- Email: [email protected]
Treatment Outcome of Anaplastic Oligodendroglioma: Korean Multicenter Retrospective Study
E80
International Journal of Radiation Oncology Biology Physics
2201
accepted as an essential component of treatment. However, the role and optimum timing of radiation therapy (RT) still remains controversial. In this study, we investigated the impact of the RT timing in patients with PCNSL. Materials/Methods: A total of 76 patients, who were treated with RT alone or high-dose methotrexate-based chemotherapy for PCNSL between June 2006 and July 2014, were retrospectively analyzed. The upfront RT group consisted of 5 patients, who were treated with RT alone, and 14 patients, who received RT immediately after the completion of first-line chemotherapy. In the remaining 57 patients, RT were deferred (n Z 15) or omitted (n Z 42) (the withholding RT group). RT consisted of whole brain RT with a median dose of 30.6 Gy (range, 23.4-45.6 Gy) with or without local boost. As a result, the median total radiation dose was 41.4 Gy (range, 23.4-50.4 Gy). Results: The median patient age for all patients was 52 years (range, 21-79 years), and 43 (57%) patients were younger than 60. The median follow-up time was 27 months for the surviving patients. The median overall survival (OS) and progression-free survival (PFS) for all patients were 56.8 months and 14.9 months, respectively. PFS was significantly better in the upfront RT group than the withholding RT group (median PFS, 47.4 versus 11.8 months, p Z 0.033), while OS did not show significant difference between two groups (the 3-year OS rate, 66% versus 58%, p Z 0.594). Conclusion: Upfront RT markedly improved PFS, although its survival benefit was not apparent. Therefore, we suggest that deferring or omitting RT should not be considered as a routine practice for patients with PCNSL. Author Disclosure: H. Kim: None. C. Suh: None. J. Cho: None. Y. Suh: None.
Newly Diagnosed Non-Small Cell Lung Cancer (NSCLC) With 1-3 Brain Metastases: Validation of the Disease Specific GPA M. Greer,1 N.M. Woody,2 C.A. Reddy,2 G.M. Videtic,2 S.T. Chao,2 E.S. Murphy,2 J.H. Suh,2 L. Angelov,2 G. Barnett,2 M.A. Vogelbaum,2 and K.L. Stephans2; 1Cleveland Clinic Lerner College of Medicine, Cleveland, OH, 2Cleveland Clinic, Cleveland, OH Purpose/Objective(s): Use of the disease-specific graded prognostic assessment (DS-GPA) for brain metastases is a powerful prognostic tool. The survival estimates obtained for this tool may not reflect the prognosis of patients with brain metastases at the time of NSCLC who are naı¨ve to other therapies. Materials/Methods: We identified all patients with newly diagnosed NSCLC with 1-3 brain metastases treated with gamma knife radiosurgery between 1997 and 2011 from an IRB approved registry. We included both patients treated with GK alone or in combination with whole brain radiation therapy (WBRT) for the initial management of brain metastases. We evaluated potential prognostic factors for overall survival including age, treatment modality, Karnofsky Performance Score (KPS), histology, disease burden in the lungs, location of presenting symptoms, and extracranial metastases by Cox Proportional Hazards. Patients were stratified by NSCLC DS-GPA to evaluate the accuracy of survival estimates in patients with newly diagnosed lung cancer. Results: 164 patients were identified with 85 (52%) treated with gammaknife (GK) alone and 79 (48%) treated with up front GK and WBRT. Patients treated with GK alone had a median survival of 9.1 months versus 8.5 months in patients treated with GK and WBRT (p-valueZ 0.093). Neither group demonstrated differences in disease progression, with GK and GK+WBRT median time to disease progression at 6.7 and 6.1 months respectively, pvalueZ 0.52. Significant risk factors for overall survival on univariate analysis were KPS, HR 0.98 (95% CI 0.97-0.99), symptomatic extracranial disease, HR 0.55 (CI 0.36-0.84), presence of extracranial metastases, HR 0.45 (CI 0.34-0.70), and higher number of brain metastases, 1.61 (CI 1.102.35). Neither age, HR 1.0 (CI 0.9-1.0) nor up front addition of WBRT to GK, HR 0.76 (CI 0.55-1.05) were significantly associated with improved survival. On multivariate analysis only presence of extracranial metastases was significant for disease progression, HR 0.60 (CI 0.39-0.93). Median overall survival stratified by DS-GPA of 0-1, 1.5-2, 2.5-3 and 3.5-4 were 2.8, 6.7, 9.8, and 13.2 months, respectively, consistent with survival estimates for brain metastases in NSCLC as a whole which are 3.0, 6.5, 11.3, and 14.8 months. Conclusion: The prognosis for patients with newly diagnosed NSCLC with synchronous brain metastases is consistent with survival estimates from DS-GPA for NSCLC. In addition to DS-GPA presences of symptoms of systemic disease were associated a worse prognosis. Patients with newly diagnosed NSCLC do not have an improved prognosis compared to what DS-GPA would predict and those with low GPA may not benefit from additional aggressive therapies. Author Disclosure: M. Greer: None. N.M. Woody: None. C.A. Reddy: None. G.M. Videtic: Editor for Thoracic Section of Red Journal; International Journal of Radiation Oncology. S.T. Chao: Speaker’s Bureau; Varian medical systems. E.S. Murphy: None. J.H. Suh: Consultant; Varian Medical Systems. L. Angelov: None. G. Barnett: None. M.A. Vogelbaum: Consultant; Neuralstem, Inc., Pharmacokinesis, Inc. Royalty; Infuseon Therapeutics, Inc. Chair and Co-chair; NRG Oncology. K.L. Stephans: None.
2202 Upfront Radiation Therapy Improves Progression Free Survival in Patients With Primary CNS Lymphoma H.J. Kim,1 C.O. Suh,2 J.H. Cho,3 and Y.G. Suh2; 1Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea, 2Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea, 3Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul 120-752, South Korea Purpose/Objective(s): In patients with primary CNS lymphoma (PCNSL), high-dose methotrexate-based chemotherapy is generally
2203 Treatment Outcome of Anaplastic Oligodendroglioma: Korean Multicenter Retrospective Study H.C. Kang,1 T. Yu,2 D.H. Lim,3 I.H. Kim,2 W.K. Chung,4 C.O. Suh,5 B.O. Choi,6 K.H. Cho,7 J.H. Cho,8 J.H. Kim,9 and I.A. Kim10; 1Dongnam Institute of Radiological & Medical Sciences, Busan, South Korea, 2Seoul National University College of Medicine, Seoul, South Korea, 3Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, 4Chonnam National University Hwasun Hospital, Hwasun, South Korea, 5Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea, 6The Catholic University of Korea, College of Medicine, Seoul, South Korea, 7Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, South Korea, 8 Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul 120-752, South Korea, 9Keimyung University Dongsan Medical Center, Daegu, South Korea, 10Seoul National University, Seoul, South Korea Purpose/Objective(s): Although some existing evidence supports the addition of chemotherapy (CT) to radiation therapy (RT) for anaplastic oligodendroglioma treatment, controversy about both the criteria for suitable candidates and the optimal treatment schedule remains. We presented the postoperative treatment outcomes of Korean patients with oligodendroglial tumors. Materials/Methods: Data from 376 newly diagnosed anaplastic oliogodendroglial tumor patients from nine Korean institutes were reviewed from 2000 to 2010. Results: Total tumor removal was performed in 146 patients. More than 85% of the entire patients received postoperative RT, and 59% received CT. Approximately 50% (nZ189) received CT in addition to RTand 9% (nZ32) received CT only. A multivariate analysis revealed that younger age, frontal lobe location of the tumor, gross total removal, 1p/19q codeletion, and initial RT were associated with longer progression-free and overall survival rates. No difference was observed in outcomes from the treatment that included either temozolomide or PCV (procarbazine, lomustine, and vincristine) in addition to RT regardless of the 1p/19q deletion status. Conclusion: A clear improvement in progression-free and overall survival was observed for RT and combined CT/RT but not CT only. Postoperative RT appears to improve survival for all patients. Total removal and 1p/19q
Volume 93 Number 3S Supplement 2015 codeletion may not be sufficient criteria to omit RT as a treatment option. These results suggest that RT should continue to be offered as a treatment option for patients with anaplastic oligodendroglial tumors. Author Disclosure: H. Kang: None. T. Yu: None. D. Lim: None. I. Kim: None. W. Chung: None. C. Suh: None. B. Choi: None. K. Cho: None. J. Cho: None. J. Kim: None. I. Kim: None.
2204 Evaluating the Impact of Hippocampal Sparing During Whole-Brain Radiation Therapy on Neurocognitive Functions and the Correlations With Hippocampal Dosimetry: A Preliminary Report of a Prospective Observational Study P.F. Tsai,1 T. Wu,1 C.C. Yang,2 C.K. Tseng,1 P.C. Pai,1 D.L. Tsan,1 and S.Y. Lin1; 1Chang Gung Memorial Hospital, Taoyuan 333, Taiwan, 2 Chang Gung University, Taoyuan 333, Taiwan Purpose/Objective(s): Whole brain radiation therapy (WBRT) is the treatment of choice for patients with brain metastases. However, neurocognitive functions (NCF) decline due to impaired hippocampal neurogenesis might occur after WBRT. It is hypothesized that conformal hippocampal sparing during the course of WBRT (HS-WBRT) might provide meaningful NCF preservation. Our study aims to demonstrate the impact of delivering HA-WBRT on NCF changes in patients receiving therapeutic or prophylactic WBRT. Additionally, we attempt to investigate the correlations between hippocampal dosimetric parameters and the above NCF changes or declines Materials/Methods: Forty prospectively enrolled patients were referred for WBRT for PCI or treating oligometastatic brain disease. Before the initiation of HA-WBRT course, all participants must receive baseline neurocognitive assessment, including memory, executive functions and psychomotor speed. The primary endpoint is delayed recall, as determined by the change/decline in either verbal memory (WMS IIIe Word List Learning) or non-verbal memory (WMS III- Visual Reproduction) from baseline assessment to 4 months after the start of HA-WBRT. Hippocampal dosimetric parameters include mean dose received by the hippocampus, the dose delivered to 100% (D100%) of the hippocampus, and V40. Results: Only 3 patients belonged to the clinical setting of PCI; the remaining 37 patients had oligometastatic brain disease, in which the majority metastasized from primary lung cancer. Regarding neurocognitive outcomes, no statistically significant differences were found between various NCF scores obtained at baseline and at post-radiation therapy intervals, in terms of immediate verbal memory and non-verbal memory, except for delayed recall memory on Word List (F Z5.727, p Z0.048). According to the Spearman correlation coefficients, all dosimetric parameters we are interested in fail to be significantly correlated with NCF decline/change after HS-WBRT in the current report. Conclusion: Functional preservation by hippocampal sparing during the course of WBRT could largely be achieved in this preliminary study. Our study further suggests that HA-WBRT should be a feasible technique preserving important neurocognitive functions while maintaining intracranial control. Author Disclosure: P. Tsai: None. T. Wu: None. C. Yang: None. C. Tseng: None. P. Pai: None. D. Tsan: None. S. Lin: None.
2205 Relationship Between Subventricular Zone Dose and Survival in Patients With Glioblastoma Multiforme Treated With Surgery Followed Radiation Chemotherapy P. Foro,1 O. Pera,2 N. Rodriguez De Dios,1 J. Sanz,1 A. Reig Castillejo,2 I. Membrive Conejo,2 E. Fernandez-Velilla,2 J. Quera,2 A. Ortiz,2 and M. Algara1; 1Hospital de la Esperanza. Parc de Salut Mar. IMIM (Hospital del Mar Medical Research Institute). Universitat Pompeu Fabra., Barcelona, Spain, 2Hospital de la Esperanza. Parc de Salut Mar. IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
Poster Viewing Session
E81
Purpose/Objective(s): Several studies show that there is a relationship between the dose to the subventricular zone and survival, however the results are contradictory. We present the results of 53 patients treated at our institution, to determine if there be relationship between dose of subventricular zone and survival in patients with glioblastoma treated with surgery followed radio-chemotherapy. Materials/Methods: Between 2006 and 2013, we study retrospectively 53 patients with glioblastoma multiple treated with surgery followed by radiochemotherapy. The relationships between subventricular zone doses (SVZ), progression free survival (PFS) and overall survival (OS) were examined using Cox proportional hazards models. The covariates to estimate their impact were: sex, age, localization, surgery, adjuvant temozolomide, MGMT status. Results: The median age was 68(84-30) years, 58.1% were men, the localization of tumors were distributed equally in both hemispheres, biopsy was performed in 9.4%, subtotal resection at 52.8% and total resection at 37.7%, 43.2% of patients MGMT gene promoter was methylated. Median PFS and OS was 9.5 (6.7-12.3) and 15.8 (11.8-19-8) months respectively. The median dose to the ipsilateral, contralateral, and bilateral SVZ was 52.2 [41.7, 57.5], 43.1 [31.6, 51] and 47.2 [37.5, 54.3] Gy respectively. The OS was higher in patients receiving 51 Gy in the contralateral SVZ (PZ0.012); adjusted HR Z 0.195 [95% IC, 0.0550.697] and those that surgical resection was performed against which only biopsy were performed (PZ0.037); adjusted HRZ0.100 [95% IC, 0.0120.870] respectively. Also these variables were related with PFS, higher doses in the contralateral SVZ (PZ0.002) adjusted HR Z 0.112 [95% ICZ 0.029-0.439] and surgical resection (PZ0.002) adjusted HRZ 0.021 [95% ICZ0.002-0.233]), were associated with better PFS. Conclusion: High-dose radiation in contralateral SVZ and surgical resection was associated with a significant improvement in PFS and OS in patients treated with surgery followed by radio chemotherapy for glioblastoma multiforme. Author Disclosure: P. Foro: None. O. Pera: None. N. Rodriguez De Dios: None. J. Sanz: None. A. Reig Castillejo: None. I. Membrive Conejo: None. E. Fernandez-Velilla: None. J. Quera: None. A. Ortiz: None. M. Algara: None.
2206 Fractionated Stereotactic Radiation Therapy Combined With Temozolomide for Refractory Brain Metastases: A Phase II Trial Y. Ma,1 J.P. Xiao,2 Y. Zhang,3 N. Bi,4 D. Liu,5 Y. Xu,6 H. Zhang,6 J. Li,6 and Y. Li7; 1Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China, 2Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China, 3Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Beijing, Beijing, China, 4 Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 5 Cancer Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China, 6Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China, 7Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Beijing, Beijing, China Purpose/Objective(s): A prospective phase II trial was conducted to investigate the feasibility and safety of fractionated stereotactic radiation therapy (FSRT) combined with temozolomide (TMZ) for refractory brain metastases. Materials/Methods: Patients with 3 lesions (group A), the volume of the largest lesion 6cc (group B) or meningeal metastases (group C) were enrolled. FSRT with or without whole brain radiotherapy (WBRT) was given to the patients. TMZ was administrated 75 mg/m2 concurrently, followed by 6 cycles of adjuvant TMZ (150 mg/m2/d, d1-5, q28d) if necessary. The response was assessed by MRI after 2-3 months from treatment according to RTOG9508 criteria. Toxicity was recorded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE,
International Journal of Radiation Oncology Biology Physics
2201
accepted as an essential component of treatment. However, the role and optimum timing of radiation therapy (RT) still remains controversial. In this study, we investigated the impact of the RT timing in patients with PCNSL. Materials/Methods: A total of 76 patients, who were treated with RT alone or high-dose methotrexate-based chemotherapy for PCNSL between June 2006 and July 2014, were retrospectively analyzed. The upfront RT group consisted of 5 patients, who were treated with RT alone, and 14 patients, who received RT immediately after the completion of first-line chemotherapy. In the remaining 57 patients, RT were deferred (n Z 15) or omitted (n Z 42) (the withholding RT group). RT consisted of whole brain RT with a median dose of 30.6 Gy (range, 23.4-45.6 Gy) with or without local boost. As a result, the median total radiation dose was 41.4 Gy (range, 23.4-50.4 Gy). Results: The median patient age for all patients was 52 years (range, 21-79 years), and 43 (57%) patients were younger than 60. The median follow-up time was 27 months for the surviving patients. The median overall survival (OS) and progression-free survival (PFS) for all patients were 56.8 months and 14.9 months, respectively. PFS was significantly better in the upfront RT group than the withholding RT group (median PFS, 47.4 versus 11.8 months, p Z 0.033), while OS did not show significant difference between two groups (the 3-year OS rate, 66% versus 58%, p Z 0.594). Conclusion: Upfront RT markedly improved PFS, although its survival benefit was not apparent. Therefore, we suggest that deferring or omitting RT should not be considered as a routine practice for patients with PCNSL. Author Disclosure: H. Kim: None. C. Suh: None. J. Cho: None. Y. Suh: None.
Newly Diagnosed Non-Small Cell Lung Cancer (NSCLC) With 1-3 Brain Metastases: Validation of the Disease Specific GPA M. Greer,1 N.M. Woody,2 C.A. Reddy,2 G.M. Videtic,2 S.T. Chao,2 E.S. Murphy,2 J.H. Suh,2 L. Angelov,2 G. Barnett,2 M.A. Vogelbaum,2 and K.L. Stephans2; 1Cleveland Clinic Lerner College of Medicine, Cleveland, OH, 2Cleveland Clinic, Cleveland, OH Purpose/Objective(s): Use of the disease-specific graded prognostic assessment (DS-GPA) for brain metastases is a powerful prognostic tool. The survival estimates obtained for this tool may not reflect the prognosis of patients with brain metastases at the time of NSCLC who are naı¨ve to other therapies. Materials/Methods: We identified all patients with newly diagnosed NSCLC with 1-3 brain metastases treated with gamma knife radiosurgery between 1997 and 2011 from an IRB approved registry. We included both patients treated with GK alone or in combination with whole brain radiation therapy (WBRT) for the initial management of brain metastases. We evaluated potential prognostic factors for overall survival including age, treatment modality, Karnofsky Performance Score (KPS), histology, disease burden in the lungs, location of presenting symptoms, and extracranial metastases by Cox Proportional Hazards. Patients were stratified by NSCLC DS-GPA to evaluate the accuracy of survival estimates in patients with newly diagnosed lung cancer. Results: 164 patients were identified with 85 (52%) treated with gammaknife (GK) alone and 79 (48%) treated with up front GK and WBRT. Patients treated with GK alone had a median survival of 9.1 months versus 8.5 months in patients treated with GK and WBRT (p-valueZ 0.093). Neither group demonstrated differences in disease progression, with GK and GK+WBRT median time to disease progression at 6.7 and 6.1 months respectively, pvalueZ 0.52. Significant risk factors for overall survival on univariate analysis were KPS, HR 0.98 (95% CI 0.97-0.99), symptomatic extracranial disease, HR 0.55 (CI 0.36-0.84), presence of extracranial metastases, HR 0.45 (CI 0.34-0.70), and higher number of brain metastases, 1.61 (CI 1.102.35). Neither age, HR 1.0 (CI 0.9-1.0) nor up front addition of WBRT to GK, HR 0.76 (CI 0.55-1.05) were significantly associated with improved survival. On multivariate analysis only presence of extracranial metastases was significant for disease progression, HR 0.60 (CI 0.39-0.93). Median overall survival stratified by DS-GPA of 0-1, 1.5-2, 2.5-3 and 3.5-4 were 2.8, 6.7, 9.8, and 13.2 months, respectively, consistent with survival estimates for brain metastases in NSCLC as a whole which are 3.0, 6.5, 11.3, and 14.8 months. Conclusion: The prognosis for patients with newly diagnosed NSCLC with synchronous brain metastases is consistent with survival estimates from DS-GPA for NSCLC. In addition to DS-GPA presences of symptoms of systemic disease were associated a worse prognosis. Patients with newly diagnosed NSCLC do not have an improved prognosis compared to what DS-GPA would predict and those with low GPA may not benefit from additional aggressive therapies. Author Disclosure: M. Greer: None. N.M. Woody: None. C.A. Reddy: None. G.M. Videtic: Editor for Thoracic Section of Red Journal; International Journal of Radiation Oncology. S.T. Chao: Speaker’s Bureau; Varian medical systems. E.S. Murphy: None. J.H. Suh: Consultant; Varian Medical Systems. L. Angelov: None. G. Barnett: None. M.A. Vogelbaum: Consultant; Neuralstem, Inc., Pharmacokinesis, Inc. Royalty; Infuseon Therapeutics, Inc. Chair and Co-chair; NRG Oncology. K.L. Stephans: None.
2202 Upfront Radiation Therapy Improves Progression Free Survival in Patients With Primary CNS Lymphoma H.J. Kim,1 C.O. Suh,2 J.H. Cho,3 and Y.G. Suh2; 1Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea, 2Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea, 3Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul 120-752, South Korea Purpose/Objective(s): In patients with primary CNS lymphoma (PCNSL), high-dose methotrexate-based chemotherapy is generally
2203 Treatment Outcome of Anaplastic Oligodendroglioma: Korean Multicenter Retrospective Study H.C. Kang,1 T. Yu,2 D.H. Lim,3 I.H. Kim,2 W.K. Chung,4 C.O. Suh,5 B.O. Choi,6 K.H. Cho,7 J.H. Cho,8 J.H. Kim,9 and I.A. Kim10; 1Dongnam Institute of Radiological & Medical Sciences, Busan, South Korea, 2Seoul National University College of Medicine, Seoul, South Korea, 3Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, 4Chonnam National University Hwasun Hospital, Hwasun, South Korea, 5Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea, 6The Catholic University of Korea, College of Medicine, Seoul, South Korea, 7Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, South Korea, 8 Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul 120-752, South Korea, 9Keimyung University Dongsan Medical Center, Daegu, South Korea, 10Seoul National University, Seoul, South Korea Purpose/Objective(s): Although some existing evidence supports the addition of chemotherapy (CT) to radiation therapy (RT) for anaplastic oligodendroglioma treatment, controversy about both the criteria for suitable candidates and the optimal treatment schedule remains. We presented the postoperative treatment outcomes of Korean patients with oligodendroglial tumors. Materials/Methods: Data from 376 newly diagnosed anaplastic oliogodendroglial tumor patients from nine Korean institutes were reviewed from 2000 to 2010. Results: Total tumor removal was performed in 146 patients. More than 85% of the entire patients received postoperative RT, and 59% received CT. Approximately 50% (nZ189) received CT in addition to RTand 9% (nZ32) received CT only. A multivariate analysis revealed that younger age, frontal lobe location of the tumor, gross total removal, 1p/19q codeletion, and initial RT were associated with longer progression-free and overall survival rates. No difference was observed in outcomes from the treatment that included either temozolomide or PCV (procarbazine, lomustine, and vincristine) in addition to RT regardless of the 1p/19q deletion status. Conclusion: A clear improvement in progression-free and overall survival was observed for RT and combined CT/RT but not CT only. Postoperative RT appears to improve survival for all patients. Total removal and 1p/19q
Volume 93 Number 3S Supplement 2015 codeletion may not be sufficient criteria to omit RT as a treatment option. These results suggest that RT should continue to be offered as a treatment option for patients with anaplastic oligodendroglial tumors. Author Disclosure: H. Kang: None. T. Yu: None. D. Lim: None. I. Kim: None. W. Chung: None. C. Suh: None. B. Choi: None. K. Cho: None. J. Cho: None. J. Kim: None. I. Kim: None.
2204 Evaluating the Impact of Hippocampal Sparing During Whole-Brain Radiation Therapy on Neurocognitive Functions and the Correlations With Hippocampal Dosimetry: A Preliminary Report of a Prospective Observational Study P.F. Tsai,1 T. Wu,1 C.C. Yang,2 C.K. Tseng,1 P.C. Pai,1 D.L. Tsan,1 and S.Y. Lin1; 1Chang Gung Memorial Hospital, Taoyuan 333, Taiwan, 2 Chang Gung University, Taoyuan 333, Taiwan Purpose/Objective(s): Whole brain radiation therapy (WBRT) is the treatment of choice for patients with brain metastases. However, neurocognitive functions (NCF) decline due to impaired hippocampal neurogenesis might occur after WBRT. It is hypothesized that conformal hippocampal sparing during the course of WBRT (HS-WBRT) might provide meaningful NCF preservation. Our study aims to demonstrate the impact of delivering HA-WBRT on NCF changes in patients receiving therapeutic or prophylactic WBRT. Additionally, we attempt to investigate the correlations between hippocampal dosimetric parameters and the above NCF changes or declines Materials/Methods: Forty prospectively enrolled patients were referred for WBRT for PCI or treating oligometastatic brain disease. Before the initiation of HA-WBRT course, all participants must receive baseline neurocognitive assessment, including memory, executive functions and psychomotor speed. The primary endpoint is delayed recall, as determined by the change/decline in either verbal memory (WMS IIIe Word List Learning) or non-verbal memory (WMS III- Visual Reproduction) from baseline assessment to 4 months after the start of HA-WBRT. Hippocampal dosimetric parameters include mean dose received by the hippocampus, the dose delivered to 100% (D100%) of the hippocampus, and V40. Results: Only 3 patients belonged to the clinical setting of PCI; the remaining 37 patients had oligometastatic brain disease, in which the majority metastasized from primary lung cancer. Regarding neurocognitive outcomes, no statistically significant differences were found between various NCF scores obtained at baseline and at post-radiation therapy intervals, in terms of immediate verbal memory and non-verbal memory, except for delayed recall memory on Word List (F Z5.727, p Z0.048). According to the Spearman correlation coefficients, all dosimetric parameters we are interested in fail to be significantly correlated with NCF decline/change after HS-WBRT in the current report. Conclusion: Functional preservation by hippocampal sparing during the course of WBRT could largely be achieved in this preliminary study. Our study further suggests that HA-WBRT should be a feasible technique preserving important neurocognitive functions while maintaining intracranial control. Author Disclosure: P. Tsai: None. T. Wu: None. C. Yang: None. C. Tseng: None. P. Pai: None. D. Tsan: None. S. Lin: None.
2205 Relationship Between Subventricular Zone Dose and Survival in Patients With Glioblastoma Multiforme Treated With Surgery Followed Radiation Chemotherapy P. Foro,1 O. Pera,2 N. Rodriguez De Dios,1 J. Sanz,1 A. Reig Castillejo,2 I. Membrive Conejo,2 E. Fernandez-Velilla,2 J. Quera,2 A. Ortiz,2 and M. Algara1; 1Hospital de la Esperanza. Parc de Salut Mar. IMIM (Hospital del Mar Medical Research Institute). Universitat Pompeu Fabra., Barcelona, Spain, 2Hospital de la Esperanza. Parc de Salut Mar. IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
Poster Viewing Session
E81
Purpose/Objective(s): Several studies show that there is a relationship between the dose to the subventricular zone and survival, however the results are contradictory. We present the results of 53 patients treated at our institution, to determine if there be relationship between dose of subventricular zone and survival in patients with glioblastoma treated with surgery followed radio-chemotherapy. Materials/Methods: Between 2006 and 2013, we study retrospectively 53 patients with glioblastoma multiple treated with surgery followed by radiochemotherapy. The relationships between subventricular zone doses (SVZ), progression free survival (PFS) and overall survival (OS) were examined using Cox proportional hazards models. The covariates to estimate their impact were: sex, age, localization, surgery, adjuvant temozolomide, MGMT status. Results: The median age was 68(84-30) years, 58.1% were men, the localization of tumors were distributed equally in both hemispheres, biopsy was performed in 9.4%, subtotal resection at 52.8% and total resection at 37.7%, 43.2% of patients MGMT gene promoter was methylated. Median PFS and OS was 9.5 (6.7-12.3) and 15.8 (11.8-19-8) months respectively. The median dose to the ipsilateral, contralateral, and bilateral SVZ was 52.2 [41.7, 57.5], 43.1 [31.6, 51] and 47.2 [37.5, 54.3] Gy respectively. The OS was higher in patients receiving 51 Gy in the contralateral SVZ (PZ0.012); adjusted HR Z 0.195 [95% IC, 0.0550.697] and those that surgical resection was performed against which only biopsy were performed (PZ0.037); adjusted HRZ0.100 [95% IC, 0.0120.870] respectively. Also these variables were related with PFS, higher doses in the contralateral SVZ (PZ0.002) adjusted HR Z 0.112 [95% ICZ 0.029-0.439] and surgical resection (PZ0.002) adjusted HRZ 0.021 [95% ICZ0.002-0.233]), were associated with better PFS. Conclusion: High-dose radiation in contralateral SVZ and surgical resection was associated with a significant improvement in PFS and OS in patients treated with surgery followed by radio chemotherapy for glioblastoma multiforme. Author Disclosure: P. Foro: None. O. Pera: None. N. Rodriguez De Dios: None. J. Sanz: None. A. Reig Castillejo: None. I. Membrive Conejo: None. E. Fernandez-Velilla: None. J. Quera: None. A. Ortiz: None. M. Algara: None.
2206 Fractionated Stereotactic Radiation Therapy Combined With Temozolomide for Refractory Brain Metastases: A Phase II Trial Y. Ma,1 J.P. Xiao,2 Y. Zhang,3 N. Bi,4 D. Liu,5 Y. Xu,6 H. Zhang,6 J. Li,6 and Y. Li7; 1Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China, 2Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China, 3Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Beijing, Beijing, China, 4 Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 5 Cancer Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China, 6Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China, 7Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Beijing, Beijing, China Purpose/Objective(s): A prospective phase II trial was conducted to investigate the feasibility and safety of fractionated stereotactic radiation therapy (FSRT) combined with temozolomide (TMZ) for refractory brain metastases. Materials/Methods: Patients with 3 lesions (group A), the volume of the largest lesion 6cc (group B) or meningeal metastases (group C) were enrolled. FSRT with or without whole brain radiotherapy (WBRT) was given to the patients. TMZ was administrated 75 mg/m2 concurrently, followed by 6 cycles of adjuvant TMZ (150 mg/m2/d, d1-5, q28d) if necessary. The response was assessed by MRI after 2-3 months from treatment according to RTOG9508 criteria. Toxicity was recorded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE,