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Significance of Indeterminate Pulmonary Nodules Identified on Chest Computed-tomography in Adult Patients with Newly Diagnosed Sarcoma
Proceedings of the 53rd Annual ASTRO Meeting
3001
The Role of Radiotherapy for Large and Locally Advanced Non-Melanoma Skin Carcinoma
C. L. Matthiesen, C. Forest, S. Thompson, S. Admad, T. Herman, C. Bogardus University of Oklahoma Health Sciences Center, Oklahoma City, OK Purpose/Objective(s): Non-melanoma skin cancer (NMSC) is the most common of all cancers. Patients presenting with early (T1N0M0) stages of disease have a 90 - 95% cure rate following any treatment including surgery, cryotherapy, electrocautery, Moh’s surgery, or radiation therapy (RT). Patients with T2-T4 NMSC lesions may present a unique treatment challenge. We reviewed patients treated with RT for T2-T4 NMSC and analyzed outcomes by lesion categories, histology, RT technique, efficacy, morbidity, and identified prognostic factors. Materials/Methods: A retrospective chart review was performed of 70 patients and 85 T2-T4 NMSC lesions who received RT from 2004 - 2010. Fifty-six lesions (65.9%) were previously untreated, seventeen (20.0%) were recurrent, and twelve (14.1%) were post-operative. Forty-three lesions (50.6%) were staged T2, twenty lesions (23.5%) T3, and twenty-two lesions (25.9%) T4. The skin of the head and neck was the most common lesion site (83.5%). Basal and squamous cell histologies were approximately equal. Electron therapy (62.4%), 3D conformal (10.5%) and IMRT (27.1%) were included RT techniques. Eleven T4 lesions (50.0%) had bony erosion, and twelve patients (17.1%) had nodal involvement. Median follow-up was 12 months (range 2 - 50 months). Results: Following completion of all therapy, 44 living patients (62.9%) had no evidence of disease, of which 40 (90.9%) required no additional therapy following RT. Twenty-two patients (31.4%) had died, of which 10 deaths (45.5%) were attributed to local failure and systemic progression, and one from acute reactions following RT. Out of twelve non-NMSC related deaths, 11 (91.7%) were known to have local control of disease. Overall achievement of tumor complete response (CR) to all therapy and RT alone was 95.3% and 86% for T2, 70% and 65% for T3, and 68.2% and 59.1% for T4 lesions, respectively. No statistically significant differences were found among RT techniques to achieve CR, and were 77.3% and 67.7% for electron and photon techniques. Post-operative lesions were the most likely to achieve CR to RT (83.3%), followed by untreated lesions (73.2%) and recurrent lesions (70.6%). Thirty-seven (88.1%) and twenty-six (60.5%) lesions of all basal and squamous cell histologies achieved a CR to RT alone. Statistically significant factors for CR included basal cell histology (p = 0.005), and tumor stage T2 (0.01). Conclusions: RT for T2-T4 NMSC is an effective treatment approach for many patients. Lesions with basal cell histology and stage T2 are statistically favored to achieve CR to RT alone. Post-operative RT for lesions which are not completely resected is also effective. IMRT has clinical advantages over 3D conformal and electron therapy in select cases. A multidisciplinary approach provides the most collaborative determination of the most appropriate treatment course. Author Disclosure: C.L. Matthiesen: None. C. Forest: None. S. Thompson: None. S. Admad: None. T. Herman: None. C. Bogardus: None.
3002
Significance of Indeterminate Pulmonary Nodules Identified on Chest Computed-tomography in Adult Patients with Newly Diagnosed Sarcoma
E. A. Wiegner, A. Y. Minn, D. Abelson, J. D. Murphy, C. Jacobs, S. S. Donaldson, D. S. Kapp Stanford University, Stanford, CA Purpose/Objective(s): To determine the significance of indeterminate pulmonary nodules identified on initial chest computed tomography (CT) in adult patients with newly diagnosed sarcomas. Materials/Methods: Between June 1996 and May 2009, 56 consecutive patients with newly diagnosed sarcoma and indeterminate pulmonary nodules observed on initial chest CT were identified. Histologic subtypes included malignant fibrous histiocytoma (n = 14), leiomyosarcoma (n = 9), liposarcoma (n = 6), and other tumor histology (n = 27). The primary tumor site was extremity (n = 29), retroperitoneal (n = 8) and other site (n = 19). Thirty-five patients had high grade tumors, 8 had intermediate grade and 13 had low grade tumors. The median age at diagnosis was 48 years (range 18 - 76 years). Pulmonary nodules were classified as indeterminate if they were less than or equal to 10 mm in size. The initial chest CT for all patients was reviewed by a radiologist and the size, number, and location of pulmonary nodules were recorded. The radiology reports of all subsequent chest CT studies were reviewed to determine if the patient developed pulmonary metastases. The median follow-up from time of diagnosis was 40 months (range 5.2 -115 months). Results: The 3-year local-regional control, freedom-from-lung-metastases (FFLM), and overall survival for all patients were 91%, 79%, and 89% respectively. On initial chest CT, 11 patients had a single pulmonary nodule, 26 patients had 2 - 4 nodules and 19 patients had 5 or more pulmonary nodules. The median size of the largest pulmonary nodule on initial chest CT scan was 4 mm (range 1 - 10 mm). The median number of CT scans for all patients was 6 (range 1 - 11). Thirteen patients developed lung metastases at median time 17 months after diagnosis (range 1.8 - 65 months). In 11 patients lung metastases were confirmed by surgical resection and in 2 patients by radiographic progression resulting in change in systemic therapy. Among the 13 patients with lung metastases, 12 had high grade primary tumors and 1 had an intermediate grade tumor. On univariate analysis, patients with high grade tumors had significantly worse FFLM than those patients with low or intermediate grade tumors, 69% versus 95% respectively (p = 0.025). The number and size of pulmonary nodules on initial chest CT, tumor histology, primary tumor site and size were not associated with the development of lung metastases on univariate analysis. Conclusions: Patients with high grade sarcomas and indeterminate pulmonary nodules on staging chest CT were more likely to develop pulmonary metastases than patients with low or intermediate grade primary tumors. Author Disclosure: E.A. Wiegner: None. A.Y. Minn: None. D. Abelson: None. J.D. Murphy: None. C. Jacobs: None. S.S. Donaldson: None. D.S. Kapp: None.
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3001
The Role of Radiotherapy for Large and Locally Advanced Non-Melanoma Skin Carcinoma
C. L. Matthiesen, C. Forest, S. Thompson, S. Admad, T. Herman, C. Bogardus University of Oklahoma Health Sciences Center, Oklahoma City, OK Purpose/Objective(s): Non-melanoma skin cancer (NMSC) is the most common of all cancers. Patients presenting with early (T1N0M0) stages of disease have a 90 - 95% cure rate following any treatment including surgery, cryotherapy, electrocautery, Moh’s surgery, or radiation therapy (RT). Patients with T2-T4 NMSC lesions may present a unique treatment challenge. We reviewed patients treated with RT for T2-T4 NMSC and analyzed outcomes by lesion categories, histology, RT technique, efficacy, morbidity, and identified prognostic factors. Materials/Methods: A retrospective chart review was performed of 70 patients and 85 T2-T4 NMSC lesions who received RT from 2004 - 2010. Fifty-six lesions (65.9%) were previously untreated, seventeen (20.0%) were recurrent, and twelve (14.1%) were post-operative. Forty-three lesions (50.6%) were staged T2, twenty lesions (23.5%) T3, and twenty-two lesions (25.9%) T4. The skin of the head and neck was the most common lesion site (83.5%). Basal and squamous cell histologies were approximately equal. Electron therapy (62.4%), 3D conformal (10.5%) and IMRT (27.1%) were included RT techniques. Eleven T4 lesions (50.0%) had bony erosion, and twelve patients (17.1%) had nodal involvement. Median follow-up was 12 months (range 2 - 50 months). Results: Following completion of all therapy, 44 living patients (62.9%) had no evidence of disease, of which 40 (90.9%) required no additional therapy following RT. Twenty-two patients (31.4%) had died, of which 10 deaths (45.5%) were attributed to local failure and systemic progression, and one from acute reactions following RT. Out of twelve non-NMSC related deaths, 11 (91.7%) were known to have local control of disease. Overall achievement of tumor complete response (CR) to all therapy and RT alone was 95.3% and 86% for T2, 70% and 65% for T3, and 68.2% and 59.1% for T4 lesions, respectively. No statistically significant differences were found among RT techniques to achieve CR, and were 77.3% and 67.7% for electron and photon techniques. Post-operative lesions were the most likely to achieve CR to RT (83.3%), followed by untreated lesions (73.2%) and recurrent lesions (70.6%). Thirty-seven (88.1%) and twenty-six (60.5%) lesions of all basal and squamous cell histologies achieved a CR to RT alone. Statistically significant factors for CR included basal cell histology (p = 0.005), and tumor stage T2 (0.01). Conclusions: RT for T2-T4 NMSC is an effective treatment approach for many patients. Lesions with basal cell histology and stage T2 are statistically favored to achieve CR to RT alone. Post-operative RT for lesions which are not completely resected is also effective. IMRT has clinical advantages over 3D conformal and electron therapy in select cases. A multidisciplinary approach provides the most collaborative determination of the most appropriate treatment course. Author Disclosure: C.L. Matthiesen: None. C. Forest: None. S. Thompson: None. S. Admad: None. T. Herman: None. C. Bogardus: None.
3002
Significance of Indeterminate Pulmonary Nodules Identified on Chest Computed-tomography in Adult Patients with Newly Diagnosed Sarcoma
E. A. Wiegner, A. Y. Minn, D. Abelson, J. D. Murphy, C. Jacobs, S. S. Donaldson, D. S. Kapp Stanford University, Stanford, CA Purpose/Objective(s): To determine the significance of indeterminate pulmonary nodules identified on initial chest computed tomography (CT) in adult patients with newly diagnosed sarcomas. Materials/Methods: Between June 1996 and May 2009, 56 consecutive patients with newly diagnosed sarcoma and indeterminate pulmonary nodules observed on initial chest CT were identified. Histologic subtypes included malignant fibrous histiocytoma (n = 14), leiomyosarcoma (n = 9), liposarcoma (n = 6), and other tumor histology (n = 27). The primary tumor site was extremity (n = 29), retroperitoneal (n = 8) and other site (n = 19). Thirty-five patients had high grade tumors, 8 had intermediate grade and 13 had low grade tumors. The median age at diagnosis was 48 years (range 18 - 76 years). Pulmonary nodules were classified as indeterminate if they were less than or equal to 10 mm in size. The initial chest CT for all patients was reviewed by a radiologist and the size, number, and location of pulmonary nodules were recorded. The radiology reports of all subsequent chest CT studies were reviewed to determine if the patient developed pulmonary metastases. The median follow-up from time of diagnosis was 40 months (range 5.2 -115 months). Results: The 3-year local-regional control, freedom-from-lung-metastases (FFLM), and overall survival for all patients were 91%, 79%, and 89% respectively. On initial chest CT, 11 patients had a single pulmonary nodule, 26 patients had 2 - 4 nodules and 19 patients had 5 or more pulmonary nodules. The median size of the largest pulmonary nodule on initial chest CT scan was 4 mm (range 1 - 10 mm). The median number of CT scans for all patients was 6 (range 1 - 11). Thirteen patients developed lung metastases at median time 17 months after diagnosis (range 1.8 - 65 months). In 11 patients lung metastases were confirmed by surgical resection and in 2 patients by radiographic progression resulting in change in systemic therapy. Among the 13 patients with lung metastases, 12 had high grade primary tumors and 1 had an intermediate grade tumor. On univariate analysis, patients with high grade tumors had significantly worse FFLM than those patients with low or intermediate grade tumors, 69% versus 95% respectively (p = 0.025). The number and size of pulmonary nodules on initial chest CT, tumor histology, primary tumor site and size were not associated with the development of lung metastases on univariate analysis. Conclusions: Patients with high grade sarcomas and indeterminate pulmonary nodules on staging chest CT were more likely to develop pulmonary metastases than patients with low or intermediate grade primary tumors. Author Disclosure: E.A. Wiegner: None. A.Y. Minn: None. D. Abelson: None. J.D. Murphy: None. C. Jacobs: None. S.S. Donaldson: None. D.S. Kapp: None.
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