EP-1406: Clinical results of stereotactic radiotherapy for patients with choroidal melanoma using CyberKnife system

S124 Among pts treated for metastatic disease 1-year PFS was 56%; only 1 progression was atthe SBRT site. Conclusions: Lung SBRT can achieve good LC and acceptable rate of pulmonary AT and LT. Overall, the treatment was well tolerated, tacking also into account that the majority of our pts was elderly and with severe comorbidity. EP-1405 Stereotactic radiosurgery in the treatment of melanoma brain metastases. M. Guerrero Tejada1, I. Tovar1, M. Zurita1, R. Del moral1, J. Expósito1, M. Martínez1, M.A. Gentil1, I. Linares1, P. Vargas1, C. Prieto1 1 Hospital Universitario Virgen de las Nieves, Radiotherapy, Granada, Spain Purpose/Objective: The highrate of brain metastasis in patients with advanced melanoma has been a clinical challenge for oncologist. Surgery, stereotactic radiosurgery (SR) and whole-brain radiotherapy with/without cytotoxic chemotherapy remains the mainstay o ftreatment. Our objective is to analyze retrospectively the results of our center. Materials and Methods: From 2000 and 2012 SR has been performed in 39 metastases (24 patients, 14 women and10 men) with melanoma. Median age was 57 (Interquartile range (IQR:40-65), and the main site of the primary tumor was trunk (33% of patients). The recursive partitioning analysis (RPA) was class II in the 70% of patients. After (3 patients) or before (13 patients) RS, 80% of patients received holocranial irradiation. It is done with linear electron accelerator (ALE) with arcoterapia and cones (25.7%) or micromultiláminas (74.3%).The mean volume of treatment was 4,45 cc. The dose of coverage was 18 Gy(48,7%), 19 Gy (2,6%) and 20 Gy (48,7%). Results: Mean survival after RS was 4 months. Post-RS assessment: radiographic stable or decreased in 65,4% of cases. All patients but one were died at the end of the study, and the 46,7% of exitus result from systemic and brain disease progression (the last one was mainly due to development of new brain metastases). The patients who was alive, at the end of the study, is being treated with vemurafenib and the brain disease is stable. Non toxicity was registered in 82,4% of patients. Conclusions: RS is agood technique to treat brain metastases of melanoma and feasible. However, more studies about this technique and the new agents should be considered. EP-1406 Clinical results of stereotactic radiotherapy for patients with choroidal melanoma using CyberKnife system T. Sasaki1, K. Nakamura1, S. Ohga1, T. Yoshitake1, K. Terashima1, K. Asai1, K. Matsumoto1, H. Hirata2, H. Honda1 1 Kyushu University, Department of Clinical Radiology, Fukuoka, Japan 2 Kyushu University, Department of Health Sciences, Fukuoka, Japan Purpose/Objective: This study attempts to evaluate the efficacy of stereotactic radiotherapy (SRT) for patients with choroidal melanoma using CyberKnife® ( Accuray Inc., Sunnyvale,California) system. Materials and Methods: We performed a retrospective analysis of 16 patients with choroidal melanoma who received SRT using CyberKnife from 2006 to 2013 at Kyushu University Hospital.This cohort consisted of 10 male and 6 female with a median age of 73 years(range 41-87 years). The median tumor volume was 1640 mm3, and the margin dose was 50 Gy/5 Fr. For the stabilization of the eye position in this series, eye movement of each patient during treatment was monitored with machine vision system. Pan-retinal photocoagulation was performed in all patients before and after SRT to prevent neovascular glaucoma. Results: After a median follow-up of 19 months (range 6-87 months), local control, defined as continuous tumor regression or stable disease of the tumor, was achieved in 14 out of 16 patients at final observation date. Only one patient developed systemic metastases and died of melanoma. Overall visual acuity was reduced after SRT in all patients, however 13 patients displayed preserved visual function better than hand-movement perception. Ophthalmectomy was not performed in any patients. Tumor resection was performed only one patient. Radiation retinopathy was found seven patients. Only one patient had radiation induced cataract. None had neovascular glaucoma after SRT. Conclusions: SRT using CyberKnife with machine vision system provides excellent control of choroidal melanoma with a decrease in tumor volume. This procedure preserves the eyeball and its visual function, and achieves sufficient local tumor control without severe adverse events.

ESTRO 33, 2014 EP-1407 Multi-institutional planning study for spine stereotactic body radiation therapy with cyberknife in Japan H. Tanaka1, T. Furuya1, K. Nihei1, K. Karasawa1, N. Shikama2, Y. Kumazaki2, K. Miyaura2, H. Mayahara3, H. Nishimura3, M. Nakayama3 1 Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Radiation Oncology, Tokyo, Japan 2 Saitama Medical University International Medical Center, Radiation Oncology, Hidaka, Japan 3 Kobe Minimally Invasive Cancer Center, Radiation Oncology, Kobe, Japan Purpose/Objective: Spine Stereotactic Body Radiation Therapy (SBRT) is an emerging treatment for patients with spinal metastases. Several prospective trials are ongoing all over the world. We made a planning study including 3 Japanese institutions using CyberKnife in preparation for a multi-institutional prospective study. This study aims to assess and minimize inter-institutional variations in treatment planning in spine SBRT. Materials and Methods: Anonymized data of 2 vertebral metastases were used in this study (case 1/2, 5th thoracic spine / 10ththoracic spine). Targets were contoured by a single radiation oncologist. The clinical target volume (CTV) was contoured under the International Spine Radiosurgery Consortium Consensus Guidelines. The planning target volume (PTV) was determined by adding 2mm to the CTV. The organs at risk consisted of esophagus, spinal cord or thecal sac, lung, kidney, and small bowel. At first, this study was performed with Protocol 1, but a wide inter-institutional variations were observed. Protocol 2 was made to reduce the inter-institutional variations. Fractionation schedule was 24 Gy in 2 fractions in both protocols. Dose limitations are determined as follows; Protocol 1: D95% for PTV more than70% of the prescribed dose, the maximum dose less than 140%, Protocol 2: D95% forPTV more than 80% or 70% depending on the shape of CTV and Bilsky grade, D50% between 95% and 107%, the maximum dose less than 140%. These dose parameters were calculated using MultiPlan in 3 institutions. We compared inter-institutional variations of dose volume histogram (DVH) between the 2 protocols. Results: In Protocol 1, D95% for the PTV ranged from 70.0% to 85% and D50% for the PTV ranged from 99.2% to 109.6% in case 1,70.4% to 81.7% and 91.3% to 119.2% in case 2, respectively. In Protocol 2, the corresponding values ranged from 72.5% to 85% and D50% of the PTV ranged from 103.8% to 105% in case 1, 75.4% to 79.2% and 104.2% to 105.4% in case 2. Conclusions: We succeed to reduce inter-institutional variations with dose limitation of D95% and D50%. EP-1408 Stereotactic body radiotherapy using 4D image-guidance for inoperable primary liver cancer or metastases W. Wong1, K.S. Haghighi2, D. Goldstein3 1 Prince of Wales Hospital, Department of Radiation Oncology, Randwick, Australia 2 Prince of Wales Hospital, HPB and Transplant Surgery, Randwick, Australia 3 Prince of Wales Hospital, Department of Medical Oncology, Randwick, Australia Purpose/Objective: Curative resection of primary liver cancer and hepatic oligometastatic disease may not always be possible due to patient and disease factors. Biological dose escalation through stereotactic body radiotherapy (SBRT) is emerging as a treatment option to achieve long term local control and potentially cure for those patients who are not surgical candidates. Materials and Methods: We present our case series of patients who underwent treatment using four-dimensional (4D) image-guided SBRT to account for organ movement due to respiratory motion. The dose delivered was 40Gy in 5 fractions, treated second daily on a conventional linear accelerator. The malignancies treated include hepatocellular carcinoma (HCC), cholangiocarcinoma and solitary metastatic colorectal cancer to the liver. Patients were of Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1. Results: As of October 2013, we have observed 100% response rate to SBRT in our sample pilot group (n=4) based on progress CT scans and/or PET/CT scans. All patients are alive and had not received any other therapy after SBRT. Follow-up ranged between 5 and 20 months. Patients were aged between 23 and 75 years. The size of the lesions ranged from 3cm to 9cm and one patient had multi-focal recurrent hepatocellular carcinoma. Reasons for inoperability include medical