCDM = 65.8% vs. 58.4%,p=0.20, and

AUCdeathNED=73.3% vs. 68.3%,p=0.08), but unfortunately only borderline significant in cross

validation.

Conclusions: The multi endpoint model performed better than staging with UICC 8th edition and can

used to guide the design of future trials. The model is presented as an online tool, but needs external

validation.

93. Cytological Presentation of Thyroid Carcinoma – The impact of MDT

Rovira Aleix

Guy's and St Thomas Fundation Trust

Volpini Luigi1, Nixon Iain1, Jeannon JP1, Karan Kapoor1, Ash Chandra1, Muffadal Moonin1, Edward Odell1,

Rose Ngu1, Ricard Simo1 1Guy's and St Thomas Fundation Trust

Rationale: For many years, a significant number of thyroid carcinomas were diagnosed retrospectively

on histopathology specimens or required staged procedures due to unsatisfactory cytological diagnosis.

The introduction of ultrasound guided FNAC has reduced the number of staged procedures but numbers

remain high. The aim of this study is to compare two retrospective cohorts of patients diagnosed of

thyroid cancer before and after the centralization of the thyroid multidisciplinary team (MDT) and assess

its impact.

Materials and methods: A retrospective review of 187 consecutive patients with the primary diagnosis

of thyroid cancer were collected and analyzed. The first cohort of 83 patients were diagnosed from 2001

to 2007 and the second with 104 patients from 2008 to 2014.

The cytological classification from the BTA was used. Patients referred from other units with the

established diagnosis of thyroid cancer and patients with recurrent disease were excluded.

Results: In the first cohort the number of Thy 1 was 11 (13%) and in the second 1 (1%) and this difference

is significant (p=0.001). The overall distribution of THY categories was significantly different between the

first and second cohort, (THY 2, 1% versus 5%, THY3 31% versus 26%, THY4 13% versus 12%, THY5 41%

versus 57%, p=0.004).

Conclusions: With the establishment of a central Thyroid MDT and a single dedicated team performing

and reviewing USS guided FNACs, the number of thyroid cancer primary up front diagnoses has

significantly increased and the number of nondiagnostic samples has significantly decreased.

94. Outcomes following initial presentation and diagnosis of head and neck cancer

Rovira Aleix

Guy's and St Thomas NHS Fundation trust

Volpini Luigi1, Tornari Christotomos1, Oakley Richard1, Arora Asit1, Jeannon JP1, Simo Ricard1 1Guy's and St Thomas NHS Fundation trust

Rationale: Cancer survival in England is lower than the European average. A National Cancer Intelligence

Network (NCIN) publication identified 24% of all cancers in England presenting via emergency services,

with advanced stage of diagnosis and poorer prognosis.

The study’s aim was to identify patients presenting to Guy’s and St Thomas’ Hospital with a new

diagnosis of head and neck squamous cell carcinoma (HNSCC), following initial assessment via the

emergency department, and determine disease status and survival outcome two years post diagnosis.

Materials and methods:

• Setting: academic, tertiary referral centre.

• Retrospective study.

• Inclusion criteria: all new HNSCC patients presenting via the emergency route over a 2 year period

(01/10/2008 to 01/10/2010)

• Data analysis performed using PASW Statistics 18.0

Results: Twenty-one patients meet the inclusion criteria, with 85% male, and average age of 64 years

(range: 36-79 years). ECOG performance status was 0 for 81% and 1 for 19% of patients. Patients

presented with AJCC stage III or IV disease, and the 2 year overall survival rate of 38% was significantly

lower compared to survival of HNSCC patients presenting via other routes, with 85% of deaths occurring

within one year of presentation and diagnosis.

Conclusions: Although there are multiple routes to diagnosis, no previous studies have compared the

differences in outcomes and survival rates between routes for HNSCC, for which delayed presentation

via the emergency route appears to confer a significantly worse prognosis.

95. Patient and tumor characteristics in relation to vital state in laryngeal cancer patients

Ruiter Lilian

UMC Utrecht

van Gils C., Bruggink A., Terhaard C.H.J., de Bree R., Willems S., van Dijk B.A.C.

Rationale: Studies on recurrence and survival of laryngeal carcinoma have been performed, but there is

a need for better prediction of those at risk for adverse outcome. Our goal is to explore which patient

and tumor characteristics are related to vital state.

Materials and methods: From the Netherlands Cancer Registry, patients with laryngeal carcinoma

between 2010 and 2014 in the Netherlands will be extracted. The patient and tumor characteristics of

these patients will be investigated in relation to survival. Linkage with PALGA (nationwide network and

registry of histopathology and cytopathology in the Netherlands) will additionally provide information

on pathologically confirmed recurrences.

Results: In total, 3705 laryngeal tumors in 3683 patients were included of which 39% had a stage I

disease, 22% stage II, 19% stage III, 19% stage IVA and 1% stage IVB disease. Overall survival decreased

by ascending stage. For stage I disease 2-years overall survival was 94% (CI: 93%-96%), stage II 85%(CI:

82%-89%), stage III 76% (CI: 72%- 80%), stage IVA 62% (CI: 58%-67%) stage IVB 33% (CI: 13%-54%). The

most common treatment regimes in stage I disease were surgery (57%) and radiotherapy (41%). For

stage II disease 86% and 12% of the patients were treated with radiotherapy and surgery respectively.

The majority of the patients in stage III received radiotherapy (75%) and 25% received other therapies.

The most common treatment regimes in stage IVA were surgery (32%), radiotherapy (37%) and chemo

radiation (12%).

Conclusions: Diagnosis of patients in advanced stage (III or IV) disease occurred in 40% of the cases.

Survival in patients with laryngeal carcinoma decreased by ascending stage. Most common treatment

regimes were surgery and radiotherapy and heavily dependent on stage. Overall survival was higher

compared to other Western countries.

96. Incidence and survival of oropharyngeal cancer in Denmark: A nation-wide, population-based

study from 1980-2014

Schmidt Jensen Jakob

Rigshospitalet, University of Copenhagen

Hebbelstrup Jensen David, Grønhøj Christian, Kim Schmidt Karnov Kirstine, Nørregaard Cecilie, Klitmøller

Agander Tina, Specht Lena, von Buchwald Christian

Rationale: Oropharyngeal carcinomas (OPCs) constitute a significant and increasing proportion of head

and neck carcinomas (HNCs) and are an important global cause of morbidity and mortality. The purpose

of this study was to determine trends in incidence and survival in OPC in the Danish population from

1980 to 2014

Materials and methods: This study included all patients registered in the nationwide Danish Cancer

Registry (DCR) over the period 1980–2014. The age-adjusted incidence rates (AAIR) per 100,000, annual

percentage change (APC) and average annual percent change (AAPC) were evaluated. Five-year relative

survival (RS) was calculated with Cox regression analyses in relation to gender, anatomical location, and

histology.

Results: A total of 6841 patients (71 % male) were included, with a median age at diagnosis of 61 years.

The AAIR of patients with OPC increased from 0.96 per 100,000 in 1980 to 4.49 per 100,000 in 2014 with

an AAPC of 4.90. The 5-year relative survival increased significantly from 37.5 % over the period 1980-

1984 to 58.8 % (21.3 percentage points) over the period 2010-2014. With no significant difference

stratified for gender. Tumours located at the palatine tonsils (n=3333) and salivary gland OPC (n=90) had

significantly better survival compared with other sub-locations and histology subtypes. In the APC model

the birth cohort effect rate ratio increased until 1925 and then decreased until 1935 from which point

it increased in the last cohorts.

Conclusions: In this population-based study, we observed a significant increase in the incidence of OPCs

and in the relative survival for OPC. We also identified a profound birth cohort effect on the incidence.

97. hTERT promoter methylation pattern is altered in blood leukocytes of head and neck cancer

patients

Sobecka Agnieszka

Department of Head and Neck Surgery, Poznan University of Medical Sciences, The Greater Poland

Cancer Centre, Poznan, Poland

Radiobiology Lab, The Greater Poland Cancer Centre, Poznan, Poland

Barczak Wojciech1,2, Blaszczak Wiktoria2, Golusinski Pawel1, Rubis Blazej3, Masternak Michal M.1,4,

Suchorska Wiktoria M.2,5, Golusinski Wojciech1 1Department of Head and Neck Surgery, Poznan University of Medical Sciences, The Greater Poland

Cancer Centre, Poznan, Poland 2Radiobiology Lab, The Greater Poland Cancer Centre, Poznan, Poland 3Department of Clinical Chemistry and Molecular Diagnostics, Poznan University of Medical Sciences,

Poznan, Poland 4University of Central Florida, Burnett School of Biomedical Sciences 5Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland

Rationale: The head and neck squamous cell carcinoma (HNSCC) is the sixth leading cause of cancer

worldwide, representing over half a million incidents every year. Cancer cells, including HNSCC, are

characterized by an increased telomerase activity. This enzymatic complex is active in approximately 80-

90% of all malignancies, and is regulated by many factors, i.e. methylation of hTERT gene promoter.

hTERT gene is also surmised to be differentially methylated in cancer patients than in controls. The aim

of this study was to analyze the hTERT gene promoter methylation status in blood leukocytes of HNSCC

patients.

Materials and methods: DNA was extracted from PBMC (Peripheral Blood Mononuclear Cells) of 92

patients with histologically diagnosed HNSCC and 53 healthy volunteers. Methylation status of 19 CpG

islands was estimated using bisulfide conversion technique followed by sequencing of PCR products.

Results: Close-to-significant (p=0,0532) differences in the general frequency of hTERT CpG sites

methylation was detected between patients and healthy controls. However, it was discovered that some

of analyzed positions (CpG islands: 1 [p=0,0235], 5 [p=0,0462], 8 [p=0,0343]) are significantly more often

methylated in HNSCC patients than in controls. The opposite finding was observed in case of CpG

position 2 (p=0,0210). Furthermore, closer analysis of single CpG positions revealed differences in

methylation status dependent on anatomical site and TNM classification.

Conclusions: Alterations in methylation profile of hTERT gene promoter represent common event during

cancerogenesis in HNSCC patients. Nevertheless, level of hTERT promoter methylation in PBMC depends

on invasion status and anatomical localization of the tumor. hTERT promoter methylation profile

(general or in single CpG positions) can be a potential molecular marker of head and neck cancer

progression, however future studies with long-term follow-up and extended study group are needed to

determine the clinical relevance of this parameter in HNSCC diagnostics.

98. Three-Dimensional Printing of Patient-Specific Surgical Plates in Head and Neck

Reconstruction: A Prospective Study

Su Richard Yuxiong

The University of Hong Kong, Hong Kong

Yang Weifa1, Choi Wing Shan1, Leung Yiu Yan1, Du Ruxu1, Curtin Justin Paul1 1The University of Hong Kong, Hong Kong

Rationale: Surgical plates have been extensively used in head and neck reconstruction and conventional

plates are mass-produced with universal configurations. To overcome disadvantages of conventional

surgical plates, we have been exploring patient-specific surgical plates using the three-dimensional (3D)

printing technology. We hypothesized that the application of 3D-printed patient-specific surgical plates

in head and neck reconstruction is feasible, safe and precise.

Materials and methods: We are conducting a prospective clinical trial to assess the feasibility, safety

and accuracy of applying 3D-printed patient-specific surgical plates in head and neck reconstruction. The

primary endpoint was the intraoperative success rate. Secondary endpoints included the incidence and

severity of postoperative adverse events within six months after surgery. The accuracy of surgical

outcomes was also explored by comparing the planned and final positions of the maxilla, mandible and

grafted bone segments.

Results: From December 2016 to October 2017, ten patients were enrolled and underwent head and

neck reconstruction using 3D-printed patient-specific surgical plates. The patient-specific surgical plates

adapted to bone surface precisely and no plate-bending was performed. The intraoperative success rate

was 100%. The average follow-up period was 5.2 months. No major adverse events were observed. The

absolute distance deviation of integral mandible or maxilla was 1.40±0.63 mm, which showed a high

accuracy of reconstruction.

Conclusions: The 3D printing of patient-specific surgical plates could be effective in head and neck

reconstruction. Surgical procedures were simplified. The precise jaw reconstruction was achieved with

high accuracy. Long-term results with a larger sample size are warranted to support a final conclusion.

99. Open partial horizontal laryngectomy by CO2 fiber laser resection: preliminary results

Succo Giovanni

Head and Neck Oncology Service, Oncology Dept., University of Turin, Candiolo Cancer Institute - FPO,

IRCCS, Turin, Italy

Crosetti Erika1, Caracciolo Alessandra1, Maldi Elena2 1Head and Neck Oncology Service, Oncology Dept., University of Turin, Candiolo Cancer Institute - FPO,

IRCCS, Turin, Italy 2Pathology Unit, Candiolo Cancer Institute - FPO, IRCCS, Turin, Italy

Rationale: In recent decades, the traditional CO2 laser has emerged as a surgical instrument with great

potential thanks to its fine cutting precision with low thermal damage, resulting in better surgical

precision and faster wound healing. Recently, the application of CO2 fiber laser technology to ENT

surgery has led to new interesting scenarios. The CO2 fiber laser has already shown great potential in

endoscopic surgery, but could also be successfully employed in open surgery.

Materials and methods: From February 2017 to November 2017, CO2 fiber laser technology has been

used to perform 15 consecutive OPHLs in our Institute. The surgical procedures followed the same steps

as in conventional OPHL.

Results: No acute complications occurred. In the immediate post-operative period, endoscopic

evaluation showed a reduction in tissue edema compared to similar resections performed with the

standard method. The CO2 fiber laser is an ergonomic and easily manageable cutting device, not

associated with contractions during muscular resections, with variable power settings and a hemostatic

effect. In addition, the possibility of a perpendicular/tangential orientation of the beam toward tissue,

especially during cartilage/muscle/mucosa cutting, determines a better quality of resection as well as of

the surgical margins.

Conclusions: The application of a CO2 fiber laser showed some very useful features for the head and

neck surgeon performing OPHLs: in particular, a high cutting precision with very low tissue damage; the

possibility of delivering energy without touching the organ; variable power for the various surgical steps

and a very good maneuverability of the manipulators during the procedure, allowing the surgeon to

“draw” the resection with great accuracy.

100. Anterolateral Thigh Flap Perforator Variability and Split Flap Strategies

Sudirman Siti Radhziah

E-da hospital, Kaohsiung, Taiwan

Shih Hsiang-Shun

E-da Hospital, Kaohsiung, Taiwan

Rationale: Anterolateral thigh flap perforator variability is common and splitting this flap to dual skin

paddles was limited to those with at least two sizeable perforators. A split flap is ideal in many head and

neck reconstruction cases with both an intraoral mucosal and external skin defect. We introduce a

simple, clinically relevant classification system for anterolateral thigh flap based on perforator

anatomical variability. We also suggest various strategies to split the flap when unfavourable vascular

anatomy is encountered including those with only one sizeable perforator.

Materials and methods: A retrospective review of prospectively collected data on 99 consecutive

patients operated on by a single experienced surgeon over a period of two years (January 2014 to

January 2016).

Results: We have observed seven different types of perforator anatomic variability in the anterolateral

thigh flap whilst attempting to split the flap. Type I flap, which has multiple perforators from the

descending branch, was the most common (39 percent). In 25 percent of cases, there was only one

sizeable perforator from either the descending (Type IV, 19 percent) or the transverse /oblique branch

(Type V, six percent) of the lateral circumflex femoral artery. It was still possible to split flaps with the

type IV and V perforator variation using a myocutaneous flap for one of the skin paddles. 95 percent of

the flaps harvested could be successfully split with our strategies when there was at least one suitable

perforator.

Conclusions: Perforator variability is common in anterolateral thigh flap but can be overcome by the

suggested strategies such that most flaps including those with only one sizeable perforator can be split.

101. Complications and Difficulties in patients during surgery and post operative period for locally

advanced thyroid cancers in a newly setup cancer centre

Sumit Gupta

Homi Bhabha Cancer Hospital, Sangrur

Latika Kansal1, Debashish Chaudhary1, Tapas Dora1 1Homi Bhabha Cancer Hospital, Sangrur

Rationale: This study evaluates the complications and difficulties in patients during surgery and post

operative period for locally advanced thyroid cancers in a newly setup cancer centre.

Materials and methods: A retrospective analysis of 43 diagnosed locally advanced T3 and T4 thyroid

cancer patients from January 2015 to October 2017 who underwent total Thyroidectomy/completion

Thyroidectomy with central compartment clearance/inspection with or without neck dissection. Out of

43 patients twenty seven patients of papillary thyroid cancer, 9 cases of medullary thyroid cancers, 2

cases of poorly differentiated cancer and 5 cases of follicular thyroid cancer.

Results: Of the 43 patients, 31 underwent Total Thyroidectomy with central compartment clearance

with bilateral level ii-v neck dissection, 10 patients underwent completion Thyroidectomy with central

compartment inspection, 2 patients underwent Total Laryngectomy with Total Thyroidectomy with

bilateral neck dissection where disease involving trachea and larynx. Most difficulties faced during

surgery when disease involving the Tracheoesophageal groove so shaving off the disease from trachea,

oesophagus and recurrent laryngeal nerve done in 6 patients of papillary cancer of thyroid, in 3 patients

disease along common carotid artery also shaved off, 16 patients were having central compartment

nodes and 4 patients central compartment going retrosternally out of 4 patients 2 patients underwent

R0 resection The main postoperative complications were transient hypocalcemia in 32..5 % , permanent

hypocalcemia in 13.9%, transient vocal cord palsy in 18.6% and permanent vocal cord palsy in 9.3%,

wound complications were nil and no patients underwent postoperatively tracheostomy.

Conclusions: Thyroid surgery can be performed safely in a peripheral cancer hospital under direct

supervision of an experienced surgeon with acceptable morbidity. Hypocalcemia is the most significant

complication in advanced thyroid cancer when there are central compartment neck nodes dissections.

Shaving off the disease can be safe in papillary carcinoma of thyroid where the patients are going to

receive radioiodine ablation. In Medullary carcinoma of thyroid shaving off the disease is quite

controversial.

102. The survival of patients underwent salvage neck dissection with neck recurrence of head neck

cancer: one cancer center experience

Süslü Nilda

Hacettepe University Faculty of Medicine Ankara

Kuşçu Oğuz1, Yazıcı Gözde1, Cengiz Mustafa1, Aksoy Sercan1, Güllü İbrahim1, Dolgun Anıl1, Hoşal Şeifk2 1Hacettepe University Faculty of Medicine Ankara 2Ankara Liv Hospital Ankara

Rationale: To evaluate the factors that has an impact on survival of head and neck cancer patients with

neck reccurence.

Materials and methods: Between 2010-2015, 92 patients with recurrent squamous cell cancer in the

neck who underwent salvage neck dissection were retrospectively reviewed for survival, in Hacettepe

University Faculty of Medicine Department of Otorhinolaryngology Head and Neck Surgery.

Results: The 2-year and 5- year overall survival (OS) rates were 48.4% and 9.9 %, respectively. The 2-

year and 5-year disease free survival rates (DFS) were 38.1% and 5.6 %, respectively. Primary site of

tumor, primary treatment, isolated neck reccurence, time to neck reccurence, adjuvant therapy after

salvage surgery, pathologic N stage of recurrent tumor were analyzed for the impact on survival. Re-

irradiation after salvage neck dissection was found as a significant factor for the DFS, when compared

with re-irradiation with concurrent chemotherapy (p=0.020). In multivariate analysis, rN stage revealed

as a significant factor that affects OS and DFS with a p value of 0.001 and 0.046, respectively.

Conclusions: The survival of patients with neck recurrence is quitely low which is in agreement with the

literature. The N stage of the recurrent tumor is the only significant factor that has an impact on survival

in these patients.

103. Positive fresh frozen section margins as an adverse independent prognostic factor for local

recurrence in oral cancer patients

Szewczyk Mateusz

Department of Head and Neck Surgery Poznan University of Medical Sciences, The Greater Poland

Cancer Centre

Golusinski Wojciech1, Pazdrowski Jakub1, Masternak Michal1,2, Golusinski Pawel1,3 1Department of Head and Neck Surgery Poznan University of Medical Sciences, The Greater Poland

Cancer Centre 2College of Medicine, Burnett School of Biomedical Sciences, University of Central Florida, Orlando 3Head and Neck Cancer Biology Lab, Department of Biology and Environmental Sciences

Rationale: Objectives: To access: 1. what is the value of further surgical resection (completion surgery)

in cases with a positive intraoperative margin analysis; 2. Should cancers that undergo completion

surgery following positive intraoperative margin analysis with subsequent negative margins be

considered true R0 resections in terms of adjuvant treatment planning.

Objective study: Retrospective analysis of patients with primary oral cancer.

Materials and methods: 151 patients underwent primary surgical resection of oral squamous cell

carcinoma with intraoperative margin examination. In all cases where frozen section margin analysis

was positive, an extended resection was performed. Only patients with clear final margins were included

in the study.

Results: The intraoperative analysis of surgical margins revealed that cancer free margins were achieved

in 123 cases (81.5%). In 28 specimens (18.5%) the surgical margins were positive. Local recurrence was

observed in 28 (18,5%) while regional recurrence developed in 30 (19,9%) patients. Factors significantly

(p<0.05) increased the risk of local recurrence: Advanced stage of the disease (III/IV); N-positive status;

lymphovascular invasion (LVI) and positive fresh frozen surgical margins. On multivariate analysis, only

positive fresh frozen surgical margins and advanced stage of the disease remained significant

independent adverse factors.

Conclusions: Our study demonstrates that positive fresh frozen margins, regardless of re-resection to

R0 status, could be a powerful adverse factor that determines an aggressive nature of the tumour. This

feature should be taken into consideration in adjuvant treatment planning. The greatest impact this

could have is in borderline clinical situations when the indication for adjuvant treatment may be

questionable.

104. The role of extended histological evaluation in oral cancer patients with local recurrences

Szybiak Bartosz

Department of Head and Neck Surgery; Greater Poland Cancer Centre

Rationale: Oral cancer is the second most prevalent head and neck malignancy in Poland. The incidence

of these types of cancer is constantly growing. Almost 40 % of the oral cancers are located on the tongue.

Materials and methods: The study comprised of a group of 50 patients with local recurrence of the

tongue and floor of the mouth cancer. The group was selected from 266 of surgically treated patients.

The local recurrence rate was 18,8%. The mean age of patients was 57 years. In all patients with local

recurrence extended histological examination under the guidance of the British Pathologists Consensus

was conducted.

Results: In 10 (20%) patients, primary tumors were found to be histologically aggressive as indicated by

the infiltration of the vessels, nerves and muscles. In 13 (26%) cases, the cancer infiltrated both the

vessels and nerves or the vessels and muscles, and in 14 (28%) other cases, only one of above mentioned

structures. The infiltration of the vessels, nerves and muscles correlates with depth of invasion and

pattern of invasion proposed by M. Brandwein- Gensler. The latter is regarded as a strong prognostic

factor.

The pattern of invasion turned out to be a strong prognostic factor, independent of the clinical stage of

the tumor (T stage). There is correlation between the local recurrence rate and the number of infiltrated

structures. Moreover, the infiltration of vessels, nerves and muscles clearly affected the period to

recurrence. The correlation was noticed between infiltration of vessels and the presence of metastasis

to lymph nodes in the neck.

Conclusions: The progression of cancer depends strongly on histopathological features. Infiltration of

vessels, nerves and muscles indicates high aggressiveness of the primary tumor and is negative

prognostic risk factor for local recurrence. Invasion of vessels correlates with regional metastasis and

may influence the decision of performing the elective neck surgery.

105. Pigmented Epithelioid Melanocytoma with nodal melanosis - a rare cause of cystic cervical

lymphadenopathy

Tan Hiang Jin

Singapore General Hospital, Singapore

Tan Choon Chieh

Sengkang General Hospital, Singapore

Rationale: Pigmented epithelioid melanocytoma (PEM) is rare tumor of the skin. Since reported by

Zembowicz et al in 2004, there are not many studies about this condition. Even rarer, a PEM associated

with nodal melanosis. We present a rare case of pigmented epithelioid melanocytoma with nodal

melanosis.

Materials and methods: We report a case of pigmented epithelioid melanocytoma with nodal melanosis

in a 57-year-old gentleman. He first presented with cervical lymph node swelling where excision biopsy

was performed and histology returned as nodal melanosis. Upon thorough examination, a black nodule

was found on his back and excised.

Results: Histology returned as pigmented epithelioid melanocytoma. Prior to this, he had computed

tomography (CT) scan of chest, abdomen and pelvis which returned normal. He also had both upper and

lower gastrointestinal endoscopies performed which showed no abnormalities.

Conclusions: Pigmented epithelioid melanocytoma is a rare disease with many unanswered questions.

Further studies and long term follow up are required to understand the disease and the relationship

with nodal melanosis.

106. Pre-Disposing Factors and Complication Rates across a decade of Total Laryngectomy

Thompson Christopher

NHS Lothian, Edinburgh

Rationale: Total laryngectomy (TL) is a complex and invasive procedure associated with the potential for

significant morbidity. Primary TL (PTL) can be differentiated from Salvage TL (STL), with the latter being

performed following failure of other treatment modalities.

Both pre-disposing factors and complication rates of TL remain under-reported and are of particular

interest to clinicians when advising on the management of advanced laryngeal and hypopharyngeal

cancers. Due to this, we aimed to analyse and report complication rates and factors associated with

complications (Pharyngo-cutaneous fistula (PCF) and Neo-pharyngeal stenosis (NPS)).

Materials and methods: A retrospective review of all patients undergoing TL in NHS Lothian from 2006-

2016 was performed using pathology, Ehealth and speech-therapy records. Complication rates and

possible pre-disposing factors for the development of PCF were analysed using Chi-square tests and

logistic regression.

Results: A total of 173 patients (114=PTL, 59=STL) were identified. The majority of cancers arose from a

laryngeal subsite and a male predominance of increasing age was seen. Median follow-up time after PTL

was 21.5 months (range 1-97 months) and 27 months after STL (range 1-99 months).

Complication rates in PTL were; PCF - 6%, NPS – 9.6% and PCF - 20%, NPS - 14% in STL. Patients were

significantly more likely to develop PCF following STL vs. PTL (p=0.005) but this was not the case with

NPS (p=0.5). Additionally, patients were significantly more likely to develop NPS following previous PCF

vs. no previous PCF in STL (42% vs. 6.4% of patients, p=0.001), but not in PTL.

Analysis showed no association between pre-op Hb levels and the development of PCF. Similarly, no

association was found between PCF and post-op Chemo/Radiotherapy.

Conclusions: In both cohorts, rates of PCF and NPS were similar to those reported in the literature.

Patients were significantly more likely to develop PCF following STL in comparison to PTL and a

significant relationship was seen between PCF and NPS development in the STL cohort only. Contrasting

to others’ findings, no associations were found between possible pre-disposing factors (pre-operative

Hb levels or previous Chemo/Radiotherapy) and development of PCF.

107. Clinical outcomes for T1N0 oral tongue cancer patients, underwent surgery with and without

postoperative radiotherapy

Toprani Rajendra

HCG Cancer Center, Ahmedabad, India

Rationale: The aim of this study was to assess the results of curative surgery with and without

radiotherapy in patients with T1 N0 oral tongue squamous cell carcinoma (OSCC) and to evaluate survival

and prognostic factors.

Materials and methods: Retrospective analysis of 42 patients with T1 N0 OSCC who received surgery

between 2009 and 2012. Fourteen patients (33.3%) received postoperative radiotherapy (PORT). Patient

characteristics, tumor characteristics, treatment modality, failure patterns, and survival rates were

analyzed.

Results: The median follow-up was 45 months. The five-year disease-free survival (DFS) rate was 78.57%.

Higher tumor grade and invasion depth ≥ 0.5 cm were the significant prognostic factors affecting five-

year OS and in the risk group, there was no local failure in patients with postoperative radiotherapy.

Conclusions: In T1 N0 OSCC, factors that affected prognosis after primary surgery were higher tumor

grade and deep invasion depth over 0.5 cm. Postoperative radiotherapy should be considered in early

oral tongue cancer patients with these high-risk pathologic features.

108. Outcomes of Microvascular Free Flap Reconstruction of Head and Neck defects after major

Ablative Surgery: An experience of 891 cases at a single institute

Toprani Rajendra

HCG cancer centre, Ahmedabad, India

Rationale: To evaluate the clinical outcomes in patients who underwent different microvascular free

flap reconstructionsof head and neck defects after major ablative surgery.

Materials and methods: We reviewed the medical records of patients with head and neck cancer who

underwent microvascular free flap reconstruction after major ablative surgery retrospectively from

January 2012 to July 2017 at our department of Head and Neck Oncology and reconstructive surgery.

Results: 891 patients included 627(70.3%) men and 264(29.7%) women, with mean age of 46.83 years.

Most common primary tumor site was the Buccal Mucosa (72.33%). The most commonly used free flap

was the radial forearm free flap (48.48%), followed by the free anterolateral thigh flap (39.17%), free

fibula flap (10.44%), free jejunum (1.23%) and Medial Sural Artery perforator flap (0.67%). The overall

success rate was 96.86%, with 3.14% of flap failure. 91 (10.21%) re-explorations were done for flap

compromise. The problem with the flap was venous and arterial in 76% and 24% respectively. 63 flaps

(69.23%) were salvaged successfully and 28 (3.14%) flap failures.

Conclusions: The microvascular free flap reconstruction of head and neck defects is safe with high

success rate. The vigilant monitoring and timely re-explorations which reflect free flap outcome.

109. The impact of enhanced recovery pathways on outcomes after salvage surgery for recurrent/

persistent head and neck cancers in elderly patients: single tertiary centre review

Tornari Chrysostomos

Guy's and St Thomas' NHS Foundation Trust

Volpini Luigi1, Rovira-Casas Aleix1, Jeannon Jean-Pierre1, Simo Ricard1, Oakley Richard1 1Guy's and St Thomas' NHS Foundation Trust

Rationale: Head and neck cancer recurrence is a challenging topic that requires a multidisciplinary

approach to optimise treatment options. After primary chemoradiotherapy, patients’ performance

status is often impacted and this may affect their suitability for salvage surgery. This is particularly true

for elderly patients who are often judged to be unfit for surgical therapy. Such patients’ treatment

options are, therefore, limited to palliative or supportive treatment. Our institution adopted an

enhanced recovery pathway for all patient undergoing major head and neck resections. This comprises

the input of Care of the Elderly physicians that allows pre-operative counselling of mortality and

morbidity risks for patients as well as medical optimisation for surgery. We analysed our salvage surgery

database to identify patients who were more than 65 years old at the time of their procedure. We

analysed their perioperative complication rate and rate of pre-operative carbohydrate loading to

identify adherence to enhanced recovery principles.

Materials and methods: Single institution retrospective patient review of salvage surgery database and

patient records for patients aged over 65 years undergoing salvage surgery between 2011 and 2015.

Pre-operative assessment, pre-operative carbohydrate loading, total hospital stay and complications

were recorded.

Results: Of 61 patients undergoing salvage surgery, 19 met our age inclusion criteria. Six of these patient

(32%) underwent age-specific pre-operative assessment. Fifteen (79%) had pre-operative carbohydrate

loading appropriate to their feeding route. The median post-operative hospital stay lasted 10.5 days.

There was one mortality within 30 days of surgery (5%) with a mean Clavien-Dindo score of 1.5 for the

whole group. One-year survival was 84%.

Conclusions: Salvage surgery after chemoradiation for head and neck cancers carries a high risk of

morbidity and mortality that is exacerbated in the geriatric population. Multidisciplinary patient

selection and optimisation along with age-specific pre-operative medical input are likely to be

responsible for our patient survival rate that compares favourably with other published series.

110. Prognostic role of extracapsular spread in planned neck dissection after Chemoradiotherapy

Valero Cristina

Hospital de la Santa Creu i Sant Pau (Barcelona)

León Xavier1, Pardo Laura1, Sansa Aina1, Rodriguez Camilo1, Rovira Carlota1, Casasayas Maria1, Gutierrez

Alfons1, Neumann Eduard1, Quer Miquel1 1Hospital de la Santa Creu i Sant Pau (Barcelona)

Rationale: The aim of this study was to evaluate the prognostic significance of metastatic nodes with

extracapsular spread (ECS) in head and neck squamous cell carcinoma (HNSCC) patients treated with a

planned neck dissection after an initial treatment with chemoradiotherapy.

Materials and methods: We carried out a retrospective study of 109 HNSCC patients with clinically

positive neck nodes at diagnosis that achieved a complete response in the primary location after

chemoradiotherapy, and were subsequently treated with a planned neck dissection.

Results: Five-year disease-specific survival for patients without residual metastatic nodes in the neck

dissection (pN0, n=69) was 75.7% (95% CI: 64.4-87.0%). For patients with metastatic nodes without ECS

(pN+/ECS-, n=17), the corresponding disease-specific survival was 74.0% (95% CI: 48.2-99.8%), and for

patients with metastatic neck nodes with ECS (pN+/ECS+, n=23) it was 8.7% (95% CI: 0.0-24.3%)

(P=0.0001). In patients with an oropharyngeal carcinoma, there were differences in the prognostic

capacity of the pathological status of the neck according to the Human Papiloma Virus (HPV) category.

Patients with oropharyngeal HPV-negative tumors had a similar behavior to the other HNSCC locations,

with a significant decrease in disease-specific survival for those patients with pN+/ECS+ (p=0.0001). In

contrast, no differences in disease-specific survival were found according to the pathological status of

the neck in patients with HPV-positive oropharyngeal tumors.

Conclusions: The presence of ECS in the pathological study of the planned neck dissections carried out

after chemoradiotherapy in patients with HPV-negative HNSCC allowed the identification of a group of

patients with a high risk of failure.

111. Patient and tumor characteristics of patients with epithelial head and neck cancer by referral

status to a head and neck oncology center in a nationally centralized setting

van Dijk Boukje

Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht

Campschroer Gaby1, Halmos Gyuri2, Merkx Matthias (Thijs)3 1Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht 2University of Groningen, University Medical Center Groningen, Groningen 3Radboud University Medical Center, Nijmegen

Rationale: Head and neck cancer patient care has been centralized in the Netherlands since the mid-

nineties: all patients should be referred to a head and neck oncology center (HNOC) or a preferred

partner (HNPP). We aimed to discover whether patients were referred to a HNOC/HNPP, and if

patient/tumor characteristics differed by referral status.

Materials and methods: Patient and tumor characteristics of invasive epithelial head and neck tumors

were extracted from the population-based Netherlands Cancer Registry for the year 2015. We

determined whether patients were unknown in a HNOC/HNPP (unknown), known but not treated in a

HNOC/HNPP (untreated) or treated in a HNOC/HNPP (treated)-the latter group included the decision

not to treat. Differences in characteristics were tested using chi-square or Fisher’s Exact test for

categorical variables, depending on applicability and ANOVA for age. A Kaplan-Meier analyses was

performed for survival.

Results: Of 2,933 patients diagnosed in 2015; 73 patients (2.5%) were unknown to a HNOC/HNPP, 122

patients (4.2%) were untreated in a HNOC/HNPP and 2,738 (93.4%) were treated in a HNOC/HNPP.

There was no difference in sex distribution, but patients unknown (71 years) or untreated (66 years)

were older at diagnosis than those treated in a HNOC/HNPP (65 years). Squamous cell carcinoma in a

cervical lymph node with unknown primary location (SCCCUP) was most often unknown (7.1%) or

untreated (8.3%) in a HNOC/HNPP, while the second highest proportion equaled 2.8% in oral cavity

cancer (unknown) and 7.2% for larynx carcinoma (untreated). A distant metastasis was more often

present at diagnosis if unknown (6.9%) or untreated (4.1%) compared to treated in HNOC/HNPP (2.9%).

Treatment was more common if treated in a HNOC/HNPP (92% vs 91% in untreated vs 67% in unknown;

p<0.001). The difference remained after restriction to 400 patients older than 80 or with distant

metastasis or with SCCCUP (78% vs 78% in untreated vs 29% in unknown; p<0.001). In this restricted

population, the 1-year survival equaled 64%, 39% and 19% respectively; in the total group: 1-year

survival equaled 80%, 70% and 60%, respectively)

Conclusions: The centralization rate of head and neck cancer care is very high in the Netherlands. A

tentative conclusion on these preliminary results indicate the chance to receive treatment might be

higher if a patient is known in a HHOC/HNPP.

112. Up-front and Salvage Transoral Laser Microsurgery (TLM) for Glottic Squamous Cell

Carcinoma: a Single Centre Retrospective Case Series

Vander Poorten Vincent

UZ Leuven, Leuven, Belgium

Bijnens Jacqueline1, Delaere Pierre1, Nuyts Sandra1, Clement Paul1, Meulemans Jeroen1 1UZ Leuven, Leuven, Belgium

Rationale: Transoral laser microsurgery (TLM) is a minimally invasive surgical alternative for irradiation

in the primary management of early glottic cancer. More recently, TLM emerged as a possible salvage

treatment for selected radiorecurrent cancers. We reviewed outcomes of primary and salvage TLM.

Materials and methods: We retrospectively reviewed records of 154 consecutive patients who

underwent TLM. Descriptive statistics, overall survival, disease specific survival disease free survival and

local control rates (Kaplan-Meier) were evaluated, as well as the variation of these outcomes between

subgroups (Log-rank analysis).

Results: Of 154 patients, 114(74,0%) underwent TLM as a primary treatment and 40(26,0%) were

treated in a salvage setting for recurrent or second primary cancer. Cordectomies performed were type

I (n=51; 33,1%), type II (n=22; 14,3%), type III (n=45; 29,2%), type IV (n=7; 4,5%), types Va-b-c-d (n=21;

13,6%) and type VI (n=5; 3,2%). Resection margins were judged clear or close (<1mm) in 41 patients

(26,6%), positive in 53 cases (34,4%) and non-evaluable in 60 patients (39,0%). Second look TLM was

performed in 29 patients (50% of them with positive resection margins) and radiotherapy was associated

as adjuvant therapy in 5 patients (3,2%). Functional results were excellent with no postoperative need

for tubefeeding nor tracheotomy. For patients alive at the end of follow-up, mean follow-up was 57

months (SD=42,4 months). Estimated 3-year overall survival (OS) was 95,4% (SE=1,8%), 3-year disease

specific survival (DSS) was 100% and 3 year-disease free survival (DFS) was 77,9% (SE=3,8%). Upon

subgroup analysis, no differences in OS, DSS and DFS were observed between the up-front and salvage

group (log rank analysis; p>0,05). Moreover, section margin status, cT classification, involvement of the

anterior commissure and subglottic extension did not influence estimated DFS. 3-year estimated local

control with 1 initial laser procedure was 78,7% (SE=3,7%). Overall larynx preservation rate at the end

of follow-up was 91,6% and was significantly higher in the up-front group (99,1%) compared to the

salvage group (70,0%) (Chi square; p<0,001).

Conclusions: This study confirms excellent oncologic outcomes of up-front TLM for early glottic cancer

with almost 100% laryngeal preservation rate. In the salvage setting, TLM allows avoidance of total

laryngectomy in the majority of cases.

113. Endoscopic approaches for malignant tumors of sinonasal tract and anterior skull base: our

experience

Veneri Antonio

AOUI Verona

Molteni Gabriele1, Marchioni Daniele1 1AOUI Verona

Rationale: Paranasal sinus and anterior skull base tumor can present in many histologic varieties.

Diagnosis is difficult because late onset of symptoms. Nowaday tansnasal endoscopic surgery is the gold

standard approach for many nasal and anterior skull base tumors. We present our experience as Skull

base team of Verona University in multidisciplinary endoscopic management of malignant tumors of

sinonasal tract and anterior skull base.

Materials and methods: A retrospective analysis of 25 patients (mean 60,33 years old, range 34-84)

affected by malignant tumors of the sinonasal tract and anterior skull base treated endoscopically by

Skull Base Team of the University Hospital of Verona in the last 2 years.

A chart review of clinical data, follow up and surgical videos will be presented.

Results: 25 patients affected by malignant tumor was treated endoscopicaly. The most frequents

histopatological diagnosis were: squamous cell carcinoma (28%), chordoma (28%), Adenocarcinoma

(16%), sarcoma (12%), undifferentiated carcinoma (12%), melanoma (4%). All of these tumors were

treated through the following endoscopic approaches: ESS (32%), transcribiform (28%), transclival

(20%), transellar (8%), transplanum (4%). Overall, 7 (28%) of patients received an adjuvant treatments.

Only 1 patient experienced a postoperative complication: a CSF leakage who underwent an endoscopic

closure.

A recurrence of desease was obseved in 7 cases (all chordomas and one indifferentiated carcinoma).

Conclusions: Malignant tumor of the sinonasal tract and anterior skull base may underwent a safe and

complete resection through a trans-nasal endoscopic approach. Low percentage of complications occur

if the resection is complete. Multidisciplinary approach with ENT, neurosurgeon and neuroradiologist is

mandatory for the treatment of these pathologies.

114. Management of thyroid cancer with gross angioinvasion - Surgical technique and outcome

Volpini Luigi

Guy's and St Thomas' NHS Foundation Trust

Rovira-Casas Aleix1, Tornari Chrysostoms1, Odell Eddy1, Mohan H1, Harrison-Phipps K1, Panuschka C1,

Jeannon Jean-Pierre1, Oakley Richard1, Simo Ricard1 1Guy's and St Thomas' NHS Foundation Trust

Rationale: Macrovascular invasion by thyroid carcinoma is very uncommon and usually has a very poor

prognosis. The aim of this paper is to describe the clinical presentation, diagnostic difficulties,

management, surgical technique and outcome of this uncommon presentation

Materials and methods: Retrospective review of 4 patients presented with gross invasion of the internal

jugular (IJV) and innominate vein presenting to the Head and Neck Unit at Guy’s and St Thomas’ Hospital

NHS Foundation Trust between 2000 to 2012. Patients were investigated with Thyroid Function Test,

Ultrasound Fine-Needle Aspiration Cytology and Magnetic Resonance Imaging when indicated

Results: Four consecutive patients with gross macroscopic invasion by thyroid carcinoma were included.

Age ranged between 36 and 86 years. All patients were treated with total thyroidectomy and excision

of the intravascular neoplastic thrombus. One patient required total laryngectomy for laryngeal

invasion. Three patients underwent selective neck dissection and excision of the IJV. The histological

analysis showed poorly differentiated thyroid carcinoma in three patients and papillary thyroid

carcinoma in one. Three patients received post-operative radioactive iodine and TSH suppression. Two

patients died, one of distant metastasis 10 years from presentation, the other of severe bleeding two

weeks postoperatively. Two patients were alive at the time of the review, one with distant metastasis

and the other one just completed radio-iodine ablation

Conclusions: The management of thyroid carcinoma with gross angioinvasion is still controversial due

to its rarity. Treatment including total thyroidectomy, excision of the intravascular thrombus with or

without resection of the involved vessel is advisable. This should be followed with radioactive iodine and

TSH suppression. Despite best efforts the prognosis of these patients is very poor.

115. Detection of serological HPV16 Status in the course of therapy in patients with oropharyngeal

carcinoma

Weiland Thomas

HNO-Univ.Klinik Graz

Wolf Axel1, Vasicek Sarah1, Pondorfer Prisca1, Holzmeister Clemens1, Moser Ulrich1, Brcic Luka2, Thurnher

Dietmar2 1HNO-Univ.Klinik Graz 2Institut für Pathologie der Medizinischen Universität Graz

Rationale: Advanced HPV-associated oropharyngeal carcinoma is related to a better prognosis and a

lower recurrence rate compared to equivalent HPV-negative tumors. This awareness led to studies

focusing on eventual de-escalation of therapy to possibly raise the quality of life of those patients.

The incidence of HPV-related oropharyngeal carcinoma ascends provably in industrial countries. An early

diagnosis crucially effects prognosis. Beside classical risk factors such as smoking and alcohol, which can

be easily ascertained, the detection of a tumor-relevant HPV infection proves to be difficult.

A competitive ligand assay for the detection of HPV16 L1 antibodies may provide new perspectives in

risk stratification and early diagnosis of HPV-related oropharyngeal carcinoma.

Materials and methods: We analyzed 30 patient serums with histologically proven oropharyngeal SCC

at the time of diagnosis and during treatment by using a competitive ligand assay (Abviris) to detect

HPV16 L1 antibodies. Furthermore we quantified antibodies by using photometry.

Additionally PCR and hybridization were performed to detect HPV-DNA including genotyping of 32 HPV-

subtypes.

Results: The majority of HPV16-DNA-positive patients showed “classic” trends of declining antibody

titers during treatment. Occasional patients showed interesting trends with decreasing titers initially

and an increase during follow-up lacking of clinical evidence of recurrence so far.

Conclusions: The detection of HPV16 L1-antibodies using a competitive ligand assay (Abviris) during

treatment shows potential for monitoring therapy success in patients with HPV-associated

oropharyngeal carcinoma. A longer follow-up period is necessary to see whether a sudden increase of

antibody titers is of any prognostic significance.

116. Lymph nodes metastasis of papillary thyroid carcinoma to the neck with absence of tumor in

the thyroid gland

Weinstein Omri

The Baruch Padeh Medical Center, Poria, Israel affiliated with Bar-Ilan University, Faculty of Medicine

Goshen Sivan1, Merchavy Shlomo1 1The Baruch Padeh Medical Center, Poria, Israel affiliated with Bar-Ilan University, Faculty of Medicine

Rationale: Papillary thyroid carcinoma (PTC) frequently metastasizes to the regional neck lymph nodes.

However, lymph node metastasis in the neck, as a sole presenting symptom without any tumor found

in histology of the thyroid gland, is very rare.

Materials and methods: Case report and review of world literature concerning metastasis of lymph

nodes as a sole presenting symptom of papillary thyroid carcinoma, without any tumor seen in the

thyroid specimen.

Results: 54-year-old healthy female referred to our clinic, due to an increased cervical mass on the left

side of her neck for 9 months. She underwent a complete assessment including cervical US, FNA, Chest

and neck CT. Cervical US revealed 29 mm mass on the left side of the neck and a 10-mm nodule in her

left thyroid gland. FNA guided by US was performed with the result of papillary carcinoma in the cervical

mass and benign lesion from the thyroid nodule. Due to those finding a total thyroidectomy was done

with left lateral neck dissection. The pathological specimen revealed metastatic papillary carcinoma in

the neck with an absence of tumor in the thyroid gland.

Conclusions: Even though metastatic papillary thyroid carcinoma to lymph nodes with no involvement

of the thyroid tissue is rare, it should be always considered as the only presenting symptom of occult

papillary carcinoma.

117. Use of Submandibular Gland Flap for Repairing Defects after Tumor Resection in the Parotid

Region

Yang Bin

Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital,

Capital Medical University, Beijing 100050, China

Rationale: The deformity, concave defects and Frey syndrome that developafter parotidectomy can lead

to dissatisfactory esthetics and quality of life.

Materials and methods: Fifty-six patients subjected to parotidectomy were divided into 2 groups. The

parotid region defects in 26 patients were repaired using a submandibular gland flap, and 30 untreated

cases served as a control. Esthetic results and complications,such asfacial dysfunction, Frey syndrome,

salivary fistula, wound healing, auricular region numbness and xerostomia,were evaluated

postoperatively.

Results: The submandibular gland flap transfer group showed much better esthetic results and areduced

frequency of Frey syndrome compared with the untreated control group. Common complications (facial

paralysis, salivary fistula, wound healing delay, and auricular region numbness) did not differbetween

the submandibular gland flap transfer and untreated control groups. Xerostomia prevalence at 3 months

after surgery was higher in the submandibular gland transfer group than in the untreated control group.

However, dry mouth symptoms were greatly alleviated in the submandibular transfer group at 6 months

after surgery such thattheir rate of occurrence was not significantly different from that in the untreated

control group.

Conclusions: Submandibular gland flap offers a new cosmetic option for reconstruction and preventing

Frey syndrome after parotidectomy.