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121 oral High dose rate (HDR) interstitial brachytherapy for stage III and IV head and neck cancers
$60
Saturday, May 15, 2004
Proffered papers
Results: Median Follow up = 32 (2-108) months Local control = 50/56 (89%) DFS = 46/56 (82%) OS = 36/56 (64%). We noticed 4 chronic soft tissue necroses and 4 osteoradionecroses. 7 patients had temporary soft tissue necrosis which healed on therapy. Discussion: Our results i s comparable to recently published results for LDR ~9~lr brachytherapy (Gibbs et al Int.J.Radition Oncol. Biol. Phys. 2003:57:s.489-494). Local control for advanced tumours (T3-T4) seems to be better than with external radiotherapy alone (Mendenhall et al JCO 2000tt 8;s 35-42). Conclusion: PDR brachytherapy seems to give the same excellent results as LDR ~921rbrachytherapy. 120 oral Primary carcinoma of the oropharynx, relapse and complications: cost analysis comparing brachytherapy versus surgery
P. Levenda.q~, W. Nijdam ~, I. Noever ~, C. Uyl-de Groot2, M. van Agthoven 2 1Erasmus MC - Daniel den Hoed, Radiation Oncology, Rotterdam, The Netherlands 2Institute Medical Technology Assessment, Rotterdam, The Netherlands Purpose : the objective of this study is to compare costs for BT as opposed to S for the primary treatment (Tx) of oropharyngeal cancers (Oph), for the Iocoregional relapses (LRR), distant metastasis (M+) and for the treatment of grade Ill/IV complications necessitating hospital admission. Materials : From 1991-2001 (minimum FU 2-years), cancer in the OPh was treated by EBRT + BT boost, and ND in case of N+ disease (BT-group: 157). If BT is not feasible, combined resection with postoperative EBRT (S-group: 110) is performed. Mean costs of Tx, time to (months)- and mean costs of LRR, M+, and grade Ill/IV complications, were calculated for BT- and S-group. Lecoregional control (LRC), DFS and OS were computed according to Kaplan Meier. Results : Mean Costs of Tx, LRR, M+ and Grade Ill/IV complications: see table. .................i......................... ............................................................... .............. ........ Months I Months i~ i Group cTs~s ,u*~ LRR Months to M+ I t ~ L,ompq.~l Costs M+ costs ! m I Costs i LRR i i Co p. '. iBT .........
S
12~07
16
................
~...........................
19319!
11
12589
22
40sl
............................ i...............................................
i 7401
15
~ 7 i ........................
4187 I
8
7380 . . . . . -I
158571
(Costs are computed in Euros ~ Clinical outcome: LRC 5-yrs: 85% (BT), 82% (S). D F S 5-yrs: 61% (BT), 48% (S). OS 5-yrs: 65% (BT), 52% (S). Conclusions : The costs of Tx in case of BT (12507 Euro) were less as opposed to S (19319 Euro). The costs of S, being the main modality for the LRR of the BT-group, was high (12589 Euro); moreover, costs of clinical treatment of Grade Ill/IV complications were higher for the S-group (15857 vs. 7380 Euro). Main underlying cause for differences in costs between S and radiation is number of admission days, i.e. for LRR 21 vs. 14 days, complications 31 vs. 15 days, whereas no difference for M+ (9 vs. 8 days). This study exemplifies that main costs are generated within 24 months after initial treatment. Moreover, costs can be used in prioritizing treatment modalities for H&N cancers, in particular in case of equal clinical outcome.
121 oral High dose rate (HDR) interstitial brachytherapy for stage III and IV head and neck cancers
A. Puthawala 1'2,A. Syed ~'2,A. Sharmd 'z, J. Hepef 'z ~Long Beach Memorial Medical Center, Radiation Oncology, Long Beach, U.S.A. 2UCI Medical Center, Radiation Oncology, Orange, U.S.A Purpose: To evaluate the efficacy and safety of dose fractionation schedule for high dose rate interstitial brachytherapy in the treatment of head and neck cancers. Method and Material: Fifty patients with biopsy-proven head and neck cancer treated between March, 1997 through January, 2003. All patients had stage III or IV disease and received external beam irradiation to the primary and the neck to a total dose of 50.4 Gy in five-and-one-half weeks prior to brachytherapy. The brachytherapy dose of 18-24 Gy delivered in six to eight equal fractions BID to the primary site and 20-32 Gy in five to eight fractions BID to the neck. Equivalent HDR fractionation schedule was derived using linear-quadratic equation based on our LDR experience.
Results: Locoregional tumor control at two years was 86% for the entire group with five year disease-free survival of 60%. RTOG Grade III and IV late side effects such as osteoradionecrosis or soft tissue necrosis occurred in 7% of patients. These results are comparable to our long term results using low dose rate brachytherapy. Conclusions: The dose fractionation schedule used for high dose rate interstitial brachytherapy, which was based on our long term experience using low dose rate brachytherapy, appears to be efficacious and safe and provides comparable results. 122 oral First report of an institutional phase I-II trial perioperative fractionated HDR brachytherapy (PHDRB)
of
R. Martfnez-Mon,qe1, M. Cambeiro ~, C. Garran 1, M. Jurado 2, J. Alcalde s, M. San Julian ~, S. Amillo4, C. Concejo3, J. HemandezLizoain5, F. Pardo5 University of Navarra, Oncology, Pamplona, Spain 2University of Navarra, Gynecology, Pamplona, Spain 3University of Navarra, ENT/Oral surgery, Pamplona, Spain 4University of Navarra, Orthopedics, Pamplona, Spain 5University of Navarra, Digestive Surgery, Pamplona, Spain Background: To determine the feasibi~ity of a 4Gy bid PHDRB regimen. Protocol characteristics included: 1) implantation of catheters during open surgery; 2) CT-based dosimetry following the rules of the Paris system with manual optimization, 3) PHDRB dose assignment according to the quality of the surgical resection (R0 vs. R1 vs. R2) as described in the final pathology report. Material and methods: 111 patients have been included during the study period 2000-2003. Main groups were head and neck 41, sarcomas 34, gynecologic 15, colorectal 9 and other 12. Resection type was categorized as R0, R1 and R2 in 21, 88 and 2 patients, respectively. R1 resections were close in 45 patients (average margin distance of 3.2ram) and microscopically positive in 43 patients. 29 previously irradiated patients were treated with surgical resection + PHDRB. No further external beam radiation (EBRT) was given. The brachytherapy dose was 4 Gy bid x 8 (32 Gy total dose) for R0 resections, 4 Gy bid x 10 (40 Gy total dose) for R1 resections and 4 Gy bid x 12 (48 Gy total dose) for R2 resections. 82 unirradiated patients (54 with primary disease, 28 with recurrent disease after surgery) patients were treated with
Saturday, May 15, 2004
Proffered papers
Results: Median Follow up = 32 (2-108) months Local control = 50/56 (89%) DFS = 46/56 (82%) OS = 36/56 (64%). We noticed 4 chronic soft tissue necroses and 4 osteoradionecroses. 7 patients had temporary soft tissue necrosis which healed on therapy. Discussion: Our results i s comparable to recently published results for LDR ~9~lr brachytherapy (Gibbs et al Int.J.Radition Oncol. Biol. Phys. 2003:57:s.489-494). Local control for advanced tumours (T3-T4) seems to be better than with external radiotherapy alone (Mendenhall et al JCO 2000tt 8;s 35-42). Conclusion: PDR brachytherapy seems to give the same excellent results as LDR ~921rbrachytherapy. 120 oral Primary carcinoma of the oropharynx, relapse and complications: cost analysis comparing brachytherapy versus surgery
P. Levenda.q~, W. Nijdam ~, I. Noever ~, C. Uyl-de Groot2, M. van Agthoven 2 1Erasmus MC - Daniel den Hoed, Radiation Oncology, Rotterdam, The Netherlands 2Institute Medical Technology Assessment, Rotterdam, The Netherlands Purpose : the objective of this study is to compare costs for BT as opposed to S for the primary treatment (Tx) of oropharyngeal cancers (Oph), for the Iocoregional relapses (LRR), distant metastasis (M+) and for the treatment of grade Ill/IV complications necessitating hospital admission. Materials : From 1991-2001 (minimum FU 2-years), cancer in the OPh was treated by EBRT + BT boost, and ND in case of N+ disease (BT-group: 157). If BT is not feasible, combined resection with postoperative EBRT (S-group: 110) is performed. Mean costs of Tx, time to (months)- and mean costs of LRR, M+, and grade Ill/IV complications, were calculated for BT- and S-group. Lecoregional control (LRC), DFS and OS were computed according to Kaplan Meier. Results : Mean Costs of Tx, LRR, M+ and Grade Ill/IV complications: see table. .................i......................... ............................................................... .............. ........ Months I Months i~ i Group cTs~s ,u*~ LRR Months to M+ I t ~ L,ompq.~l Costs M+ costs ! m I Costs i LRR i i Co p. '. iBT .........
S
12~07
16
................
~...........................
19319!
11
12589
22
40sl
............................ i...............................................
i 7401
15
~ 7 i ........................
4187 I
8
7380 . . . . . -I
158571
(Costs are computed in Euros ~ Clinical outcome: LRC 5-yrs: 85% (BT), 82% (S). D F S 5-yrs: 61% (BT), 48% (S). OS 5-yrs: 65% (BT), 52% (S). Conclusions : The costs of Tx in case of BT (12507 Euro) were less as opposed to S (19319 Euro). The costs of S, being the main modality for the LRR of the BT-group, was high (12589 Euro); moreover, costs of clinical treatment of Grade Ill/IV complications were higher for the S-group (15857 vs. 7380 Euro). Main underlying cause for differences in costs between S and radiation is number of admission days, i.e. for LRR 21 vs. 14 days, complications 31 vs. 15 days, whereas no difference for M+ (9 vs. 8 days). This study exemplifies that main costs are generated within 24 months after initial treatment. Moreover, costs can be used in prioritizing treatment modalities for H&N cancers, in particular in case of equal clinical outcome.
121 oral High dose rate (HDR) interstitial brachytherapy for stage III and IV head and neck cancers
A. Puthawala 1'2,A. Syed ~'2,A. Sharmd 'z, J. Hepef 'z ~Long Beach Memorial Medical Center, Radiation Oncology, Long Beach, U.S.A. 2UCI Medical Center, Radiation Oncology, Orange, U.S.A Purpose: To evaluate the efficacy and safety of dose fractionation schedule for high dose rate interstitial brachytherapy in the treatment of head and neck cancers. Method and Material: Fifty patients with biopsy-proven head and neck cancer treated between March, 1997 through January, 2003. All patients had stage III or IV disease and received external beam irradiation to the primary and the neck to a total dose of 50.4 Gy in five-and-one-half weeks prior to brachytherapy. The brachytherapy dose of 18-24 Gy delivered in six to eight equal fractions BID to the primary site and 20-32 Gy in five to eight fractions BID to the neck. Equivalent HDR fractionation schedule was derived using linear-quadratic equation based on our LDR experience.
Results: Locoregional tumor control at two years was 86% for the entire group with five year disease-free survival of 60%. RTOG Grade III and IV late side effects such as osteoradionecrosis or soft tissue necrosis occurred in 7% of patients. These results are comparable to our long term results using low dose rate brachytherapy. Conclusions: The dose fractionation schedule used for high dose rate interstitial brachytherapy, which was based on our long term experience using low dose rate brachytherapy, appears to be efficacious and safe and provides comparable results. 122 oral First report of an institutional phase I-II trial perioperative fractionated HDR brachytherapy (PHDRB)
of
R. Martfnez-Mon,qe1, M. Cambeiro ~, C. Garran 1, M. Jurado 2, J. Alcalde s, M. San Julian ~, S. Amillo4, C. Concejo3, J. HemandezLizoain5, F. Pardo5 University of Navarra, Oncology, Pamplona, Spain 2University of Navarra, Gynecology, Pamplona, Spain 3University of Navarra, ENT/Oral surgery, Pamplona, Spain 4University of Navarra, Orthopedics, Pamplona, Spain 5University of Navarra, Digestive Surgery, Pamplona, Spain Background: To determine the feasibi~ity of a 4Gy bid PHDRB regimen. Protocol characteristics included: 1) implantation of catheters during open surgery; 2) CT-based dosimetry following the rules of the Paris system with manual optimization, 3) PHDRB dose assignment according to the quality of the surgical resection (R0 vs. R1 vs. R2) as described in the final pathology report. Material and methods: 111 patients have been included during the study period 2000-2003. Main groups were head and neck 41, sarcomas 34, gynecologic 15, colorectal 9 and other 12. Resection type was categorized as R0, R1 and R2 in 21, 88 and 2 patients, respectively. R1 resections were close in 45 patients (average margin distance of 3.2ram) and microscopically positive in 43 patients. 29 previously irradiated patients were treated with surgical resection + PHDRB. No further external beam radiation (EBRT) was given. The brachytherapy dose was 4 Gy bid x 8 (32 Gy total dose) for R0 resections, 4 Gy bid x 10 (40 Gy total dose) for R1 resections and 4 Gy bid x 12 (48 Gy total dose) for R2 resections. 82 unirradiated patients (54 with primary disease, 28 with recurrent disease after surgery) patients were treated with