- Email: [email protected]
226 Timing of androgen deprivation therapy after radical radiotherapy failure — A survey of Canadian practitioners
$66
September 13-16
proportion of G 3-4 acute toxicity was acceptable, and is similar to previous studies. Response rates are similar to CRT. Celecoxib has a modest activity on IFP, however this result is limited by the small number of patients. Further follow-up will be required. 225 Clinical Experience of the Multimodality Management of Anaplastic Thyroid Cancer D. Pudney, H. Lau, D. Ruether Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta depudnev~cancerboard, ab. ca
Background: Anaplastic thyroid cancer (ATC) is a rare and poor prognostic tumour. Median survival is only three to six months. Accelerated hyperfractionated radiation schedules have been advocated to counteract the effect of tumour repopulation and are associated with good local control rates. Objectives: We describe our recent clinical experience of hyperfractionated radiotherapy with concurrent low dose Doxorubicin in the management of ATC. Methods: Patients with ATC who received multimodality therapy were identified from cancer registry data. Treatment details, toxicity and survival data were determined retrospectively. Results: Five patients have been treated at this centre since 2002. All had inoperable Stage IVB disease. Three patients received neo-adjuvant chemotherapy with Docetaxel (75mg/m2), Doxorubicin (50mg/m 2) and Cyclophosphamide (500mg/m2). Two patients had a partial response to neoadjuvant chemotherapy. All patients received hyperfractionated radiotherapy (total tumour dose of 46-58 Gy in 1.6 Gy fractions twice daily) with weekly low dose Doxorubicin. Radiotherapy was delivered in two phases using a 3D conformal technique. The Phase I volume received 28-34 Gy and included gross disease and at risk lymph nodes. The Phase II volume received 14.4-25.6 Gy and included gross disease only. All patients received concurrent weekly Doxorubicin (20mg/m2). Responses were seen in four patients, and one patient has had surgical resection of residual tumour with complete pathological response. Median overall survival and progression free survival is 11 months. Combined modality treatment was associated with Grade 3-4 toxicity in three patients. Conclusions: Accelerated hyperfractionated radio-therapy with concurrent low dose Doxorubicin for ATC is technically feasible. Progression free survival and median survival in this cohort is 11 months. Hyperfractionated radiotherapy with concurrent low dose Doxorubicin is a promising therapy for patients with inoperable ATC and good KPS. 226 Timing of Androgen Deprivation Therapy After Radical Radiotherapy Failure A Survey of Canadian Practitioners P.C. Cheung I, D.A. Loblaw 1, T. Pickles~, H. Lukka 3, S. Faria 4, L. Klotz 1 Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario1; British Columbia Cancer Agency, University of British Columbia, Vancouver, British Columbia2; ]uravinski Cancer Centre, McMaster University, Hamilton, Ontario3; Montreal General Hospital, McGill University, Montreal, Quebec 4 patrick, cheung@sunnvbrook, ca
Purpose: To survey Canadian prostate cancer practitioners about the use and timing of androgen deprivation therapy (ADT) after radical radiotherapy (RT) failure in clinical practice as well as survey feasibility issues regarding a clinical trial examining the timing of ADT. Methods and Materials: The survey was emailed in October 2004 to members of the Genitourinary Radiation Oncologists of Canada and the Canadian Urologic Association. There were seven questions about current practice, seven questions addressed feasibility issues within a clinical trial and there was one demographic question. All questions had categorical
CARO 2 0 0 6
response sets; four questions also allowed individual responses. Responses were reported by frequency. Results: There were 96 respondents (50 Urologists, 42 Radiation Oncologists and four Medical Oncologists). Most respondents (69%) use PSA doubling time (PSAdt) and PSA level when deciding to start ADT in asymptomatic patients. When using a PSA level, 53% start ADT <10 ng/ml, 37% 1020, 10% 20-40, 0% >40 ng/ml. Fifty-eight percent start ADT when PSAdt < 6months, 37% 6-12months, 5% 12-24 months. Seventy-five percent use LHRH monotherapy and 51% use intermittent therapy off protocol. Of those that use combined androgen blockade, only 9% use in continuously. In a clinical trial, 86% would be comfortable starting ADT <6 ng/ml and 61% would be comfortable withholding it until PSA >20. Over 1,500 patients were estimated as being available for a trial on the timing of ADT for RT failures. Overall survival (37%) and time to androgen-independent disease (26%) were the most frequently cited primary outcomes. Eight-six percent felt that the timing of ADT was a moderately (35%) to very important (51%) research question. Conclusions: ADT is commonly initiated when PSA <10 or PSAdt <12mo. A clinical trial examining the timing of ADT after RT failure has strong support and appears to be feasible. 227 Prospectively Recording Outcomes at Point-of-Care for Head and Neck Cancer: Integrating Quality Assurance and Clinical Practice S.H. Huang, B. O'Sullivan, G. Lockwood, T. Michaelson, J. Waldron, A. Bayley, B. Cummings, L. Dawson, J. Kim, J. Ringash Princess Margaret Hospital, University of Toronto, Toronto, Ontario shaoh ui. huana@rmD, uhn. on. ca
Objective: To increase the validity and reliability of oncology outcome data. Background: The head and neck radiation (H and N) site group at Princess Margaret Hospital has established an Anthology system to record outcomes prospectively at point-ofcare for all H and N cancer patients. Methods: All H and N patients undergoing consultation with a H and N Radiation Oncologist (RO) are registered into a H and N Cohort within a billing database. Clinical data is electronically recorded in two existing systems: (1) a radiotherapy record and verify record (RR) and (2) a hospital medical record (MR). A new process was initiated in which data is transferred daily from the HN Cohort into the Anthology and merged with clinical data from the RR and MR. A list for the following day's HN clinic, indicating patient disease site, stage and radiotherapy details, is provided to each RO. When billing events are submitted, ROs also indicate the following outcome events observed during clinic: recurrence (local/regional/distant), second malignancy, RTOG Grade 3/4 toxicity. These are transferred to the Anthology. Quality assurance processes have been established to ensure complete, accurate, and timely data capture. Results: Since July 1, 2003, about 1,200 cases have been registered. ROs have been compliant with the process. Regular follow-up data has been entered for more than 95% of cases. Recording and entry of data is efficient (approximately five minutes). Data within the anthology can be readily sorted and analyzed. ROs report increased efficiency of clinics due to the availability of the patient summary list. The list also serves as a reminder to enter data in RR. Conclusions: The initial two years have demonstrated the feasibility of real-time outcome recording at point of care. The quality assurance process has been important to ensure the accuracy and completeness of data. Our next step is to audit the database to determine data validity. 228 The Measurement of Acute Radiation Dermatitis in Patients Undergoing Radiotherapy for Breast Cancer T. T. T. Vu1, S. Gardner z, I. Olivotto 2, E. Rakovitch 1, J-P. Pignol 1
September 13-16
proportion of G 3-4 acute toxicity was acceptable, and is similar to previous studies. Response rates are similar to CRT. Celecoxib has a modest activity on IFP, however this result is limited by the small number of patients. Further follow-up will be required. 225 Clinical Experience of the Multimodality Management of Anaplastic Thyroid Cancer D. Pudney, H. Lau, D. Ruether Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta depudnev~cancerboard, ab. ca
Background: Anaplastic thyroid cancer (ATC) is a rare and poor prognostic tumour. Median survival is only three to six months. Accelerated hyperfractionated radiation schedules have been advocated to counteract the effect of tumour repopulation and are associated with good local control rates. Objectives: We describe our recent clinical experience of hyperfractionated radiotherapy with concurrent low dose Doxorubicin in the management of ATC. Methods: Patients with ATC who received multimodality therapy were identified from cancer registry data. Treatment details, toxicity and survival data were determined retrospectively. Results: Five patients have been treated at this centre since 2002. All had inoperable Stage IVB disease. Three patients received neo-adjuvant chemotherapy with Docetaxel (75mg/m2), Doxorubicin (50mg/m 2) and Cyclophosphamide (500mg/m2). Two patients had a partial response to neoadjuvant chemotherapy. All patients received hyperfractionated radiotherapy (total tumour dose of 46-58 Gy in 1.6 Gy fractions twice daily) with weekly low dose Doxorubicin. Radiotherapy was delivered in two phases using a 3D conformal technique. The Phase I volume received 28-34 Gy and included gross disease and at risk lymph nodes. The Phase II volume received 14.4-25.6 Gy and included gross disease only. All patients received concurrent weekly Doxorubicin (20mg/m2). Responses were seen in four patients, and one patient has had surgical resection of residual tumour with complete pathological response. Median overall survival and progression free survival is 11 months. Combined modality treatment was associated with Grade 3-4 toxicity in three patients. Conclusions: Accelerated hyperfractionated radio-therapy with concurrent low dose Doxorubicin for ATC is technically feasible. Progression free survival and median survival in this cohort is 11 months. Hyperfractionated radiotherapy with concurrent low dose Doxorubicin is a promising therapy for patients with inoperable ATC and good KPS. 226 Timing of Androgen Deprivation Therapy After Radical Radiotherapy Failure A Survey of Canadian Practitioners P.C. Cheung I, D.A. Loblaw 1, T. Pickles~, H. Lukka 3, S. Faria 4, L. Klotz 1 Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario1; British Columbia Cancer Agency, University of British Columbia, Vancouver, British Columbia2; ]uravinski Cancer Centre, McMaster University, Hamilton, Ontario3; Montreal General Hospital, McGill University, Montreal, Quebec 4 patrick, cheung@sunnvbrook, ca
Purpose: To survey Canadian prostate cancer practitioners about the use and timing of androgen deprivation therapy (ADT) after radical radiotherapy (RT) failure in clinical practice as well as survey feasibility issues regarding a clinical trial examining the timing of ADT. Methods and Materials: The survey was emailed in October 2004 to members of the Genitourinary Radiation Oncologists of Canada and the Canadian Urologic Association. There were seven questions about current practice, seven questions addressed feasibility issues within a clinical trial and there was one demographic question. All questions had categorical
CARO 2 0 0 6
response sets; four questions also allowed individual responses. Responses were reported by frequency. Results: There were 96 respondents (50 Urologists, 42 Radiation Oncologists and four Medical Oncologists). Most respondents (69%) use PSA doubling time (PSAdt) and PSA level when deciding to start ADT in asymptomatic patients. When using a PSA level, 53% start ADT <10 ng/ml, 37% 1020, 10% 20-40, 0% >40 ng/ml. Fifty-eight percent start ADT when PSAdt < 6months, 37% 6-12months, 5% 12-24 months. Seventy-five percent use LHRH monotherapy and 51% use intermittent therapy off protocol. Of those that use combined androgen blockade, only 9% use in continuously. In a clinical trial, 86% would be comfortable starting ADT <6 ng/ml and 61% would be comfortable withholding it until PSA >20. Over 1,500 patients were estimated as being available for a trial on the timing of ADT for RT failures. Overall survival (37%) and time to androgen-independent disease (26%) were the most frequently cited primary outcomes. Eight-six percent felt that the timing of ADT was a moderately (35%) to very important (51%) research question. Conclusions: ADT is commonly initiated when PSA <10 or PSAdt <12mo. A clinical trial examining the timing of ADT after RT failure has strong support and appears to be feasible. 227 Prospectively Recording Outcomes at Point-of-Care for Head and Neck Cancer: Integrating Quality Assurance and Clinical Practice S.H. Huang, B. O'Sullivan, G. Lockwood, T. Michaelson, J. Waldron, A. Bayley, B. Cummings, L. Dawson, J. Kim, J. Ringash Princess Margaret Hospital, University of Toronto, Toronto, Ontario shaoh ui. huana@rmD, uhn. on. ca
Objective: To increase the validity and reliability of oncology outcome data. Background: The head and neck radiation (H and N) site group at Princess Margaret Hospital has established an Anthology system to record outcomes prospectively at point-ofcare for all H and N cancer patients. Methods: All H and N patients undergoing consultation with a H and N Radiation Oncologist (RO) are registered into a H and N Cohort within a billing database. Clinical data is electronically recorded in two existing systems: (1) a radiotherapy record and verify record (RR) and (2) a hospital medical record (MR). A new process was initiated in which data is transferred daily from the HN Cohort into the Anthology and merged with clinical data from the RR and MR. A list for the following day's HN clinic, indicating patient disease site, stage and radiotherapy details, is provided to each RO. When billing events are submitted, ROs also indicate the following outcome events observed during clinic: recurrence (local/regional/distant), second malignancy, RTOG Grade 3/4 toxicity. These are transferred to the Anthology. Quality assurance processes have been established to ensure complete, accurate, and timely data capture. Results: Since July 1, 2003, about 1,200 cases have been registered. ROs have been compliant with the process. Regular follow-up data has been entered for more than 95% of cases. Recording and entry of data is efficient (approximately five minutes). Data within the anthology can be readily sorted and analyzed. ROs report increased efficiency of clinics due to the availability of the patient summary list. The list also serves as a reminder to enter data in RR. Conclusions: The initial two years have demonstrated the feasibility of real-time outcome recording at point of care. The quality assurance process has been important to ensure the accuracy and completeness of data. Our next step is to audit the database to determine data validity. 228 The Measurement of Acute Radiation Dermatitis in Patients Undergoing Radiotherapy for Breast Cancer T. T. T. Vu1, S. Gardner z, I. Olivotto 2, E. Rakovitch 1, J-P. Pignol 1