- Email: [email protected]
213 A pilot study of accelerated preoperative hype rfractionated pelvic irradiation with or without low dose preoperative prophylactic liver irradiation in patients with locally advanced rectal cancer
$62
September 13-16
Methods: Between December 2005 and February 2006 seven self-selected oncologists (four medical and three radiation) were provided Toshiba M200 Prot~g~ tablet computers using Microsoft XP Professional Tablet, in addition to a proprietary information system (CAIS), E-Film and Internet Explorer. The computers were connected to a secure wireless network (802.11g) within an ambulatory clinic setting. An evaluation questionnaire assessed: 1) The user's perception of the tablet computer's technical properties; 2) how well the tablet could be integrated into the clinic environment during patient encounters; 3) how well the tablet supported the user's interaction with established Agency-standard software. The questionnaire consisted of 68 questions using seven-point Likert scale items ranging from Strongly Disagree (1) to Strongly Agree (7). Results: Average user age: 42 years, five male, two female; two extensive, five intermediate computing experience. Network connectivity was inconsistent. Windows Journal was not considered useful by most users for making notes. Image download was considered slow with screen size and resolution not useful for evaluation of x-ray images. E-Film navigation and comparing image series were not as easy as with a desktop. Internet access was equivalent to that of a desktop computer. Users were indifferent when asked if the tablet computers were as useful as desktop computers in supporting clinical activities and did not consider the tablet computer functional enough to replace a desktop computer in the support of clinical activities. There were, however, useful functions not easily supported by desktop computers such as in-room reviewing of films and current lab results, reviewing Web-based knowledge/information sources and printing patient information. Conclusions: Wireless tablet computers currently have the potential to enhance targeted activities within the realm of outpatient cancer care. Additional user input is ongoing. 212 M e t h o d s to Reduce I n t e s t i n a l M o r b i d i t y f r o m Radiation T h e r a p y to Unilateral Pelvic Bone Metastases: An I n v e s t i g a t i o n to Assess Feasibility S. Scott, W. Levin, N. Lamacchia, K. Maddix, F. Cheung, A. Bezjak, M. McLean, R. Wong Princess Margaret Hospital, University of Toronto, Toronto, Ontario wilfred.levin@rmp, uhn. on. ca Background: Patients with metastases to unilateral pelvic bones are usually treated with a parallel-opposed pair (POP). The treated volume includes a significant amount of intestine that receives full dose. Objectives: Can the volume of bowel be reduced with the use of oblique fields without compromising the dose to the clinical target volume (CTV)? Is the method feasible with conventional simulation? Is it verifiable and reproducible for daily practice? Methods: Four treatment plans were produced from the pelvic CT of an index patient. Using the Pinnacle system, a CTV was drawn for the pelvic bones. The small bowel and large intestine were also contoured. Distributions and dose volume histograms (DVH) were generated for plans of a conventional POP, a POP with half beam block, and for oblique opposed fields with half beam block at gantry angles of both 10 and 20 degrees. Results: All the distributions achieved the prescribed dose to the CI-V (20 Gy). The DVH values at 15 Gy for the intestinal volume showed a reduction of 10% for the POP with half beam block and reductions of 43% and 73% for the oblique plans at 10 and 20 degrees respectively. In practice, with conventional simulation the iliac bones can be readily visualized in profile and the treatment fields verified with check films or electronic portal imaging. The simulation of the 20-degree oblique plan required a simple geometric calculation to establish the depths for dose calculation. Conclusions: The use of oblique fields for treating unilateral pelvic bone metastases yields a better therapeutic ratio than the conventional POP. The basic simulation at an obliquity of ten or twenty degrees does not present any significant technical or dosimetric challenges. Palliative patients with
CARO 2 0 0 6
unilateral pelvic bone metastases can be simply treated in this way with a great reduction of potential intestinal morbidity. 213 A Pilot Study of Accelerated Preoperative H y p e r f r a c t i o n a t e d Pelvic I r r a d i a t i o n W i t h or W i t h o u t Low Dose P r e o p e r a t i v e Prophylactic Liver I r r a d i a t i o n in Patients w i t h Locally Advanced Rectal Cancer R. Suwinski 1, J. Wydmanski 1, I. Pawelczyk2, J. Starzewski 2 Centre of Oncology, Gliwice, Polandl; Department of Colorectal Surgery, Medical University of Silesia, Sosnowiec, Poland2 [email protected] Purpose: To evaluate the feasibility of preoperative accelerated hyperfractionated pelvic irradiation (HART) with or without low-dose preoperative prophylactic liver irradiation (PLI) in patients with locally advanced rectal cancer. M a t e r i a l and methods: Between 1999 and 2003 62 patients were enrolled: 38 (61%) received HART and 24 (39%) HART and PLI. The pelvis was irradiated twice a day, with a minimal interfraction interval of six hours: the total dose of 42 Gy was given in 1.5 Gy per fractions over 18 days. The PLI (14 Gy in 10 daily fractions of 1.4 Gy) was given simultaneously with the morning fraction of HART. Twenty patients (32%), including 7 in PLI group, received 5-FU based postoperative chemotherapy. Results: The acute normal tissue reactions appeared tolerable irrespectively of PLI. Six to twelve months after completion of combined therapy the mean ALAT levels in patients treated with HART alone (25 patients), HART + chemotherapy (13 patients), HART + PLI (17 patients), and HART + PLI + chemotherapy (7 patients) were 15, 21, 26 and 55 IU/I respectively. A mild increase of ALAT levels observed in the HART + PLI + chemotherapy subgroup was non-symptomatic. Three-year actuarial Ioco-regional control rate in a group of 62 patients was 94% . None of the patients who received PLI developed metastases during the follow-up, compared to 10 out of 38 patients (26%) with no PLI. A difference in metastases-free survival in favour of HART+PLI can be, however, partially attributed to selection of patients for PLI who were in less advanced stage of disease than those treated with HART. Conclusions: Further use of PLI may be limited due to asymptomatic, but detectable biochemical changes of liver function when PLI is sequentially combined with chemotherapy. Accelerated hyperfractionated irradiation of the pelvis may be considered, on the other hand, as a candidate for evaluation in future randomized studies on adjuvant treatment for rectal cancer. 214 Flare Pain in the T r e a t m e n t of Bone M e t a s t a s e s C. Bolduc, E. Barnes, C. Gillies, L. Wynnychuk Toronto Sunnybrook Regional Cancer Centre, University of Toronto, Toronto, Ontario carriebolduc@qmail, corn I n t r o d u c t i o n : Thirty to sixty percent of cancer patients are affected by bone metastases. A significant number will experience pain from their bony disease, which can be effectively palliated by local radiation. Following radiation treatment, some patients experience a worsening of symptoms known as the 'flare pain' phenomenon. Limited literature exists regarding this phenomenon in radiation oncology, however there is no consensus regarding the incidence, onset, duration or clinical definition. The primary objectives of this study were to determine whether a common definition of flare pain could be identified, how to define this clinically, including when flare pain occurred, the incidence and duration, and whether patients were treated for flare pain. Methods: In February 2006, all practicing Radiation Oncologists (RO) within Ontario (n=142) were sent an email survey to solicit their opinions regarding flare pain following radiation therapy for bone metastases. Results: Fifty-eight responses were received, yielding a response rate of 41%. The most common definition of flare pain was "a transient increase in pain within the treatment
September 13-16
Methods: Between December 2005 and February 2006 seven self-selected oncologists (four medical and three radiation) were provided Toshiba M200 Prot~g~ tablet computers using Microsoft XP Professional Tablet, in addition to a proprietary information system (CAIS), E-Film and Internet Explorer. The computers were connected to a secure wireless network (802.11g) within an ambulatory clinic setting. An evaluation questionnaire assessed: 1) The user's perception of the tablet computer's technical properties; 2) how well the tablet could be integrated into the clinic environment during patient encounters; 3) how well the tablet supported the user's interaction with established Agency-standard software. The questionnaire consisted of 68 questions using seven-point Likert scale items ranging from Strongly Disagree (1) to Strongly Agree (7). Results: Average user age: 42 years, five male, two female; two extensive, five intermediate computing experience. Network connectivity was inconsistent. Windows Journal was not considered useful by most users for making notes. Image download was considered slow with screen size and resolution not useful for evaluation of x-ray images. E-Film navigation and comparing image series were not as easy as with a desktop. Internet access was equivalent to that of a desktop computer. Users were indifferent when asked if the tablet computers were as useful as desktop computers in supporting clinical activities and did not consider the tablet computer functional enough to replace a desktop computer in the support of clinical activities. There were, however, useful functions not easily supported by desktop computers such as in-room reviewing of films and current lab results, reviewing Web-based knowledge/information sources and printing patient information. Conclusions: Wireless tablet computers currently have the potential to enhance targeted activities within the realm of outpatient cancer care. Additional user input is ongoing. 212 M e t h o d s to Reduce I n t e s t i n a l M o r b i d i t y f r o m Radiation T h e r a p y to Unilateral Pelvic Bone Metastases: An I n v e s t i g a t i o n to Assess Feasibility S. Scott, W. Levin, N. Lamacchia, K. Maddix, F. Cheung, A. Bezjak, M. McLean, R. Wong Princess Margaret Hospital, University of Toronto, Toronto, Ontario wilfred.levin@rmp, uhn. on. ca Background: Patients with metastases to unilateral pelvic bones are usually treated with a parallel-opposed pair (POP). The treated volume includes a significant amount of intestine that receives full dose. Objectives: Can the volume of bowel be reduced with the use of oblique fields without compromising the dose to the clinical target volume (CTV)? Is the method feasible with conventional simulation? Is it verifiable and reproducible for daily practice? Methods: Four treatment plans were produced from the pelvic CT of an index patient. Using the Pinnacle system, a CTV was drawn for the pelvic bones. The small bowel and large intestine were also contoured. Distributions and dose volume histograms (DVH) were generated for plans of a conventional POP, a POP with half beam block, and for oblique opposed fields with half beam block at gantry angles of both 10 and 20 degrees. Results: All the distributions achieved the prescribed dose to the CI-V (20 Gy). The DVH values at 15 Gy for the intestinal volume showed a reduction of 10% for the POP with half beam block and reductions of 43% and 73% for the oblique plans at 10 and 20 degrees respectively. In practice, with conventional simulation the iliac bones can be readily visualized in profile and the treatment fields verified with check films or electronic portal imaging. The simulation of the 20-degree oblique plan required a simple geometric calculation to establish the depths for dose calculation. Conclusions: The use of oblique fields for treating unilateral pelvic bone metastases yields a better therapeutic ratio than the conventional POP. The basic simulation at an obliquity of ten or twenty degrees does not present any significant technical or dosimetric challenges. Palliative patients with
CARO 2 0 0 6
unilateral pelvic bone metastases can be simply treated in this way with a great reduction of potential intestinal morbidity. 213 A Pilot Study of Accelerated Preoperative H y p e r f r a c t i o n a t e d Pelvic I r r a d i a t i o n W i t h or W i t h o u t Low Dose P r e o p e r a t i v e Prophylactic Liver I r r a d i a t i o n in Patients w i t h Locally Advanced Rectal Cancer R. Suwinski 1, J. Wydmanski 1, I. Pawelczyk2, J. Starzewski 2 Centre of Oncology, Gliwice, Polandl; Department of Colorectal Surgery, Medical University of Silesia, Sosnowiec, Poland2 [email protected] Purpose: To evaluate the feasibility of preoperative accelerated hyperfractionated pelvic irradiation (HART) with or without low-dose preoperative prophylactic liver irradiation (PLI) in patients with locally advanced rectal cancer. M a t e r i a l and methods: Between 1999 and 2003 62 patients were enrolled: 38 (61%) received HART and 24 (39%) HART and PLI. The pelvis was irradiated twice a day, with a minimal interfraction interval of six hours: the total dose of 42 Gy was given in 1.5 Gy per fractions over 18 days. The PLI (14 Gy in 10 daily fractions of 1.4 Gy) was given simultaneously with the morning fraction of HART. Twenty patients (32%), including 7 in PLI group, received 5-FU based postoperative chemotherapy. Results: The acute normal tissue reactions appeared tolerable irrespectively of PLI. Six to twelve months after completion of combined therapy the mean ALAT levels in patients treated with HART alone (25 patients), HART + chemotherapy (13 patients), HART + PLI (17 patients), and HART + PLI + chemotherapy (7 patients) were 15, 21, 26 and 55 IU/I respectively. A mild increase of ALAT levels observed in the HART + PLI + chemotherapy subgroup was non-symptomatic. Three-year actuarial Ioco-regional control rate in a group of 62 patients was 94% . None of the patients who received PLI developed metastases during the follow-up, compared to 10 out of 38 patients (26%) with no PLI. A difference in metastases-free survival in favour of HART+PLI can be, however, partially attributed to selection of patients for PLI who were in less advanced stage of disease than those treated with HART. Conclusions: Further use of PLI may be limited due to asymptomatic, but detectable biochemical changes of liver function when PLI is sequentially combined with chemotherapy. Accelerated hyperfractionated irradiation of the pelvis may be considered, on the other hand, as a candidate for evaluation in future randomized studies on adjuvant treatment for rectal cancer. 214 Flare Pain in the T r e a t m e n t of Bone M e t a s t a s e s C. Bolduc, E. Barnes, C. Gillies, L. Wynnychuk Toronto Sunnybrook Regional Cancer Centre, University of Toronto, Toronto, Ontario carriebolduc@qmail, corn I n t r o d u c t i o n : Thirty to sixty percent of cancer patients are affected by bone metastases. A significant number will experience pain from their bony disease, which can be effectively palliated by local radiation. Following radiation treatment, some patients experience a worsening of symptoms known as the 'flare pain' phenomenon. Limited literature exists regarding this phenomenon in radiation oncology, however there is no consensus regarding the incidence, onset, duration or clinical definition. The primary objectives of this study were to determine whether a common definition of flare pain could be identified, how to define this clinically, including when flare pain occurred, the incidence and duration, and whether patients were treated for flare pain. Methods: In February 2006, all practicing Radiation Oncologists (RO) within Ontario (n=142) were sent an email survey to solicit their opinions regarding flare pain following radiation therapy for bone metastases. Results: Fifty-eight responses were received, yielding a response rate of 41%. The most common definition of flare pain was "a transient increase in pain within the treatment