1047 Palliation of symptomatic recurrences in previously irradiated head & neck tumors: Minimal complications using high dose rate afterloading brachytherapy

Proceedings of the 38th Annual ASTRO Meeting

267

1046 RADIOTHER4PEUTIC

PALLIATION

Silverman,

Center, Richmond,

OF BRAIN

Larry N., Friedman,

Department Virginia

of Radiation

METASTASIS:

Richard Oncology,

A RETROSPECTIVE

B., Lutz, Stephen T., Lu, Jiandong., Medical

College

of Virginia,

QUALITY

OF LIFE ANALYSIS

and Huang, David T.

Richmond,

Virginia

and Hunter

Holmes

McGuire

VA Medical

PURPOSE/OBJECTIVE: To assess quality of life effects of radiation therapy on patients with brain metastasis. Not only is data on this subject rare, there is also no psychometrically tested brain metastasis symptom scale. We report data using a scale of our own design. MATERIALS & METHODS: Over 200 charts of patients treated for brain metastasis from various primary sites between 1990 and 1995 were reviewed. Seventy-two patients met the criteria for evaluation. They were all treated with radiotherapy and steroids. The majority of patients received a median dose of 30 Gy (Range 20 - 55) to the whole brain. Treatment over 40 Gy was delivered via a boost, either external beam or stereotactic. Pre and post-therapy symptoms of impaired vision, speech, sensation, motor strength, gait, cranial nerves, headache, seizure, lethargy, mentation, and nausea and vomiting were scored. Each symptom was evaluated separately. Following therapy, patients were noted to have improvement, no change, or worsening symptoms. Steroid and anti-seizure medication use pre and post-therapy were also recorded. RESULTS: Patient characteristics: median age is 62 (Range 27 - 82 years); Female : Male = 1.4 : 1; Single : Multiple metastasis = 1 : 2.3. The primary sites included: lung=56%, breast=15%, unknowu=l l%, and various=lV%. The histologies included: adenocarcinoma=26%, squamous cell carcinoma=21%, small cell carcinoma=15%, infiltrating ductal=l4%, and various=24%. All patients had a minimum of one month post-treatment follow up (Range 1 - 24 mths). Sixteen patients are still living. Eighty-nine percent were symptomatic at presentation and 36% presented with only one symptom. The incidence of symptoms before treatment was: altered mentation=26%, decreased motor strength=26%, headache=24%, seizure=21%, altered gait=20%, nausea/vomiting=lV%, speech deticit=15%, lethargy=1 l%, visual change=V%, altered sensation=7%, and cranial nerve deticits=3%. A statistically significant improvement in mentation (p
1047 PALLIATION OF SYMPTOMATIC MINIMAL COMPLICATIONS USING Janet Nettleton, Department

M.D.,

RECURRENCES IN PREVIOUSLY HIGH DOSE RATE AFTERLOADING

Lobna Sedky, M.D., Albert Kasenter,

of Radiation

Oncology

& Biophysics,

MS., Deborah

Eastern Virginia

Medical

IRRADIATED HEAD BRACHYTHERAPY

Kuban, M.D., School, Norfolk,

and Anas El-Mahdi,

& NECK

TUMORS:

M.D., Sc.D., F.A.C.R.

VA 23507

Purpose: This study was undertaken

to determine the effectiveness of HDR Irl92 afterloading brachytherapy (HDRAB) in improving the quality of life in previously irradiated patients who are not candidates for further external beam therapy or palliative surgery. We have reviewed our experience with HDRAB for treatment of recurrent head and neck tumors and analyzed the percent of patients palliated, the duration of response, complications, and dose and fractionation schemes.

MATERIALS AND METHODS: There were 497 patients with head and neck tumors seen in our department between 1988 and 1995. Recurrences were typically treated with surgery or additional external beam radiotherapy. However, 23 patients had distressing symptomatic recurrent tumors within previously irradiated fields and were not candidates for further surgery or external beam radiothempy. These patients received palliative HDRAB treatment to 32 separate sites, 21 through interstitial and 11 through intracavitary techniques. Treated sites included neck nodes, nasal cavity, nasophatynx and hypopharynx. The major presenting symptoms were pain bleeding, nasal obstruction and dysphagia. The median size of symptomatic recurrent masses was approximately 4 cm x 5 cm. Several dose and fractionation schemes were utilized; however, most patients were treated to a total dose of 20 to 30 Gy in 10 treatments over 5 consecutive days without a weekend break. The interfinction interval was at least 6 hours. Response to treatment was assessed over at least a 6 month period or until death. A palliative response was defined as alleviation of the specific presenting sign or symptom for a minimum of 3 months time. Patients who expired less than 3 months after treatment were recorded as a failure. RESULTS: Overall, 69% of patents were palliated at least 3 months with minimal complications. There is a trend towards more durable results, longer than 6 months, in patients treated to the higher total dose of 30 Gy (Fischer exact p = 0.018). Complications in all treated patients were limited to acute mucositis, desquamation, fibrosis and erythema. There were no severe complications including hemorrhage, tistula formation, bone necrosis or infection. CONCLUSION: Effective results suggest that HDRAB The more durable palliation

palliative therapy improves quality of life by relieving symptoms without causing further problems. Chu may provide outpatient palliation for these difficult patients in a safe, efficient and cost effective manner. was seen in those patients treated to the higher dose of 30 Gy delivered BID over 5 days.