- Email: [email protected]
Concurrent Erlotinib and Radiotherapy for Elderly Squamous Cell Esophageal Carcinoma: Results of a Pilot Study
Proceedings of the 53rd Annual ASTRO Meeting the degree to which the shape of a tumor likes a sphere. A less spherical tumor is more likely a responder. Standard Deviation (AUC = 0.84) computes the standard deviation of CT numbers in a tumor. A tumor with greater standard deviation in PostCT is more likely a responder. Correlation (AUC = 0.84) measures texture gray-tone linear-dependencies in an image. A tumor with smaller correlation in Post-CT is more likely a responder. Conclusions: We demonstrated that some spatial-temporal PET/CT features have higher discriminant power than SUVmax and SUVpeak. The results suggested that all shape, texture and intensity information are important in the evaluation of tumor response. The metabolic activity of the entire tumor should be evaluated in addition to that of the most active part of the tumor. Author Disclosure: S. Tan: None. G. Kim: None. S. Feigenberg: None. W. Chen: None. M. Lu: None. W. D’Souza: None. M. Suntharalingam: None. W. Lu: None.
2210
Designed-Seamless Irradiation Technique (D-SLIT) for Extended Whole Mediastinal Proton-Beam Irradiation for Esophageal Cancer
N. Okonogi1,2, T. Hashimoto2, M. Ishida2, T. Terunuma2, T. Okumura2, T. Sakae2, H. Sakurai2 1 Gunma University Heavy Ion Medical Center, Maebashi, Japan, 2Proton Medical Research Center, University of Tsukuba, Tsukuba, Japan Purpose/Objective(s): This study investigates the feasibility of a practical technique to effectively connect proton-beam therapy (PBT) fields for esophageal cancer with larger regional field beyond available field size of PBT. Materials/Methods: The 20 patients of esophageal cancer with larger regional field than the available single field size (15-cm in our facility) of PBT were enrolled in this study. The computed tomography (CT) images were taken at 5-mm intervals during the expiratory phase under a respiratory gating system. The clinical target volume (CTV) was divided into two sections to be covered by single PBT field, namely, craniad CTV and caudal CTV. Subsequently, two isocenters of CTV was aligned in cranio-caudal (CC) axis to reduce the uncertainty resulting from movements of treatment couch in anterior-posterior and left-right directions. After setting proton beam parameters for each CTV, D-SLIT required following two adjustments to obtain the appropriate dose distributions; (1) blocking the part of CTVs by multi leaf collimator (MLC), and (2) fine-tuning the isocenter distance by the half width of MLC leaf (2.5-mm in our facility). After these steps, the inferior border of craniad field was designed to match the superior border of caudal field. The dose distributions along the CC axis around the field junction were evaluated on treatment-planning system. After validation of dose profile using imaging plates (IP) in all cases, 8 patients actually received PBT with this technique. Results: For evaluation of dose conformity, the average and standard deviation (S.D.) in the minimum dose, the maximum dose, and the dose range between the maximum dose and the minimum dose around the field junction on treatment-planning system were 95.9 ± 3.2%, 105.3 ± 4.1%, and 9.4 ± 5.2%. The average ± S.D. of the ‘discordant distance’ which means inhomogeneous, uneven dose distribution range at the gap of two fields was 10.6 ± 4.2 mm. The dose profile validated by IP correlated with the result on treatment-planning system in each case, and the error range was within 5.0%. No significant treatment-related toxicities around the field junction were observed in 8 patients actually received PBT with D-SLIT. Conclusions: The dose distributions around the field junction using D-SLIT were available, indeed clinical outcomes were acceptable. Our results suggest that D-SLIT can be useful treatment strategy of PBT for extensive esophageal cancer. Author Disclosure: N. Okonogi: None. T. Hashimoto: None. M. Ishida: None. T. Terunuma: None. T. Okumura: None. T. Sakae: None. H. Sakurai: None.
2211
Concurrent Erlotinib and Radiotherapy for Elderly Squamous Cell Esophageal Carcinoma: Results of a Pilot Study
Y. Zhai, Z. G. Hui, J. B. Wang, J. Liang, J. M. Lv, Z. M. Zhou, Q. F. Feng, H. X. Zhang, D. F. Chen, L. H. Wang Cancer Hospital, 100021, China Purpose/Objective(s): Concurrent chemoradiotherapy is the standard treatment for locally advanced esophageal squamous cell carcinoma (ESCC), but at the expense of increased toxicities. However, quite a few patients cannot endure chemoradiotherapy due to their old age or malnutrition. Erlotinib, an inhibitor of epidermal growth factor receptor tyrosine kinase, was effective in treating ESCC with mild toxicities. This pilot study is to investigate the feasibility and efficacy of concurrent erlotinib and radiotherapy for elderly ESCC. Materials/Methods: Between December 2007 and August 2010, eighteen pathologically diagnosed ESCC patients were enrolled in the study. The median age was 71.5 years. The disease was stage II, III and IV in 4, 10 and 4 patients, respectively. Seven patients received surgery before, including 3 with post-operative local-regional recurrence. All patients were treated with concurrent erlotinib and intensity-modulated radiation therapy. Erlotinib was given orally 150mg/d for at least 8 weeks. Radiotherapy was given by 2 Gy per day, 5 days per week to a total dose of 46 to 70 Gy. The overall survival (OS), progression free survival (PFS) and local-regional free survival (LRFS) were calculated using the Kaplan-Meier method. Toxicities were evaluated according to the NCI-CTC 3.0. Results: At one month post-radiotherapy, there were 2 (11.1%) complete response, 8 (44.4%) partial response and 5 (27.8%) stable disease. With a median follow up of 26.1 months, 14 patients (77.8%) achieved local control. The median recurrencefree time was reached. Four patients died of distant metastasis and 3 died of local progression. The median time of OS, PFS and LRFS was 28.7, 12 and 12 months, respectively. Grade 3 esophagitis was observed in 5 patients (27.8%), grade 3 skin rash in 2 patients (11.1%). Radiation pneumonitis of grade 2 and 4 was observed in one each. There is no grade 3/4 impaired liver function or hematological toxicities. Conclusions: Concurrent erlotinib and radiotherapy is effective and tolerable in elderly ESCC patients who are unfit for concurrent chemoradiotherapy. Prospective trial is necessary to confirm the efficacy and feasibility. Author Disclosure: Y. Zhai: None. Z.G. Hui: None. J.B. Wang: None. J. Liang: None. J.M. Lv: None. Z.M. Zhou: None. Q.F. Feng: None. H.X. Zhang: None. D.F. Chen: None. L.H. Wang: None.
S313
2210
Designed-Seamless Irradiation Technique (D-SLIT) for Extended Whole Mediastinal Proton-Beam Irradiation for Esophageal Cancer
N. Okonogi1,2, T. Hashimoto2, M. Ishida2, T. Terunuma2, T. Okumura2, T. Sakae2, H. Sakurai2 1 Gunma University Heavy Ion Medical Center, Maebashi, Japan, 2Proton Medical Research Center, University of Tsukuba, Tsukuba, Japan Purpose/Objective(s): This study investigates the feasibility of a practical technique to effectively connect proton-beam therapy (PBT) fields for esophageal cancer with larger regional field beyond available field size of PBT. Materials/Methods: The 20 patients of esophageal cancer with larger regional field than the available single field size (15-cm in our facility) of PBT were enrolled in this study. The computed tomography (CT) images were taken at 5-mm intervals during the expiratory phase under a respiratory gating system. The clinical target volume (CTV) was divided into two sections to be covered by single PBT field, namely, craniad CTV and caudal CTV. Subsequently, two isocenters of CTV was aligned in cranio-caudal (CC) axis to reduce the uncertainty resulting from movements of treatment couch in anterior-posterior and left-right directions. After setting proton beam parameters for each CTV, D-SLIT required following two adjustments to obtain the appropriate dose distributions; (1) blocking the part of CTVs by multi leaf collimator (MLC), and (2) fine-tuning the isocenter distance by the half width of MLC leaf (2.5-mm in our facility). After these steps, the inferior border of craniad field was designed to match the superior border of caudal field. The dose distributions along the CC axis around the field junction were evaluated on treatment-planning system. After validation of dose profile using imaging plates (IP) in all cases, 8 patients actually received PBT with this technique. Results: For evaluation of dose conformity, the average and standard deviation (S.D.) in the minimum dose, the maximum dose, and the dose range between the maximum dose and the minimum dose around the field junction on treatment-planning system were 95.9 ± 3.2%, 105.3 ± 4.1%, and 9.4 ± 5.2%. The average ± S.D. of the ‘discordant distance’ which means inhomogeneous, uneven dose distribution range at the gap of two fields was 10.6 ± 4.2 mm. The dose profile validated by IP correlated with the result on treatment-planning system in each case, and the error range was within 5.0%. No significant treatment-related toxicities around the field junction were observed in 8 patients actually received PBT with D-SLIT. Conclusions: The dose distributions around the field junction using D-SLIT were available, indeed clinical outcomes were acceptable. Our results suggest that D-SLIT can be useful treatment strategy of PBT for extensive esophageal cancer. Author Disclosure: N. Okonogi: None. T. Hashimoto: None. M. Ishida: None. T. Terunuma: None. T. Okumura: None. T. Sakae: None. H. Sakurai: None.
2211
Concurrent Erlotinib and Radiotherapy for Elderly Squamous Cell Esophageal Carcinoma: Results of a Pilot Study
Y. Zhai, Z. G. Hui, J. B. Wang, J. Liang, J. M. Lv, Z. M. Zhou, Q. F. Feng, H. X. Zhang, D. F. Chen, L. H. Wang Cancer Hospital, 100021, China Purpose/Objective(s): Concurrent chemoradiotherapy is the standard treatment for locally advanced esophageal squamous cell carcinoma (ESCC), but at the expense of increased toxicities. However, quite a few patients cannot endure chemoradiotherapy due to their old age or malnutrition. Erlotinib, an inhibitor of epidermal growth factor receptor tyrosine kinase, was effective in treating ESCC with mild toxicities. This pilot study is to investigate the feasibility and efficacy of concurrent erlotinib and radiotherapy for elderly ESCC. Materials/Methods: Between December 2007 and August 2010, eighteen pathologically diagnosed ESCC patients were enrolled in the study. The median age was 71.5 years. The disease was stage II, III and IV in 4, 10 and 4 patients, respectively. Seven patients received surgery before, including 3 with post-operative local-regional recurrence. All patients were treated with concurrent erlotinib and intensity-modulated radiation therapy. Erlotinib was given orally 150mg/d for at least 8 weeks. Radiotherapy was given by 2 Gy per day, 5 days per week to a total dose of 46 to 70 Gy. The overall survival (OS), progression free survival (PFS) and local-regional free survival (LRFS) were calculated using the Kaplan-Meier method. Toxicities were evaluated according to the NCI-CTC 3.0. Results: At one month post-radiotherapy, there were 2 (11.1%) complete response, 8 (44.4%) partial response and 5 (27.8%) stable disease. With a median follow up of 26.1 months, 14 patients (77.8%) achieved local control. The median recurrencefree time was reached. Four patients died of distant metastasis and 3 died of local progression. The median time of OS, PFS and LRFS was 28.7, 12 and 12 months, respectively. Grade 3 esophagitis was observed in 5 patients (27.8%), grade 3 skin rash in 2 patients (11.1%). Radiation pneumonitis of grade 2 and 4 was observed in one each. There is no grade 3/4 impaired liver function or hematological toxicities. Conclusions: Concurrent erlotinib and radiotherapy is effective and tolerable in elderly ESCC patients who are unfit for concurrent chemoradiotherapy. Prospective trial is necessary to confirm the efficacy and feasibility. Author Disclosure: Y. Zhai: None. Z.G. Hui: None. J.B. Wang: None. J. Liang: None. J.M. Lv: None. Z.M. Zhou: None. Q.F. Feng: None. H.X. Zhang: None. D.F. Chen: None. L.H. Wang: None.
S313