- Email: [email protected]
Quality of Life (QOL) in Patients Undergoing Intracranial Radiation Therapy (RT)
E524
International Journal of Radiation Oncology Biology Physics
None. H. Biers: None. A. Day: None. L. Hintenlang: None. B.C. May: None. R.C. Miller: None.
need persists for novel apps to streamline patient treatment and communication, and to increase physician productivity. Currently there are no validated apps for patient engagement, communication, or symptom monitoring in the field of radiation oncology. Generally, patients on treatment report symptoms to their physicians once per week so that changes in symptom management are reliant on patient recall. The objective of this study was to determine if patients will use a real-time symptom management smartphone app 4 times per day that has the ability to help manage and improve care delivered by radiation oncologists. Materials/Methods: Adults with head and neck cancer who were undergoing definitive radiation therapy (5-7 weeks) at Vanderbilt University Medical Center were recruited in person to participate in the study. A simple, user-friendly app with an alert system and provider dashboard, termed PrimeMD, was installed on the patient’s smartphone. An alarm alerted patients 4 times per day to enter their pain levels, whether or not they had taken their medication, and whether their pain affected their ability to eat and drink. This report was sent to a dashboard that could be viewed by a healthcare provider. Severe pain or an inability to eat and drink for 12 hours prompted an e-mail alert directly to the provider and was labeled on the dashboard. Upon concluding the study, patients completed an exit survey containing 5 sections including general satisfaction, usability of the app, and whether they would recommend the app to another patient. Results: Of the 24 individuals who participated in the study, 45% were female, 8% were African American, 50% had at least some college, and the mean age was 58.4 years (Range 41-82). Eighteen patients had evaluable app data and used the app for a mean of 18.8 days (Range 4-45). Sixteen patients completed the exit survey and when asked to rate their general satisfaction with the app, the median score was 90 of 100. When asked to rate the usability of the app, the median score was 95 of 100. When patients were asked whether they would recommend the app to other patients, the median score was 100 of 100. The most common comments were that patients liked the simplicity, reminders, quickness of use, and improved communication with their physicians. Conclusion: Within the field of radiation oncology there are no apps that allow for patient engagement and communication with the physician. The use of PrimeMD in a population of head and neck cancer patients demonstrated the need and desire by patients, regardless of education level or age, for a novel app that can allow for better patient management, communication, and earlier interventions. Author Disclosure: J. Friedman: None. R.M. Ber: None. S. Ridner: None. M. Dietrich: None. K. Johnson: None.
3285 Prognostic Value of Baseline Quality of Life in Patients Receiving Stereotactic Radiosurgery for Brain Metastases C.C. Vu,1 M.D. Johnson,2 H. Ye,1 E. Ducharme,2 M.D. Manders,2 and I.S. Grills2; 1Beaumont Health, Royal Oak, MI, 2Beaumont Health System, Royal Oak, MI Purpose/Objective(s): To evaluate the prognostic value of baseline quality of life (QOL) on overall survival in patients receiving stereotactic radiosurgery for brain metastases. Materials/Methods: One-hundred and ninety-eight patients undergoing stereotactic radiosurgery (SRS) alone (Gamma Knife) for brain metastases were treated between 5/2007 and 11/2014. EORTC QLQ-C30 and BN-20 surveys were collected at baseline and given to patients every 3 months after treatment. The EORTC QLQ-C30 is a 30-question survey that evaluates quality-of-life along global, functional and symptom scales. The EORTC QLQ-BN20 is a 20-question survey designed specifically for patients with brain malignancies. All patients had baseline QOL and survival data available for analysis. The median number of metastases treated was 2 (range 1-14). The median treatment volume was 6.4 cm2 (range 0.1-60.9 cm2). The most common primary tumor sites were lung (66%), breast (14%), and melanoma (5%). Patients with a history of concurrent or prior whole brain RT or resection were excluded. Forty-nine percent of patients had chemotherapy either before or following SRS, within a median of 1 month (range 0-90 months). Univariate and multivariate Cox proportional hazards regression were used to identify baseline demographic, tumor, treatment, and quality-of-life predictors of overall survival. Results: Median follow-up was 7.4 months (18 months for living patients). Median age was 62 years (range 30-89 years). Fifty-eight percent, 21%, 9%, 8%, and 5% of patients had KPS of 100, 90, 80, 70, and less than 70, respectively. Eighty percent of patients were RPA 2. Median overall survival was 10.1 months. The mean Global Health Status / Quality of Life score was 55.2, and the highest symptom scales were insomnia (46.3), fatigue (45.5), future uncertainty (41.3), and pain (33.3). On univariate analysis, younger age (P Z 0.016), higher KPS (P < 0.001), lower RPA class (P Z 0.001), improved physical functioning (P Z 0.023), decreased nausea/vomiting (P Z 0.006), and decreased diarrhea (P Z 0.031) were associated with improved overall survival. The final multivariate model found lower RPA class (HR Z 3.131, 95% CI Z 1.717 e 5.709, P < 0.001), higher physical functioning (HR Z .992, 95% CI Z .985 - .999, P Z .017), and decreased nausea/vomiting (HR Z 1.013, 95% CI 1.0051.022, P Z 0.002) to be predictive of improved overall survival. Conclusion: Baseline QOL scores can be predictive of overall survival in patients with brain metastases treated with radiosurgery alone. Higher physical functioning and decreased nausea/vomiting at baseline were predictors of improved overall survival in our population, independent of known predictors of overall survival such as RPA. Author Disclosure: C.C. Vu: None. M.D. Johnson: None. H. Ye: None. E. Ducharme: None. M.D. Manders: None. I.S. Grills: Stock; Greater Michigan Gamma Knife Facility. Radiation Oncology Residency Program Director; Oakland University William Beaumont.
3286 PrimeMD, a Real-Time Symptom Management Smartphone Application for Head and Neck Cancer Patients Undergoing Radiation Therapy J. Friedman,1 R.M. Ber,2 S. Ridner,3 M. Dietrich,3 and K. Johnson4; 1 Vanderbilt University, Nashville, TN, 2Meharry Medical College School of Medicine, Nashville, TN, 3Vanderbilt University School of Nursing, Nashville, TN, 4Vanderbilt University Department of Computer Science, Nashville, TN Purpose/Objective(s): The medical industry has been inundated with smartphone applications (apps) designed to be clinical tools. However, a
3287 Quality of Life (QOL) in Patients Undergoing Intracranial Radiation Therapy (RT) J. Burkeen,1 T. Pan,1 D.C. Marshall,1 S. McDuff,2 M.K. Gorman,1 P. Sanghvi,1 R. Cheng,1 C. McDonald,1 and J.A. Hattangadi1; 1University of California, San Diego, La Jolla, CA, 2Harvard Radiation Oncology Program, Boston, MA Purpose/Objective(s): Patients with brain tumors generally have poor survival. Treatment modalities including RT are employed to control disease and prolong life. Yet side effects of RT as well as brain disease itself can significantly impact QOL. Materials/Methods: We conducted a prospective longitudinal study of QOL in primary and metastatic brain tumor patients receiving intracranial RT. Prior to RT, eligible patients completed a core overall QOL tool (EORTC QLQ C-15-PAL) and a brain tumor specific module (QLQ-BN20). Patients repeated these questionnaires 1 month post-RT and every 3 months until patient death or study withdrawal. Baseline patient data collected included treatment type, age, KPS, histology, radiation courses, use of steroids, and chemotherapy. Pearson correlations, paired t-tests, and ANOVA were used to assess changes in QOL scores at baseline and 3 month follow up and to explore associations between clinical variables and QOL. Results: Among 78 patients studied with at least 3 month post RT follow up, median age was 58 years and median baseline KPS was 90. Fifty-four percent had primary brain tumors while 46% had brain metastases.
Volume 96 Number 2S Supplement 2016
Poster Viewing E525
Intracranial treatments included fractionated partial brain RT (44%), stereotactic radiosurgery (SRS, 47%), whole brain RT (WBRT, 6%), and combined partial brain RT and SRS (2%). Most (67%) received systemic therapy and 50% received steroids. Age at baseline was negatively correlated with headache symptom burden at 3 months (r Z -.288, p Z .03). Baseline KPS was positively correlated with headache symptom burden (r Z 0.29, p Z .029) and negatively correlated with seizure symptom burden (r Z -0.46, p < .001) at 3 month follow up. At baseline, fatigue (39.9827.97), insomnia (33.4932.39), drowsiness (33.2329.11), and uncertainty about the future (36.3926.39) were prominent. At 3 month follow up, patients’ feeling of future uncertainty improved (t Z 2.76, p Z .008), whereas nausea (t Z -2.29, p Z .02) and appetite loss (t Z -3.02, pZ .004) worsened. No other QOL symptom scores significantly changed from baseline to 3 months. Type of radiation received was not associated with QOL symptom scores at 3-months, nor was tumor histology or origin (i.e., primary versus metastatic). However, there was a strong trend for patients who received partial brain RT to report more difficulty with coordination (2024.07) compared to those who received SRS (9.4715; F Z 2.74, p Z .054). Conclusion: Following intracranial RT, we observed improvement in uncertainty about the future. Most QOL domains, however, remained unchanged and nausea and appetite worsened. Patients who received partial brain RT reported more difficulty with coordination than those receiving SRS. These data may allow the better prediction of QOL outcomes as it relates to clinical and treatment variables. Author Disclosure: J. Burkeen: None. T. Pan: None. D.C. Marshall: None. S. McDuff: None. M. Gorman: None. P. Sanghvi: None. R. Cheng: None. C. McDonald: None. J.A. Hattangadi: None.
GTR were associated with more favorable OS (HR 0.652, 95% CI 0.4500.927, PZ0.017; HR 0.608, 95% CI 0.449-0.819, PZ0.001, respectively). Patients receiving RT compared with those who did not were less likely to have undergone GTR (23.01% vs. 45.17% respectively, P<0.001). Conclusion: Adult patients with spinal ependymoma were predominantly white, with peak age in 18-44 group, and advanced age predicting worse OS. More than half of patients received surgery, while a smaller subset received RT. Although RT was associated with poorer OS, this is most likely a result of selection bias of patients with less than GTR or higher grade receiving RT. Any extent of surgery was associated with more favorable OS. Given the potential selection bias and lack of detailed information on histology, chemotherapy and RT dose in SEER database, further study is needed to validate our findings. Author Disclosure: L.J. Kim: None. K. Yang: None. J.H. Suh: Consultant; Varian Medical Systems. Head of department; Cleveland Clinic. E.S. Murphy: None. S.T. Chao: None.
3288
Purpose/Objective(s): To systematically review the efficacy and safety of various antiemetics in the prophylaxis of radiation-induced nausea and vomiting (RINV). Materials/Methods: A literature search of Ovid MEDLINE, EMBASE and Cochrane CENTRAL was performed to identify randomized controlled trials (RCTs) that evaluated the efficacy of prophylaxis for RINV in patients receiving radiotherapy to abdomen/pelvis, including total body irradiation (TBI). Primary endpoints were complete control of nausea and complete control of vomiting during acute and delayed phases. Secondary endpoints included use of rescue medication, quality of life, and incidence of adverse events. Results: 17 RCTs were identified. Among patients receiving radiotherapy to abdomen/pelvis, our meta-analysis showed that 5-hydroxytryptamine-3 receptor antagonists (5HT3 RAs) were significantly more efficacious than placebo and dopamine antagonists in both complete control of vomiting (OR 0.49, 95% confidence interval [CI] 0.33-0.72 and OR 0.17, 95% CI 0.05-0.58 respectively) and complete control of nausea (OR 0.43, 95% CI 0.26-0.70 and OR 0.46, 95% CI 0.24-0.88 respectively). 5HT3 RAs were also more efficacious than rescue therapy and dopamine antagonists plus dexamethasone. The addition of dexamethasone to 5HT3 RA compared to 5HT3 RA alone provides a modest improvement in prophylaxis of RINV. Among patients receiving TBI, 5HT3 RA was more effective than other agents (placebo, combination of metoclopramide, dexamethasone, and lorazepam). Conclusion: 5HT3 RAs are more effective than other antiemetics for prophylaxis of RINV in patients receiving radiation therapy to abdomen/ pelvis and TBI. Future RCTs should investigate the efficacy of newer agents such as aprepitant in addition to 5HT3 RAs in prophylaxis of RINV during both acute and delayed phases. Author Disclosure: W. Li: None. J.M. van der Velden: None. S. Raman: None. M. Popovic: None. H. Lam: None. K. Wong: None. R. Ngan: None. M. Burbach: None. C. de Angelis: None. R. McDonald: None. E. Chow: None.
Treatment and Prognosis in Adult Patients With Spinal Ependymoma L.J.Y. Kim,1 K. Yang,2 J.H. Suh,3 E.S. Murphy,3 and S.T. Chao3; 1Case Western Reserve University School of Medicine, Cleveland, OH, 2 Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, 3Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH Purpose/Objective(s): Ependymomas are primary central nervous system tumors that in adult patients arise most frequently in the spinal canal. Although optimal management comprises gross total resection, no randomized trial has been performed to evaluate the efficacy of adjuvant radiation therapy (RT) to treat these infiltrative tumors. The objective of our study is to analyze population-based data to assess the response of adult patients with primary spinal ependymoma to treatment regimens including RT and surgery. Materials/Methods: Adult patients of age 18 or older with the diagnosis of ependymoma and with primary tumor site in spinal cord (C70.1), spinal meninges (C72.0), or cauda equina (C72.1) were identified from the Surveillance, Epidemiology, and End Results (SEER) database (1973-2012). Treatment information for radiation therapy and surgery was obtained. Surgical treatment was categorized into no surgery, subtotal resection (STR), and gross total resection (GTR). Demographic and clinicopathological predictors were analyzed using chi-square test, t-test, and logistic regression modeling. Kaplan-Meier analysis and multivariate Cox proportional hazard modeling were used to assess the impact of treatment on overall survival (OS). Results: 1557 adult patients with primary spinal ependymoma were identified. Fifty-two percent of patients were male and 86.6% were white. The median age was 47 years with 18-44 as the peak age group (43.7%). 20.9% of patients received RT, amongst whom 6.75% were WHO grade I, 20.6% grade II, and 1.53% grade III. Surgery was performed in 14.3% of patients with STR and 40.5% with GTR. OS at 10 years was 84.9%, with a median follow-up time of 26.8 years. Advanced age at diagnosis and high WHO grades were associated with poor OS, with 1.61% of age 75+ and 0.53% of grade III at 10 years, respectively. Multivariate analysis adjusting for gender, year of diagnosis, and treatment regimens showed worse OS in age groups greater than 75 years of age (HR 17.602, 95% CI 11.64026.382, P<0.001, using age 18-44 as reference). RT was also associated with unfavorable OS (HR 1.860, 95% CI 1.426-2.422, P<0.001). STR and
3289 Prophylaxis of Radiation-Induced Nausea and Vomiting: A Systematic Review and Meta-Analysis of Randomized Controlled Trials W.S. Li,1 J.M. van der Velden,2 S. Raman,3 M. Popovic,3 H. Lam,3 K.H. Wong,1 R. Ngan,1 M.J.P. Burbach,2 C. de Angelis,3 R. McDonald,3 and E. Chow3; 1Queen Elizabeth Hospital, Kowloon, Hong Kong, 2 University Medical Center Utrecht, Utrecht, Netherlands, 3Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
3290 Single 19-Gy High-Dose-Rate Brachytherapy Monotherapy for Treatment of Prostate Cancer: Tolerability and Dosimetric Predictors of Acute Toxicity and Health-Related Quality of Life M.M. Al-Hanaqta,1 D.A. Loblaw,2 H.T. Chung,3 P. Cheung,4 A. Mamedov,5 M. McGuffin,6 A. Ravi,2 L. Zhang,4 and G. Morton2;
International Journal of Radiation Oncology Biology Physics
None. H. Biers: None. A. Day: None. L. Hintenlang: None. B.C. May: None. R.C. Miller: None.
need persists for novel apps to streamline patient treatment and communication, and to increase physician productivity. Currently there are no validated apps for patient engagement, communication, or symptom monitoring in the field of radiation oncology. Generally, patients on treatment report symptoms to their physicians once per week so that changes in symptom management are reliant on patient recall. The objective of this study was to determine if patients will use a real-time symptom management smartphone app 4 times per day that has the ability to help manage and improve care delivered by radiation oncologists. Materials/Methods: Adults with head and neck cancer who were undergoing definitive radiation therapy (5-7 weeks) at Vanderbilt University Medical Center were recruited in person to participate in the study. A simple, user-friendly app with an alert system and provider dashboard, termed PrimeMD, was installed on the patient’s smartphone. An alarm alerted patients 4 times per day to enter their pain levels, whether or not they had taken their medication, and whether their pain affected their ability to eat and drink. This report was sent to a dashboard that could be viewed by a healthcare provider. Severe pain or an inability to eat and drink for 12 hours prompted an e-mail alert directly to the provider and was labeled on the dashboard. Upon concluding the study, patients completed an exit survey containing 5 sections including general satisfaction, usability of the app, and whether they would recommend the app to another patient. Results: Of the 24 individuals who participated in the study, 45% were female, 8% were African American, 50% had at least some college, and the mean age was 58.4 years (Range 41-82). Eighteen patients had evaluable app data and used the app for a mean of 18.8 days (Range 4-45). Sixteen patients completed the exit survey and when asked to rate their general satisfaction with the app, the median score was 90 of 100. When asked to rate the usability of the app, the median score was 95 of 100. When patients were asked whether they would recommend the app to other patients, the median score was 100 of 100. The most common comments were that patients liked the simplicity, reminders, quickness of use, and improved communication with their physicians. Conclusion: Within the field of radiation oncology there are no apps that allow for patient engagement and communication with the physician. The use of PrimeMD in a population of head and neck cancer patients demonstrated the need and desire by patients, regardless of education level or age, for a novel app that can allow for better patient management, communication, and earlier interventions. Author Disclosure: J. Friedman: None. R.M. Ber: None. S. Ridner: None. M. Dietrich: None. K. Johnson: None.
3285 Prognostic Value of Baseline Quality of Life in Patients Receiving Stereotactic Radiosurgery for Brain Metastases C.C. Vu,1 M.D. Johnson,2 H. Ye,1 E. Ducharme,2 M.D. Manders,2 and I.S. Grills2; 1Beaumont Health, Royal Oak, MI, 2Beaumont Health System, Royal Oak, MI Purpose/Objective(s): To evaluate the prognostic value of baseline quality of life (QOL) on overall survival in patients receiving stereotactic radiosurgery for brain metastases. Materials/Methods: One-hundred and ninety-eight patients undergoing stereotactic radiosurgery (SRS) alone (Gamma Knife) for brain metastases were treated between 5/2007 and 11/2014. EORTC QLQ-C30 and BN-20 surveys were collected at baseline and given to patients every 3 months after treatment. The EORTC QLQ-C30 is a 30-question survey that evaluates quality-of-life along global, functional and symptom scales. The EORTC QLQ-BN20 is a 20-question survey designed specifically for patients with brain malignancies. All patients had baseline QOL and survival data available for analysis. The median number of metastases treated was 2 (range 1-14). The median treatment volume was 6.4 cm2 (range 0.1-60.9 cm2). The most common primary tumor sites were lung (66%), breast (14%), and melanoma (5%). Patients with a history of concurrent or prior whole brain RT or resection were excluded. Forty-nine percent of patients had chemotherapy either before or following SRS, within a median of 1 month (range 0-90 months). Univariate and multivariate Cox proportional hazards regression were used to identify baseline demographic, tumor, treatment, and quality-of-life predictors of overall survival. Results: Median follow-up was 7.4 months (18 months for living patients). Median age was 62 years (range 30-89 years). Fifty-eight percent, 21%, 9%, 8%, and 5% of patients had KPS of 100, 90, 80, 70, and less than 70, respectively. Eighty percent of patients were RPA 2. Median overall survival was 10.1 months. The mean Global Health Status / Quality of Life score was 55.2, and the highest symptom scales were insomnia (46.3), fatigue (45.5), future uncertainty (41.3), and pain (33.3). On univariate analysis, younger age (P Z 0.016), higher KPS (P < 0.001), lower RPA class (P Z 0.001), improved physical functioning (P Z 0.023), decreased nausea/vomiting (P Z 0.006), and decreased diarrhea (P Z 0.031) were associated with improved overall survival. The final multivariate model found lower RPA class (HR Z 3.131, 95% CI Z 1.717 e 5.709, P < 0.001), higher physical functioning (HR Z .992, 95% CI Z .985 - .999, P Z .017), and decreased nausea/vomiting (HR Z 1.013, 95% CI 1.0051.022, P Z 0.002) to be predictive of improved overall survival. Conclusion: Baseline QOL scores can be predictive of overall survival in patients with brain metastases treated with radiosurgery alone. Higher physical functioning and decreased nausea/vomiting at baseline were predictors of improved overall survival in our population, independent of known predictors of overall survival such as RPA. Author Disclosure: C.C. Vu: None. M.D. Johnson: None. H. Ye: None. E. Ducharme: None. M.D. Manders: None. I.S. Grills: Stock; Greater Michigan Gamma Knife Facility. Radiation Oncology Residency Program Director; Oakland University William Beaumont.
3286 PrimeMD, a Real-Time Symptom Management Smartphone Application for Head and Neck Cancer Patients Undergoing Radiation Therapy J. Friedman,1 R.M. Ber,2 S. Ridner,3 M. Dietrich,3 and K. Johnson4; 1 Vanderbilt University, Nashville, TN, 2Meharry Medical College School of Medicine, Nashville, TN, 3Vanderbilt University School of Nursing, Nashville, TN, 4Vanderbilt University Department of Computer Science, Nashville, TN Purpose/Objective(s): The medical industry has been inundated with smartphone applications (apps) designed to be clinical tools. However, a
3287 Quality of Life (QOL) in Patients Undergoing Intracranial Radiation Therapy (RT) J. Burkeen,1 T. Pan,1 D.C. Marshall,1 S. McDuff,2 M.K. Gorman,1 P. Sanghvi,1 R. Cheng,1 C. McDonald,1 and J.A. Hattangadi1; 1University of California, San Diego, La Jolla, CA, 2Harvard Radiation Oncology Program, Boston, MA Purpose/Objective(s): Patients with brain tumors generally have poor survival. Treatment modalities including RT are employed to control disease and prolong life. Yet side effects of RT as well as brain disease itself can significantly impact QOL. Materials/Methods: We conducted a prospective longitudinal study of QOL in primary and metastatic brain tumor patients receiving intracranial RT. Prior to RT, eligible patients completed a core overall QOL tool (EORTC QLQ C-15-PAL) and a brain tumor specific module (QLQ-BN20). Patients repeated these questionnaires 1 month post-RT and every 3 months until patient death or study withdrawal. Baseline patient data collected included treatment type, age, KPS, histology, radiation courses, use of steroids, and chemotherapy. Pearson correlations, paired t-tests, and ANOVA were used to assess changes in QOL scores at baseline and 3 month follow up and to explore associations between clinical variables and QOL. Results: Among 78 patients studied with at least 3 month post RT follow up, median age was 58 years and median baseline KPS was 90. Fifty-four percent had primary brain tumors while 46% had brain metastases.
Volume 96 Number 2S Supplement 2016
Poster Viewing E525
Intracranial treatments included fractionated partial brain RT (44%), stereotactic radiosurgery (SRS, 47%), whole brain RT (WBRT, 6%), and combined partial brain RT and SRS (2%). Most (67%) received systemic therapy and 50% received steroids. Age at baseline was negatively correlated with headache symptom burden at 3 months (r Z -.288, p Z .03). Baseline KPS was positively correlated with headache symptom burden (r Z 0.29, p Z .029) and negatively correlated with seizure symptom burden (r Z -0.46, p < .001) at 3 month follow up. At baseline, fatigue (39.9827.97), insomnia (33.4932.39), drowsiness (33.2329.11), and uncertainty about the future (36.3926.39) were prominent. At 3 month follow up, patients’ feeling of future uncertainty improved (t Z 2.76, p Z .008), whereas nausea (t Z -2.29, p Z .02) and appetite loss (t Z -3.02, pZ .004) worsened. No other QOL symptom scores significantly changed from baseline to 3 months. Type of radiation received was not associated with QOL symptom scores at 3-months, nor was tumor histology or origin (i.e., primary versus metastatic). However, there was a strong trend for patients who received partial brain RT to report more difficulty with coordination (2024.07) compared to those who received SRS (9.4715; F Z 2.74, p Z .054). Conclusion: Following intracranial RT, we observed improvement in uncertainty about the future. Most QOL domains, however, remained unchanged and nausea and appetite worsened. Patients who received partial brain RT reported more difficulty with coordination than those receiving SRS. These data may allow the better prediction of QOL outcomes as it relates to clinical and treatment variables. Author Disclosure: J. Burkeen: None. T. Pan: None. D.C. Marshall: None. S. McDuff: None. M. Gorman: None. P. Sanghvi: None. R. Cheng: None. C. McDonald: None. J.A. Hattangadi: None.
GTR were associated with more favorable OS (HR 0.652, 95% CI 0.4500.927, PZ0.017; HR 0.608, 95% CI 0.449-0.819, PZ0.001, respectively). Patients receiving RT compared with those who did not were less likely to have undergone GTR (23.01% vs. 45.17% respectively, P<0.001). Conclusion: Adult patients with spinal ependymoma were predominantly white, with peak age in 18-44 group, and advanced age predicting worse OS. More than half of patients received surgery, while a smaller subset received RT. Although RT was associated with poorer OS, this is most likely a result of selection bias of patients with less than GTR or higher grade receiving RT. Any extent of surgery was associated with more favorable OS. Given the potential selection bias and lack of detailed information on histology, chemotherapy and RT dose in SEER database, further study is needed to validate our findings. Author Disclosure: L.J. Kim: None. K. Yang: None. J.H. Suh: Consultant; Varian Medical Systems. Head of department; Cleveland Clinic. E.S. Murphy: None. S.T. Chao: None.
3288
Purpose/Objective(s): To systematically review the efficacy and safety of various antiemetics in the prophylaxis of radiation-induced nausea and vomiting (RINV). Materials/Methods: A literature search of Ovid MEDLINE, EMBASE and Cochrane CENTRAL was performed to identify randomized controlled trials (RCTs) that evaluated the efficacy of prophylaxis for RINV in patients receiving radiotherapy to abdomen/pelvis, including total body irradiation (TBI). Primary endpoints were complete control of nausea and complete control of vomiting during acute and delayed phases. Secondary endpoints included use of rescue medication, quality of life, and incidence of adverse events. Results: 17 RCTs were identified. Among patients receiving radiotherapy to abdomen/pelvis, our meta-analysis showed that 5-hydroxytryptamine-3 receptor antagonists (5HT3 RAs) were significantly more efficacious than placebo and dopamine antagonists in both complete control of vomiting (OR 0.49, 95% confidence interval [CI] 0.33-0.72 and OR 0.17, 95% CI 0.05-0.58 respectively) and complete control of nausea (OR 0.43, 95% CI 0.26-0.70 and OR 0.46, 95% CI 0.24-0.88 respectively). 5HT3 RAs were also more efficacious than rescue therapy and dopamine antagonists plus dexamethasone. The addition of dexamethasone to 5HT3 RA compared to 5HT3 RA alone provides a modest improvement in prophylaxis of RINV. Among patients receiving TBI, 5HT3 RA was more effective than other agents (placebo, combination of metoclopramide, dexamethasone, and lorazepam). Conclusion: 5HT3 RAs are more effective than other antiemetics for prophylaxis of RINV in patients receiving radiation therapy to abdomen/ pelvis and TBI. Future RCTs should investigate the efficacy of newer agents such as aprepitant in addition to 5HT3 RAs in prophylaxis of RINV during both acute and delayed phases. Author Disclosure: W. Li: None. J.M. van der Velden: None. S. Raman: None. M. Popovic: None. H. Lam: None. K. Wong: None. R. Ngan: None. M. Burbach: None. C. de Angelis: None. R. McDonald: None. E. Chow: None.
Treatment and Prognosis in Adult Patients With Spinal Ependymoma L.J.Y. Kim,1 K. Yang,2 J.H. Suh,3 E.S. Murphy,3 and S.T. Chao3; 1Case Western Reserve University School of Medicine, Cleveland, OH, 2 Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, 3Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH Purpose/Objective(s): Ependymomas are primary central nervous system tumors that in adult patients arise most frequently in the spinal canal. Although optimal management comprises gross total resection, no randomized trial has been performed to evaluate the efficacy of adjuvant radiation therapy (RT) to treat these infiltrative tumors. The objective of our study is to analyze population-based data to assess the response of adult patients with primary spinal ependymoma to treatment regimens including RT and surgery. Materials/Methods: Adult patients of age 18 or older with the diagnosis of ependymoma and with primary tumor site in spinal cord (C70.1), spinal meninges (C72.0), or cauda equina (C72.1) were identified from the Surveillance, Epidemiology, and End Results (SEER) database (1973-2012). Treatment information for radiation therapy and surgery was obtained. Surgical treatment was categorized into no surgery, subtotal resection (STR), and gross total resection (GTR). Demographic and clinicopathological predictors were analyzed using chi-square test, t-test, and logistic regression modeling. Kaplan-Meier analysis and multivariate Cox proportional hazard modeling were used to assess the impact of treatment on overall survival (OS). Results: 1557 adult patients with primary spinal ependymoma were identified. Fifty-two percent of patients were male and 86.6% were white. The median age was 47 years with 18-44 as the peak age group (43.7%). 20.9% of patients received RT, amongst whom 6.75% were WHO grade I, 20.6% grade II, and 1.53% grade III. Surgery was performed in 14.3% of patients with STR and 40.5% with GTR. OS at 10 years was 84.9%, with a median follow-up time of 26.8 years. Advanced age at diagnosis and high WHO grades were associated with poor OS, with 1.61% of age 75+ and 0.53% of grade III at 10 years, respectively. Multivariate analysis adjusting for gender, year of diagnosis, and treatment regimens showed worse OS in age groups greater than 75 years of age (HR 17.602, 95% CI 11.64026.382, P<0.001, using age 18-44 as reference). RT was also associated with unfavorable OS (HR 1.860, 95% CI 1.426-2.422, P<0.001). STR and
3289 Prophylaxis of Radiation-Induced Nausea and Vomiting: A Systematic Review and Meta-Analysis of Randomized Controlled Trials W.S. Li,1 J.M. van der Velden,2 S. Raman,3 M. Popovic,3 H. Lam,3 K.H. Wong,1 R. Ngan,1 M.J.P. Burbach,2 C. de Angelis,3 R. McDonald,3 and E. Chow3; 1Queen Elizabeth Hospital, Kowloon, Hong Kong, 2 University Medical Center Utrecht, Utrecht, Netherlands, 3Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
3290 Single 19-Gy High-Dose-Rate Brachytherapy Monotherapy for Treatment of Prostate Cancer: Tolerability and Dosimetric Predictors of Acute Toxicity and Health-Related Quality of Life M.M. Al-Hanaqta,1 D.A. Loblaw,2 H.T. Chung,3 P. Cheung,4 A. Mamedov,5 M. McGuffin,6 A. Ravi,2 L. Zhang,4 and G. Morton2;