3708 - Validation of a Novel Predictive Radiation Treatment Score for Radiation Treatment Completion in Head and Neck Cancers

L. Ottensoser¹, H. Rahman², D. Frank³, D. Kamdar⁴, L. Pereira⁴, M. Ghaly⁵, W. J. Talcott¹, B. Jones⁶, N. Seetharamu¹, K. Sullivan³, B. A. Miles⁷, G. Har-El⁸, R. Epstein⁹, and B. Parashar¹; ¹Northwell, Lake Success, NY, ²Office of Academic Affairs, Northwell Health, New York, NY, ³Northwell Health, Lake Success, NY, ⁴Northwell Health, New Hyde Park, NY, ⁵Department of Radiation Medicine, Northwell, Lake Success, NY, ⁶Department of Radiation Medicine, Northwell Health, New York City, NY, ⁷Department of Otolaryngology, Northwell Health, New York City, NY, ⁸Northwell Health Lenox Hill Hospital, New York, NY, ⁹Zucker School of Medicine at Hofstra/Northwell, Hemsptead, NY

Purpose/Objective(s): Radiotherapy (RT) is a mainstay of management of head and neck cancer (HNC) but is associated with high rates of severe toxicity. Currently there is a lack of objective criteria that can predict premature RT termination or delayed RT treatment completion. This study aims to evaluate objective criteria that can be used to identify patients who are less likely to tolerate an extended course of RT treatment. Materials/

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

Abstract 3708 – Table 1: Criteria for RT completion score

Age

ECOG Performance Status

Head & Neck Site

RT Field

# RT Fractions

Systemic Therapy

Surgery Prior to RT

Comorbidities