S388 I. J. Radiation Oncology d Biology d Physics Volume 75, Number 3, Supplement, 2009

Conclusions: p16INK4a over-expression was common in our series of oral cavity tumors and is a marker of favorable prognosis.p16+ was not a reliable predictor of HPV-positivity in our cohort of young patients with oral tongue tumors, although a strongcorrelation has been reported for oropharyngeal cancers. The biology of p16+ in the absence of HPV infection is not well under-stood. Unidentified etiologic agents other than high-risk HPV subtypes may be associated with SCCOT patients who lack tradi-tional risk factors for the development of disease.

Author Disclosure: S.L. Harris, None; R.J. Kimple, None; N.H. Feinberg, None; W.T. Seaman, None; D.N. Hayes, None; L.B.Thorne, None; M.E. Couch, None.

2460 Use of Internet-based Survivorship Care Plans by Survivors of Head and Neck Cancer

C. E. Hill-Kayser, C. Vachani, M. K. Hampshire, J. M. Metz

University of Pennsylvania Medical Center, Philadelphia, PA

Purpose/Objective(s): Despite improved survival rates, radiotherapy (RT), surgery, and systemic treatments for head/neck can-cers may be associated with serious late effects, including carotid disease, xerostomia, and speech/swallow dysfunction. Survivor-ship care plans (SCP) have been recommended by the Institute of Medicine for all cancer survivors, and may be particularlyimportant for survivors of head/neck malignancies. We report for the first time use of an Internet-based tool for creation ofSCP by survivors of head/neck cancers.

Materials/Methods: OncoLife, a program for creation of SCP, was made publicly accessible in 5/2007 via OncoLink (www.oncolink.org), a website serving .3.9 million pages/months to .385,000 unique IP addresses and based at the University of Penn-sylvania. Users responding to queries regarding demographics, diagnosis, and treatment receive comprehensive, individualizedguidelines for future care; queries and guidelines have evolved over 4 iterations. Data have been maintained with review by theinstitutional IRB.

Results: From 5/07–3/09, 4796 individuals completed OncoLife surveys; 120 were survivors of head/neck cancer (2.5%). Head/neck cancer survivors were slightly older than the general user population (median 51 years at diagnosis and 54 currently vs. 49 and52, respectively, p = 0.043), with the average time since diagnosis 3.5 years in both groups. Male users represented 65% of head/neck survivors versus 27% of general users (p\0.001). Head/neck cancer survivors reported having been treated with RT (92%),surgery (88%), and chemotherapy (62%), compared to general users reporting treatment with RT (59%), surgery (83%), and che-motherapy (80%) (p\0.001, p = 0.91, and p = 0.024, respectively). Head/neck cancer survivors reported having RT to the primarytumor site in 96% of cases, and for metastatic disease in 4%. Chemotherapy agents were most often cis/carboplatinum (86%), ce-tuximab (28%), and/or taxanes (26%). Surgical treatments consisted of primary tumor/lymph node removal in 93% of cases. Head/neck cancer survivors report being followed by an oncologist and a primary care provider (PCP) (43%), only an oncologist (35%),and only a PCP (12%). Only 12% report having received survivorship information previously.

Conclusions: OncoLife represents the first Internet-based tool for creation of SCP, and head/neck cancer survivors appear willingto use this type of tool. Most report receiving multimodality treatment, including local RT. Known side effects of RT to the head/neck, in combination with surgical/chemotherapeutic toxicity, put this group at particular risk for late effects. Only half report beingfollowed by a PCP, and most have never before received survivorship information. Future goals include further individualization ofplans, and improved access to underserved populations.

Author Disclosure: C.E. Hill-Kayser, None; C. Vachani, None; M.K. Hampshire, None; J.M. Metz, None.

2461 Dose/Time Volume Histograms of the Oral Mucosa are Predictive of the Use of PEG During IMRT for

Oropharyngeal Carcinoma

G. Sanguineti1, B. G. Gunn2, E. J. Endres2, C. Fiorino3

1Johns Hopkins University, Baltimore, MD, 2University of Texas Medical Branch, Galveston, TX, 3San Raffaele Hospital, Milan,Italy

Purpose/Objective(s): Severe mucosal toxicity along with its clinical manifestations (pain, dysphagia) is a limiting factor ofIMRT for head and neck cancer. Establishment of oral mucosa dose-time-volume relationships might improve compliance throughapplication of appropriate constraints.

Materials/Methods: Data of 59 consecutive patients treated with IMRT alone at UTMB for T1-3N0-3 oropharyngeal carcinomawere recovered. All patients were treated with a dose-painting approach and 3 dose levels. 25/59 received an hyperfractionatedregimen (1.3 Gy, twice daily, HYPER) to a prescribed total dose of 78 Gy to the tumor volume; the remaining 34 patients weretreated with once-a-day fractionation schedules (non-HYPER) to either 66 Gy at 2.2 Gy per fraction (9 patients) or 70 Gy at 2Gy (25 patients). It was our policy not to use the prophylactic insertion of a PEG tube before IMRT, but rather based on patientsymptoms during treatment as appropriate. A number of clinical and dosimetric factors, including the DVH of oral mucosa, wereconsidered. DVH were rebinned to calculate the average DVH per week (DVHw). DVHw of patients with and without PEG duringIMRT were compared through two-sided t tests in order to assess the best predicting region of the DVHw, both in the whole pop-ulation and in the non-HYPER group. Receiving-operator characteristics curves (ROC) were used to assess the most predictivedose-volume combinations and logistic univariate and multivariate models were assessed.

Results: Overall 22/59 patients needed a PEG tube, 15/25 in HYPER and 7/34 in non-HYPER group. The most predictive region ofDVHw was around 9.5–10 Gy/week; ROC curves suggested 64 cc and 54 cc to be the best cut-off values for V9.5 Gy and V10 Gy,respectively. At univariate logistic analysis, fractionation, mean dose to oral mucosa, mean week-dose to oral mucosa, V9.5 Gy andV10 Gy were strongly correlated with the increased risk of PEG placement with p values ranging between 0.0015 and 0.006. Ina multivariate logistic analyses including fractionation and V9.5 Gy ($ vs. \ 64cc), V9.5 Gy resulted to be the most predictiveparameter (OR = 30.8, 95%CI: 3.7–254.2, p = 0.0015), in agreement with a quasi-threshold effect for this endpoint, confirmedeven in the group of non-HYPER patients (OR = 21, 95%CI: 2.1–210.1, p = 0.01).

Conclusions: Current analysis supports the existence of a quasi-threshold relationship between the amount of oral mucosa receiv-ing more than 9.5–10 Gy per week and the need of PEG during IMRT; when possible, reducing V9.5–V10 Gy of oral mucosabelow 50–60 cc may reflect in a substantial reduced risk of gastrostomy. A prospective validation study is warranted.

Author Disclosure: G. Sanguineti, None; B.G. Gunn, None; E.J. Endres, None; C. Fiorino, None.