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EP-1090 PRIMARY DIFFUSE LARGE B-CELL LYMPHOMA OF THE STOMACH: PROGNOSTIC FACTORS AND OUTCOMES IN 160 INDIAN PATIENTS
S422
Results: Median follow-up for surviving patients is 10 months. 8 patients have died, all with progressive pancreatic cancer. 3 are alive with progressive disease, 7 are alive without disease or without disease progression. No patient demonstrated any grade 3 toxicity during treatment or during the follow-up period. 3 patients experienced acute grade 2 gastrointestinal (GI) toxicity during treatment although no patient treated with a plan that avoided anterior and left lateral fields (associated with reduced small bowel and gastric exposure) experienced grade 2 GI toxicity. Median weight loss for all patients during treatment was 1.68Kg (range: loss of 9.86Kg to gain of 4.86Kg). Median weight loss for patients treated without anterior or left lateral fields was 0.79Kg (range: loss of 6.59Kg to gain of 4.86Kg). The weight loss difference between the two groups was statistically significant by the one-side Wilcoxon rank sum test (p=0.0256). Conclusions: Proton therapy which avoids the use of anterior and left lateral fields allows for sparing of the small bowel and stomach and is associated with virtual elimination of radiation related gastrointestinal toxicity. Although long-term follow-up will be needed to assess efficacy, we believe that protons may allow for radiotherapy dose escalation, chemotherapy intensification and possibly increased utilization of preoperative neoadjuvant radiotherapy.
ESTRO 31
39% (n=62), Surgery (Sx) and CTh for 22.5% (n=36), CTh and radiotherapy (RT) for 33% (n=53), and all three modalities were used in 5.5% (n=9). Amongst those receiving RT, 37% were treated using 3DCRT technique and 64.5% received an RT dose of >40Gy. Results: After a median follow-up of 52 months, the 5-year PFS & OS were 59.3% and 68.1%, respectively. On multivariate analysis; age ≥ 50yrs (HR=2.17, 95%CI=1.17-3.99, p=0.013), WHO PS ≥2 (HR=1.91, 95%CI=1.02-3.58, p=0.045), presence of multiple or diffuse lesions on endoscopy (HR=2.17, 95%CI=1.13-4.18, p=0.020), and Hb level <10gm/dl (HR=1.90, 95%CI=1.04-3.48, p=0.038) were found to have a significant negative influence on the OS. The IPI was also found to be a significant prognostic indicator for 5yr-OS: low=78.5% vs. lowintermediate=61.4% vs. intermediate=42.4% vs. high=28.6%, p<0.001. Combined modality treatment resulted in a significantly better outcome than CTh alone (5yr-OS: CT+RT=79.3% vs. Sx+CT=73.2% vs. Sx+CT+RT=76.2% vs. CT Alone= 55.5%, p=0.005). On multivariate analysis, the hazard ratio for death in patients receiving CT alone was 2.31 (95%CI=1.22-4.37, p=0.010). The PFS (p<0.001) and OS (p=0.001) rates were significantly better for patients receiving a RT dose of >40Gy. Conclusions: Age at diagnosis, WHO PS, Hb level, IPI, and the number of lesions in the stomach significantly influenced outcome in patients with primary gastric DLBCL. Combined modality treatment, comprising of CTh & RT (with a RT dose of 45Gy), results in satisfactory outcome in patients with this uncommon neoplasm.
ELECTRONIC POSTER: CLINICAL TRACK: GENITOURINARY (PROSTATE INCLUDED) EP-1091 SIMULTANOUS INTEGRATED BOOST USING INTENSITY MODULATED RADIATION THERAPY FOR HORMONE RESISTANT PROSTATE CANCER S. Obata1, Y. Ohta1, T. Kan1, S. Kanegae1, Y. Inoue1, M. Matsuo2, T. Hakariya3 1 Nagasaki Prefecture Shimabara Hospital, Department of Radiology and Radiotherapy, Shimabara, Japan 2 Nagasaki Prefecture Shimabara Hospital, Department of Urology, Shimabara, Japan 3 National Hospital Organaization Nagasaki Medical Center, Department of Urology, Ohmura, Japan
EP-1090 PRIMARY DIFFUSE LARGE B-CELL LYMPHOMA OF THE STOMACH: PROGNOSTIC FACTORS AND OUTCOMES IN 160 INDIAN PATIENTS T. Basu1, S. Laskar1, R. Nair2, S. Gujral3, T. Shet3, M. Sengar2, H. Menon2, K. Mohandas4, M. Muckaden1 1 Tata Memorial Hospital, radiation oncology, Mumbai, India 2 Tata Memorial Hospital, medical oncology, Mumbai, India 3 Tata Memorial Hospital, pathology, Mumbai, India 4 Tata Memorial Hospital, gastroenterology, Mumbai, India Purpose/Objective: To evaluate the prognostic factors and treatment outcome of Indian patients with primary Diffuse Large B-Cell Lymphoma (DLBCL) of the stomach treated at a single institution. Materials and Methods: From January 1990 to December 2007, 160 patients with DLBCL of the Stomach were treated at the Hospital. Median age was 49 years, and majority of the patients (69%) were males. Systemic symptoms were present in 21%; 23% had a WHO performance status (PS) of 2 or more; 36% presented with stage I, 43% had stage II, and 21% had Stage III-IV disease. On initial endoscopy, 46% (n=74) had single lesions, while the remaining had multiple lesions or diffuse involvement of the stomach. As per the international prognostic index (IPI), 59.5% (n=95) were low risk, 23 % (n=37) were low intermediate, 13 % (n=21) were intermediate, and 4.5% (n=4) were high risk. Treatment comprised of chemotherapy (CTh) alone for
Purpose/Objective: The usefulness of radiation therapy for the hormone resistant prostate cancer (HRPC) remains still unclear, but some have reported the increasing therapeutic dose or the widening irradiation field contributed greatly to HRPC. We researched the outcome and adverse events of simultaneous integrated boost using intensity modulated radiation therapy (SIB-IMRT) for HRPC in our hospital. Materials and Methods: A total of ten cases with HRPC underwent SIB-IMRT between June 2009 and April 2011. The dose of radiation to the prostate and seminal vesicles was 72-76Gy, pelvic dose of radiation to the lymph nodes was 52-58Gy which was adjusted according to the age and the complications. Results: The median age was 72.5years (63-80years) and the median prostate-specific antigen (PSA) value was 2.5ng/ml (0.35-284ng/ml). At the median observation time of 15months, PSA non-remnant rate was 70%, and at that of 7months, PSA non-remnant rate was 75% in the group of the positive nodal metastases. Conclusions: SIB-IMRT for HRPC has recognized to be a certain effect without any serious adverse events. Moreover, the accumulation of the cases should be needed because SIB-IMRT can be one of the useful treatments. EP-1092 HIGH DOSE (> 76 GY) IMRT AFTER PROSTATECTOMY: A TOXICITY EVALUATION G. Heinrich1, P. Castro Peña1, P. Murina1, L. Caussa1, C. Sanchez2, D. Venencia2, S. Zunino1 1 Instituto de Radioterapia - Fundacion Marie Curie, Radiation Oncology, Cordoba, Argentina 2 Instituto de Radioterapia - Fundacion Marie Curie, Medical Physics, Cordoba, Argentina Purpose/Objective: Retrospective evaluation of gastrointestinal (GI) and genitourinary (GU) toxicity after a treatment of high dose (> 76 Gy) IMRT after prostatectomy in prostate cancer patients. Materials and Methods: Between July 2009 and December 2010, 19 patients with prostatectomy were irradiated with IMRT. A Scan-CT
Results: Median follow-up for surviving patients is 10 months. 8 patients have died, all with progressive pancreatic cancer. 3 are alive with progressive disease, 7 are alive without disease or without disease progression. No patient demonstrated any grade 3 toxicity during treatment or during the follow-up period. 3 patients experienced acute grade 2 gastrointestinal (GI) toxicity during treatment although no patient treated with a plan that avoided anterior and left lateral fields (associated with reduced small bowel and gastric exposure) experienced grade 2 GI toxicity. Median weight loss for all patients during treatment was 1.68Kg (range: loss of 9.86Kg to gain of 4.86Kg). Median weight loss for patients treated without anterior or left lateral fields was 0.79Kg (range: loss of 6.59Kg to gain of 4.86Kg). The weight loss difference between the two groups was statistically significant by the one-side Wilcoxon rank sum test (p=0.0256). Conclusions: Proton therapy which avoids the use of anterior and left lateral fields allows for sparing of the small bowel and stomach and is associated with virtual elimination of radiation related gastrointestinal toxicity. Although long-term follow-up will be needed to assess efficacy, we believe that protons may allow for radiotherapy dose escalation, chemotherapy intensification and possibly increased utilization of preoperative neoadjuvant radiotherapy.
ESTRO 31
39% (n=62), Surgery (Sx) and CTh for 22.5% (n=36), CTh and radiotherapy (RT) for 33% (n=53), and all three modalities were used in 5.5% (n=9). Amongst those receiving RT, 37% were treated using 3DCRT technique and 64.5% received an RT dose of >40Gy. Results: After a median follow-up of 52 months, the 5-year PFS & OS were 59.3% and 68.1%, respectively. On multivariate analysis; age ≥ 50yrs (HR=2.17, 95%CI=1.17-3.99, p=0.013), WHO PS ≥2 (HR=1.91, 95%CI=1.02-3.58, p=0.045), presence of multiple or diffuse lesions on endoscopy (HR=2.17, 95%CI=1.13-4.18, p=0.020), and Hb level <10gm/dl (HR=1.90, 95%CI=1.04-3.48, p=0.038) were found to have a significant negative influence on the OS. The IPI was also found to be a significant prognostic indicator for 5yr-OS: low=78.5% vs. lowintermediate=61.4% vs. intermediate=42.4% vs. high=28.6%, p<0.001. Combined modality treatment resulted in a significantly better outcome than CTh alone (5yr-OS: CT+RT=79.3% vs. Sx+CT=73.2% vs. Sx+CT+RT=76.2% vs. CT Alone= 55.5%, p=0.005). On multivariate analysis, the hazard ratio for death in patients receiving CT alone was 2.31 (95%CI=1.22-4.37, p=0.010). The PFS (p<0.001) and OS (p=0.001) rates were significantly better for patients receiving a RT dose of >40Gy. Conclusions: Age at diagnosis, WHO PS, Hb level, IPI, and the number of lesions in the stomach significantly influenced outcome in patients with primary gastric DLBCL. Combined modality treatment, comprising of CTh & RT (with a RT dose of 45Gy), results in satisfactory outcome in patients with this uncommon neoplasm.
ELECTRONIC POSTER: CLINICAL TRACK: GENITOURINARY (PROSTATE INCLUDED) EP-1091 SIMULTANOUS INTEGRATED BOOST USING INTENSITY MODULATED RADIATION THERAPY FOR HORMONE RESISTANT PROSTATE CANCER S. Obata1, Y. Ohta1, T. Kan1, S. Kanegae1, Y. Inoue1, M. Matsuo2, T. Hakariya3 1 Nagasaki Prefecture Shimabara Hospital, Department of Radiology and Radiotherapy, Shimabara, Japan 2 Nagasaki Prefecture Shimabara Hospital, Department of Urology, Shimabara, Japan 3 National Hospital Organaization Nagasaki Medical Center, Department of Urology, Ohmura, Japan
EP-1090 PRIMARY DIFFUSE LARGE B-CELL LYMPHOMA OF THE STOMACH: PROGNOSTIC FACTORS AND OUTCOMES IN 160 INDIAN PATIENTS T. Basu1, S. Laskar1, R. Nair2, S. Gujral3, T. Shet3, M. Sengar2, H. Menon2, K. Mohandas4, M. Muckaden1 1 Tata Memorial Hospital, radiation oncology, Mumbai, India 2 Tata Memorial Hospital, medical oncology, Mumbai, India 3 Tata Memorial Hospital, pathology, Mumbai, India 4 Tata Memorial Hospital, gastroenterology, Mumbai, India Purpose/Objective: To evaluate the prognostic factors and treatment outcome of Indian patients with primary Diffuse Large B-Cell Lymphoma (DLBCL) of the stomach treated at a single institution. Materials and Methods: From January 1990 to December 2007, 160 patients with DLBCL of the Stomach were treated at the Hospital. Median age was 49 years, and majority of the patients (69%) were males. Systemic symptoms were present in 21%; 23% had a WHO performance status (PS) of 2 or more; 36% presented with stage I, 43% had stage II, and 21% had Stage III-IV disease. On initial endoscopy, 46% (n=74) had single lesions, while the remaining had multiple lesions or diffuse involvement of the stomach. As per the international prognostic index (IPI), 59.5% (n=95) were low risk, 23 % (n=37) were low intermediate, 13 % (n=21) were intermediate, and 4.5% (n=4) were high risk. Treatment comprised of chemotherapy (CTh) alone for
Purpose/Objective: The usefulness of radiation therapy for the hormone resistant prostate cancer (HRPC) remains still unclear, but some have reported the increasing therapeutic dose or the widening irradiation field contributed greatly to HRPC. We researched the outcome and adverse events of simultaneous integrated boost using intensity modulated radiation therapy (SIB-IMRT) for HRPC in our hospital. Materials and Methods: A total of ten cases with HRPC underwent SIB-IMRT between June 2009 and April 2011. The dose of radiation to the prostate and seminal vesicles was 72-76Gy, pelvic dose of radiation to the lymph nodes was 52-58Gy which was adjusted according to the age and the complications. Results: The median age was 72.5years (63-80years) and the median prostate-specific antigen (PSA) value was 2.5ng/ml (0.35-284ng/ml). At the median observation time of 15months, PSA non-remnant rate was 70%, and at that of 7months, PSA non-remnant rate was 75% in the group of the positive nodal metastases. Conclusions: SIB-IMRT for HRPC has recognized to be a certain effect without any serious adverse events. Moreover, the accumulation of the cases should be needed because SIB-IMRT can be one of the useful treatments. EP-1092 HIGH DOSE (> 76 GY) IMRT AFTER PROSTATECTOMY: A TOXICITY EVALUATION G. Heinrich1, P. Castro Peña1, P. Murina1, L. Caussa1, C. Sanchez2, D. Venencia2, S. Zunino1 1 Instituto de Radioterapia - Fundacion Marie Curie, Radiation Oncology, Cordoba, Argentina 2 Instituto de Radioterapia - Fundacion Marie Curie, Medical Physics, Cordoba, Argentina Purpose/Objective: Retrospective evaluation of gastrointestinal (GI) and genitourinary (GU) toxicity after a treatment of high dose (> 76 Gy) IMRT after prostatectomy in prostate cancer patients. Materials and Methods: Between July 2009 and December 2010, 19 patients with prostatectomy were irradiated with IMRT. A Scan-CT