- Email: [email protected]
1025 Stereotactic radiosurgery for brain metastases: Results and prognostic factors
228
I. J. Radiation
[email protected]
Volume
39, Number
2, Supplement,
1997
1025 STEREOTACTIC
RADIOSZIRGERY
FOR
BRAIN
METASTASES:
RESULTS
AND
PROGNOSTIC
FACTORS
Moshe H. Maor M.D.‘, Praveen Dubey M.D.’ , Fady B. Geara M.D., Ph.D.‘. Susan L. Tucker Ph.D.‘, Lei Don8 Ph.D.‘. Brian N. Mathur B.S., Raymond Sawaya M.D.J and Samuel J. Hassenbusch M.D.’
Almon S. Shiu Ph.D.‘,
Department of Radiation Oncology’, Biomathematics’, Radiation Physics’. and Neurosurgery” The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston Texas 77030. PURPOSE: Whole brain Irradiation (WBI) with or without treatment of choice for metsstatic brain disease. Recently, alternative for surgical resection and has showed promising determine the prognostic factors of tumor response and survival
surgical resection of brain metastases have long been considered the stereotactic radiosurgery (SRS) was introduced as a noninvasive results. This study was conducted to analyze our results and to after SRS for single or multiple brain metastases.
& METHODS: Between 80991 and 8/1996, 98 patients with brain metsstases received SRS at the University of Texas M.D. Andesron Cancer Center. There were 50 males and 48 females. The median age was 52 years (range: 12-77 years). Primary sites were distributed as follows: lung (26). melanoma (21), kidney (15), breast (8), gastrointestinal (6), other or unknown sites (8); 14 patients were treated for recurrent primary or metsstatic nenroglial tumors. Based on histological types, we arbitrarily subdivided these tumors into radioresponsive (lymphomas, squamous cell, small cell, large cell, and adenocarcinomas; 47, 49%) and, less radioresponsive tumors (melanomas, renal cell carcinomas, neuoglial tumors and others; 50, 5 1o/o). Sixty eight patients had supratentorial tumors (69%), while 30 patients had infratentorinl disease (31%). For 44 patients (45%) SRS was the first treatment for their brain disease. Fifty four patients (55%) were referred for SRS after they developed recurrences after surgery, WBI, and/or chemotherapy; of these, 34 had received one course of treatment prior to SRS, 13 had received 2 courses, 3 had received 3 courses, and 4 had received 4 previous conrses of therapy. Fifty six patients (57%) had solitary brain lesions. Sixty three patients (64%) had evidence of extracranial disease at the time of SRS. The radiation was delivered with 6 MV photons using a linac to a median dose of 18 Gy (range: 9-22 Gy). The median cone size was 2.5 cm (range: 1.05-4.00 cm). Only 6 patients received WBI in addition to SRS (6%). Local objective response of the treated lesion was defined as the existence of complete (CR) or partial radiographic response (PR) on computed tomography scan or magnetic resonance imaging. Median follow-up among surviving patients is 15.3 months. MATERIALS
RESULTS: Median survival from diagnosis of brain metastases and from treatment by SRS was 9.4 and 8.5 months, respectively. Actuarial l-, and 2-year survival rates from the time of SRS were. 38% and 23%, respectively. Sixty patients (61%) achieved an objective radiographic response to SRS (CR, t-1=15; PR, n=45); 15 showed no response and 4 had progressive disease. In 19 patients no follow-up imaging studies were obtained. Age, cone size, number of arcs, tumor location, histology, and delivery of additional WBI did not influence objective response rates. However, patients with solitaty lesions were more likely to achieve an objective response in the treated lesion than those who had multiple lesions (83% vs. 63%; p=O.O5). Sex and radiation dose had a borderline but nonsignificant effect (p= 0.07 and 0.12, respectively). Four severe complications were observed after SRS: fatal brain hemorrhage (n=l), symptomatic radiation necrosis (n=2), and facial nerve palsy (n=l). This study confirms the role of SRS as an effective minimally invasive treatment option that could be used for patients with solitary, symptomatic, and surgically inaccessible brain metsstases. The lack of influence of histologic type on treatment response after SRS is in agreement with other reports and indicates that SRS may represent a superior treatment option to conventional radiation treatment for patients with less radioresponsive tumors.
CONCLUSIONS:
1026 SURVEY L. Chen, University
OF SEXUAL EDUCATIONAL NEEDS IN RADIATION ONCOLOGY PATIENTS M. D.; P. Sweeney, M. D.; G. Wallace, R. N.; P. Neish, R. N.; S. Vijayakumar, of Chicago
Purpose:To
M. D.
aaaeaa the knowledge of and need for education about sexuality in oncology patients treated with radiation therapy. Methods and Materials: Patients who received radiation therapy for any disease site were given a selfassessment survey to complete to determine their opinions on sexuality and needs for sexual education. The surveys were given to patients on follow-up visit seen approximately 6 months to 2 years after radiation therapy. All patients were diagnosed with a malignancy and asked to participate on a voluntary basis; confidentiality was ensured by excluding any identifying patient information on the survey form. Respondents were polled with a survey that consisted of 17 questions about their sexual activity. Questions were broadly categorized into the following: definition of sexual activity, frequency of sexual activity prior to and after diagnosis and treatment of cancer, perception of sexual attractiveness, sexual satisfaction in the relationship, patient perception of partner’s sexual satisfaction in the relationship, educational needs with regard to sexuality after therapy for cancer, and demographic information. Results: All patients were over age 18, and received radiation therapy as part of the treatment. Patients A total of 28 patients with all disease sites were included in the survey, regardless of stage or diagnosis. completed the survey form, which was approved by our institutional review board. Forty-three percent of patients felt that the cancer diagnosis or treatment effect was the cause of not engaging in sexual intercourse. Fifty percent reported not having the same sexual desire as before the diagnosis of cancer, while 46% reported having the same sexual desire as prior to the diagnosis of cancer. Forty-six percent felt less attractive than before the diagnosis of cancer, while 43% felt the same as before diagnosis. Thirty-six percent of patients received no information with regards to sexuality and cancer, while 18% received a brochure; however, 11% felt too little information was given. Thirty-six percent reported not receiving arty information with regards to sexuality after their diagnosis of cancer. Sixty-one percent of patients never had negative emotions about sex with their partner prior to the diagnosis of cancer, while 54% reported never having had negative emotions about sex after their diagnosis of cancer. Conclusion: Results of the survey reveal that the diagnosis and therapy in patients polled had a moderate Nearly 50% of patients reported the diagnosis or impact upon the sexual activity of most patients. treatment sequelae as the cause of decreased sexual activity, and fifty percent did not have the same sexual desire as prior to therapy. We continue to assess the educational needs of our oncology patients by implementing a survey of sexuality at the time of initial consultation, at the completion of radiation therapy, and follow-up.
I. J. Radiation
[email protected]
Volume
39, Number
2, Supplement,
1997
1025 STEREOTACTIC
RADIOSZIRGERY
FOR
BRAIN
METASTASES:
RESULTS
AND
PROGNOSTIC
FACTORS
Moshe H. Maor M.D.‘, Praveen Dubey M.D.’ , Fady B. Geara M.D., Ph.D.‘. Susan L. Tucker Ph.D.‘, Lei Don8 Ph.D.‘. Brian N. Mathur B.S., Raymond Sawaya M.D.J and Samuel J. Hassenbusch M.D.’
Almon S. Shiu Ph.D.‘,
Department of Radiation Oncology’, Biomathematics’, Radiation Physics’. and Neurosurgery” The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston Texas 77030. PURPOSE: Whole brain Irradiation (WBI) with or without treatment of choice for metsstatic brain disease. Recently, alternative for surgical resection and has showed promising determine the prognostic factors of tumor response and survival
surgical resection of brain metastases have long been considered the stereotactic radiosurgery (SRS) was introduced as a noninvasive results. This study was conducted to analyze our results and to after SRS for single or multiple brain metastases.
& METHODS: Between 80991 and 8/1996, 98 patients with brain metsstases received SRS at the University of Texas M.D. Andesron Cancer Center. There were 50 males and 48 females. The median age was 52 years (range: 12-77 years). Primary sites were distributed as follows: lung (26). melanoma (21), kidney (15), breast (8), gastrointestinal (6), other or unknown sites (8); 14 patients were treated for recurrent primary or metsstatic nenroglial tumors. Based on histological types, we arbitrarily subdivided these tumors into radioresponsive (lymphomas, squamous cell, small cell, large cell, and adenocarcinomas; 47, 49%) and, less radioresponsive tumors (melanomas, renal cell carcinomas, neuoglial tumors and others; 50, 5 1o/o). Sixty eight patients had supratentorial tumors (69%), while 30 patients had infratentorinl disease (31%). For 44 patients (45%) SRS was the first treatment for their brain disease. Fifty four patients (55%) were referred for SRS after they developed recurrences after surgery, WBI, and/or chemotherapy; of these, 34 had received one course of treatment prior to SRS, 13 had received 2 courses, 3 had received 3 courses, and 4 had received 4 previous conrses of therapy. Fifty six patients (57%) had solitary brain lesions. Sixty three patients (64%) had evidence of extracranial disease at the time of SRS. The radiation was delivered with 6 MV photons using a linac to a median dose of 18 Gy (range: 9-22 Gy). The median cone size was 2.5 cm (range: 1.05-4.00 cm). Only 6 patients received WBI in addition to SRS (6%). Local objective response of the treated lesion was defined as the existence of complete (CR) or partial radiographic response (PR) on computed tomography scan or magnetic resonance imaging. Median follow-up among surviving patients is 15.3 months. MATERIALS
RESULTS: Median survival from diagnosis of brain metastases and from treatment by SRS was 9.4 and 8.5 months, respectively. Actuarial l-, and 2-year survival rates from the time of SRS were. 38% and 23%, respectively. Sixty patients (61%) achieved an objective radiographic response to SRS (CR, t-1=15; PR, n=45); 15 showed no response and 4 had progressive disease. In 19 patients no follow-up imaging studies were obtained. Age, cone size, number of arcs, tumor location, histology, and delivery of additional WBI did not influence objective response rates. However, patients with solitaty lesions were more likely to achieve an objective response in the treated lesion than those who had multiple lesions (83% vs. 63%; p=O.O5). Sex and radiation dose had a borderline but nonsignificant effect (p= 0.07 and 0.12, respectively). Four severe complications were observed after SRS: fatal brain hemorrhage (n=l), symptomatic radiation necrosis (n=2), and facial nerve palsy (n=l). This study confirms the role of SRS as an effective minimally invasive treatment option that could be used for patients with solitary, symptomatic, and surgically inaccessible brain metsstases. The lack of influence of histologic type on treatment response after SRS is in agreement with other reports and indicates that SRS may represent a superior treatment option to conventional radiation treatment for patients with less radioresponsive tumors.
CONCLUSIONS:
1026 SURVEY L. Chen, University
OF SEXUAL EDUCATIONAL NEEDS IN RADIATION ONCOLOGY PATIENTS M. D.; P. Sweeney, M. D.; G. Wallace, R. N.; P. Neish, R. N.; S. Vijayakumar, of Chicago
Purpose:To
M. D.
aaaeaa the knowledge of and need for education about sexuality in oncology patients treated with radiation therapy. Methods and Materials: Patients who received radiation therapy for any disease site were given a selfassessment survey to complete to determine their opinions on sexuality and needs for sexual education. The surveys were given to patients on follow-up visit seen approximately 6 months to 2 years after radiation therapy. All patients were diagnosed with a malignancy and asked to participate on a voluntary basis; confidentiality was ensured by excluding any identifying patient information on the survey form. Respondents were polled with a survey that consisted of 17 questions about their sexual activity. Questions were broadly categorized into the following: definition of sexual activity, frequency of sexual activity prior to and after diagnosis and treatment of cancer, perception of sexual attractiveness, sexual satisfaction in the relationship, patient perception of partner’s sexual satisfaction in the relationship, educational needs with regard to sexuality after therapy for cancer, and demographic information. Results: All patients were over age 18, and received radiation therapy as part of the treatment. Patients A total of 28 patients with all disease sites were included in the survey, regardless of stage or diagnosis. completed the survey form, which was approved by our institutional review board. Forty-three percent of patients felt that the cancer diagnosis or treatment effect was the cause of not engaging in sexual intercourse. Fifty percent reported not having the same sexual desire as before the diagnosis of cancer, while 46% reported having the same sexual desire as prior to the diagnosis of cancer. Forty-six percent felt less attractive than before the diagnosis of cancer, while 43% felt the same as before diagnosis. Thirty-six percent of patients received no information with regards to sexuality and cancer, while 18% received a brochure; however, 11% felt too little information was given. Thirty-six percent reported not receiving arty information with regards to sexuality after their diagnosis of cancer. Sixty-one percent of patients never had negative emotions about sex with their partner prior to the diagnosis of cancer, while 54% reported never having had negative emotions about sex after their diagnosis of cancer. Conclusion: Results of the survey reveal that the diagnosis and therapy in patients polled had a moderate Nearly 50% of patients reported the diagnosis or impact upon the sexual activity of most patients. treatment sequelae as the cause of decreased sexual activity, and fifty percent did not have the same sexual desire as prior to therapy. We continue to assess the educational needs of our oncology patients by implementing a survey of sexuality at the time of initial consultation, at the completion of radiation therapy, and follow-up.