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239 Pure hypofractionation for prostate cancer
$70
September 13-16
238 Lacrimal Gland Function I n P a t i e n t s W i t h Thyroid Cancer T r e a t e d W i t h Radioactive I o d i n e A. Fard-Esfahani, H. Mirshekarpour, B. Fallahi, M. Eftekhari, M. Saghari, D. Beiki, A. Takavar Tehran University of Medical Sciences, Tehran, Iran fardesfa @sina. tums. ac. ir Objectives: To assess lacrimal gland function after radioiodine therapy in patients with thyroid cancer. Methods: We studied 100 eyes of 50 patients who had received high doses of 1-131 (cumulative dose: 100-450mCi) for treatment of differentiated thyroid carcinoma (exposed group). The patients were studied at least 3 months after their last radioiodine therapy. Dry eye symptoms (obtained via a standard questionnaire) and Schirmer test results (mm/5min) in this group were compared with unexposed group (100 eyes of 50 individuals), sex and age matched. Cases with another known cause of dry eye were not included in either group. Results: The study demonstrated a significantly lower wetting amount of the Schirmer paper in exposed group compared to unexposed group. The mean of Schirmer test in the exposed group was 14.5± 10.8, while this value was 18.2±11.0 for the unexposed group (p=0.016). In the exposed group, wetting results were 0-4 mm in 21%, 5-9 mm in 20% and = 10 mm in 59%, while these results were as 6%, 17% and 77% in the unexposed group, respectively (p=0.004). In a qualitative analysis, by considering strip wetting = 10ram as normal and less than that as abnormal, 41% of the exposed eyes vs 23% of the unexposed eyes had abnormal tests (p=0.006). In subjective evaluation, 51% of the exposed eyes and 50% of the unexposed ones revealed at least one of the dry eye symptoms in the questionnaire. Data analysis showed no significant difference between the number of symptoms in the two groups. Conclusions: Reduction in the tear secretion from major and/or minor lacrimal glands is seen after high-dose radioiodine therapy, which seems to be severe in many cases. However dry eye symptoms are no more frequent than in the unexposed population. 239 Pure H y p o f r a c t i o n a t i o n f o r P r o s t a t e Cancer D. Panjwani, D. Gopaul, V. Basrur, M. Berry, K. Fleming Grand River Hospital Integrated Cancer Program, Kitchener, Ontario dilip.panjwani@qrhosp, on. ca Background: Prostate Cancer is believed to have a low alpha/beta ratio, and hence hypofractionation should improve the therapeutic ratio, by reducing the acute and consequential late toxicities of radiotherapy. However, the hypofractionation protocols used recently have inbuilt acceleration, which cancels out the potential for reduction in such toxicities. Though it is considered prudent to use IMRT for hypofractionation protocols, there is no radiobiological reason why conformal radiotherapy would not be as safe as when used with conventional fractionation. We have therefore begun a Phase I/II study of pure hypofractionation for prostate cancer without IMRT, the early results of which will be presented. M a t e r i a l s and Methods: From July 2005, we have to date enrolled 50 consecutive eligible patients with low and intermediate risk prostate cancer. Low risk patients are treated twice a week to a total dose of 5000 cGy in 15 fractions, over 7 weeks, and intermediate risk patients are treated on alternate weekdays, to a total dose of 6000 cGy in 20 fractions over eight weeks. Conformal four-field box beam arrangements were used in all cases except one, in which oblique beams were used to be able to satisfy the dose constraints, image guidance using fiducial markers is employed. Results: Early results show a very low maximum acute GI Grade 2 or greater toxicity of only 3%, and low maximum acute GU Grade 2 or greater toxicity of 12%. No patient has developed late toxicity or biochemical failure, but it is too early to meaningfully comment on these parameters. Results updated to September 2006 will be presented at the conference.
CARO 2 0 0 6
Conclusions: Pure hypofractionation is feasible using conformal radiotherapy, without IMRT, and the acute toxicities of this novel fractionation scheme are lower than in reported series of conventional fractionation or accelerated hypofractionation using radiobiologically equivalent doses, as would be expected from radio-biological principles. 24O A Prospective Cohort Study to Describe t h e Factors Predictive o f I n t e r r u p t i o n During Fluoroscopic S i m u l a t i o n f o r Palliative R a d i o - t h e r a p y E. Christensen, K. Maddix, S. Scott, F. Cops, K. Burrows, L. Wang, D. Grabarz, R. Wong Princess Margaret Hospital, Toronto, Ontario eva. christensen (~utoronto. ca Purpose: Planning of simple palliative radiotherapy (RT) is typically accomplished using fluoroscopic-guided simulation (SIM). Strategies to improve the quality and efficiency of the planning process can directly impact patient care. Information on the average duration and factors predictive for interruptions of the planning process provide benchmarks against which novel strategies can be compared. Objectives: To describe the average SIM duration, factors predictive of, and frequency of SIM interruption for patients undergoing fluoroscopic planning for palliative RT. Methods: Pts undergoing fluoroscopic SIM for palliative RT were eligible. SIM duration, interruption frequency, and nature of the interruptions (major = pt comes out of position completely, SIM restarted; minor = pause to adjust pt to make them more comfortable) were recorded. Consenting pts provided additional information including surgical history, co-morbid conditions, pre, during and post SIM pain scores (ten point pain scale), and pt demographics. Set-up and technique information were also collected. A sample size of 183 was planned to provide sufficient power to detect significant differences between key subgroups. P r e l i m i n a r y Results: Between November 2005 to March 2006, SIM data was collected for 139 pts. The most common treatment site was spine (36%), followed by chest/ribs (18%), lung (16%), long bone (16%), other (24%). The mean SIM time was 25 ±11min. The interruption rate was 10%, where 57% were classified as major. The average interruption time was 8.2 ±9.2 min. Fifteen patients consented to provide additional information. The general characteristics of this subgroup were similar to the group of 139. Average pain scores before, during, and after SIM were 4.0 +2.6, 4.5 ±2.5 and 4.5±2.6 respectively. Accrual is ongoing. Conclusions: SIM interruption occurred in approximately 10% of patients. This is major in over half of the patients. Potential factors predictive of interruptions will be explored. 241 The N u m b e r of A x i l l a r y Nodes R e m o v e d as a P r e d i c t o r O f Regional Recurrence in Node N e g a t i v e Breast Cancer O. Vujovic, E. Yu, A. Cherian, R. Dar, L. Stitt, F. Perera London Regional Cancer Program, London Health Sciences Centre, London, Ontario OIoa. Vuiovic(~lhsc. on. ca Purpose- To determine if the number of axillary nodes removed is a predictor of recurrence in node negative breast cancer. M a t e r i a l s and Methods: Five hundred thirty-six patients with T1-T2, NO invasive breast cancer, treated with lumpectomy and axillary node dissection (AND), were reviewed from January 1, 1986 to December 31, 1992. Patients received radiation to whole breast only, without regional nodal radiation. There was no adjuvant chemotherapy or Tamoxifen given. Patients were grouped according to the number of axillary nodes dissected as follows: 1-5 nodes (91 patients), 6-10 nodes (225 patients) and >10 nodes (220 patients). Hazard ratios and p-values were determined for time to local recurrence, regional recurrence and for disease specific survival. Results: Median follow-up was 11.2 years. The overall local recurrence and regional recurrence rates for the three groups
September 13-16
238 Lacrimal Gland Function I n P a t i e n t s W i t h Thyroid Cancer T r e a t e d W i t h Radioactive I o d i n e A. Fard-Esfahani, H. Mirshekarpour, B. Fallahi, M. Eftekhari, M. Saghari, D. Beiki, A. Takavar Tehran University of Medical Sciences, Tehran, Iran fardesfa @sina. tums. ac. ir Objectives: To assess lacrimal gland function after radioiodine therapy in patients with thyroid cancer. Methods: We studied 100 eyes of 50 patients who had received high doses of 1-131 (cumulative dose: 100-450mCi) for treatment of differentiated thyroid carcinoma (exposed group). The patients were studied at least 3 months after their last radioiodine therapy. Dry eye symptoms (obtained via a standard questionnaire) and Schirmer test results (mm/5min) in this group were compared with unexposed group (100 eyes of 50 individuals), sex and age matched. Cases with another known cause of dry eye were not included in either group. Results: The study demonstrated a significantly lower wetting amount of the Schirmer paper in exposed group compared to unexposed group. The mean of Schirmer test in the exposed group was 14.5± 10.8, while this value was 18.2±11.0 for the unexposed group (p=0.016). In the exposed group, wetting results were 0-4 mm in 21%, 5-9 mm in 20% and = 10 mm in 59%, while these results were as 6%, 17% and 77% in the unexposed group, respectively (p=0.004). In a qualitative analysis, by considering strip wetting = 10ram as normal and less than that as abnormal, 41% of the exposed eyes vs 23% of the unexposed eyes had abnormal tests (p=0.006). In subjective evaluation, 51% of the exposed eyes and 50% of the unexposed ones revealed at least one of the dry eye symptoms in the questionnaire. Data analysis showed no significant difference between the number of symptoms in the two groups. Conclusions: Reduction in the tear secretion from major and/or minor lacrimal glands is seen after high-dose radioiodine therapy, which seems to be severe in many cases. However dry eye symptoms are no more frequent than in the unexposed population. 239 Pure H y p o f r a c t i o n a t i o n f o r P r o s t a t e Cancer D. Panjwani, D. Gopaul, V. Basrur, M. Berry, K. Fleming Grand River Hospital Integrated Cancer Program, Kitchener, Ontario dilip.panjwani@qrhosp, on. ca Background: Prostate Cancer is believed to have a low alpha/beta ratio, and hence hypofractionation should improve the therapeutic ratio, by reducing the acute and consequential late toxicities of radiotherapy. However, the hypofractionation protocols used recently have inbuilt acceleration, which cancels out the potential for reduction in such toxicities. Though it is considered prudent to use IMRT for hypofractionation protocols, there is no radiobiological reason why conformal radiotherapy would not be as safe as when used with conventional fractionation. We have therefore begun a Phase I/II study of pure hypofractionation for prostate cancer without IMRT, the early results of which will be presented. M a t e r i a l s and Methods: From July 2005, we have to date enrolled 50 consecutive eligible patients with low and intermediate risk prostate cancer. Low risk patients are treated twice a week to a total dose of 5000 cGy in 15 fractions, over 7 weeks, and intermediate risk patients are treated on alternate weekdays, to a total dose of 6000 cGy in 20 fractions over eight weeks. Conformal four-field box beam arrangements were used in all cases except one, in which oblique beams were used to be able to satisfy the dose constraints, image guidance using fiducial markers is employed. Results: Early results show a very low maximum acute GI Grade 2 or greater toxicity of only 3%, and low maximum acute GU Grade 2 or greater toxicity of 12%. No patient has developed late toxicity or biochemical failure, but it is too early to meaningfully comment on these parameters. Results updated to September 2006 will be presented at the conference.
CARO 2 0 0 6
Conclusions: Pure hypofractionation is feasible using conformal radiotherapy, without IMRT, and the acute toxicities of this novel fractionation scheme are lower than in reported series of conventional fractionation or accelerated hypofractionation using radiobiologically equivalent doses, as would be expected from radio-biological principles. 24O A Prospective Cohort Study to Describe t h e Factors Predictive o f I n t e r r u p t i o n During Fluoroscopic S i m u l a t i o n f o r Palliative R a d i o - t h e r a p y E. Christensen, K. Maddix, S. Scott, F. Cops, K. Burrows, L. Wang, D. Grabarz, R. Wong Princess Margaret Hospital, Toronto, Ontario eva. christensen (~utoronto. ca Purpose: Planning of simple palliative radiotherapy (RT) is typically accomplished using fluoroscopic-guided simulation (SIM). Strategies to improve the quality and efficiency of the planning process can directly impact patient care. Information on the average duration and factors predictive for interruptions of the planning process provide benchmarks against which novel strategies can be compared. Objectives: To describe the average SIM duration, factors predictive of, and frequency of SIM interruption for patients undergoing fluoroscopic planning for palliative RT. Methods: Pts undergoing fluoroscopic SIM for palliative RT were eligible. SIM duration, interruption frequency, and nature of the interruptions (major = pt comes out of position completely, SIM restarted; minor = pause to adjust pt to make them more comfortable) were recorded. Consenting pts provided additional information including surgical history, co-morbid conditions, pre, during and post SIM pain scores (ten point pain scale), and pt demographics. Set-up and technique information were also collected. A sample size of 183 was planned to provide sufficient power to detect significant differences between key subgroups. P r e l i m i n a r y Results: Between November 2005 to March 2006, SIM data was collected for 139 pts. The most common treatment site was spine (36%), followed by chest/ribs (18%), lung (16%), long bone (16%), other (24%). The mean SIM time was 25 ±11min. The interruption rate was 10%, where 57% were classified as major. The average interruption time was 8.2 ±9.2 min. Fifteen patients consented to provide additional information. The general characteristics of this subgroup were similar to the group of 139. Average pain scores before, during, and after SIM were 4.0 +2.6, 4.5 ±2.5 and 4.5±2.6 respectively. Accrual is ongoing. Conclusions: SIM interruption occurred in approximately 10% of patients. This is major in over half of the patients. Potential factors predictive of interruptions will be explored. 241 The N u m b e r of A x i l l a r y Nodes R e m o v e d as a P r e d i c t o r O f Regional Recurrence in Node N e g a t i v e Breast Cancer O. Vujovic, E. Yu, A. Cherian, R. Dar, L. Stitt, F. Perera London Regional Cancer Program, London Health Sciences Centre, London, Ontario OIoa. Vuiovic(~lhsc. on. ca Purpose- To determine if the number of axillary nodes removed is a predictor of recurrence in node negative breast cancer. M a t e r i a l s and Methods: Five hundred thirty-six patients with T1-T2, NO invasive breast cancer, treated with lumpectomy and axillary node dissection (AND), were reviewed from January 1, 1986 to December 31, 1992. Patients received radiation to whole breast only, without regional nodal radiation. There was no adjuvant chemotherapy or Tamoxifen given. Patients were grouped according to the number of axillary nodes dissected as follows: 1-5 nodes (91 patients), 6-10 nodes (225 patients) and >10 nodes (220 patients). Hazard ratios and p-values were determined for time to local recurrence, regional recurrence and for disease specific survival. Results: Median follow-up was 11.2 years. The overall local recurrence and regional recurrence rates for the three groups