Volume 84 � Number 3S � Supplement 2012 Poster Viewing Abstracts S517

applicator was constructed by attaching brachytherapy catheters at 1 cm

intervals to a 5 mm thick bolus. Two treatment plans were generated for

brachytherapy: one for Iridum-192 HDR and the other which assumed

treatment with 50 kVp EBT using the same applicator. A third plan was

generated for a 2 full arc 6 MV photon VMAT (also with a 5 mm thick

bolus). The target and organs at risk (OARs) were contoured on

a simulation CT scan. The prescription was 36 Gy in 8 fractions for a 9

cm � 12 cm � 1 cm target. The plans were optimized to a standard

target coverage (V100% > 98%) and to minimize dose to OARs using

Nucletron Oncentra MasterPlan (HDR), Varian BrachyVision (EBT) and

Eclipse (VMAT). We compared mean target dose, dose heterogeneity,

and doses to OARs.

Results: The target V100% and D90% were 98% and 104% (HDR), 100%

and 119% (EBT), and 98% and 102% (VMAT). The mean (and range from

minimum to 1cc maximum) target doses were HDR 119% (86-157%),

EBT 164% (86-271%), and VMAT 104% (96-108%). The Table

summarizes mean dose to OARs.

Conclusions: EBT provided the least dose to closest OAR (brain) due to

rapid dose fall-off of low-energy X-rays, but it resulted in higher mean

target doses and more heterogeneity than HDR and VMAT. HDR and

VMAT provided similar V100% and D90% target doses. As expected,

VMAT provided most dose uniformity. All methods resulted in acceptable

normal tissue doses, but they were lower for EBT and VMAT than HDR

specifically for this lesion located on the top of the skull. Comparative

dosimetry facilitates treatment modality selection for extensive superficial

lesions with complex surfaces, irregular contours, and close proximity to

OARs.

Author Disclosure: S. Park: None. M. Kamrava: None. O. Kayode: None.

S.P. Lee: None. M.L. Steinberg: None. D.J. Demanes: None.

2798Fentanyl Pectin Nasal Citrate (FPNC) to Control Breakthrough Pain(BP) and Improve Dysphagia in Head-and-Neck Cancer PatientsReceiving Radiation Therapy (RT)I. Prieto,1 J. Pardo,2 A. Perez-Casas,1 J. Olivera,1 J. Luna,1 and J. Vara1;1Fundacion Jimenez Diaz, Madrid, Spain, 2Hospital General de Cataluna,

Barcelona, Spain

Purpose/Objective(s): To evaluate the breakthrough pain control and the

improvement of the dysphagia in head and neck cancer patients (HNCP)

who develop mucositis and moderate-severe dysphagia radiation therapy-

induced.

Materials/Methods: Eleven patients with breakthrough pain due to

radiation therapy-induced mucositis were selected to start treatment

with FPNC in order to relief the pain associated with swallowing.

Patients were already receiving an opioid treatment at total dose

equivalent to 40-80 mg morphine. Incidental pain was treated before

eating 4-5 times /day with a dose of 100-400 mg of FPNC. Data related

to tolerance, pain relief and efficient dose for swallowing maintenance

were collected.

Results: Patients who adhered to the FPNC treatment reached satisfactory

pain control. Three patients chose do not receive the basal opioid treat-

ment, and then achieved BP relieve only with FPNC. The efficient dose of

FPNC was 200 mg in most of patients. Only 1 needed 400 mg. The mean

onset time of the pain relief was 7 minutes (range 5-10) in 6 patients, and

the mean response duration was 60 min (range 45-75 min). This relief

effect allowed oral feeding, nutritional parameters maintenance, and,

therefore, improvement in the patient’s quality of life. Also permitted

deliver RT treatment without interruptions.

Conclusions: BP management is difficult to manage and so are most

agents used to treat it. HNCP treated with radiation therapy develop oral

mucositis with severe breakthrough incidental pain associated with swal-

lowing, so a simple, rapid and strong analgesic is needed. The oral rescue

dose is likely to be inadequate for a significant percentage of these patients

with xerostomia and severe oral pain. The intranasal way eliminate this

problem and offers a rapid an efficient absorption. FPNC seems to be

particularly beneficial and well accepted in patients with BP due to radi-

ation therapy-induced mucositis.

Author Disclosure: I. Prieto: None. J. Pardo: None. A. Perez-Casas: None.

J. Olivera: None. J. Luna: None. J. Vara: None.

2799WITHDRAWN

2800Prognostic Utility of Pretreatment Metabolic Tumor Volume, GrossTumor Volume, Maximum Standardized Uptake Value in Head-and-Neck Cancer Patients Receiving IMRTP. Romesser,1 B.A. Shah,1 M.M. Qureshi,1 S. Jalisi,1,2

R.M. Subramaniam,1,2 and M. Truong1,2; 1Boston University School of

Medicine, Boston, MA, 2Boston Medical Center, Boston, MA

Purpose/Objective(s): This retrospective study compared the prognostic

utility of pretreatment metabolic tumor volume (MTV), gross tumor

volume (GTV) and raw maximum standardized uptake value (SUVmax),

with respect to tumor control and survival in patients with head and

neck squamous cell carcinoma (HNSCC) undergoing intensity modu-

lated radiation therapy (IMRT) with or without concomitant

chemotherapy.

Materials/Methods: Between 2004 and 2009, 41 HNSCC patients who

underwent a pretreatment PET/CT and definitive IMRT were identified.

All PET/CT studies were retrieved from the electronic archival system

and reviewed on a MIMvista workstation (software version 4.1). Fused

PET/CT images were reviewed in axial, coronal, and sagittal planes.

SUVmax and MTV were obtained from the PET/CT scans. GTVs

manually contoured by the radiation oncologist were obtained from the

Dose Volume Histograms (DVH). The SUVmax was defined as the

maximum standardized uptake value within the tumor normalized to lean

body mass, MTV was defined as the tumor volume with FDG uptake

using a gradient-based (PET Edge) auto-segmentation method. Local

(LC), nodal (NC), distant (DC), overall (OC) control and overall (OS)

and disease free (DFS) survival were calculated using the Kaplan Meier

product-limit method. Receiver operator characteristic (ROC) curves

were constructed by plotting sensitivity versus (1-specificity) and

optimum cutoff values for above parameters were derived for endpoint

LC. Percent area under the ROC curves (AUC) and their 95% confidence

intervals were found. A probability value of less than 0.05 was consid-

ered statistically significant.

Results: Median follow up was 24.2 months (range, 2.7- 56.3 months).

The GTV and MTV were 22.2 cc, and 7.2 cc respectively. The median

SUVmax was 15.8. Patients with smaller GTVs (<22.2 cc) demon-

strated two-year actuarial LC rates of 100% versus 56.4% (pZ0.001)

and OS rates of 94.4% versus 65.9% (pZ0.045). Similarly, a smaller

MTV (<7.2 cc) correlated with improved LC and OS with two-year

actuarial LC rates of 100% versus 54.2% (pZ0.0003) and OS rates of

94.7% versus 64.2% (pZ0.040). Smaller GTV and MTV correlated with

improved NC, DC, OC and DFS. SUVmax did not correlate with LC

and OS when analyzed by median threshold. An exploratory analysis

using ROC curves constructed for the LC endpoint identified a cutoff

value of SUVmax of 19.3 (AUCZ73%, 95% CI 56% - 85%), GTV of

29.6 cc (AUCZ89%, 95% CI 75% - 97%), and MTV of 7.7 cc

(AUCZ81%, 95% CI 66% - 92%). Both GTV and MTV retained

significance using ROC optimized cutoff values. In all cases the MTV

was smaller than the GTV.

Conclusions: In HNSCC patients undergoing IMRT, MTV and GTV

demonstrate superior prognostic utility compared to SUVmax.

Author Disclosure: P. Romesser: None. B.A. Shah: None. M.M. Qureshi:

None. S. Jalisi: None. R.M. Subramaniam: None. M. Truong: None.