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Clinical Outcomes of Body Gamma Knife Therapy for PHC
Proceedings of the 51st Annual ASTRO Meeting
2214
Clinical Outcomes of Body Gamma Knife Therapy for PHC
P. Li, T. Y. Xia, D. S. Chang, Y. J. Wang, H. Q. Li, Q. X. Sun, Y. Li Air Force General Hospital Beijing, Beijing, China Purpose/Objective(s): To evaluate the effects and radiation reaction of patients primary hepatic carcinoma of early stage by the Bodyg-knife treatment. Materials/Methods: 52 patients of stage I/II primary hepatic carcinoma were treated with the Stereotactic Gamma Ray WholeBody Therapeutic System (Bodyg-knife), including 10 patients of stage Iand 42 patients of stageII. For Bodyg-knife treatment a stereotactic body frame for exact tumor localization, reproducible fixation, CT simulation and 3-D treatment plan has been developed. A three dimensional margin of 1cm were added to GTV. 50% isodose line was prescription dose line and covered 100% area of PTV and 70% isodose line covered more than 80% area of GTV. According to the tumors size, position and function of the liver, they were irradiated 3-5Gy per fraction at 50% isodose line, 5 fraction per week and a total dose of 40-51Gy at PTV margin, 60-70Gy at GTV margin and 80102Gy at tumor centrical area was delivered in 23 weeks. The median follow-up duration was 26 months. Results: The complete response rate (CR) and the overall response rate (CR+PR) were 46.2% and 80.8%, respectively, after 23months of the treatments. The 1-, 2- and 3-year overall survival rates were 82.2%,79.0% and 49.6%,respectively. The 1-, 2and 3-year Tumor-specific survival rates were 95.2%,95.2%and 64.9%,respectively. The major treatment-related acute gastrointestinal toxicities included nausea or vomiting. The incidence of Grade I/IIgastrointestinal toxicities was 19.2%. The acute hematologic toxicities were 21.2% in Grade I, 11.5% in Grade IIand 1.9% in Grade III. None of all patients were observed with acute hepatic toxicities during the treatment . Late hepatic toxicities were 13.5% in GradeI/IIand 3.8% in Grade III. The whole process was bearable for all patients after allopathy. Conclusions: Body g-knife Treatment is effective and safe which fraction schema of 3-5 Gy/fraction, 5 days a week with a total dose of 4551Gy at 50% dose line was delivered for patients with early stage primary hepatic carcinomas. It can improve the local control rate and survival rate for patients with stage I/II. Author Disclosure: P. Li, None; T.Y. Xia, None; D.S. Chang, None; Y.J. Wang, None; H.Q. Li, None; Q.X. Sun, None; Y. Li, None.
2215
Early Experience with the Use of Gold Fiducial Markers in the Image Guided Radiotherapy (IGRT) of Pancreatic Cancers
R. Jacob, S. Shen, J. Stewart, S. Varadarajulu University of Alabama, Birmingham, AL Purpose/Objective(s): To study daily set up variations of the target during pancreatic IMRT using implanted Gold Fiducial Markers. To determine daily variations in target position relative to skeletal anatomy and to estimate margins required around the target when IMRT is delivered without using fiducials, but using skeletal anatomy for Image Guidance. Materials/Methods: Nine patients with pancreatic cancer underwent placement of at least 3 gold fiducials in the tumor (n = 6) or residual pancreas (n = 3), by endoscopic ultrasound guidance (EUS). Patients were immobilized using alpha-cradle for RT. For RT planning, 2 gated CT scans (at end of expiration & end of inspiration performed with exact immobilization) or a 4-D CT was obtained. 54, 50 and 45 Gy in 25 fractions was planned to the GTV, GTV+1cm, and lymphatics respectively in patient with inoperable tumors. In post-op RT, 50 Gy was planned to the tumor bed and 45 Gy to the lymphatics. An appropriate gating margin was added to all volumes to account for residual respiratory movements. All patients were treated using gated IMRT on a linear accelerator. A gated on-board kilovoltage (kv) image was obtained daily in the treatment position prior to RT and fused with planning gated DRR. Treatment was delivered following alignment of fiducial positions on the kv and DRR images. For purpose of this analysis, image fusion was also performed based on skeletal anatomy, which is the current standard of care and the shifts of fiducials in the anteriorposterior (A-P), superior-inferior (S-I) and left-right (L-R) directions were recorded. A non-gated CT was performed at week 4 of RT and another at 5 weeks following RT to check for possible migration of fiducials. Results: There was no increase in time required for gated kv imaging and image fusion using fiducials, compared to conventional IGRT using skeletal registration. Migration of fiducial markers was not seen based on CT imaging. The mean daily shifts (and range) between images based on skeletal fusion and fiducial location were 0.2 cm (0.1-1.0 cm), 0.5 cm (0.2-1.5 cm) and 0.4 cm (0.2-2.0 cm) in the A-P, S-I and L-R directions respectively. A margin of 0.4, 1.0 and 0.8 cm (2 standard deviations) would be needed in the A-P, S-I and L-R directions to account for soft-tissue set-up error when daily imaging is performed solely using skeletal alignment. Conclusions: The daily soft-tissue set-up variations of target in the treatment of pancreatic cancers were studied. IGRT using implanted fiducials helps to reduce the target margins compared to skeletal registration. An additional margin is needed around the target when IMRT is delivered using skeletal registration without fiducials. Our data also suggests that the margins currently used in conventional pancreatic RT may be inadequate for some patients. Author Disclosure: R. Jacob, None; S. Shen, None; J. Stewart, None; S. Varadarajulu, None.
2216
High-dose versus Standard-dose Radiation Therapy in Combined-modality Therapy for Esophageal Cancer
C. Lee, Y. Suh, I. Lee, S. Yoo, J. Cha, H. Yoon, K. Keum, J. Seong, C. Suh, G. Kim Yonsei University College of Medicine, Seoul, Republic of Korea Purpose/Objective(s): To compare the survival, local control, and toxicity of combined-modality therapy using high-dose (63 Gy) versus standard-dose (54 Gy) radiation therapy for the treatment of patients with esophageal cancer.
S277
2214
Clinical Outcomes of Body Gamma Knife Therapy for PHC
P. Li, T. Y. Xia, D. S. Chang, Y. J. Wang, H. Q. Li, Q. X. Sun, Y. Li Air Force General Hospital Beijing, Beijing, China Purpose/Objective(s): To evaluate the effects and radiation reaction of patients primary hepatic carcinoma of early stage by the Bodyg-knife treatment. Materials/Methods: 52 patients of stage I/II primary hepatic carcinoma were treated with the Stereotactic Gamma Ray WholeBody Therapeutic System (Bodyg-knife), including 10 patients of stage Iand 42 patients of stageII. For Bodyg-knife treatment a stereotactic body frame for exact tumor localization, reproducible fixation, CT simulation and 3-D treatment plan has been developed. A three dimensional margin of 1cm were added to GTV. 50% isodose line was prescription dose line and covered 100% area of PTV and 70% isodose line covered more than 80% area of GTV. According to the tumors size, position and function of the liver, they were irradiated 3-5Gy per fraction at 50% isodose line, 5 fraction per week and a total dose of 40-51Gy at PTV margin, 60-70Gy at GTV margin and 80102Gy at tumor centrical area was delivered in 23 weeks. The median follow-up duration was 26 months. Results: The complete response rate (CR) and the overall response rate (CR+PR) were 46.2% and 80.8%, respectively, after 23months of the treatments. The 1-, 2- and 3-year overall survival rates were 82.2%,79.0% and 49.6%,respectively. The 1-, 2and 3-year Tumor-specific survival rates were 95.2%,95.2%and 64.9%,respectively. The major treatment-related acute gastrointestinal toxicities included nausea or vomiting. The incidence of Grade I/IIgastrointestinal toxicities was 19.2%. The acute hematologic toxicities were 21.2% in Grade I, 11.5% in Grade IIand 1.9% in Grade III. None of all patients were observed with acute hepatic toxicities during the treatment . Late hepatic toxicities were 13.5% in GradeI/IIand 3.8% in Grade III. The whole process was bearable for all patients after allopathy. Conclusions: Body g-knife Treatment is effective and safe which fraction schema of 3-5 Gy/fraction, 5 days a week with a total dose of 4551Gy at 50% dose line was delivered for patients with early stage primary hepatic carcinomas. It can improve the local control rate and survival rate for patients with stage I/II. Author Disclosure: P. Li, None; T.Y. Xia, None; D.S. Chang, None; Y.J. Wang, None; H.Q. Li, None; Q.X. Sun, None; Y. Li, None.
2215
Early Experience with the Use of Gold Fiducial Markers in the Image Guided Radiotherapy (IGRT) of Pancreatic Cancers
R. Jacob, S. Shen, J. Stewart, S. Varadarajulu University of Alabama, Birmingham, AL Purpose/Objective(s): To study daily set up variations of the target during pancreatic IMRT using implanted Gold Fiducial Markers. To determine daily variations in target position relative to skeletal anatomy and to estimate margins required around the target when IMRT is delivered without using fiducials, but using skeletal anatomy for Image Guidance. Materials/Methods: Nine patients with pancreatic cancer underwent placement of at least 3 gold fiducials in the tumor (n = 6) or residual pancreas (n = 3), by endoscopic ultrasound guidance (EUS). Patients were immobilized using alpha-cradle for RT. For RT planning, 2 gated CT scans (at end of expiration & end of inspiration performed with exact immobilization) or a 4-D CT was obtained. 54, 50 and 45 Gy in 25 fractions was planned to the GTV, GTV+1cm, and lymphatics respectively in patient with inoperable tumors. In post-op RT, 50 Gy was planned to the tumor bed and 45 Gy to the lymphatics. An appropriate gating margin was added to all volumes to account for residual respiratory movements. All patients were treated using gated IMRT on a linear accelerator. A gated on-board kilovoltage (kv) image was obtained daily in the treatment position prior to RT and fused with planning gated DRR. Treatment was delivered following alignment of fiducial positions on the kv and DRR images. For purpose of this analysis, image fusion was also performed based on skeletal anatomy, which is the current standard of care and the shifts of fiducials in the anteriorposterior (A-P), superior-inferior (S-I) and left-right (L-R) directions were recorded. A non-gated CT was performed at week 4 of RT and another at 5 weeks following RT to check for possible migration of fiducials. Results: There was no increase in time required for gated kv imaging and image fusion using fiducials, compared to conventional IGRT using skeletal registration. Migration of fiducial markers was not seen based on CT imaging. The mean daily shifts (and range) between images based on skeletal fusion and fiducial location were 0.2 cm (0.1-1.0 cm), 0.5 cm (0.2-1.5 cm) and 0.4 cm (0.2-2.0 cm) in the A-P, S-I and L-R directions respectively. A margin of 0.4, 1.0 and 0.8 cm (2 standard deviations) would be needed in the A-P, S-I and L-R directions to account for soft-tissue set-up error when daily imaging is performed solely using skeletal alignment. Conclusions: The daily soft-tissue set-up variations of target in the treatment of pancreatic cancers were studied. IGRT using implanted fiducials helps to reduce the target margins compared to skeletal registration. An additional margin is needed around the target when IMRT is delivered using skeletal registration without fiducials. Our data also suggests that the margins currently used in conventional pancreatic RT may be inadequate for some patients. Author Disclosure: R. Jacob, None; S. Shen, None; J. Stewart, None; S. Varadarajulu, None.
2216
High-dose versus Standard-dose Radiation Therapy in Combined-modality Therapy for Esophageal Cancer
C. Lee, Y. Suh, I. Lee, S. Yoo, J. Cha, H. Yoon, K. Keum, J. Seong, C. Suh, G. Kim Yonsei University College of Medicine, Seoul, Republic of Korea Purpose/Objective(s): To compare the survival, local control, and toxicity of combined-modality therapy using high-dose (63 Gy) versus standard-dose (54 Gy) radiation therapy for the treatment of patients with esophageal cancer.
S277