200 Impact of Weight Loss on Grip Strength in Head and Neck Cancer Patients Receiving Radiation Therapy A. Hilbert, J. McGuire, S. Rentz, D.A. Elliott, and J.M. Holland; Oregon Health and Science University, Portland, OR Purpose/Objective(s): Malnutrition is a common complication for head and neck cancer (HNC) patients receiving radiation therapy (RT) or che- moradiation therapy (CRT). The Academy of Nutrition and Dietetics (AND) and the American Society of Parenteral and Enteral Nutrition (ASPEN) define moderate and severe malnutrition as the presence of 2 or more of the following: inadequate energy intake, weight loss, loss of body fat, loss of muscle mass, fluid accumulation, or reduced grip strength. In malnutrition, decreased muscle function may respond more quickly to nutritional deprivation than changes in weight. Research suggests that grip strength is a feasible tool for the bedside assessment of muscle function. The purpose of this study was to implement grip strength assessment as part of the nutrition assessment for HNC patients receiving RT or CRT and to investigate the relationship between grip strength and weight loss before and after 7 weeks of RT. Materials/Methods: Grip strength, assessed by dynamometry, and weight were recorded the first and last week of RT. Each hand was measured 3 times and the average was calculated. Hand dominance was noted. Sub- jects were classified as malnourished if they met the AND/ASPEN malnutrition criteria for weight loss and reduced grip strength. Reduced grip strength was defined as a grip strength 2 standard deviations (SD) below the normative standards provided with the dynamometer. Descrip- tive statistics were used to describe the subject population, changes in grip strength, and changes in weight. Correlation between change in grip strength and change in weight was performed using the Pearson correlation. Results: Eleven subjects, with a median age of 59 years (53-74), received RT (nZ4) or CRT (nZ7). Mean change in grip strength for the left hand was -1.03.8 kg (SD) and for the right hand was -0.75.6 kg (SD). The mean weight loss was 6.66.4 kg (SD). Decreased grip strength correlated weakly with weight loss for both the left (rZ0.248, 90% confidence in- terval [CI] -0.205-0.501, PZ.462), and right hand (rZ0.180, 90% CI -0.396-0.686, PZ.596). Two subjects (18%) at the initial treatment visit and 1 subject (9%) at the last treatment visit qualified as malnourished. Conclusion: Although this study found no statistical correlation between weight loss and grip strength in the small series of HNC patients receiving RTor CRT, collecting data on grip strength using the dynamometer proved feasible. To more accurately diagnose malnutrition using the criteria of reduced grip strength, further research is needed to establish grip strength reference ranges. Author Disclosure: A. Hilbert: None. J. McGuire: None. S. Rentz: None. D.A. Elliott: None. J.M. Holland: None. 201 Parapharyngeal Space Tumor: Submandibular Approach Without Mandibulotomy K. Luna-Ortiz, 1 O. Villa-Zepeda, 2 J. Carrillo, 3 E. Molina-Frias, 4 and A. Gomez-Pedraza 5 ; 1 Instituto Nacional de Cancerologia, Mexico City, Mexico, 2 Instituto Nacional de Cancerologia, Mexico City, Mexico, 3 Instituto Nacional de Cancerologia, Mexico City, Mexico, 4 Instituto Nacional de Cancerologia, Mexico City, Mexico, 5 Instituto Nacional de Cancerologia, Mexico City, Mexico Purpose/Objective(s): From all head and neck tumors, only 0.5% occur in the parapharyngeal space, and 80% are benign tumors. Surgery is the cornerstone of treatment. The deep location of this space and of sur- rounding structures have given origin to a large number of surgical approaches for resection of parapharyngeal tumors. Our experience using the transcervical approach on 14 patients who had surgery upfront for treatment of these neoplasms is described. Materials/Methods: A retrospective descriptive case series analysis of patients with parapharyngeal space tumors treated from January 2009 to July 2015 was performed. Results: Fourteen patients were included: 11 females (76.9%) and 3 males (23.1%) with a mean age of 46.9 years (range 20-75 years). The most common symptom reported at presentation to our clinic was a foreign body sensation in the oropharynx and pain. Navigation-guided surgery was used in 2 cases. Mean size of tumors was 4.7 cm. Complete resection of lesions was performed in all cases, and the only major complication was major bleeding in 1 case (7.1%). Conclusion: According to the present analysis, the submandibular transcervical approach is an effective and safe technique that allows resection of large parapharyngeal tumors, even those close to the skull base. It has minimal morbidity, prevents morbidity associated man- dibulotomy, and allows extension to a transparotid, transmandibular, and even to an infratemporal fossa approach. Navigation is indicated in tu- mors 2 cm. The submandibular transcervical approach should be considered upfront for tumors 6 cm, preferentially 0.5 cm distant from skull base. Author Disclosure: K. Luna-Ortiz: None. O. Villa-Zepeda: None. J. Carrillo: None. E. Molina-Frias: None. A. Gomez-Pedraza: None. 202 WITHDRAWN 203 Prognostic Value of Lymph Node Status Is Greater Than Lymph Node Ratio and AJCC N Staging for Head and Neck Squamous Cell Carcinomas T. Roberts, 1 A.D. Colevas, 1 W. Hara, 1 F.C. Holsinger, 1 I. Oakley-Girvan, 2 and V. Divi 1 ; 1 Stanford University, Stanford, CA, 2 Cancer Prevention Institute of California, Fremont, CA Purpose/Objective(s): Changes in the epidemiology of head and neck cancers have created a need for new lymph node prognostics. The lymph node ratio (LNR) has been proposed as an alternative staging system, but this metric has limitations that may attenuate its prognostic value. This study sought to test the prognostic value of the lymph node status (pN) and compare it to the LNR and American Joint Committee on Cancer (AJCC) N staging. Materials/Methods: The Survival, Epidemiology, and End Results (SEER) database was used to identify surgical cases from 2004 to 2012. The study sample was grouped based on AJCC N stage, LNR, and pN and analyzed using the Kaplan-Meier method and multivariate Cox propor- tional hazard models. Models were compared using the Akaiki Informa- tion Criterion (AIC). The sample was also analyzed by site of primary tumor. Results: We identified 12,437 patients in the SEER database for analysis. Distribution of nodal staging was 5282 N0 patients, 2483 N1 patients, 4454 N2 patients, and 218 N3 patients. Twenty-four percent of patients had an oropharyngeal primary. Kaplan-Meier survival curves showed improved prognostic ability for pN and LNR staging relative to the AJCC system. Tumors with >5 positive nodes were associated with the worst overall survival (5-year survival rate Z 16%). Oropharyngeal tumors had better outcomes for all groupings in all staging systems as compared to those in nonoropharyngeal sites. Using the pN staging system, >5 positive nodes in oropharyngeal tumors was strongly associated with decreased survival (5-year survival rate Z 53%), while patients with 0 to 5 positive nodes had similar 5-year survival.Multivariate regression outputs demon- strated more prognostic hazard ratios and a lower AIC for the pN model compared to the AJCC N stage and LNR models (Table 1). Hazard ratios were 1.78 (95% confidence interval [CI], 1.62-1.95) for 1 positive node, 2.53 (95% CI, 2.32-2.75) for 2-5 positive nodes, and 4.64 (95% CI, 4.18- 5.14) for >5 nodes. Conclusion: The pN models demonstrated superior prognostic value compared to the LNR and AJCC N staging in the overall study sample Volume 94  Number 4  2016 Posters 911