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PO-0955 ULTRASOUND HISTOGRAM ASSESSMENT OF PAROTID-GLAND INJURY FOLLOWING HEAD-AND-NECK CANCER RADIOTHERAPY
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patients included in these protocols acute morbidity iss evaluated, and the results from a single institution are reported. Materials and Methods: In the DBCG HYPO protocol pa atients ≥41 years and operated with breast conserving strategy (BCS) forr an early breast cancer pT1-2, pN0 (mi+), M0 are randomised to 50 Gy / 25 fr versus 40 Gy / 15 fr. The randomisation is stratified for institution, breast size, boost and systemic therapy. In the DBCG PBI proto ocol women ≥60 years and operated with BCS for an early non-lobula ar breast cancer pT1, pN0, M0, grade I or II, ER pos and HER2 neg are treated with 40 Gy / 15 fr and randomised to whole breast irradiation (WBI) versus partial breast irradiation (PBI). The randomisation is stratified for institution and systemic therapy. The primary en ndpoint in both protocols is fibrosis ≥grade 2. In 80 consecutive patients from the protocols acute morbidity is also evaluated, and byy now we have included 35 patients: 12 pts from HYPO 50 Gy-arm, 17 pts HYPO 40 Gy-arm, 3 pts from PBI partial-arm and 3 pts from PBI whole-arm. The acute morbidities are defined as dermatitis, itching, pain, p fatigue and dyspnea according to the Common Toxicity Criteria (CT TC), version 4.0. Evaluations are done at baseline and 3, 5, 7, and 9 weeks w after start of RT. The statistics are based on morbidity dichotomiized in grades 01 versus grades 2-3. Results: At baseline 7 pts are ≤ 50 years, 9 pts are current c smokers, 18 pts have small breasts (CTV breast ≤ 600 cm3 3), 16 pts have received chemotherapy and pain-scores are grade 0--1. The patients develop acute morbidities within the first 7 weeks, and no grade 3 morbidities are seen. Grade 2 dermatitis in week 5 is seen s more often among pts in NORMO 50 Gy-arm (67%) compared to HYPO H 40 Gy-arm (24%), P=0.005. This finding is true for the whole cohorrt in DBCG HYPO and for non-smokers (P=0.001). Grade 2 pain is found in 17% of the patients in the DBCG HYPO protocol with no differen nce between the fractionation arms, but in week 5 more patients ha ave pain if they have large breasts (p=0.045), are smokers (p=0.002) and have had chemotherapy (p=0.007). There are no differences seen related to itching, fatigue and dyspnea. Only one pt in DB BCG PBI scores dermatitis grade 2 in week 5. Conclusions: Adjuvant RT of early breast cancer is in general well tolerated, the highest level of morbidity is grade 2 on a scale 0-3. We find less acute grade 2 dermatitis among patients trea ated with 40 Gy / 15 fr compared to 50 Gy / 25 fr at 5 weeks aftter start of RT. Patients with large breasts, or who smoke, or who have had chemotherapy more often experience radiation-rela ated pain. The study is ongoing and results from more patients will be provided at the meeting.This study is supported by the Center fo or Interventional Research in Radiation Oncology (CIRRO) and the Danish Cancer Society. PO-0955 ULTRASOUND HISTOGRAM ASSESSMENT OF PAROTID-GLAND INJURY FOLLOWING HEAD-AND-NECK CANCER RADIOTHERAPY X. Yang1, S. Tridandapani2, J. Beitler1, D. Yu1, E. Yoshida1, W. Curran1, T. Liu1 1 Emory University, Radiation Oncology, Atlanta GA, USSA 2 Emory University, Radiology and Imaging Sciences, Atlanta GA, USA Purpose/Objective: Xerostomia (dry mouth) resultingg from radiation damage to the parotid glands is one of the most comm mon side effects of head-and-neck cancer radiotherapy (RT). The purpo ose of this study is to investigate the use of sonographic histograms to quantitatively assess parotid-gland injury and dry mouth in patientss post head-andneck cancer RT. Materials and Methods: In this pilot study, 12 post-RT T head-and-neck cancer patients and 7 healthy volunteers were enrolled. Each participant underwent one ultrasound study, in wh hich longitudinal (vertical) ultrasound scan of the bilateral parotiid glands were performed – a total of 24 post-irradiation and 14 normal parotid glands were examined. The average follow-up time for the post-RT patients was 17.2 months (range: 12.1 to 39 months) and the median radiation dose to the parotid glands was 32.3 Gy (rangge: 11.0 to 63.4 Gy). The 14 normal parotid glands served as the co ontrol group. All parotid glands were contoured on the ultrasound B-mo ode images by a radiologist, and echo histograms were then calculated. For each parotid gland, 6 sonographic features were computed from the echointensity histogram: peak intensity value (Ipeak), - 3-dB intensity width (W3-dB), the low (<50% Ipeak) intensity width (Wlow), the high (>50% Ipeak) intensity width (Whigh), the area of th he low intensity (Alow), and the area of high intensity (Ahigh). The ese sonographic features provided quantitative evaluation of the morphologic m and microstructural integrity of the parotid gland.
ESTRO 31
Results: Significant differences (p<0.05) were observed in 4 sonographic features between post-RT patien nts and healthy volunteers (Table 1). As shown in Figure 1(a), the e normal parotid glands appeared homogeneous and demonstrated d increased echogenicity relative to adjacent muscles on the ultrasound images. As shown in Figure 1(b), in post-RT patients, increa ased heterogeneity and decreased echogenicity relative to adjacent muscles were observed in post-irradiated parotid glands: both may have resulted from fibrotic changes induced by radiation.
Conclusions: We developed a family of sono ographic features derived from ultrasound echo histogram and demon nstrated the feasibility of quantitative evaluation of radiation-induce ed parotid-gland injury. These sonographic features may serve as ima aging signatures to assess radiation-induced parotid-gland injury and xe erostomia.
POSTER: RTT TRACK: PATIEN NT PREPARATION, PATIENT IMMOBILIZATION AND SUP PPORT AIDS PO-0956 SUPPORT POSITIONING AND ORGAN REGIST TRATION DURING BREAST CANCER IRRADIATION: THE SUPPORT 4 ALL ST TUDY 1 2 2 3 H. Probst , A. Taylor , C. Bragg , D. Dodwell , S. Haake4, J. Hart4, D. Green1, P. Shuttleworth3 1 Sheffield Hallam University, Faculty of Health and Wellbeing, Sheffield, United Kingdom 2 Sheffield Teaching Hospitals, Radiotherapy and a Oncology, Sheffield, United Kingdom 3 Leeds Teaching Hospitals NHS Trust, Bexley Institute for Oncology, Leeds, United Kingdom 4 Sheffield Hallam University, Centre Sport En ngineering Research, Sheffield, United Kingdom Purpose/Objective: With greater use of 3D conformal and IMRT techniques for post operative breast irradiation following wide local excision (WLE) there is a need to consid der the effectiveness of immobilisation methods used to maximise tre eatment outcomes. Aims and Objectives: The aim was to devvelop a detailed product specification for the development of a prottotype to immobilise the breast. Objectives were to: · Complete a systematic review of the litera ature on the effectiveness of current immobilisation methods. · Establish stakeholder views on a support brra for immobilisation that could also preserve patient modesty. · Produce a detailed product specification n of a prototype breast immobilisation device. Materials and Methods: A systematic revie ew of the literature was followed by a qualitative investigation off stakeholder views. To reduce the opportunity for bias all articles in ncluded in the systematic review were assessed independently by two members of the project team.
patients included in these protocols acute morbidity iss evaluated, and the results from a single institution are reported. Materials and Methods: In the DBCG HYPO protocol pa atients ≥41 years and operated with breast conserving strategy (BCS) forr an early breast cancer pT1-2, pN0 (mi+), M0 are randomised to 50 Gy / 25 fr versus 40 Gy / 15 fr. The randomisation is stratified for institution, breast size, boost and systemic therapy. In the DBCG PBI proto ocol women ≥60 years and operated with BCS for an early non-lobula ar breast cancer pT1, pN0, M0, grade I or II, ER pos and HER2 neg are treated with 40 Gy / 15 fr and randomised to whole breast irradiation (WBI) versus partial breast irradiation (PBI). The randomisation is stratified for institution and systemic therapy. The primary en ndpoint in both protocols is fibrosis ≥grade 2. In 80 consecutive patients from the protocols acute morbidity is also evaluated, and byy now we have included 35 patients: 12 pts from HYPO 50 Gy-arm, 17 pts HYPO 40 Gy-arm, 3 pts from PBI partial-arm and 3 pts from PBI whole-arm. The acute morbidities are defined as dermatitis, itching, pain, p fatigue and dyspnea according to the Common Toxicity Criteria (CT TC), version 4.0. Evaluations are done at baseline and 3, 5, 7, and 9 weeks w after start of RT. The statistics are based on morbidity dichotomiized in grades 01 versus grades 2-3. Results: At baseline 7 pts are ≤ 50 years, 9 pts are current c smokers, 18 pts have small breasts (CTV breast ≤ 600 cm3 3), 16 pts have received chemotherapy and pain-scores are grade 0--1. The patients develop acute morbidities within the first 7 weeks, and no grade 3 morbidities are seen. Grade 2 dermatitis in week 5 is seen s more often among pts in NORMO 50 Gy-arm (67%) compared to HYPO H 40 Gy-arm (24%), P=0.005. This finding is true for the whole cohorrt in DBCG HYPO and for non-smokers (P=0.001). Grade 2 pain is found in 17% of the patients in the DBCG HYPO protocol with no differen nce between the fractionation arms, but in week 5 more patients ha ave pain if they have large breasts (p=0.045), are smokers (p=0.002) and have had chemotherapy (p=0.007). There are no differences seen related to itching, fatigue and dyspnea. Only one pt in DB BCG PBI scores dermatitis grade 2 in week 5. Conclusions: Adjuvant RT of early breast cancer is in general well tolerated, the highest level of morbidity is grade 2 on a scale 0-3. We find less acute grade 2 dermatitis among patients trea ated with 40 Gy / 15 fr compared to 50 Gy / 25 fr at 5 weeks aftter start of RT. Patients with large breasts, or who smoke, or who have had chemotherapy more often experience radiation-rela ated pain. The study is ongoing and results from more patients will be provided at the meeting.This study is supported by the Center fo or Interventional Research in Radiation Oncology (CIRRO) and the Danish Cancer Society. PO-0955 ULTRASOUND HISTOGRAM ASSESSMENT OF PAROTID-GLAND INJURY FOLLOWING HEAD-AND-NECK CANCER RADIOTHERAPY X. Yang1, S. Tridandapani2, J. Beitler1, D. Yu1, E. Yoshida1, W. Curran1, T. Liu1 1 Emory University, Radiation Oncology, Atlanta GA, USSA 2 Emory University, Radiology and Imaging Sciences, Atlanta GA, USA Purpose/Objective: Xerostomia (dry mouth) resultingg from radiation damage to the parotid glands is one of the most comm mon side effects of head-and-neck cancer radiotherapy (RT). The purpo ose of this study is to investigate the use of sonographic histograms to quantitatively assess parotid-gland injury and dry mouth in patientss post head-andneck cancer RT. Materials and Methods: In this pilot study, 12 post-RT T head-and-neck cancer patients and 7 healthy volunteers were enrolled. Each participant underwent one ultrasound study, in wh hich longitudinal (vertical) ultrasound scan of the bilateral parotiid glands were performed – a total of 24 post-irradiation and 14 normal parotid glands were examined. The average follow-up time for the post-RT patients was 17.2 months (range: 12.1 to 39 months) and the median radiation dose to the parotid glands was 32.3 Gy (rangge: 11.0 to 63.4 Gy). The 14 normal parotid glands served as the co ontrol group. All parotid glands were contoured on the ultrasound B-mo ode images by a radiologist, and echo histograms were then calculated. For each parotid gland, 6 sonographic features were computed from the echointensity histogram: peak intensity value (Ipeak), - 3-dB intensity width (W3-dB), the low (<50% Ipeak) intensity width (Wlow), the high (>50% Ipeak) intensity width (Whigh), the area of th he low intensity (Alow), and the area of high intensity (Ahigh). The ese sonographic features provided quantitative evaluation of the morphologic m and microstructural integrity of the parotid gland.
ESTRO 31
Results: Significant differences (p<0.05) were observed in 4 sonographic features between post-RT patien nts and healthy volunteers (Table 1). As shown in Figure 1(a), the e normal parotid glands appeared homogeneous and demonstrated d increased echogenicity relative to adjacent muscles on the ultrasound images. As shown in Figure 1(b), in post-RT patients, increa ased heterogeneity and decreased echogenicity relative to adjacent muscles were observed in post-irradiated parotid glands: both may have resulted from fibrotic changes induced by radiation.
Conclusions: We developed a family of sono ographic features derived from ultrasound echo histogram and demon nstrated the feasibility of quantitative evaluation of radiation-induce ed parotid-gland injury. These sonographic features may serve as ima aging signatures to assess radiation-induced parotid-gland injury and xe erostomia.
POSTER: RTT TRACK: PATIEN NT PREPARATION, PATIENT IMMOBILIZATION AND SUP PPORT AIDS PO-0956 SUPPORT POSITIONING AND ORGAN REGIST TRATION DURING BREAST CANCER IRRADIATION: THE SUPPORT 4 ALL ST TUDY 1 2 2 3 H. Probst , A. Taylor , C. Bragg , D. Dodwell , S. Haake4, J. Hart4, D. Green1, P. Shuttleworth3 1 Sheffield Hallam University, Faculty of Health and Wellbeing, Sheffield, United Kingdom 2 Sheffield Teaching Hospitals, Radiotherapy and a Oncology, Sheffield, United Kingdom 3 Leeds Teaching Hospitals NHS Trust, Bexley Institute for Oncology, Leeds, United Kingdom 4 Sheffield Hallam University, Centre Sport En ngineering Research, Sheffield, United Kingdom Purpose/Objective: With greater use of 3D conformal and IMRT techniques for post operative breast irradiation following wide local excision (WLE) there is a need to consid der the effectiveness of immobilisation methods used to maximise tre eatment outcomes. Aims and Objectives: The aim was to devvelop a detailed product specification for the development of a prottotype to immobilise the breast. Objectives were to: · Complete a systematic review of the litera ature on the effectiveness of current immobilisation methods. · Establish stakeholder views on a support brra for immobilisation that could also preserve patient modesty. · Produce a detailed product specification n of a prototype breast immobilisation device. Materials and Methods: A systematic revie ew of the literature was followed by a qualitative investigation off stakeholder views. To reduce the opportunity for bias all articles in ncluded in the systematic review were assessed independently by two members of the project team.