- Email: [email protected]
Evaluation of Prognostic Factors in Clinical Blood Examinations in Patients Undergoing Chemoradiation Therapy for Stage II-III Thoracic Esophageal Cancer
E152
International Journal of Radiation Oncology Biology Physics
in response rates based on TTV (pZ0.17). On multivariate analysis, increased TTV was significantly associated with increased LR (pZ0.01) and decreased OS (pZ0.0004). For patients with TTV 500 cc, median OS was 15.0 months, and one-year OS was 70%. For patients with TTV > 500 cc, median OS was 6.3 months, and one-year OS was 24% (pZ0.004). One-year LR was 18% in patients with TTV 500 cc and 85% in patients with TTV > 500 cc (pZ0.0005). Conclusion: Increased TTV is significantly associated with increased LR and decreased OS in patients with HCC regardless of other factors such as stage or portal vein thrombosis. Dose calculations for 90Y glass microspheres are based on total infused volume of liver and do not account for tumor volume. Further evaluation of the distribution of delivered microspheres could elicit more information regarding the effect of TTV on 90Y dosimetry. Patients with larger tumor burdens may also benefit from subsequent locoregional or systemic therapies to improve outcomes. Author Disclosure: A.A. Weiner: None. F.F. Youssef: None. T.A. DeWees: None. J.R. Olsen: Employee; Washington University School of Medicine. Research Grant; ViewRay, Inc., RadioMed Corp. Honoraria; ViewRay, Inc. Travel Expenses; ViewRay, Inc. Patent/License Fees/ Copyright; Varian Medical Systems. M.D. Darcy: None. G.M. Foltz: None. S.J. Klein: None. N. Saad: Proctor; Sirtex Medical. D.A. Zuckerman: Speaker’s Bureau; BTG. P.J. Parikh: Research Grant; Varian Medical Systems, Philips Healthcare. Stock; Holaira.
(lipase > 5xULN and neutrophils <500/mL). Both, dose level 1 and 2 each, had a DLT among the first 3 patients, requiring additional 3 patients at the same dose level as per protocol. However, dose level 3 (62Gy) was completed, with no DLTs in 3 patients. Overall, 56% of patients had a partial response and 28% showed stable disease of the treated liver lesions according to RECIST criteria. No patient experienced > grade 2 acute or late gastrointestinal toxicity. No signs of radiation induced liver disease (RILD) occurred. Two patients in dose level 3 experienced lymphocytopenia grade 4, with no clinical impact. Conclusion: The maximum tolerated dose could not be determined. Conventionally fractionated RT of at least 62Gy can be considered as safe for patients with HCC. Higher dose levels need investigation. External beam RT within multimodal treatment concepts merits controlled trials. Author Disclosure: E. Herrmann: None. D. Naehrig: None. J. Buijsen: None. I.F. Ciernik: None. D.R. Zwahlen: None. A. Franzetti Pellanda: None. A. Meister: None. P. Brauchli: None. S. Berardi: None. E. Ku¨ttel: None. S. Demmel: None. M. Bigler: None. M. Sassowski: None. J. Dufour: None. D.M. Aebersold: None.
2386 External Beam Radiation Therapy for Unresectable Hepatocellular Carcinoma: An International Multicenter Phase I Trial, SAKK 77/07 E. Herrmann,1 D. Naehrig,2 J. Buijsen,3 I.F. Ciernik,4 D.R. Zwahlen,5 A. Franzetti Pellanda,6 A. Meister,7 P. Brauchli,8 S. Berardi,8 E. Ku¨ttel,8 S. Demmel,8 M. Bigler,8 M. Sassowski,9 J.F. Dufour,10 and D.M. Aebersold11; 1Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Switzerland, Bern, Switzerland, 2Division of Radiation Oncology, Basel University Hospital, Basel, Switzerland, 3MAASTRO Clinic, Maastricht, Drenthe, Netherlands, 4 City Hospital Dessau, Dessau, Germany, 5Kantonsspital Graubunden, Untervaz CH 7204, Switzerland, 6Clinica Luganese, Lugano, Switzerland, 7 Spital Aarau, Aarau, Switzerland, 8SAKK, Bern, Switzerland, 9 Department of Radiation Oncology and Division of Medical Radiation Physics, Bern University Hospital, Bern, Switzerland, 10University Clinic of Visceral Surgery and Medicine, Department of Hepatology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland, 11 Inselspital, Bern University Hospital, and University of Bern, Switzerland Purpose/Objective(s): To assess the feasibility and safety of conventionally fractionated radiation therapy (cfRT) in patients with hepatocellular carcinoma (HCC). Materials/Methods: This is a phase I multicenter clinical trial for patients with histologically confirmed stage cT1-4, cN0-1 HCC and Child-Pugh score (CP) A or B disease. Metastatic HCC was allowed if 90% of total tumor volume was located within the liver. Patients were to be enrolled onto five dose-escalation levels (from 54-70Gy in 2Gy fractions) based on a modified 3 + 3 design. Primary trial endpoint was dose-limiting toxicity (DLT), as specifically defined for 17 clinical and 9 laboratory parameters as grade 3 or 4 toxicity (CTCAE vs. 3). The threshold to declare a dose level as maximum tolerated dose (MTD) was defined as a DLT rate of 16.7% in dose levels 1-3, and 10% in dose levels 4-5. Best objective response of target liver lesions and adverse events were assessed as secondary endpoints. Results: The trial was terminated early due to low accrual. Nineteen patients were recruited. Fifteen patients were evaluable for the primary endpoint and 18 for the secondary endpoints. Median age was 69 years (range 45-82y). Twelve patients had CP A and three patients CP B disease. A total of 15 lesions were treated. Median size was 70mm (range 18-186 mm). Median follow-up was 11.8 months. The maximum tolerated dose was not reached, due to early trial termination. One of 6 patients in dose level 1 and 1 of 6 patients in dose level 2 experienced DLTs
2387 Evaluation of Prognostic Factors in Clinical Blood Examinations in Patients Undergoing Chemoradiation Therapy for Stage II-III Thoracic Esophageal Cancer R. Umezawa,1 H. Matsushita,2 T. Sugawara,3 M. Kubozono,3 T. Yamamoto,3 Y. Ishikawa,4 M. Kozumi,3 N. Takahashi,3 Y. Katagiri,3 N. Kadoya,4 K. Takeda,5 and K. Jingu3; 1National Cancer Center Hospital, Tokyo, Japan, 2Tohoku University Graduate School of Medicine, Sendai, Japan, 3Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan, 4Department of Radiation Oncology, Tohoku University Graduate School of Medicine,, Sendai, Japan, 5 Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Tohoku University, Sendai, Japan Purpose/Objective(s): Chemoradiation therapy (CRT) is one of the curative treatments for thoracic esophageal cancer. We considered that prognostic markers in CRT, especially for stage II-III, are important for predicting the life expectancy and selecting the treatment strategy. Some studies have shown that factors in clinical blood examinations such as Creactive protein (CRP), hemoglobin (Hb), platelets (Plt) and albumin (Alb) were significant prognostic factors for several types of cancers We retrospectively evaluated prognostic factors in clinical blood examinations in patients undergoing CRT for stage II-III thoracic esophageal cancer. Materials/Methods: Between 2000 and 2012, 298 patients with stage II-III (T1-3N0-1M0:UICC2002) thoracic esophageal cancer underwent CRT. All patients had squamous cell carcinoma and were treated by three protocols of CRT as follows. Arm A consisted of two cycles of cisplatin (CDDP) at 70 mg/m2 (day 1 and 29) and 5-fluorouracil at 700 mg/m2/24h (day 1-4 and 29-32) with radiation therapy (RT) of 60 Gy (30 fractions) without break. Arm B consisted of two cycles of CDDP at 40 mg/m2 (day 1, 8, 36 and 43) and 5-fluorouracil at 700 mg/m2/24h (day1-5, 8-12, 36-40 and 43-47) with radiation therapy (RT) of 60 Gy (30 fractions) including a two-week break. Arm C consisted of two cycles of nedaplatin (CDGP) at 70 mg/m2 (day 1 and 29) and 5-fluorouracil at 500 mg/m2/24h (day 1-4 and 29-32) with radiation therapy (RT) of 60-70 Gy (30-35 fractions) without a break. CRP, hemoglobin, platelets and albumin were measured before CRT. Overall survival (OS) was estimated using the Kaplan-Meier method. Prognostic factors were evaluated by univariate analysis using the log-rank test and by multivariate analysis using the Cox proportional hazards regression model. Results: The median follow-up period was 27.4 months (range, 1.8-135.1 months). The 3-year and 5-year OS rates were 59.3% and 50.2%, respectively. The 5-year OS rates for CRP level of less than 0.5 mg/dl and CRP level of 0.5 mg/dl or more were 52.5% and 46.9%, respectively (p Z 0.031). The 5-year OS for Hb level of more than 13 g/dl and Hb level of 13 g/dl or less were 52.0% and 48.3%, respectively (p Z 0.1475). The 5-year OS rates for Plt level of 300 /nl or less and Plt level of more than 300 /nl were 53.3% and 41.6%, respectively (p Z 0.025). The 5-year OS
Volume 93 Number 3S Supplement 2015 rates for Alb level of more than 3.5 g/dl and Alb level of 3.5 g/dl or less were 53.9% and 35.5%, respectively (p Z 0.002). In multivariate analysis, Alb level tended to be a significant factor (p Z 0.053). Conclusion: Results of clinical blood examinations might be prognostic factors in CRT for stage II-III thoracic esophageal cancer. The condition of nutrition before CRT might have a great impaction. Author Disclosure: R. Umezawa: None. H. Matsushita: None. T. Sugawara: None. M. Kubozono: None. T. Yamamoto: None. Y. Ishikawa: None. M. Kozumi: None. N. Takahashi: None. Y. Katagiri: None. N. Kadoya: None. K. Takeda: None. K. Jingu: None.
2388 Perineural Invasion and Radial Margin Predict Survival in Neoadjuvant Radiation Chemotherapy for Advanced Rectal Cancer A. Reig Castillejo,1 I. Membrive,2 P. Foro,2 N. Rodriguez De Dios,1 J. Sanz,1 J. Quera,3 E. Fernandez -Velilla,1 O. Pera,3 A. Ortiz,3 and M. Algara2; 1Hospital de I’Esperanc¸a, Barcelona, Spain, 2Hospital de la Esperanza. Parc de Salut Mar. IMIM (Hospital del Mar Medical Research Institute). Universitat Pompeu Fabra., Barcelona, Spain, 3 Hospital de la Esperanza. Parc de Salut Mar. IMIM (Hospital del Mar Medical Research Institute)., Barcelona, Spain Purpose/Objective(s): Tumor response to neoadjuvant radiochemotherapy is determined at the time of surgical resection with histologic examination and is quantified on a spectrum ranging from no response to complete response. Good responder patients (Mandard classification I/II, compared to bad responders III/IV/V) achieve low level of local and distant relapses, with good survival. Other factors, as perineural, venous, vascular invasion, and positive radial margin also worsen prognosis. To assess the predictive factors for survival in our series of 115 patients. Materials/Methods: Between January 2006 and December 2013, patients diagnosed of rectal adenocarcinoma received neoadjuvant radiochemotherapy. There were 77 men and 38 women. A pelvic CT and MRI were done to all patients. Patients received pelvic radiation therapy to a total dose of 45-50.4 Gy with concomitant chemotherapy. An anterior resection was performed to 101 patients and an abdomino perineal resection to 14. Mandard classification was used to evaluate grade of pathologic response (TRG1-5). Log Rank test were used for univariate analysis and Cox regression for multivariate. Results: There were 11 local and 24 distant relapses. Specific survival at 5 years was 75.1 0.1%. Pathologic specimen showed: 16 TRG1, 43 TRG2, 39 TRG3, 17 TRG4. 11/115 patients had positive radial margin; 23/115 perineural invasion, 10/115 venous or arterial invasion and 14/115 patients small vessels invasion. In univariate analysis, distance to anal verge p< 0.04, radial margin p< 0.01, perineural invasion p< 0.000, venous invasion p< 0.001 and good grade regression p< 0.009 are predictive factors for survival. In multivariate analysis only radial margin p < 0.03 and perineural invasion p< 0.000 were predictive factors for survival. Good responders, compared to bad responders, showed decrease distant relapses p < 0.04, less perineural invasion p < 0.000, venous or vascular invasion p< 0.000, and small vessels invasion p < 0.000. None of the 16 patients who achieved a complete pathologic response (TRGI) had perineural, venous or vascular invasion in the histologic specimen and radial margin were negative. In univariate analysis we could also find distance to anal verge 5 cm as the only predictive factor to find positive margin in the histologic specimen. Conclusion: Tumors located 5 cm from anal verge, predict to have positive margins in histologic specimen. Positive margin and perineural invasion are predictive factors for survival. Good responders have less perineural, vascular or venous invasion than bad responders with decrease distant relapses. Author Disclosure: A. Reig Castillejo: None. I. Membrive: None. P. Foro: None. N. Rodriguez De Dios: None. J. Sanz: None. J. Quera: None. E. Fernandez-Velilla: None. O. Pera: None. A. Ortiz: None. M. Algara: None.
Poster Viewing Session E153
2389 Outcome of Proximal Esophageal Cancer After Definitive Combined Chemoradiation: A Multicenter Retrospective Study E. Herrmann,1 N. Mertineit,2 B. De Bari,3 L. Hoeng,4 F. Caparrotti,5 R. Jumeau,6 O. Elc¸in,2 N. Cihoric,7 P. Wolfensberger,8 K. Loessl,2 D.M. Aebersold,9 and E.M. Ozsahin10; 1Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Switzerland, Bern, Switzerland, 2Department of Radiation Oncology, Bern University Hospital, and University of Bern, Switzerland, Bern, Switzerland, 3Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland, 4Department of Radiation Oncology, Kantonsspital St. Gallen, Switzerland, St. Gallen, Switzerland, 5 Hopitaux Universitaires de Geneva, Geneva, Geneva, Switzerland, 6 Department of Radiation Oncology, Lausanne University Hospital, Lausanne, Switzerland, 7Inselspital, Bern 3010, Switzerland, 8University Bern Switzerland, Bern, Switzerland, 9Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland, 10Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland Purpose/Objective(s): To report oncological outcome and toxicity rates of definitive external beam radiation therapy (RT) combined with platinbased chemotherapy (CRT) in the management of proximal esophageal cancer. Materials/Methods: The medical records of patients with stage cT1-4 cN0-3 cM0 proximal esophageal cancer (tumor below the inferior border of the cricoid cartilage, up to 22 cm from the incisors) treated with platinebased definitive CRT between 2004 and 2013 in four institutions were retrospectively studied. Acute and chronic toxicities were evaluated with CTCAE v.4. The impact of possible patient related and procedural characteristics on loco-regional control (LRC), overall survival (OS) and disease-free survival (DFS) were evaluated using the log-rank test and multivariate Cox proportional hazards model. Primary endpoint was LRC. Results: We included 55 patients (13 females, 42 males), mean age was 65 (range: 42-78) with a median follow up of 34 months (range: 6-110). Median time interval from diagnosis to RT was 89 days (range: 6-178). Median radiation dose was 56Gy (range 28-72). Induction chemotherapy (ICHT) was given in 58% of patients. Actuarial LRC, DFS and OS at 3 years were 52% (95% CI: 37-67%), 35% (95% CI: 22-50%) and 52% (95% CI: 37-67%), respectively. On univariate analyses, the only significant prognostic factor for LRC was the time interval from diagnosis to RT. During RT, acute toxicities (dysphagia, pain, skin-reaction) ranged from grade 0 to 3, without significant dose-dependent differences. Dysphagia at last follow-up ranged from grade 0 to 4. After backwards elimination, multivariate models were statistically significant for DFS and OS when patients received a total radiation dose >56Gy together with ICHT (p < 0.05). Conclusion: Combined CRT is a reliable therapeutic alternative for proximal esophageal cancer, with anticipated treatment related toxicities. Further examination and randomized prospective trials are needed to assess this combined treatment modality for increased DFS and OS. Author Disclosure: E. Herrmann: None. N. Mertineit: None. B. De Bari: None. L. Hoeng: None. F. Caparrotti: None. R. Jumeau: None. O. Elc¸in: None. N. Cihoric: None. P. Wolfensberger: None. K. Loessl: None. D.M. Aebersold: None. E. Ozsahin: None.
2390 Impact of Incidental Angiotensin Converting Enzyme Inhibitor (ACEi) and Angiotensin Receptor Blocker (ARB) Use on Pathologic Complete Response (pCR) to Neoadjuvant Chemoradiation (NA-CRT) in Esophageal Cancer J. Hyder,1 H. Boggs,1 M.D. Chuong,2 M. Suntharalingam,2 W. Burrows,2 N. Horiba,3 D.P. Zandberg,3 T.N. Tyer,1 E.P. Cohen,4,5 Z. Vujaskovic,2 and P. Mohindra2; 1Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 2University of Maryland School of Medicine, Baltimore, MD, 3Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, 4Department of Nephrology, Medical College of Wisconsin, Milwaukee, WI, 5Department of Veteran Affairs, Milwaukee, WI
International Journal of Radiation Oncology Biology Physics
in response rates based on TTV (pZ0.17). On multivariate analysis, increased TTV was significantly associated with increased LR (pZ0.01) and decreased OS (pZ0.0004). For patients with TTV 500 cc, median OS was 15.0 months, and one-year OS was 70%. For patients with TTV > 500 cc, median OS was 6.3 months, and one-year OS was 24% (pZ0.004). One-year LR was 18% in patients with TTV 500 cc and 85% in patients with TTV > 500 cc (pZ0.0005). Conclusion: Increased TTV is significantly associated with increased LR and decreased OS in patients with HCC regardless of other factors such as stage or portal vein thrombosis. Dose calculations for 90Y glass microspheres are based on total infused volume of liver and do not account for tumor volume. Further evaluation of the distribution of delivered microspheres could elicit more information regarding the effect of TTV on 90Y dosimetry. Patients with larger tumor burdens may also benefit from subsequent locoregional or systemic therapies to improve outcomes. Author Disclosure: A.A. Weiner: None. F.F. Youssef: None. T.A. DeWees: None. J.R. Olsen: Employee; Washington University School of Medicine. Research Grant; ViewRay, Inc., RadioMed Corp. Honoraria; ViewRay, Inc. Travel Expenses; ViewRay, Inc. Patent/License Fees/ Copyright; Varian Medical Systems. M.D. Darcy: None. G.M. Foltz: None. S.J. Klein: None. N. Saad: Proctor; Sirtex Medical. D.A. Zuckerman: Speaker’s Bureau; BTG. P.J. Parikh: Research Grant; Varian Medical Systems, Philips Healthcare. Stock; Holaira.
(lipase > 5xULN and neutrophils <500/mL). Both, dose level 1 and 2 each, had a DLT among the first 3 patients, requiring additional 3 patients at the same dose level as per protocol. However, dose level 3 (62Gy) was completed, with no DLTs in 3 patients. Overall, 56% of patients had a partial response and 28% showed stable disease of the treated liver lesions according to RECIST criteria. No patient experienced > grade 2 acute or late gastrointestinal toxicity. No signs of radiation induced liver disease (RILD) occurred. Two patients in dose level 3 experienced lymphocytopenia grade 4, with no clinical impact. Conclusion: The maximum tolerated dose could not be determined. Conventionally fractionated RT of at least 62Gy can be considered as safe for patients with HCC. Higher dose levels need investigation. External beam RT within multimodal treatment concepts merits controlled trials. Author Disclosure: E. Herrmann: None. D. Naehrig: None. J. Buijsen: None. I.F. Ciernik: None. D.R. Zwahlen: None. A. Franzetti Pellanda: None. A. Meister: None. P. Brauchli: None. S. Berardi: None. E. Ku¨ttel: None. S. Demmel: None. M. Bigler: None. M. Sassowski: None. J. Dufour: None. D.M. Aebersold: None.
2386 External Beam Radiation Therapy for Unresectable Hepatocellular Carcinoma: An International Multicenter Phase I Trial, SAKK 77/07 E. Herrmann,1 D. Naehrig,2 J. Buijsen,3 I.F. Ciernik,4 D.R. Zwahlen,5 A. Franzetti Pellanda,6 A. Meister,7 P. Brauchli,8 S. Berardi,8 E. Ku¨ttel,8 S. Demmel,8 M. Bigler,8 M. Sassowski,9 J.F. Dufour,10 and D.M. Aebersold11; 1Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Switzerland, Bern, Switzerland, 2Division of Radiation Oncology, Basel University Hospital, Basel, Switzerland, 3MAASTRO Clinic, Maastricht, Drenthe, Netherlands, 4 City Hospital Dessau, Dessau, Germany, 5Kantonsspital Graubunden, Untervaz CH 7204, Switzerland, 6Clinica Luganese, Lugano, Switzerland, 7 Spital Aarau, Aarau, Switzerland, 8SAKK, Bern, Switzerland, 9 Department of Radiation Oncology and Division of Medical Radiation Physics, Bern University Hospital, Bern, Switzerland, 10University Clinic of Visceral Surgery and Medicine, Department of Hepatology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland, 11 Inselspital, Bern University Hospital, and University of Bern, Switzerland Purpose/Objective(s): To assess the feasibility and safety of conventionally fractionated radiation therapy (cfRT) in patients with hepatocellular carcinoma (HCC). Materials/Methods: This is a phase I multicenter clinical trial for patients with histologically confirmed stage cT1-4, cN0-1 HCC and Child-Pugh score (CP) A or B disease. Metastatic HCC was allowed if 90% of total tumor volume was located within the liver. Patients were to be enrolled onto five dose-escalation levels (from 54-70Gy in 2Gy fractions) based on a modified 3 + 3 design. Primary trial endpoint was dose-limiting toxicity (DLT), as specifically defined for 17 clinical and 9 laboratory parameters as grade 3 or 4 toxicity (CTCAE vs. 3). The threshold to declare a dose level as maximum tolerated dose (MTD) was defined as a DLT rate of 16.7% in dose levels 1-3, and 10% in dose levels 4-5. Best objective response of target liver lesions and adverse events were assessed as secondary endpoints. Results: The trial was terminated early due to low accrual. Nineteen patients were recruited. Fifteen patients were evaluable for the primary endpoint and 18 for the secondary endpoints. Median age was 69 years (range 45-82y). Twelve patients had CP A and three patients CP B disease. A total of 15 lesions were treated. Median size was 70mm (range 18-186 mm). Median follow-up was 11.8 months. The maximum tolerated dose was not reached, due to early trial termination. One of 6 patients in dose level 1 and 1 of 6 patients in dose level 2 experienced DLTs
2387 Evaluation of Prognostic Factors in Clinical Blood Examinations in Patients Undergoing Chemoradiation Therapy for Stage II-III Thoracic Esophageal Cancer R. Umezawa,1 H. Matsushita,2 T. Sugawara,3 M. Kubozono,3 T. Yamamoto,3 Y. Ishikawa,4 M. Kozumi,3 N. Takahashi,3 Y. Katagiri,3 N. Kadoya,4 K. Takeda,5 and K. Jingu3; 1National Cancer Center Hospital, Tokyo, Japan, 2Tohoku University Graduate School of Medicine, Sendai, Japan, 3Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan, 4Department of Radiation Oncology, Tohoku University Graduate School of Medicine,, Sendai, Japan, 5 Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Tohoku University, Sendai, Japan Purpose/Objective(s): Chemoradiation therapy (CRT) is one of the curative treatments for thoracic esophageal cancer. We considered that prognostic markers in CRT, especially for stage II-III, are important for predicting the life expectancy and selecting the treatment strategy. Some studies have shown that factors in clinical blood examinations such as Creactive protein (CRP), hemoglobin (Hb), platelets (Plt) and albumin (Alb) were significant prognostic factors for several types of cancers We retrospectively evaluated prognostic factors in clinical blood examinations in patients undergoing CRT for stage II-III thoracic esophageal cancer. Materials/Methods: Between 2000 and 2012, 298 patients with stage II-III (T1-3N0-1M0:UICC2002) thoracic esophageal cancer underwent CRT. All patients had squamous cell carcinoma and were treated by three protocols of CRT as follows. Arm A consisted of two cycles of cisplatin (CDDP) at 70 mg/m2 (day 1 and 29) and 5-fluorouracil at 700 mg/m2/24h (day 1-4 and 29-32) with radiation therapy (RT) of 60 Gy (30 fractions) without break. Arm B consisted of two cycles of CDDP at 40 mg/m2 (day 1, 8, 36 and 43) and 5-fluorouracil at 700 mg/m2/24h (day1-5, 8-12, 36-40 and 43-47) with radiation therapy (RT) of 60 Gy (30 fractions) including a two-week break. Arm C consisted of two cycles of nedaplatin (CDGP) at 70 mg/m2 (day 1 and 29) and 5-fluorouracil at 500 mg/m2/24h (day 1-4 and 29-32) with radiation therapy (RT) of 60-70 Gy (30-35 fractions) without a break. CRP, hemoglobin, platelets and albumin were measured before CRT. Overall survival (OS) was estimated using the Kaplan-Meier method. Prognostic factors were evaluated by univariate analysis using the log-rank test and by multivariate analysis using the Cox proportional hazards regression model. Results: The median follow-up period was 27.4 months (range, 1.8-135.1 months). The 3-year and 5-year OS rates were 59.3% and 50.2%, respectively. The 5-year OS rates for CRP level of less than 0.5 mg/dl and CRP level of 0.5 mg/dl or more were 52.5% and 46.9%, respectively (p Z 0.031). The 5-year OS for Hb level of more than 13 g/dl and Hb level of 13 g/dl or less were 52.0% and 48.3%, respectively (p Z 0.1475). The 5-year OS rates for Plt level of 300 /nl or less and Plt level of more than 300 /nl were 53.3% and 41.6%, respectively (p Z 0.025). The 5-year OS
Volume 93 Number 3S Supplement 2015 rates for Alb level of more than 3.5 g/dl and Alb level of 3.5 g/dl or less were 53.9% and 35.5%, respectively (p Z 0.002). In multivariate analysis, Alb level tended to be a significant factor (p Z 0.053). Conclusion: Results of clinical blood examinations might be prognostic factors in CRT for stage II-III thoracic esophageal cancer. The condition of nutrition before CRT might have a great impaction. Author Disclosure: R. Umezawa: None. H. Matsushita: None. T. Sugawara: None. M. Kubozono: None. T. Yamamoto: None. Y. Ishikawa: None. M. Kozumi: None. N. Takahashi: None. Y. Katagiri: None. N. Kadoya: None. K. Takeda: None. K. Jingu: None.
2388 Perineural Invasion and Radial Margin Predict Survival in Neoadjuvant Radiation Chemotherapy for Advanced Rectal Cancer A. Reig Castillejo,1 I. Membrive,2 P. Foro,2 N. Rodriguez De Dios,1 J. Sanz,1 J. Quera,3 E. Fernandez -Velilla,1 O. Pera,3 A. Ortiz,3 and M. Algara2; 1Hospital de I’Esperanc¸a, Barcelona, Spain, 2Hospital de la Esperanza. Parc de Salut Mar. IMIM (Hospital del Mar Medical Research Institute). Universitat Pompeu Fabra., Barcelona, Spain, 3 Hospital de la Esperanza. Parc de Salut Mar. IMIM (Hospital del Mar Medical Research Institute)., Barcelona, Spain Purpose/Objective(s): Tumor response to neoadjuvant radiochemotherapy is determined at the time of surgical resection with histologic examination and is quantified on a spectrum ranging from no response to complete response. Good responder patients (Mandard classification I/II, compared to bad responders III/IV/V) achieve low level of local and distant relapses, with good survival. Other factors, as perineural, venous, vascular invasion, and positive radial margin also worsen prognosis. To assess the predictive factors for survival in our series of 115 patients. Materials/Methods: Between January 2006 and December 2013, patients diagnosed of rectal adenocarcinoma received neoadjuvant radiochemotherapy. There were 77 men and 38 women. A pelvic CT and MRI were done to all patients. Patients received pelvic radiation therapy to a total dose of 45-50.4 Gy with concomitant chemotherapy. An anterior resection was performed to 101 patients and an abdomino perineal resection to 14. Mandard classification was used to evaluate grade of pathologic response (TRG1-5). Log Rank test were used for univariate analysis and Cox regression for multivariate. Results: There were 11 local and 24 distant relapses. Specific survival at 5 years was 75.1 0.1%. Pathologic specimen showed: 16 TRG1, 43 TRG2, 39 TRG3, 17 TRG4. 11/115 patients had positive radial margin; 23/115 perineural invasion, 10/115 venous or arterial invasion and 14/115 patients small vessels invasion. In univariate analysis, distance to anal verge p< 0.04, radial margin p< 0.01, perineural invasion p< 0.000, venous invasion p< 0.001 and good grade regression p< 0.009 are predictive factors for survival. In multivariate analysis only radial margin p < 0.03 and perineural invasion p< 0.000 were predictive factors for survival. Good responders, compared to bad responders, showed decrease distant relapses p < 0.04, less perineural invasion p < 0.000, venous or vascular invasion p< 0.000, and small vessels invasion p < 0.000. None of the 16 patients who achieved a complete pathologic response (TRGI) had perineural, venous or vascular invasion in the histologic specimen and radial margin were negative. In univariate analysis we could also find distance to anal verge 5 cm as the only predictive factor to find positive margin in the histologic specimen. Conclusion: Tumors located 5 cm from anal verge, predict to have positive margins in histologic specimen. Positive margin and perineural invasion are predictive factors for survival. Good responders have less perineural, vascular or venous invasion than bad responders with decrease distant relapses. Author Disclosure: A. Reig Castillejo: None. I. Membrive: None. P. Foro: None. N. Rodriguez De Dios: None. J. Sanz: None. J. Quera: None. E. Fernandez-Velilla: None. O. Pera: None. A. Ortiz: None. M. Algara: None.
Poster Viewing Session E153
2389 Outcome of Proximal Esophageal Cancer After Definitive Combined Chemoradiation: A Multicenter Retrospective Study E. Herrmann,1 N. Mertineit,2 B. De Bari,3 L. Hoeng,4 F. Caparrotti,5 R. Jumeau,6 O. Elc¸in,2 N. Cihoric,7 P. Wolfensberger,8 K. Loessl,2 D.M. Aebersold,9 and E.M. Ozsahin10; 1Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Switzerland, Bern, Switzerland, 2Department of Radiation Oncology, Bern University Hospital, and University of Bern, Switzerland, Bern, Switzerland, 3Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland, 4Department of Radiation Oncology, Kantonsspital St. Gallen, Switzerland, St. Gallen, Switzerland, 5 Hopitaux Universitaires de Geneva, Geneva, Geneva, Switzerland, 6 Department of Radiation Oncology, Lausanne University Hospital, Lausanne, Switzerland, 7Inselspital, Bern 3010, Switzerland, 8University Bern Switzerland, Bern, Switzerland, 9Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland, 10Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland Purpose/Objective(s): To report oncological outcome and toxicity rates of definitive external beam radiation therapy (RT) combined with platinbased chemotherapy (CRT) in the management of proximal esophageal cancer. Materials/Methods: The medical records of patients with stage cT1-4 cN0-3 cM0 proximal esophageal cancer (tumor below the inferior border of the cricoid cartilage, up to 22 cm from the incisors) treated with platinebased definitive CRT between 2004 and 2013 in four institutions were retrospectively studied. Acute and chronic toxicities were evaluated with CTCAE v.4. The impact of possible patient related and procedural characteristics on loco-regional control (LRC), overall survival (OS) and disease-free survival (DFS) were evaluated using the log-rank test and multivariate Cox proportional hazards model. Primary endpoint was LRC. Results: We included 55 patients (13 females, 42 males), mean age was 65 (range: 42-78) with a median follow up of 34 months (range: 6-110). Median time interval from diagnosis to RT was 89 days (range: 6-178). Median radiation dose was 56Gy (range 28-72). Induction chemotherapy (ICHT) was given in 58% of patients. Actuarial LRC, DFS and OS at 3 years were 52% (95% CI: 37-67%), 35% (95% CI: 22-50%) and 52% (95% CI: 37-67%), respectively. On univariate analyses, the only significant prognostic factor for LRC was the time interval from diagnosis to RT. During RT, acute toxicities (dysphagia, pain, skin-reaction) ranged from grade 0 to 3, without significant dose-dependent differences. Dysphagia at last follow-up ranged from grade 0 to 4. After backwards elimination, multivariate models were statistically significant for DFS and OS when patients received a total radiation dose >56Gy together with ICHT (p < 0.05). Conclusion: Combined CRT is a reliable therapeutic alternative for proximal esophageal cancer, with anticipated treatment related toxicities. Further examination and randomized prospective trials are needed to assess this combined treatment modality for increased DFS and OS. Author Disclosure: E. Herrmann: None. N. Mertineit: None. B. De Bari: None. L. Hoeng: None. F. Caparrotti: None. R. Jumeau: None. O. Elc¸in: None. N. Cihoric: None. P. Wolfensberger: None. K. Loessl: None. D.M. Aebersold: None. E. Ozsahin: None.
2390 Impact of Incidental Angiotensin Converting Enzyme Inhibitor (ACEi) and Angiotensin Receptor Blocker (ARB) Use on Pathologic Complete Response (pCR) to Neoadjuvant Chemoradiation (NA-CRT) in Esophageal Cancer J. Hyder,1 H. Boggs,1 M.D. Chuong,2 M. Suntharalingam,2 W. Burrows,2 N. Horiba,3 D.P. Zandberg,3 T.N. Tyer,1 E.P. Cohen,4,5 Z. Vujaskovic,2 and P. Mohindra2; 1Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 2University of Maryland School of Medicine, Baltimore, MD, 3Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, 4Department of Nephrology, Medical College of Wisconsin, Milwaukee, WI, 5Department of Veteran Affairs, Milwaukee, WI