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2403
S434
I. J. Radiation Oncology
● Biology ● Physics
Volume 66, Number 3, Supplement, 2006
Author Disclosure: Y.J. Hitchcock, None; K. Morton, None; J.D. Tward, None; J.M. Hoffman, None; P. Sharma, None; B. Bentz, None; D.C. Shrieve, None.
2403
The Risk of Development and Factors Affecting the Pattern of Secondary Cancers Following Thyroid Cancer Diagnosis
A. P. Brown, J. D. Tward, J. Chen, D. C. Shrieve, Y. J. Hitchcock University of Utah, Salt Lake City, UT Purpose/Objective(s): Approximately 25,000 people are diagnosed with thyroid cancer annually in the United States, and 90% of them are of the papillary or follicular type. The majority of patients are under age 50 at the time of diagnosis, and the 10-year survival exceeds 90%. We determined the risk of developing secondary cancers in survivors of thyroid cancer. Materials/Methods: The risk of second primary malignancies for papillary and follicular thyroid cancer was determined in 30,278 patients diagnosed between 1973 and 2002 from centers participating in the National Cancer Institute’s Surveillance, Epidemiology, and End Results program (SEER). Median follow up was 103 months (range 2–359 months). Risk was further assessed for the addition of radioisotope therapy, gender, latency to development of secondary cancer, and age at thyroid cancer diagnosis (⬍25 yrs, 25– 49 yrs, 50 –74 yrs and over 75 years). Results: There were 2158 patients who developed a total of 2390 secondary malignancies, significantly more than that expected in the general population (observed/expected [O/E] ⫽ 1.10 95% CI 1.05 - 1.14, p ⬍0.05, absolute excess risk per 10,000 person years [AER] ⫽ 6.90). A significantly greater risk of secondary malignancies over that expected in the general population was seen both in patients treated with radioisotopes (O/E ⫽ 1.20, 95% CI 1.07 - 1.33, AER ⫽ 11.8 ) and in patients who received no radiation treatment of any kind (O/E ⫽ 1.06, 95% CI 1.01 - 1.12, AER ⫽ 4.47), relative risk (RR) ⫽ 1.13 (95% CI 1.00 - 1.26, p⬍0.05). In patients receiving radioisotope therapy, significantly elevated risk was observed for prostate, stomach, and leukemia. In patients who received no radiotherapy of any kind, significantly elevated risk was observed for thyroid, breast, kidney, prostate and myeloma, and a significantly decreased risk was observed for esophageal and lung cancers. Increased risk was not observed in those who received combination external beam/radioisotope therapy (O/E⫽1.31 95% CI 0.86 - 1.93). Both males and females had equivalent risks of developing secondary cancers (RR⫽ 1.00, 95% CI 0.92 - 1.09). Risk was significantly elevated within the first 10 years after thyroid cancer diagnosis (years 0 –5- O/E ⫽ 1.19, 95% CI 1.11–1.27, AER⫽10.4; years 6 –10- O/E ⫽ 1.10, 95% CI 1.01–1.19, AER⫽6.4), but not for longer latency periods. The overall risk of secondary cancers was significantly elevated in those ages 25– 49 at diagnosis, but not for other age cohorts. Conclusions: In conclusion, the overall risk of secondary malignancies is increased for thyroid cancer survivors and varies by radioisotope therapy, gender, latency and age at diagnosis. Author Disclosure: A.P. Brown, None; J.D. Tward, None; J. Chen, None; D.C. Shrieve, None; Y.J. Hitchcock, None.
2404
Salvage High Dose Rate Brachytherapy and Surgery as in Recurrent Cervical Cancer
A. C. Pellizzon, P. Novaes, J. Salvajoli, M. Maia, R. Fogaroli, R. Ferrigno Hospital do cancer, Sao Paulo, SP, Brazil Background: Head and neck cancer (HNC) is the seventh most common cause of cancer death worldwide. The treatment goal for patients with loco-regional disease is organ preservation and cure. The likelihood of local control (LC) after surgery for recurrent cervical nodes may be improved by using high dose rate brachytherapy (HDR) because it may increase total biological effective dose administered, decrease the overall time, and is very conformal, allowing protection of normal surrounding structures. Purpose/Objective(s): To verify the feasibility of using I-HDR in combination to salvage surgery and EBRT for recurrent cervical cancer. Materials/Methods: Patients admitted between October, 1994 and December, 2003, were retrospectively selected. The criteria for including patients in the study were: the presence of recurrent cervical cancer treated with combination of surgery, I-HDR and a new second course of EBRT. A total of 23 patients with the following characteristics were retrospectively selected: biopsy proven SCC cancer, KPS⬎60 and, M0. Their clinical stage was defined based on preoperative clinical and radiological examinations, using the TNM classification of the AJCC. Dose prescription was based on points located between the catheters, with prescription dose encompassing the tumor bed with safety margins. The active length of catheters ranged from 25 mm to 75 mm. The EBRT course usually started immediately after the completion of the course of I-HDR. Results: Median age and follow up of patients were 56 years old (range 38 – 85) and 29 months. The total dose of I-HDR ranged from 15 Gy to 30 Gy (median 24), given in 3 to 10 fractions, in a median time of 4 days (range 2 to 8). The total treatment time, including the surgical day ranged from 7 to 49 days. The crude local control (LC) rate was 43.5% (10/23). The 5- and
I. J. Radiation Oncology
● Biology ● Physics
Volume 66, Number 3, Supplement, 2006
Author Disclosure: Y.J. Hitchcock, None; K. Morton, None; J.D. Tward, None; J.M. Hoffman, None; P. Sharma, None; B. Bentz, None; D.C. Shrieve, None.
2403
The Risk of Development and Factors Affecting the Pattern of Secondary Cancers Following Thyroid Cancer Diagnosis
A. P. Brown, J. D. Tward, J. Chen, D. C. Shrieve, Y. J. Hitchcock University of Utah, Salt Lake City, UT Purpose/Objective(s): Approximately 25,000 people are diagnosed with thyroid cancer annually in the United States, and 90% of them are of the papillary or follicular type. The majority of patients are under age 50 at the time of diagnosis, and the 10-year survival exceeds 90%. We determined the risk of developing secondary cancers in survivors of thyroid cancer. Materials/Methods: The risk of second primary malignancies for papillary and follicular thyroid cancer was determined in 30,278 patients diagnosed between 1973 and 2002 from centers participating in the National Cancer Institute’s Surveillance, Epidemiology, and End Results program (SEER). Median follow up was 103 months (range 2–359 months). Risk was further assessed for the addition of radioisotope therapy, gender, latency to development of secondary cancer, and age at thyroid cancer diagnosis (⬍25 yrs, 25– 49 yrs, 50 –74 yrs and over 75 years). Results: There were 2158 patients who developed a total of 2390 secondary malignancies, significantly more than that expected in the general population (observed/expected [O/E] ⫽ 1.10 95% CI 1.05 - 1.14, p ⬍0.05, absolute excess risk per 10,000 person years [AER] ⫽ 6.90). A significantly greater risk of secondary malignancies over that expected in the general population was seen both in patients treated with radioisotopes (O/E ⫽ 1.20, 95% CI 1.07 - 1.33, AER ⫽ 11.8 ) and in patients who received no radiation treatment of any kind (O/E ⫽ 1.06, 95% CI 1.01 - 1.12, AER ⫽ 4.47), relative risk (RR) ⫽ 1.13 (95% CI 1.00 - 1.26, p⬍0.05). In patients receiving radioisotope therapy, significantly elevated risk was observed for prostate, stomach, and leukemia. In patients who received no radiotherapy of any kind, significantly elevated risk was observed for thyroid, breast, kidney, prostate and myeloma, and a significantly decreased risk was observed for esophageal and lung cancers. Increased risk was not observed in those who received combination external beam/radioisotope therapy (O/E⫽1.31 95% CI 0.86 - 1.93). Both males and females had equivalent risks of developing secondary cancers (RR⫽ 1.00, 95% CI 0.92 - 1.09). Risk was significantly elevated within the first 10 years after thyroid cancer diagnosis (years 0 –5- O/E ⫽ 1.19, 95% CI 1.11–1.27, AER⫽10.4; years 6 –10- O/E ⫽ 1.10, 95% CI 1.01–1.19, AER⫽6.4), but not for longer latency periods. The overall risk of secondary cancers was significantly elevated in those ages 25– 49 at diagnosis, but not for other age cohorts. Conclusions: In conclusion, the overall risk of secondary malignancies is increased for thyroid cancer survivors and varies by radioisotope therapy, gender, latency and age at diagnosis. Author Disclosure: A.P. Brown, None; J.D. Tward, None; J. Chen, None; D.C. Shrieve, None; Y.J. Hitchcock, None.
2404
Salvage High Dose Rate Brachytherapy and Surgery as in Recurrent Cervical Cancer
A. C. Pellizzon, P. Novaes, J. Salvajoli, M. Maia, R. Fogaroli, R. Ferrigno Hospital do cancer, Sao Paulo, SP, Brazil Background: Head and neck cancer (HNC) is the seventh most common cause of cancer death worldwide. The treatment goal for patients with loco-regional disease is organ preservation and cure. The likelihood of local control (LC) after surgery for recurrent cervical nodes may be improved by using high dose rate brachytherapy (HDR) because it may increase total biological effective dose administered, decrease the overall time, and is very conformal, allowing protection of normal surrounding structures. Purpose/Objective(s): To verify the feasibility of using I-HDR in combination to salvage surgery and EBRT for recurrent cervical cancer. Materials/Methods: Patients admitted between October, 1994 and December, 2003, were retrospectively selected. The criteria for including patients in the study were: the presence of recurrent cervical cancer treated with combination of surgery, I-HDR and a new second course of EBRT. A total of 23 patients with the following characteristics were retrospectively selected: biopsy proven SCC cancer, KPS⬎60 and, M0. Their clinical stage was defined based on preoperative clinical and radiological examinations, using the TNM classification of the AJCC. Dose prescription was based on points located between the catheters, with prescription dose encompassing the tumor bed with safety margins. The active length of catheters ranged from 25 mm to 75 mm. The EBRT course usually started immediately after the completion of the course of I-HDR. Results: Median age and follow up of patients were 56 years old (range 38 – 85) and 29 months. The total dose of I-HDR ranged from 15 Gy to 30 Gy (median 24), given in 3 to 10 fractions, in a median time of 4 days (range 2 to 8). The total treatment time, including the surgical day ranged from 7 to 49 days. The crude local control (LC) rate was 43.5% (10/23). The 5- and