201 Quality of life in patients with brain metastases treated with a palliative course of radiotherapy

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Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontariol; Princess Margaret Hospital, University of Toronto, Toronto, Ontario2; Tom Baker Cancer Centre, Calgary, Alberta3; Cancer Research UK Clinical Centre, University of Leeds, Leeds, UK 4; European Organization for Research and Treatment of Cancer, Brussels, Belgium 5 sukirtha, tharmalinqam@sunnybrook, ca Purpose: To identify important quality of life (QOL) issues in patients with bone metastases. Methods: Patients with bone metastases and health care professionals (HCPs) involved in their care were asked to choose the most important five to ten QOL issues from a questionnaire listing 61 potential items (generated from literature review and in depth interviews with patients and HCPs) related to: symptoms (13), function (15), treatment side effects (3), psychosocial domains (27), treatment expectations (2) and other (1). Results: Three-hundred and twenty-eight patients and 106 HCPs were interviewed at Toronto Sunnybrook Regional Cancer Centre, Princess Margaret Hospital and Tom Baker Cancer Centre. Most patients were from outpatient clinics. HCPs included 36 radiation oncologists, 26 nurses, 22 medical oncologists and 11 palliative care doctors. The following issues were identified by both patients and HCPs: Long-term (or chronic) pain; difficulty carrying out usual daily tasks (grocery shopping work outside the home housework) able to perform self-care; able to perform role functioning (including domestic and family roles). Additional QOL issues from patients' perspective were: lack of energy; worry about becoming dependent on others; worry about loss of mobility compromising independence; difficulty in carrying out meaningful activity (including employment); worry about disease progression deterioration in condition and future complications; financial burden due to the illness. Additional QOL issues from HCPs' perspectives were: shortterm (or acute) severe pain; uncontrolled unmanageable pain not relieved by painkillers; pain at night preventing sleep; limited movement due to pain; pain at rest (when sitting); hope for sustained pain relief (reduce pain for as long as possible). Conclusions: HCPs identified symptoms (six related to pain), functions and treatment expectations as important QOL issues. In contrast, patients indicated financial burden and psychosocial issues as equally important QOL issues as symptoms (only one related to pain) and functions. 199 Segment Weight Optimization Treatment Planning for Adjuvant Radiochemotherapy of Gastric Carcinoma S. Leung, T. Purdie, T. Lain, J. Price, J-P. Bissonnette, L. Dawson, J. Kirn, J. Ringash Princess Margaret Hospital, Toronto, Ontario Simon. LeunQCc~rmo. uhn. on. ca Purpose: Radiotherapy volumes of gastric cancer are large and adjacent organs at risk (OARs), such as kidneys, liver, spinal cord and heart, make tumour coverage challenging if normal tissue tolerances are to be maintained. This paper presents a semi-automated planning technique that delivers adequate dose coverage to target volumes, increases dose homogeneity and maintains dose constraints of critical organs for adjuvant radiochemotherapy of gastric carcinoma. Methods and Materials: Patients were instructed to eat a standard light meal to minimize variations in stomach content and reduce potential gas present in the gastrointestinal system for CT simulation and treatments. Patients were simulated in custom-made immobilization bags in the supine position with arms above head. This ensured patient comfort and increased reproducibility for treatments. Patients were also imaged on fluoroscopy for evaluation of organ motion. OARs and target volumes were contoured with a prescription of 4500 cGy/25 Rx. Five coplanar and one non-coplanar 6 MV beams were divided in five step-and-shoot segments, each segment blocking one of the OARs exposed in the open field. Segment-weight optimization was used to obtain a conformal dose distribution using IMRT tools from Pinnacle 7.6c planning system. Dose

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volume histograms of target volumes and OARs were evaluated and optimization objectives were readjusted for further iterations until the desired dose coverage, homogeneity and constraints were met. Beam parameters, optimization objectives, shielding, and dose constraints will be detailed on the poster. Results: Since July 2005, 16 patients were treated by this technique. Average CTV and PTV volumes were 864.3cc and 1346.0cc; 4140 cGy covered 96.8% and 94.1% respectively. Average mean doses to left kidney, right kidney, liver and heart were 1810.8, 1552.6, 2524.5 and 1488.9 cGy respectively. Average maximum spinal cord dose was 3519.0 cGy. Conclusion: This technique delivered adequate dose coverage to target volumes while maintaining critical organ dose constraints. It also standardized planning procedures. 200 The Role of Radical Radiation Therapy on Medically Inoperable Clinically Localized Non-small Cell Lung Cancer Patients: The London Regional Cancer Program (LRCP) Experience E. YU1, P. Tai2, R. Ash I, M. Lee 1, L. Stitt 1, G. Rodrigues 1, R. Oar z, M. VincentI, R. Inculet ~, R. Malthaner z London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, London, Ontario1; Allan Blair Cancer Centre, University of Saskatchewan, Regina, Saskatchewan 2 Edward. Yu@lhsc. on. ca

Purpose: To review the experience of radical radiation therapy (RT) treatment in clinically localized medically inoperable nonsmall cell lung cancer (NSCLC) patients. Methods: Clinically staged node negative NSCLC patients who were not surgical candidates due to comorbid diseases but eligible for curative treatment, were reviewed between January 1985 to January 2004. Previously treated chest RT patients were excluded. Patients received RT given in localized portal underwent simulation prior to therapy with doses ranged from 50 to 64 Gy at 2 to 2.5 Gy fraction. Hazard ratios and P-values were determined for time to recurrence and patient survival. Results: A total of 76 patients were evaluable including 60% males and majority (52%) had pathology of squamous cell carcinoma. Median age was 69 years old (ages ranged from 38 to 92). Clinical stages were T1 (28%), T2 (54%), and T3 (18%). Seventy-eight percent of patients completed radical RT, 20% declined RT and 2% chose to receive chemotherapy of Cisplatin based. Median follow up was 17.6 months (ranged from 0.4 to 123 months). In the patients who completed RT two and five-year disease free survival (DFS) were 38.1% and 11.4%, overall survival (OS) were 33.3% and 6.9%, respectively. The median DFS and OS for T1, T2, and T3 were 18.7,14, 15 months; and 23.1,18.5, 14.5 months, respectively. Patients who received RT compared to no RT had median cause specific survival (CSS) of 21 months and 4.9 months (p<0.001); OS of 20 months and five months (p<0.001), respectively. Tumour size had impact on patient survival in univariate (p=0.004) and multivariate (p=0.002) analyses. Conclusions: Radical RT significantly improves survival for patients with medically inoperable clinically staged localized NSCLC, and tumour size is a predicator of patient outcome. 201 Quality of Life in Patients with Brain Metastases Treated with a Palliative Course of Radiotherapy M. Tsao, M. Doyle, N. Bradley, K. Lam, G. Chan, E. Barnes, E. Chow Toronto Sunnybrook Regional Cancer Centre, University of Toronto, Toronto, Ontario rnav. ts~o(~sunnybrook, ca

Objectives: The primary objective was to assess whether there is an improvement in quality of life (QOL) for patients with brain metastases after a course of whole brain radiotherapy (WBRT). The secondary objective was to assess the level of concordance between proxy and patient-rated QOL scores.

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M e t h o d s and Materials: This prospective study required 60 patients and 60 caregivers in order to detect a difference of 10 in global QOL scores between pre and post radiotherapy assessments. Patients with multiple brain metastases were treated with WBRT (2000 cGy in 5 daily fractions). The validated QOL questionnaire (FACT-BR) was administered to patients and their caregivers at baseline before radiotherapy, and then one and two month(s) after the completion of radiotherapy. A pair-wise T-test was used to detect a statistically significant difference in global QOL scores between pre and post radiotherapy QOL assessments. Using the Bonferroni adjustment for multiple comparisons, a p value less than 0.008 was deemed to be statistically significant. Lin's concordance correlation coefficient was used to assess concordance between patient and proxy QOL ratings. Results: We were unable to detect a difference in general QOL scores, FACT-G (p=0.342) and brain subscale scores, FACT-BR (p=0.403) at baseline as compared to 1 month following WBRT. There was a trend toward worsening FACT-G scores, p=0.013 and FACT-BR scores, p=0.044 at two months following WBRT (as compared to baseline scores). There was poor agreement (Lin's concordance=0.4136) for both FACT-G and FACT-BR scores as ranked by patients and their caregivers at baseline. Conclusions: There was a trend toward worsening general and brain specific quality of life scores, two months after WBRT. Proxy ratings of patient's QOL showed poor agreement at baseline. 202 Research and Professional D e v e l o p m e n t : V i d e o / P h o n e Conference as a F o r m a t for A d v a n c e m e n t s in Palliative Radiotherapy K. Burrows 1, C. Danjoux 2, A. Bezjak 1, F. Wong 3, J. Wu 2, G. Duncan 3, R. Samant ~, J. Wright 5, R. Wong 1 Princess Margaret Hospital, Toronto, Ontariol ; Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario2; British Columbia Cancer Board, Vancouver, British Columbia3; Ottawa Regional Cancer Center, Ottawa, Ontario4; Juravinski Regional Cancer Center, Hamilton, Ontario 5 Katy. Burro ws@rmp, uhn. on. ca Background: Communication between specialists in the area of Palliative Radiotherapy is essential for advancements in research and professional development. The integration of novel communication tools relies upon initiatives implemented by individuals closely involved in the care and treatment of palliative patients. Video/phone (V/P) conferences were implemented between eight Canadian Cancer Centres interested in maintaining research collaboration and professional development. We assessed the impact of V/P conferencing through participant and presenter survey. Methods: The Palliative Radiation Oncology Group (PROG), established in 2000,has expanded from two centres in Toronto to eight, nation-wide. V/P conferences occurred monthly throughout the academic year and participant surveys were utilized to evatuate their impact. Surveys included a 17-item questionnaire exploring 6 themes in addition to a presenter survey exploring academic output in December 2003. Results: Twenty-six V/P conferences were held SePtember 2000-December 2003. Of 20 respondents who completed the participant surveys, 80% agreed it allowed for the ability to discuss clinical practice issues in radiation oncology, 95% felt it added to their educational objectives and 80% agreed it facilitated the development of research ideas, developed protocols and provided a forum for the presentation of study results. Twenty-four of twenty-six presentations resulted in research projects of which 50% are complete while one was incorporated by the NCIC. Additionally, 75% of completed studies were published in peer-reviewed journals and 10 were presented (inter)nationally. Conclusions: V/P conferencing is an effective format for advancements in research and professional development between colleagues sharing the same interests but challenged by geographical issues. It also allowed for effective communication between specialists with the area of palliative radiotherapy. Other individuals with similar areas of interest

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experiencing geographical challenges may benefit from V/P conferencing. 203 Predictors of O u t c o m e in Cervical Esophageal Cancer S.H. Huang, G. Lockwood, J. Brierley, B. Cummings, R. Wong, J. Kim, A. Saporta, 3, Ringash Princess Margaret Hospital, University of Toronto, Toronto, OntariO shaohui, huana@rmp, uhn. on. ca Objectives: To investigate the possible prognostic factors for cervical esophageal cancer. Method: We retrospectively reviewed all cases of cervical esophageal cancer treated in one quaternary-care cancer centre between 1997 and 2005. All cases were restaged using UICC-1983 clinical staging criteria. Overall survival (OS) and Ioco-regional relapse-free survival (LRFS) were calculated using the Kaplan-Meier method. Patient (age, gender), disease (T, N category, hypopharyngeal or thoracic extension) and treatment factors (treatment modality, radiation dose, chemotherapy agent, treatment protocol) were investigated as potentially prognostic in the curative subgroup. Log rank test was performed for statistical significance (p<0.05). Results: We identified 71 cases (46 males and 26 females) with median follow-up of 2.61 years. Fifty of them were treated curatively. For the whole group, the median OS and LRFS were 1.55 and 1.44 years. At one and two years, OS was 60% and 37% and LRFS was 55% and 39%. For the curative subgroup, median OS and LRFS were 1.77 and 1.82 years; 1 and 2 year OS 79% and 48% and LRFS 69% and 49%. No statistically significant prognostic relationships were found. A trend to better OS was seen in: older patients (>64) (p=0.25), hypopharynx involvement (p=0.18), and lower T category (p=0.17). A trend to better LRFS was seen in: older patients (>64) (p=0.20), females (p=0.10), and those who received chemoradiation (p=0.10). A hypothesized improvement in survival due to change in treatment protocol in 2001 to high dose Cisplatin and conformal radiation was not statistically demonstrated, however LRFS curves suggest a trend to improvement beyond two years (p~0.47). Conclusions: Statistical power was limited due to sample size. Trends confirm previously reported prognostic factors. Longer follow-up is required to interpret a slight trend to better LRFS with high dose Cisplatin and conformal radiotherapy. 204 A Phase I I Trial of a Soy B e v e r a g e for Subjects W i t h o u t Clinical Disease w i t h Rising PSA A f t e r Radical Radiation for Prostate Cancer W. Kwan 1, G. Duncan 2, C. Van Patten 2, M. Liu 1, J. Lira 3 British Columbia Cancer Agency, Fraser Valley Centre, Surrey, British Columbia1; British Columbia Cancer Agency, Vancouver Centre, Vancouver, British Columbia2; British Columbia Cancer Agency, Vancouver Island Centre, Victoria, British Columbia 3 wkwan@bccancer, bc. ca Objectives: To evaluate the effect and tolerability of a daily soy beverage as a treatment for prostate cancer biochemical failure after radical radiation. M e t h o d s and Materials: Patients with rising PSA after radical radiation for prostate cancer but no other evidence of disease were recruited into the study which requires them to consume two cups (500ml) of soy beverage for six months. Eligible patients had non-castrate levels of serum testosterone and at least four rising PSA levels three months or more apart with biochemical failure as defined by the nadir +2 criteria. All men had monthly serum PSA measurements after commencement of the soy and had urinary phytoestrogen metabolite measurements to assess compliance. The rate of rise of serum PSA (PSA velocity) after the consumption of soy was compared with the PSA velocity prior to intervention. The study was designed with an 80% power of detecting a 50% reduction in the PSA velocity induced by the soy beverage. Results: Thirty-four patients were enrolled from September 2004 to May 2005. Five withdrew before three months of soy