591 Poster Concomitant chemoradiotherapy for localized, non-recectable esophageal cancer non-recectable esophageal cancer

Posters

589

Wednesday/Thursday, 18-19 September 2002 $183

Poster

ly improves long-term survival.

Primary ¢hemo-radiotherapy (CT-RT) for locally advanced pancreatic cancer (LAPC): phase II study

591

M. Gatti 1, R. Faggiuolo2, P. Massucco 3, A. Magnino 2, E. Sperti2, v. Macias 1, C. Ravalli 1, O. Arcidiacono 1, M. Amisano 3, G. Malinvemi I

Concomitant chemoradiotherapy recectable esophageal cancer

1institute for cancer research and treatment (IRCC), Radiotherapy, Candiolo, Turin, Italy 2institute for cancer research and treatment (IRCC), Oncology, CandleIo, Turin, Italy 3Institute for cancer research and treatment (IRCC), Surgery, Candiolo, Turin, Italy

L. Damstruo 1, A.L. Fromm 1, J.B. Serensen 1, B. Brandt2, M.B. Jendresen 3, M. Siemsen 2, J. Gustafsen 3 1Finsen Center 5073, Department of Oncology, Copenhagen, Denmark 2Cardiac Center, Department of Thoracic Surgery, Copenhagen, Denmark 3Abdominal Center, Department of Abdominal Surgery, Copenhagen, Denmark

Primary CT-RT for LAPC may improve local control, resection rate and long term survival. Various schedules have been tested with gemcitabine (GEM) and radiotherapy (RT). Twice,weekly GEM may result in increased sensitization compared to once-weekly schedule, Aim: we performed a phase II study to evaluate the toxicity and activity of twice-weekly GEM combined with RT in patients (pts) with LAPC (vessel infiltration), Patients and methods: from 8/1998 to 2/2002, 18 LAPC pts (M/F:11/7; PS: 0-2; median age 62; range: 54-75) previously untreated, received GEM (60' infusion, 2 h before RT) 100 mg/m 2 twice-weekly in 15 pts and 50 mg/m 2 in the last 3 pts, concurrently with RT. The RT technique was three dimensional conformal RT with high energy photons; the target volume included the entire lesion and the nodal areas at risk for a total dose of 45 Gy (1.8 Gy/d.). All pts had biopsy (FNAB) proven disease, measurable by CT-scan and were restaged by CT-scan (40 d. after CT-RT). Results: Toxicities: Gill-iV hematological tox. occured in 38% and 5% respectively; Gill-IV NV. and G.I. (diarrhoea) tox. in 11% and 5%. No difference in tox. was found between GEM 100 and GEM 50. The treatment was completed in 14/18 pts (88%): 3 pts stopped because of tox >3 and 1 pt progressed during treatment. Clinical benefit: immediately after CT-RT CB was found only in 3/14 pts. (21%) but 1 month later in 10/14 (71%). ORR: PR 3 pts (2! %); SD 10 (72%)(6/10 with decrease in serum CA 19.9); PD 1 (7%). 4 pts (28%, 3 with PR and 1 with SD) underwent pancreaticoduodene~tomy with D2 lymphectomy (3/4 pts pT3, 1/4 pts only microscopic cancer foci, 1/4 N+, 4/4 negative resection margins). OS in pts with surgery is 2, 6+, 12+, 14 months, Conclusion: these data show the feasibility of concurrent GEM and RT in LAPC with a high but acceptable toxicity; neoadjuvant CT-RT improved resectability, but more effective therapy options must be developed to improve survival, 590

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Preoperative irradiation improves survival in resected adenoc a r c i n o m a of gastric cardia and ¢ardio-oesophageal junction V. Skorooad. /3. Berdov Medica/ Radio/ogica/ Research Center of Russian Academy of Medica/ Sciences, 249020 Obninsk, Russia.

Purpose. Surgical treatment of proximal gastric cancer is associated with discouraging long-term survival. To evaluate the value of short-term preoperative radiation therapy in resectable proximal gastric cancer, a retrospective analysis was performed. Methods. Since 1972, 211 patients with gastric cancer, invading the cardia + low oesophagus were operated on with curative intent. In 150 patients short-term preoperative radiation therapy (20-27 Gy/5-7 days followed by surgery within 5 days) was used. The radiation therapy schemes were as the follows: concentrated irradiation (20 Gy/5 days, 70 patients), concentrated irradiation in combination with metronidazole 5 g/m 2 (18 patients), dose dynamic fractionation regime (27 Gy/7 days, 62 patients). Sixty-one patients underwent surgery alone. In 65 patients the method of treatment was determined by the randomization procedure; others were enrolled in several phase 2 trials. Total/extended gastrectomy was performed in 176 patients, subtotal proximal gastrectomy - in 35 patients. In 40% cases surrounding organ(s) were resected as well. T1 tumors were very rare (4%), most patients had T3 lesions(58%); about/had lymph node metastases, Results. Postoperative morbidity and mortality (12% in radiation therapy group and 14% in surgical group) did not differ significantly. During last decade the mortality rate decreased dramatically and reached 4-5%. In patients treated with preoperative radiation therapy overall 5-, 10-year survival and median survival time were as the follows: 36%, 28% and 28 months; in surgical group - 22%, 11% and 14 months (c2=7.577, df=l, P=0.006). Conclusion. In patients with proximal gastric cancer short-term preoperative radiation therapy does not increase postoperative mortality and significant-

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localized,

non-

AimConcomitant chemotherapy and radiotherapy may increase activity of the treatment but also.increase toxicity. The purpose of the present study was to evaluate both aspects in pts with localized non-resectable esophageal cancer.Patients and methodsPreviousty untreated pts with localized non-resectable, non-metastatic esophageal cancer, performance status 0-2, age 18 - 76 years were included in the study. Minimal staging procedure included endoscopy, CT-scan of chest and ultrasonic examination of upper abdomen. Two courses of chemotherapy was given (Cisplatin 75 mg/m 2 day 1 and 22, continuous infusion of 5-FU 800 mg/m 2 daily day 14 and 22-25) together with radiotherapy, 2 Gy x 25 fractions, total dose 50 Gy, 5 fractions/wk from day 1. Radiotherapy was planned using therapy CTscan and CAD-plan. GTV was defined from the therapy CT-scan, CTV included regional lymph nodes and PTV was defined as a 2 to 5 cm margin to CTV.Results.43 consecutively referred pts from June 1999 until February 2002 were evaluated, pretreament characteristics were: Median age 55 years (range 28-76), gender: male31, female 12, performance status: 0,1 and 2 in 11,25, and 7 pts respectively, weight loss: median 14% (range 083), histology: adenocarcinoma 18, squamous cell carcinoma 24, other histology 1.34 pts received chemotherapy and radiotherapy (dosis modification of chemotherapy was required in 7 pts). Three pts received palliative radiotherapy alone (3 Gy x 10 fractions), 4 pts received only chemotherapy, while 2 pts received chemotherapy and palliative radiotherapy. Grade 3 and 4 toxicity occurred with respect to leucopenia in 9%, thrombocytopenia in 7% and esophagitis in 37%. Median weight loss during treatment was 5% and 11 pts(26%) required a naso-gastric nutrition tube. Complete response occured in 2 and partiel in 9 pts, giving a respons rate of 26%. To date 33 pts have died: median survival from diagnosis was (all pts n=43): 33 weeks (range 11-125 +weeks) [only pts receiving concomitant chemo-radiotherapy as planned n=34]: 35 weeks (range 11-125 +weeks).Conclusions. Concomitant chemo-radiotherapy in the applied doses and schedule is feaseable, though toxic. Care should be taken to avoid weight loss during treatment and nutrition tubes should be used liberally. A subset of pts became Iongterm survivors suggesting that the treatment may have curative potential, however, further follow-up is necessary to draw firm conclusions. 592

Poster

Cardiac dose and toxicity following radiotherapy for oesophageal cancer P.G.S. Comes 1, M.A. Mos/eh-Shirazi 2, D.M. Tait 1, N. Kamangari 1, R. Ahmed 1, J.P. G/ees 1 1The Royal Marsden NHS Trust, Section of Radiotherapy, Sutton, Surrey, Un~tedKingdom 2Institute of Cancer Research and Royal Marsden NHS Trust, Joint Department of Physics, Sutton, Surrey, United Kingdom Purpose: Chemo-radiation is increasingly accepted as the treatment of choice for squamous oesophageal cancer, and for adenocarcinomas not suitable for surgery either on the grounds of tumour stage or patient performance. Long-term survival equates with that of surgery and is exposing late effects of treatment. Traditionally, spinal cord and lung have been considered the critical normal structures in oesophageal irradiation but we are aware of patients in our own series who have suffered cardiac pathology subsequent to treatment. Ischemic heart disease is a common condition and my have been coincidental but the possibility of radiation effects contributing to its emergence led us to instigate a dosimetry study to establish dose-volume histograms (DVH) for heart in this treatment setting. Method: Data for 8 mid-tower oesophageal cancer patients previously planned and treated with 2-phase radiotherapy were re-computed using the collapsed cone algorithm in ADAC Pinnacle 3 (ADAC Laboratories, Milpitas, CA, USA). The treated dose of 54Gy in 1.8Gy daily fractions, at or near the isocentre, was maintained, limiting the spinal cord dose to a maximum of 48Gy. Two phases were employed, an anterior-posterior beam arrange-