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Trends in Utilization of Radiation in the Treatment of Pediatric Hodgkin Lymphoma
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Volume 96 Number 2S Supplement 2016 Author Disclosure: S. Laskar: None. A.A. Bindal: None. N.R. Khanna: None. S. Chaudhari: None. T. Vora: None. G. Chinnaswami: None. S. Kembhavi: None. M. Ramadwar: None. S. Qureshi: None. M. Muckaden: None. P. Kurkure: None.
3354 Recurrent Medulloblastoma and Radiation Therapy H.P. Bagshaw,1 M.M. Poppe,1 and G.K. Hunter2; 1University of Utah Huntsman Cancer Institute, Salt Lake City, UT, 2Intermountain Healthcare, Murray, UT Purpose/Objective(s): To examine local control and overall survival for patients with recurrent medulloblastoma treated with or without salvage radiation therapy. Materials/Methods: An IRB approved retrospective analysis of data from 2 institutions evaluating the outcomes of children with recurrent medulloblastoma treated from 2001 to 2015 was performed. Patient variables analyzed included age, risk categorization, site of recurrence, and salvage therapy (surgery, chemotherapy, and radiation therapy). Kaplan Meier analysis and log-rank test were used to evaluate local control and overall survival. Results: Twenty-one patients with recurrent medulloblastoma were identified, treated initially with risk-adapted therapy. Eight had high risk disease at diagnosis and 13 had standard risk disease. At recurrence, 10 patients failed in the brain, 1 failed in the spine, and 10 developed leptomeningeal disease. Median follow-up was 10 months after salvage treatment. Median overall survival was 53.9 months from initial diagnosis. Patients treated with radiotherapy for salvage had improved local control and overall survival compared to those that received chemotherapy or surgery alone. Median time to progression after recurrence for patients treated with radiotherapy was 76 months compared to 9 months without (PZ0.04). Median survival after recurrence for patients treated with radiation therapy was 12 months compared to 9 months without (PZ0.01). There was no statistical significance when comparing high risk and standard risk patients. Conclusion: Radiation therapy for recurrent medulloblastoma in our cohort of children was an effective salvage treatment. Including radiation therapy in the salvage regimen provided durable local control and improved survival when compared to salvage treatment without radiation. Author Disclosure: H.P. Bagshaw: None. M.M. Poppe: None. G.K. Hunter: None.
3355 Trends in Utilization of Radiation in the Treatment of Pediatric Hodgkin Lymphoma N.A. Madden,1 J.A. Marascio,1 B.M. Rabatic,1 D. Zaenger,1 C. McDonough,1 T.S. Johnson,2 F.M. Kong,3 E.M. Marchan,1 S. Shaaban,1 W. Martin,1 B.G. Dasher,1 J.G. Stewart,1 J. Howington,1 A. Al-Basheer,1 A. Amoush,1 K. Huang,1 A. Green,1 M. Pishgou,1 C.L. Ferguson,1 and W.F. Mourad1; 1Augusta University, Augusta, GA, 2Augusta University/GRU Cancer Center, Augusta, GA, 3Department of Radiation Oncology, Augusta University, Augusta, GA Purpose/Objective(s): Hodgkin’s lymphoma (HL) is a curable form of pediatric cancer. Late effects from treatment are a concern. Radiation therapy (RT) can be associated with toxicity, including secondary malignant neoplasms (SMN). Pediatric protocols have attempted to decrease RT dose or eliminate RT due to toxicity. Here we evaluate characteristics associated with utilization of RT for pediatric HL, their effects on outcomes and development of SMN. Materials/Methods: The SEER database was queried for patients diagnosed with HL at ages 0-19 years from 1973-2012. Patient factors were assessed in regards to utilization of RT. Cause specific (CSS) and overall survival (OS) were calculated. Observed-to-expected ratios (O/E) were calculated for secondary tumor sites, comparing the development of cancer to incidence rates for the general population. P<0.05 was used to determine significance.
Results: 6572 patients were identified. 83.8% of patients were white, 52.4% male, and 54.7% of patients received RT. Use of RT decreased by decade from 71.5% between 1973 and 1979, 62.7% in the 1980s, 52.1% in the 1990s, to 49.9% in patients treated after 2010. The lowest yearly rate was 39.1% in 2012. RT use increased with age; 35% for those under 4, 50.3% from 5-9 years, 55.5% for those 10-19 years. No difference existed in RT use by sex (males 55.2% vs females 54.2%). Black patients (49.3%) were less likely to receive RT compared to whites (52.9%) and others (52.2%). 90% of patients were from metropolitan areas, with no difference in delivery of RT in metropolitan areas (54.8%) vs nonmetropolitan areas (54.4%). 332 SMNs (O/E 5.87) occurred. RT patients developed 240 SMNs (O/E 6.50) compared with 81 SMNs (O/E 4.81) in patients without RT (P<0.05). RT patients had higher rates of salivary gland, digestive, respiratory, soft tissue, breast, and hematologic cancers compared to patients not receiving RT. Females were at higher risk for all SMNs and solid tumors. For the entire cohort, 10 year CSS and OS were significantly improved for those treated with RT (92.7%, 90.6%) compared to those who did not receive RT (90%, 87.3%). By decade, CSS and OS were significantly improved in RT patients in the 1970s and 1980s. OS and CSS were also improved in the RT cohort in the 1990s and 2000s, though not significantly. Six hundred thirteen patients died from cancer, including 451 from HL and 162 from SMNs. The next leading cause of death was diseases of the heart (76). Conclusion: Use of radiation therapy for pediatric Hodgkin’s lymphoma has decreased over time. A benefit to CSS and OS for patients treated with radiation is present regardless of decade of diagnosis. Improved chemotherapy and increased OS in HL has diminished this relative difference to the point it is no longer significant. SMN is the second leading cause of mortality in this cohort and is more common in females treated with RT. Author Disclosure: N.A. Madden: None. J.A. Marascio: None. B.M. Rabatic: None. D. Zaenger: None. C. McDonough: None. T.S. Johnson: None. F. Kong: Honoraria; Varian Medical Systems, Zhejiang Cancer Center. E.M. Marchan: None. S. Shaaban: None. W. Martin: None. B.G. Dasher: None. J.G. Stewart: None. J. Howington: None. A. Al-Basheer: None. A. Amoush: None. K. Huang: None. A. Green: None. M. Pishgou: None. C.L. Ferguson: None. W.F. Mourad: None.
3356 Trends in the Use of Radiation Therapy for Pediatric T-Cell Acute Lymphoblastic Leukemia and Impact on Survival: A Population-Based Analysis M. Kassick,1 P.P. Koffer,2,3 and T.J. Kinsella4,5; 1Tufts University School of Medicine, Boston, MA, 2Tufts Medical Center, Boston, MA, 3Warren Alpert Medical School of Brown University, Providence, RI, 4Department of Radiation Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, 5Department of Radiation Oncology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI Purpose/Objective(s): Prophylactic cranial irradiation (PCI) plays an important role in the treatment of high-risk acute lymphoblastic leukemia (ALL) in the prevention of CNS relapse. However, PCI has been able to be dose reduced or eliminated altogether in a large proportion of ALL patients due to better risk stratification and more effective chemotherapy. Population based studies show the use of radiation therapy (RT) in ALL has been decreasing over the past 30 years. However, there remains a cohort of patients at a high risk of CNS failure, including those with T-cell ALL (T-ALL) for whom PCI is still routinely recommended. The objective of this study is to evaluate trends in RT use for T-ALL treated in the United States and to assess the effect of RT on survival. Materials/Methods: The Surveillance, Epidemiology and End Result (SEER) database was queried for patients aged 19 years diagnosed with ALL, T-cell variant between 1980 and 2012. SEER does not contain any data on chemotherapy use, presence of upfront CNS disease, or anatomical site in which RT was directed. Trends and predictors for RT were analyzed using chi-squared tests. Overall survival (OS) was analyzed by the KaplanMeier method and compared using log rank test. Multivariable analysis
Volume 96 Number 2S Supplement 2016 Author Disclosure: S. Laskar: None. A.A. Bindal: None. N.R. Khanna: None. S. Chaudhari: None. T. Vora: None. G. Chinnaswami: None. S. Kembhavi: None. M. Ramadwar: None. S. Qureshi: None. M. Muckaden: None. P. Kurkure: None.
3354 Recurrent Medulloblastoma and Radiation Therapy H.P. Bagshaw,1 M.M. Poppe,1 and G.K. Hunter2; 1University of Utah Huntsman Cancer Institute, Salt Lake City, UT, 2Intermountain Healthcare, Murray, UT Purpose/Objective(s): To examine local control and overall survival for patients with recurrent medulloblastoma treated with or without salvage radiation therapy. Materials/Methods: An IRB approved retrospective analysis of data from 2 institutions evaluating the outcomes of children with recurrent medulloblastoma treated from 2001 to 2015 was performed. Patient variables analyzed included age, risk categorization, site of recurrence, and salvage therapy (surgery, chemotherapy, and radiation therapy). Kaplan Meier analysis and log-rank test were used to evaluate local control and overall survival. Results: Twenty-one patients with recurrent medulloblastoma were identified, treated initially with risk-adapted therapy. Eight had high risk disease at diagnosis and 13 had standard risk disease. At recurrence, 10 patients failed in the brain, 1 failed in the spine, and 10 developed leptomeningeal disease. Median follow-up was 10 months after salvage treatment. Median overall survival was 53.9 months from initial diagnosis. Patients treated with radiotherapy for salvage had improved local control and overall survival compared to those that received chemotherapy or surgery alone. Median time to progression after recurrence for patients treated with radiotherapy was 76 months compared to 9 months without (PZ0.04). Median survival after recurrence for patients treated with radiation therapy was 12 months compared to 9 months without (PZ0.01). There was no statistical significance when comparing high risk and standard risk patients. Conclusion: Radiation therapy for recurrent medulloblastoma in our cohort of children was an effective salvage treatment. Including radiation therapy in the salvage regimen provided durable local control and improved survival when compared to salvage treatment without radiation. Author Disclosure: H.P. Bagshaw: None. M.M. Poppe: None. G.K. Hunter: None.
3355 Trends in Utilization of Radiation in the Treatment of Pediatric Hodgkin Lymphoma N.A. Madden,1 J.A. Marascio,1 B.M. Rabatic,1 D. Zaenger,1 C. McDonough,1 T.S. Johnson,2 F.M. Kong,3 E.M. Marchan,1 S. Shaaban,1 W. Martin,1 B.G. Dasher,1 J.G. Stewart,1 J. Howington,1 A. Al-Basheer,1 A. Amoush,1 K. Huang,1 A. Green,1 M. Pishgou,1 C.L. Ferguson,1 and W.F. Mourad1; 1Augusta University, Augusta, GA, 2Augusta University/GRU Cancer Center, Augusta, GA, 3Department of Radiation Oncology, Augusta University, Augusta, GA Purpose/Objective(s): Hodgkin’s lymphoma (HL) is a curable form of pediatric cancer. Late effects from treatment are a concern. Radiation therapy (RT) can be associated with toxicity, including secondary malignant neoplasms (SMN). Pediatric protocols have attempted to decrease RT dose or eliminate RT due to toxicity. Here we evaluate characteristics associated with utilization of RT for pediatric HL, their effects on outcomes and development of SMN. Materials/Methods: The SEER database was queried for patients diagnosed with HL at ages 0-19 years from 1973-2012. Patient factors were assessed in regards to utilization of RT. Cause specific (CSS) and overall survival (OS) were calculated. Observed-to-expected ratios (O/E) were calculated for secondary tumor sites, comparing the development of cancer to incidence rates for the general population. P<0.05 was used to determine significance.
Results: 6572 patients were identified. 83.8% of patients were white, 52.4% male, and 54.7% of patients received RT. Use of RT decreased by decade from 71.5% between 1973 and 1979, 62.7% in the 1980s, 52.1% in the 1990s, to 49.9% in patients treated after 2010. The lowest yearly rate was 39.1% in 2012. RT use increased with age; 35% for those under 4, 50.3% from 5-9 years, 55.5% for those 10-19 years. No difference existed in RT use by sex (males 55.2% vs females 54.2%). Black patients (49.3%) were less likely to receive RT compared to whites (52.9%) and others (52.2%). 90% of patients were from metropolitan areas, with no difference in delivery of RT in metropolitan areas (54.8%) vs nonmetropolitan areas (54.4%). 332 SMNs (O/E 5.87) occurred. RT patients developed 240 SMNs (O/E 6.50) compared with 81 SMNs (O/E 4.81) in patients without RT (P<0.05). RT patients had higher rates of salivary gland, digestive, respiratory, soft tissue, breast, and hematologic cancers compared to patients not receiving RT. Females were at higher risk for all SMNs and solid tumors. For the entire cohort, 10 year CSS and OS were significantly improved for those treated with RT (92.7%, 90.6%) compared to those who did not receive RT (90%, 87.3%). By decade, CSS and OS were significantly improved in RT patients in the 1970s and 1980s. OS and CSS were also improved in the RT cohort in the 1990s and 2000s, though not significantly. Six hundred thirteen patients died from cancer, including 451 from HL and 162 from SMNs. The next leading cause of death was diseases of the heart (76). Conclusion: Use of radiation therapy for pediatric Hodgkin’s lymphoma has decreased over time. A benefit to CSS and OS for patients treated with radiation is present regardless of decade of diagnosis. Improved chemotherapy and increased OS in HL has diminished this relative difference to the point it is no longer significant. SMN is the second leading cause of mortality in this cohort and is more common in females treated with RT. Author Disclosure: N.A. Madden: None. J.A. Marascio: None. B.M. Rabatic: None. D. Zaenger: None. C. McDonough: None. T.S. Johnson: None. F. Kong: Honoraria; Varian Medical Systems, Zhejiang Cancer Center. E.M. Marchan: None. S. Shaaban: None. W. Martin: None. B.G. Dasher: None. J.G. Stewart: None. J. Howington: None. A. Al-Basheer: None. A. Amoush: None. K. Huang: None. A. Green: None. M. Pishgou: None. C.L. Ferguson: None. W.F. Mourad: None.
3356 Trends in the Use of Radiation Therapy for Pediatric T-Cell Acute Lymphoblastic Leukemia and Impact on Survival: A Population-Based Analysis M. Kassick,1 P.P. Koffer,2,3 and T.J. Kinsella4,5; 1Tufts University School of Medicine, Boston, MA, 2Tufts Medical Center, Boston, MA, 3Warren Alpert Medical School of Brown University, Providence, RI, 4Department of Radiation Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, 5Department of Radiation Oncology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI Purpose/Objective(s): Prophylactic cranial irradiation (PCI) plays an important role in the treatment of high-risk acute lymphoblastic leukemia (ALL) in the prevention of CNS relapse. However, PCI has been able to be dose reduced or eliminated altogether in a large proportion of ALL patients due to better risk stratification and more effective chemotherapy. Population based studies show the use of radiation therapy (RT) in ALL has been decreasing over the past 30 years. However, there remains a cohort of patients at a high risk of CNS failure, including those with T-cell ALL (T-ALL) for whom PCI is still routinely recommended. The objective of this study is to evaluate trends in RT use for T-ALL treated in the United States and to assess the effect of RT on survival. Materials/Methods: The Surveillance, Epidemiology and End Result (SEER) database was queried for patients aged 19 years diagnosed with ALL, T-cell variant between 1980 and 2012. SEER does not contain any data on chemotherapy use, presence of upfront CNS disease, or anatomical site in which RT was directed. Trends and predictors for RT were analyzed using chi-squared tests. Overall survival (OS) was analyzed by the KaplanMeier method and compared using log rank test. Multivariable analysis