- Email: [email protected]
123 Management of stage I seminoma: A single institution review
CARO 2004
121 Concurrent Chemoradiotherapy for Unresectable Stage III Non-Small Cell Lung Cancer: Experience of a Single Institution, A. Fairchild, D. Hao, P. Brasher, C. Smith. Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta Background: The present standard for management of unresectable stage III non-small cell lung cancer (NSCLC) is concurrent chemoradiotherapy (CT/RT). We conducted a quality assurance project at our institution to ascertain the percentage of patients receiving standard treatment,, and to compare patient demographics, toxicities and outcomes with results of CT/RT trials in the literature. Methods: Charts of all patients with histologically documented, unresectable stage Ill NSCLC treated with concurrent CT/RT between 1997-2001 were reviewed. Results: Fifty of 89 consecutive patients were offered concurrent CT/RT. 66% were male, 64% stage IliA, and 34% had squamous cell histology. The median age was 63 years (range 45-78), and 70% had <5% weight loss at diagnosis. Median RT dose was 6100 cGy in 33 fractions, and 72% received cisplatin-based CT. 69.4% completed all planned CT/RT and the overall response rate in evaluable patients was 80% (23.3% complete response; 56.7% partial response). With a median follow-up of 34.1 months, median and three-year survival was 19.4 months (95% CI 13.4-30.2 months) and 21.9%. 74% of patients have relapsed. Median time to progression was 11.0 months (95% CI 8.2-21.4 months). Main grade 3 / 4 acute toxicities were leukopenia (16 patients; 32%), neutropenia (14 patients; 28%) and esophagitis (9 patients; 18%). The five grade 3/ 4 late toxicities were tracheoesophageal fistula, esophageal stricture, pericardial effusion, RT pneumonitis and thrombocytopenia (one patient each). There were no treatment-related deaths. Of the patients who did not receive concurrent CT/RT, 83.3% were treated with palliative intent. Conclusions: Our results are generally comparable with reported toxicities and outcomes for CT/RT in unresectable stage III NSCLC. 122 Contemporary Management of Prostate Cancer Continued: A Practice Survey of Maritime Genitourinary Radiation Oncologists. M. Behl I, D. Wilke ~, G. Rodrigues 2. Nova Scotia Cancer Center, Dalhousie, Halifax, Nova Scotia 1; London Regional Cancer Center, University of Western Ontario, London, Ontario2 Objective: To assess the practice patterns of Maritime radiation oncologists in prostate cancer treatment. Materials and Methods: A practice survey, developed and used in Ontario, was sent to genitourinary radiation oncologists practicing in the Maritimes. The survey consisted of demographic information and six clinical scenarios covering hormonal and radiation management in low-, intermediate-, and high-risk prostate cancer, and post-prostatectomy adjuvant and salvage management. Results: Survey response rate was 64% (9/14). All respondents managed low-risk prostate cancer using radiation alone (70-70.2 Gy). All respondents managed high-risk disease with neo-adjuvant hormone therapy and radiation (70 73 Gy to prostate). However, duration of hormonal therapies varied (LHRH agonist duration varied between 24 and 36 months and anti-androgen duration varied between 0 and 4 months). Radiation treatment fields differed regarding inclusion of pelvis (7/9 (78%)) and seminal vesicles (6/9 (67%)). All respondents managed intermediate-risk disease with radiation
September 9-12 S37
(70-73 Gy to prostate). Adjuvant or neo-adjuvant hormones were recommended by 7/9 (78%) of respondents. Again, duration of hormonal therapies varied (LHRH agonist duration varied between 4 and 24 months, and anti-androgen duration varied between 0 and 4 months), and inclusion of pelvis (4/9 (44%)) and seminal vesicles (3/9 (33%)) in radiation treatment fields. In the post - radical prostatectomy, margin negative setting, 5/9 (56%) of respondents recommended against treatment. In the post - radical prostatectomy, margin positive setting, respondents recommended adjuvant radiation (5/9 (56%)) or adjuvant radiation and hormonal therapy (3/9 (33%)). In the salvage setting (slowly rising PSA 4 years postprostatectomy, pT2a, close margin disease), 7/9 (78%) respondents recommended radiation alone (64-66 Gy). Conclusions: There is general agreement about treatment of low risk patients and post - radical prostatectomy, margin positive patients. Interprovincial guidelines are currently being developed. 123 Management of Stage I Seminoma: A Single Institution Review. I. A/omary, Ft. Samant, V. Gallant. Integrated Cancer Program, University of Ottawa, Ottawa, Ontario Purpose: To review the treatment and outcomes of stage I seminoma post orchidectomy. Methods: A retrospective review of all stage I seminoma patients referred for initial management was performed. Initial treatment approaches and outcomes were analyzed. Comparisons were made between patients treated with adjuvant radiotherapy and those receiving no adjuvant therapy (surveillance group). Follow-up investigations included periodic clinical assessments, chest x-rays, CT scans of the abdomen and pelvis, and bloodwork for tumour markers. Results: 150 patients with stage I seminoma were seen between February 1990 and October 2003. They had a median age of 37.5 years (range: 19-79) and a median follow-up of 44 months (range: 1-147 months). 71% of patients were treated with adjuvant radiotherapy. The 5-year relapse-free survival and overall survival for the entire group were 95% and 100%, respectively. The 5-year relapse-free survival for the adjuvant radiotherapy group was 100% compared with 79% for the surveillance group (p < 0.001). Of the 6 patients who relapsed, one patient is currently refusing treatment. Conclusions: Our results confirm the excellent prognosis for stage I seminoma patients and indicate that surveillance does not compromise survival. This adds to the evidence that surveillance is a good option for many patients and also supports our current approach, which favours surveillance for most patients with stage I seminoma, post orchidectomy. 124 Radiotherapy is an Effective Therapy for Pituitary Macroadenoma. hi. Khaouam, L. Souhami, A. Albuloushi, C. Lambert, K. Sultanem, M.S. Gans, G. Shenouda. McGill University Health Center, McGill University, Montreal, Quebec Purpose: To review the outcome and late complications in patients treated with radiotherapy for pituitary macroadenomas. Methods and Materials: Twenty-eight patients were treated with radiotherapy for pituitary macroadenomas between 1992 and 2003. Follow-up was available for 26 patients. There were 14 females and 12 males. The median age was 49 years. Fifteen patients had hormone-secreting and 13 had nonfunctioning adenomas. Except for one who had radiotherapy alone, all other patients had prior surgery. 42% of the patients
121 Concurrent Chemoradiotherapy for Unresectable Stage III Non-Small Cell Lung Cancer: Experience of a Single Institution, A. Fairchild, D. Hao, P. Brasher, C. Smith. Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta Background: The present standard for management of unresectable stage III non-small cell lung cancer (NSCLC) is concurrent chemoradiotherapy (CT/RT). We conducted a quality assurance project at our institution to ascertain the percentage of patients receiving standard treatment,, and to compare patient demographics, toxicities and outcomes with results of CT/RT trials in the literature. Methods: Charts of all patients with histologically documented, unresectable stage Ill NSCLC treated with concurrent CT/RT between 1997-2001 were reviewed. Results: Fifty of 89 consecutive patients were offered concurrent CT/RT. 66% were male, 64% stage IliA, and 34% had squamous cell histology. The median age was 63 years (range 45-78), and 70% had <5% weight loss at diagnosis. Median RT dose was 6100 cGy in 33 fractions, and 72% received cisplatin-based CT. 69.4% completed all planned CT/RT and the overall response rate in evaluable patients was 80% (23.3% complete response; 56.7% partial response). With a median follow-up of 34.1 months, median and three-year survival was 19.4 months (95% CI 13.4-30.2 months) and 21.9%. 74% of patients have relapsed. Median time to progression was 11.0 months (95% CI 8.2-21.4 months). Main grade 3 / 4 acute toxicities were leukopenia (16 patients; 32%), neutropenia (14 patients; 28%) and esophagitis (9 patients; 18%). The five grade 3/ 4 late toxicities were tracheoesophageal fistula, esophageal stricture, pericardial effusion, RT pneumonitis and thrombocytopenia (one patient each). There were no treatment-related deaths. Of the patients who did not receive concurrent CT/RT, 83.3% were treated with palliative intent. Conclusions: Our results are generally comparable with reported toxicities and outcomes for CT/RT in unresectable stage III NSCLC. 122 Contemporary Management of Prostate Cancer Continued: A Practice Survey of Maritime Genitourinary Radiation Oncologists. M. Behl I, D. Wilke ~, G. Rodrigues 2. Nova Scotia Cancer Center, Dalhousie, Halifax, Nova Scotia 1; London Regional Cancer Center, University of Western Ontario, London, Ontario2 Objective: To assess the practice patterns of Maritime radiation oncologists in prostate cancer treatment. Materials and Methods: A practice survey, developed and used in Ontario, was sent to genitourinary radiation oncologists practicing in the Maritimes. The survey consisted of demographic information and six clinical scenarios covering hormonal and radiation management in low-, intermediate-, and high-risk prostate cancer, and post-prostatectomy adjuvant and salvage management. Results: Survey response rate was 64% (9/14). All respondents managed low-risk prostate cancer using radiation alone (70-70.2 Gy). All respondents managed high-risk disease with neo-adjuvant hormone therapy and radiation (70 73 Gy to prostate). However, duration of hormonal therapies varied (LHRH agonist duration varied between 24 and 36 months and anti-androgen duration varied between 0 and 4 months). Radiation treatment fields differed regarding inclusion of pelvis (7/9 (78%)) and seminal vesicles (6/9 (67%)). All respondents managed intermediate-risk disease with radiation
September 9-12 S37
(70-73 Gy to prostate). Adjuvant or neo-adjuvant hormones were recommended by 7/9 (78%) of respondents. Again, duration of hormonal therapies varied (LHRH agonist duration varied between 4 and 24 months, and anti-androgen duration varied between 0 and 4 months), and inclusion of pelvis (4/9 (44%)) and seminal vesicles (3/9 (33%)) in radiation treatment fields. In the post - radical prostatectomy, margin negative setting, 5/9 (56%) of respondents recommended against treatment. In the post - radical prostatectomy, margin positive setting, respondents recommended adjuvant radiation (5/9 (56%)) or adjuvant radiation and hormonal therapy (3/9 (33%)). In the salvage setting (slowly rising PSA 4 years postprostatectomy, pT2a, close margin disease), 7/9 (78%) respondents recommended radiation alone (64-66 Gy). Conclusions: There is general agreement about treatment of low risk patients and post - radical prostatectomy, margin positive patients. Interprovincial guidelines are currently being developed. 123 Management of Stage I Seminoma: A Single Institution Review. I. A/omary, Ft. Samant, V. Gallant. Integrated Cancer Program, University of Ottawa, Ottawa, Ontario Purpose: To review the treatment and outcomes of stage I seminoma post orchidectomy. Methods: A retrospective review of all stage I seminoma patients referred for initial management was performed. Initial treatment approaches and outcomes were analyzed. Comparisons were made between patients treated with adjuvant radiotherapy and those receiving no adjuvant therapy (surveillance group). Follow-up investigations included periodic clinical assessments, chest x-rays, CT scans of the abdomen and pelvis, and bloodwork for tumour markers. Results: 150 patients with stage I seminoma were seen between February 1990 and October 2003. They had a median age of 37.5 years (range: 19-79) and a median follow-up of 44 months (range: 1-147 months). 71% of patients were treated with adjuvant radiotherapy. The 5-year relapse-free survival and overall survival for the entire group were 95% and 100%, respectively. The 5-year relapse-free survival for the adjuvant radiotherapy group was 100% compared with 79% for the surveillance group (p < 0.001). Of the 6 patients who relapsed, one patient is currently refusing treatment. Conclusions: Our results confirm the excellent prognosis for stage I seminoma patients and indicate that surveillance does not compromise survival. This adds to the evidence that surveillance is a good option for many patients and also supports our current approach, which favours surveillance for most patients with stage I seminoma, post orchidectomy. 124 Radiotherapy is an Effective Therapy for Pituitary Macroadenoma. hi. Khaouam, L. Souhami, A. Albuloushi, C. Lambert, K. Sultanem, M.S. Gans, G. Shenouda. McGill University Health Center, McGill University, Montreal, Quebec Purpose: To review the outcome and late complications in patients treated with radiotherapy for pituitary macroadenomas. Methods and Materials: Twenty-eight patients were treated with radiotherapy for pituitary macroadenomas between 1992 and 2003. Follow-up was available for 26 patients. There were 14 females and 12 males. The median age was 49 years. Fifteen patients had hormone-secreting and 13 had nonfunctioning adenomas. Except for one who had radiotherapy alone, all other patients had prior surgery. 42% of the patients