- Email: [email protected]
298 poster Stereotactic radiosurgery versus conformal radiosurgery in treatment planning of brain tumours
Posters
$81
Methods: Between 1995 and 1999, 8 patients with 9 brain metastases which were 4-6 cm in size were treated by SRT. All patients were initially received conventional whole brain irradiation (WBI) of 30-40 Gy / 10-20 fractions / 2-4 weeks to debulk the large tumors. However, following the WBI, all patients still had brain metastases larger than 3 cm. SRT was performed with a fusion of computed tomography and linear accelerator (FOCAL)* unit. Depending on the size and location of the tumor, daily radiation dose of SRT ranged from 3 to 10 Gy with total fraction numbers of 315. To perform this new and experimental treatment, informed consent was obtained from all patients. Follow-up studies with computed tomography or magnetic resonance imaging were usually performed every 3 months interval. No patients were lost to follow-up in this study. Results: Treatment was performed safely with no or minimal acute adverse symptoms in all patients. All the lesions showed good response to the SRT but 2 tesions had local regrowth at 6 and 12 months, respectively. Thus, the local control was achieved in 7 of the 9 lesions. A median survival time of the 8 patients was 11.5 months. So far, no late adverse effects related to the treatment were observed. Conclusions: SRT in combination with WBI seems to be highly safe and effective approach for brain metastases larger than 3 cm. Additional studies with more patients and longer follow-up periods are warranted to assess this new approach. *lnt J Radiat Oncol Biol Phys 35: 587, 1996. end 48: (in press) 2000. Cancer 82: 1062, 1998. Radiother Oncol 50:337, 1999 294
poster
Preliminary study of intra-arterial steroid infusion for patients with primary central nervous system lymphoma N. Havabuchi 1, Y. Shibamoto2, Y. Toda 1, E. Ogoh 1, G. Suzuki 1, E. Tabuchi 1, Y. Onizuka 3 l Kurume Univ. School of Medicine, Radiology, Kurume, Japan 2Kyuto Univ., Institute Frontier Med. Science, Kyuto, Japan 3Kyushu University, Fukuoka, Japan Purpose: To improve the poor prognosis of patients with primary central nervous system lymphoma (PCNSL), intra-arterial steroid infusion was used in additior~ to radiotherapy with or without systemic chemotherapy. Methods: Six patients with PCNSL were included in this study. They were diagnosed histologically or clinically. All of them were treated by intra-arterial steroid infusion (60-100 mg predonisolone sodium succinate) via right and left carotid arteries and vertebral artery after 30-50 Gy whole brain radiation and 0-20 Gy local boost radiation (total 40-60 Gy). Systemic highdose methotrexate was used in two patients. Results: All but one of the 6 patients completely responded. No special acute side effects due to steroid infusion were seen. As of May 1, 2000,3 patients are alive without relapse (6-30 months), while other 3 were dead (8, 11 and 26 months after initiation of therapy). No adverse late effects have been seen as yet. Conclusions: Although long-term adverse effects of steroid infusion therapy in additionto usual radiotherapy with or without systemic chemotherapy for PCNSL are not clear, acute side effects have not been seen. Steroid infusion therapy seems to be worth further investigation. 295
poster
Stereotactic radiosurgsry:lnitial experience at the Wesley Cancer Care Centre B. Maso_n1, D. Schlect 1, G. Trotter 2, C. Jonas 1, B. Hilder 1, S. Greenham 1, F. Tomlinson 3 1W.C.C.C., Radiation Oncology, Brisbane, Australia 2E.C.C.C., Radiation Oncology, Tugun, Australia 3Wesley Hospital, Neurosurgery, Brisbane, Australia The experience of the first 55 adult patients treated with Linac-based Stereotactic Radiosurgery [SRS] at W.C.C.C. was retrospectively analysed.The service commenced in October 1998 and this report covers patients treated in the preiod to December 1999, giving minimum follow up of 12 months. Intracranial lesions included 10 gliomas, 1 ependymoma, 30 metastatic tumors, 2 meningiomas, 4 acoustic neuromas, 5 pituitary adenomas and 3 arteriovenous malformations. The mean patient age was 51 years [range 16-88]. Mean target volume was 6.9 cc. Five patients were treated on 2 occasions. An in-house slide presentation has been developed to familiarise prospective patients with SRS. This education tool has been well received by patients and family members. Data regarding immediate side effects and patterns of intracranial lesion
control and disease progression are described. Although follow-up times in this series are short,the authors conclude that the development of SRS at the W.C.C.C. provides an important safe and effective addition to conventional treatment methods. 296
poster
Radiotherapy and chemotherapy in tl~e treatment of malignant asrocytomas _C. Tolevska, L. Maneva -Kostovska, IV. Vasev, S. veljanovska, O. Arsov IRO, Skopje, Macedonia The knowledge received through the radobiology, leads to hypothesis according to which the hyperfractionated radiotherapy could give superior results in respect to the classical radiotherapy in the treatment of malignant astrocytomas. The objectives of this study were to estimate clinicaly-the hypothesis of the superiority of the hyperfractionated radiotherapy the optimal doses of BCNU chemotherapy the toxic effects of radiotherapy and chemotherapy. There were analised 133 patients with malignant supratentorial astrocytomas, treated at the Institute of Radiotherapy and Oncology, Skopje during period from 1984-1993. They were randomized in two groups: CR group (63 patients irradiated with classical radiotherapy) and DDF group (63 patients irradiated with hyperfractionated radiotherapy). All of them recived chemotherapy with BCNU (720-1440 mg/m 2 total dose). The statistical analysis showed: -hyperfractionated radiotherapy didn't give superior results in respect to the classical radiotherapy (p=0,34 for actuarial survival, p=0,72 mdian survival). - the toxic effects of radiotherapy and chemotherapy didn't significant differ between the two groups. 297
poster
Malignant glioma in adults - the analysis of the results of conventional and hypofractionations irradiation L. Czopkiewicz, M. Pamucka Provincial Hospital of Oncology, Radiotherapy, Opole, Poland In the years 1982-1998 in our Hospital 134 patients with malignant glioma were postoperatively irradiated. There were 74 patients with Anaplastic Astrocytoma and 60 with Glioblastoma Multiforme. The age of patients ranged from 17-77, median 46,4 years. The patients were irradiated with two methods of fractionation: conventional- C- 60 Gy/30 fr. (56 pts) and hypofractionation- H- 54 Gy/9 fr. twice a week (78 pts). The patients' average survival from the group C was 24 months whereas from the group H was 18 months. The treatment was good tolerated and there were no serious side effects. In the multivariant analysis the age of the patients and histology of tumour were the most important prognostic factors. 298
poster
Stereotactic radiosurgery versus conformal radiosurgery in treatment planning of brain tumours A.R. Fischedick, U. Haverkamp, K. Freudenberg, B. PrEtmer, K. Diekmann*, M. Kocher**, C. AI DandashL P.R. MEiIler**, R. POtter* Clemenshospital, MOnster, Germany *Univ. Wien, Austria **Univ. of KSIn, Germany In radiosurgery two techniques can be used: rotational fields as well as static irregular fields. The purpose of this study is to evaluate the rotational and conformal block technique according to the homogeneity within the PTV and dose distribution within the normal tissue. For 29 patients dose distributions for both techniques were calculated. The parameters under investigation were the number of isocentres, the maximum doses, the conformal index and volumes of special isodoses. The mean volume of the PTV was 7.tcc, the number of arcs ranged from 3 to 6 (mean value 5), the number of static fields from 4 to 6 (mean value 5.5). In order to describe the spherical features of the PTVs a score was designed. The time for designing and calculating the physical treatment plan is higher for rotational techniques than for conformal techniques (1.2 x - 3x), depending on the number of isocentres, these does not change with using the optimisation tool. In all cases the dose homogeneity within the target volume (PTV) was greater for conformal therapy than for stereotactic radiosurgery. The maximum dose for single isocentric techniques was 103%, for multiple isocentres up to 250%. In most cases the conformation index is higher for the rotational technique (mean + 15%) than for the conformal technique, exceptions are small volumes (
$82
Posters
Besides the statistics it is necessary to check and to compare the doses in the organs at risk. In general the conformal technique gives lower doses to normal tissue, if tolerance doses are exceeded, alternatively rotational stereotactical dose distributions must be calculated.
COLORECTAL TUMOURS 299
poster
The treatment results of preoperative chemoradiation alone without definitive surgery in locally advanced rectal cancer J.S. Kim 1,4, G.Y. Jang 1, J.S. Kim I, W.H. Yoon2,4, K.S. Song 3,4, M.J. Cho 1,4 1College of Medicine, Chungnam National University, Therapeutic Radiology, Taejon, South Korea 2College of Medicine, Chungnam National University, General Surgery, Taejon, South Korea 3College of Medicine, Chungnam National University, Pathology, Taejon, South Korea 4Chungnam National University, Cancer Research Institute, Taejon, South Korea Purpose: To analysis the survival result of preoperative concurrent chemoradiation of patients who refused surgery in locally advanced rectal cancer. Methods: Eighteen patients with biopsy proven rectal cancer who received preoperative chemoradiation and refused surgery after neoadjuvant therapy were entered into this retrospective study. There were 13 males and 5 females with median age of 60 years. Tumor distance from the anal verge ranged from 0 to 8 cm (median 3 cm). The pretreatment TNM staging distributions were T2N0 in 6% (1), T3N0 in 33% (6), T3N1-2 in 61% (11). Radiation of 45 Gy was delivered to the whole pelvis followed by 5.4 Gy boost to primary site. Median total radiation dose was 50.4 Gy. All patients received concurrent 2 cycles of 5-fluorouracil (500 mg/m2/day) and leucovorin (20 mg/m2/day). All patients did not receive further treatment after chemoradiation. Results: Median follow-up was 28 months with a range of 8 to 81 months. Sixteen patients (89%) were candidates for Mile's operation. One patient had clinical complete response at 1 month after treatment. The 5-year overall survival and median survival were 27% and 31 months, respectively. Surprisingly, four of 18 patients (22%) survived over 5 years and considered as had achieved a pathologic complete response. Among 4 patients, 3 are still alive after 65 months and 1 died at 75 months with unknown cause. Acute treatment toxicity was acceptable. There was grade 3 leukopenia in 1 patient (6%) and grade 3 skin erythema in 9 patients (50%). Conclusions: Preoperative chemoradiation in the rectal cancer is known as increasing of tumor downstaging and the chance of sphincter preservation surgery. In this study, the 5-year survival was comparable with pathologic complete response rate in other chemoradiation studies. This result suggests that pathologic complete regression of tumor induced by preoperative chemoradiation has a potential of long-term survival 300
poster
Short-course preoperative radiation of rectal cancer: downstaging predictors J:. Kovner, D. Sarid, E. Brazovski, E. Ravid, G. Goldman, M. Rabau, B. Lifschitz-Mercer, M. Inbar TeI-Aviv Med Center, Oncology, TeI-Aviv, Israel TeI-Aiv Mad. Center, Pathology, TeI-Aviv, Israel TeI-Aviv Med. Center, Surgery, Tel-Aviv, Israel A short-course preoperative radiation can prolong overall survival of patients with rectal cancer (Swedish trial).ln present study downstaging observed as a result of such radiation was used as surrogate end point. We analyzed prognostic factors, which could predict downstaging and help to choose the patients for this treatment approach. Since 1997, forty-three patients with rectal cancer T3, ultrasonographically staged before radiation, received 25 Gy in 5 dally fractions about 2 weeks before operation.Pathological postoperative T stage was compared with the preradiation ultrasonographic one.The correlation of some treatment, tumor, and host-related features was examined. P 53 was examined by immune histochemical staining and evaluated as either negative, or positive (1+,2+,or 3+).Downstaging was observed in 37% of the time, pathological complete responce in 7%. Mean duration of radiation therapy was shorter in patients achieving downstaging:5.2 v. 6.4 days (p<0.001). Mean histologic grade was significantly lower in patients achieving downstaging:1.9 v. 2.3 (p<0.01). There was no lymph node involvement by metastases in
patients achieving downstaging: 0 v. 2 lymph nodes (p<0.01). In patients with downstaging tumor was located lower within rectum: 5.3 v. 7.1 cm (p=0.03).The patients achieving downstaging were younger than those who did not (49 v. 60 years), but age difference was not statistically significant (p=0.09). Time interval between radiation and operation was identical in groups of patients with and without downstaging (1,9 week).The number of lymph nodes examined during the operation did not differ in both groups (14.8 v. 14.4, p =0.45). P53 was positive in 100% of the time with a mean value 2.22 in the dowmstaging group v. 50% and 1.45 in the group, which did no achieve the downstaging (p=0.055) Conclusion: In short-course preoperative irradiation of rectal cancer downstaging is more frequent: when dose intensity is higher, in younger patients with more differentiated tumors with positive p 53, located lower in the rectum, without lymph nodes involvement. 301
poster
Preoperative chemoradiation using Capecitabine in locally advanced rectal cancer J.Y. Jang 1, J.S. Kim 1,4, J.S. Kim 1, W.H. Yoon2,4, K.S. Song 3,4, M.J. Cho 1,4 1College of Medicine, Chungnam National University, Therapeutic Radiology, Taejon, South Korea 2College of Medicine, Chungnam National University, General Surgery, Taejon, South Korea 3College of Medicine, Chungnam National University, Pathology, Taejon, South Korea 4Chungnam National University, Cancer Research Institute, Taejon, South Korea Purpose: Capecitabine(Xeloda) is a new fluoropyrimidine carbamate with antineoplastic activity. It is an orally administered systemic prodrug of 5'deoxy-5-fluorouridine(5'-dFUrd) which is converted to 5-fluorouracil by thymidine phosphorylase(dThdPase) selectively in tumor. Sawada et al. reported that single local irradiation with capecitabine increased dThdPase levels in WiDr human colon cancer cells implanted in nude mice by up to 13 fold at 9 days after irradiation and was much more effective than either radiation or chemotherapy. The purpose of this study is to evaluate early clinical results of preoperative chemoradiotherapy using Capecitabine in locally advanced rectal cancer. Methods: Seventeen patients with rectal cancer were treated with concurrent preoperative chemoradiotherapy for tumor downstaging and sphincter preservation. The pretreatment TNM staging distributions were T3N0 in 24% (4), T3N1-2 in 70% (12), T4N2 in 6% (1). Radiation of 45 Gy was delivered to the whole pelvis followed by 5.4 Gy boost to primary site. Median total radiation dose was 50.4 Gy. Chemotherapy consisted of concurrent 2 cycles of Xeloda (1650 mg/m2/day) and leucovorin (20 mg/m2/day) Definitive surgery was performed at six weeks after completion of preoperative treatment. Results: Excepts one patients who refused surgery, all patients received definitive surgery with negative resection margin. The pathologic tumor stage were T2N0 in 25% (4), T3N1-2 in 44% (7), T3N1 M1 in 6% (1). Pathologic complete response was achieved in 25% (4/16). The tumor and nodal downstaging was 63% and 85% on the basis of preopreative CT staging, respectively. Lymph node negative rate increased from 23% to 81% with preoperative chemoradiotherapy. Among the eight patients with tumors located below 5 cm from the anal verge, 87 %(7/8) received sphincter preservation, and tumor was downstaged in 5 patients (62%) and 4 of those (80%) received sphincter preservation. There was no significant hematologic and gastrointestinal toxicity. Grade 3 hand-foot syndrome developed in one patients(6%). There was no postoperative morbidity. Conclusions: This preliminary results suggest that preoperative chemoradiation with Capecitabine could be very safe, more tolerable and effective neoadjuvant modality. Also this treatment regimen affords to considerable downstaging, especially significant nodal downstaging and much improving sphincter preservation by tumor downstaging in distal rectal cancer. Supported by Roche Korea Co. 302
poster
The analysis of field errors by immobilization device in patients with rectal cancer Y.E. Ko 2, K,H. Kim 1, M.J. Cho 1,2, N.H. Kang 1, D.W. Kim 1, J.Y. Jang 1, J.S. Kim 1,2, J.S. Kim I I College of Medicine, Chungnam National University, Therapeutic Radiology, Taejon, South Korea 2Chungnam National University, Cancer Research Institute, Taejon, South
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Methods: Between 1995 and 1999, 8 patients with 9 brain metastases which were 4-6 cm in size were treated by SRT. All patients were initially received conventional whole brain irradiation (WBI) of 30-40 Gy / 10-20 fractions / 2-4 weeks to debulk the large tumors. However, following the WBI, all patients still had brain metastases larger than 3 cm. SRT was performed with a fusion of computed tomography and linear accelerator (FOCAL)* unit. Depending on the size and location of the tumor, daily radiation dose of SRT ranged from 3 to 10 Gy with total fraction numbers of 315. To perform this new and experimental treatment, informed consent was obtained from all patients. Follow-up studies with computed tomography or magnetic resonance imaging were usually performed every 3 months interval. No patients were lost to follow-up in this study. Results: Treatment was performed safely with no or minimal acute adverse symptoms in all patients. All the lesions showed good response to the SRT but 2 tesions had local regrowth at 6 and 12 months, respectively. Thus, the local control was achieved in 7 of the 9 lesions. A median survival time of the 8 patients was 11.5 months. So far, no late adverse effects related to the treatment were observed. Conclusions: SRT in combination with WBI seems to be highly safe and effective approach for brain metastases larger than 3 cm. Additional studies with more patients and longer follow-up periods are warranted to assess this new approach. *lnt J Radiat Oncol Biol Phys 35: 587, 1996. end 48: (in press) 2000. Cancer 82: 1062, 1998. Radiother Oncol 50:337, 1999 294
poster
Preliminary study of intra-arterial steroid infusion for patients with primary central nervous system lymphoma N. Havabuchi 1, Y. Shibamoto2, Y. Toda 1, E. Ogoh 1, G. Suzuki 1, E. Tabuchi 1, Y. Onizuka 3 l Kurume Univ. School of Medicine, Radiology, Kurume, Japan 2Kyuto Univ., Institute Frontier Med. Science, Kyuto, Japan 3Kyushu University, Fukuoka, Japan Purpose: To improve the poor prognosis of patients with primary central nervous system lymphoma (PCNSL), intra-arterial steroid infusion was used in additior~ to radiotherapy with or without systemic chemotherapy. Methods: Six patients with PCNSL were included in this study. They were diagnosed histologically or clinically. All of them were treated by intra-arterial steroid infusion (60-100 mg predonisolone sodium succinate) via right and left carotid arteries and vertebral artery after 30-50 Gy whole brain radiation and 0-20 Gy local boost radiation (total 40-60 Gy). Systemic highdose methotrexate was used in two patients. Results: All but one of the 6 patients completely responded. No special acute side effects due to steroid infusion were seen. As of May 1, 2000,3 patients are alive without relapse (6-30 months), while other 3 were dead (8, 11 and 26 months after initiation of therapy). No adverse late effects have been seen as yet. Conclusions: Although long-term adverse effects of steroid infusion therapy in additionto usual radiotherapy with or without systemic chemotherapy for PCNSL are not clear, acute side effects have not been seen. Steroid infusion therapy seems to be worth further investigation. 295
poster
Stereotactic radiosurgsry:lnitial experience at the Wesley Cancer Care Centre B. Maso_n1, D. Schlect 1, G. Trotter 2, C. Jonas 1, B. Hilder 1, S. Greenham 1, F. Tomlinson 3 1W.C.C.C., Radiation Oncology, Brisbane, Australia 2E.C.C.C., Radiation Oncology, Tugun, Australia 3Wesley Hospital, Neurosurgery, Brisbane, Australia The experience of the first 55 adult patients treated with Linac-based Stereotactic Radiosurgery [SRS] at W.C.C.C. was retrospectively analysed.The service commenced in October 1998 and this report covers patients treated in the preiod to December 1999, giving minimum follow up of 12 months. Intracranial lesions included 10 gliomas, 1 ependymoma, 30 metastatic tumors, 2 meningiomas, 4 acoustic neuromas, 5 pituitary adenomas and 3 arteriovenous malformations. The mean patient age was 51 years [range 16-88]. Mean target volume was 6.9 cc. Five patients were treated on 2 occasions. An in-house slide presentation has been developed to familiarise prospective patients with SRS. This education tool has been well received by patients and family members. Data regarding immediate side effects and patterns of intracranial lesion
control and disease progression are described. Although follow-up times in this series are short,the authors conclude that the development of SRS at the W.C.C.C. provides an important safe and effective addition to conventional treatment methods. 296
poster
Radiotherapy and chemotherapy in tl~e treatment of malignant asrocytomas _C. Tolevska, L. Maneva -Kostovska, IV. Vasev, S. veljanovska, O. Arsov IRO, Skopje, Macedonia The knowledge received through the radobiology, leads to hypothesis according to which the hyperfractionated radiotherapy could give superior results in respect to the classical radiotherapy in the treatment of malignant astrocytomas. The objectives of this study were to estimate clinicaly-the hypothesis of the superiority of the hyperfractionated radiotherapy the optimal doses of BCNU chemotherapy the toxic effects of radiotherapy and chemotherapy. There were analised 133 patients with malignant supratentorial astrocytomas, treated at the Institute of Radiotherapy and Oncology, Skopje during period from 1984-1993. They were randomized in two groups: CR group (63 patients irradiated with classical radiotherapy) and DDF group (63 patients irradiated with hyperfractionated radiotherapy). All of them recived chemotherapy with BCNU (720-1440 mg/m 2 total dose). The statistical analysis showed: -hyperfractionated radiotherapy didn't give superior results in respect to the classical radiotherapy (p=0,34 for actuarial survival, p=0,72 mdian survival). - the toxic effects of radiotherapy and chemotherapy didn't significant differ between the two groups. 297
poster
Malignant glioma in adults - the analysis of the results of conventional and hypofractionations irradiation L. Czopkiewicz, M. Pamucka Provincial Hospital of Oncology, Radiotherapy, Opole, Poland In the years 1982-1998 in our Hospital 134 patients with malignant glioma were postoperatively irradiated. There were 74 patients with Anaplastic Astrocytoma and 60 with Glioblastoma Multiforme. The age of patients ranged from 17-77, median 46,4 years. The patients were irradiated with two methods of fractionation: conventional- C- 60 Gy/30 fr. (56 pts) and hypofractionation- H- 54 Gy/9 fr. twice a week (78 pts). The patients' average survival from the group C was 24 months whereas from the group H was 18 months. The treatment was good tolerated and there were no serious side effects. In the multivariant analysis the age of the patients and histology of tumour were the most important prognostic factors. 298
poster
Stereotactic radiosurgery versus conformal radiosurgery in treatment planning of brain tumours A.R. Fischedick, U. Haverkamp, K. Freudenberg, B. PrEtmer, K. Diekmann*, M. Kocher**, C. AI DandashL P.R. MEiIler**, R. POtter* Clemenshospital, MOnster, Germany *Univ. Wien, Austria **Univ. of KSIn, Germany In radiosurgery two techniques can be used: rotational fields as well as static irregular fields. The purpose of this study is to evaluate the rotational and conformal block technique according to the homogeneity within the PTV and dose distribution within the normal tissue. For 29 patients dose distributions for both techniques were calculated. The parameters under investigation were the number of isocentres, the maximum doses, the conformal index and volumes of special isodoses. The mean volume of the PTV was 7.tcc, the number of arcs ranged from 3 to 6 (mean value 5), the number of static fields from 4 to 6 (mean value 5.5). In order to describe the spherical features of the PTVs a score was designed. The time for designing and calculating the physical treatment plan is higher for rotational techniques than for conformal techniques (1.2 x - 3x), depending on the number of isocentres, these does not change with using the optimisation tool. In all cases the dose homogeneity within the target volume (PTV) was greater for conformal therapy than for stereotactic radiosurgery. The maximum dose for single isocentric techniques was 103%, for multiple isocentres up to 250%. In most cases the conformation index is higher for the rotational technique (mean + 15%) than for the conformal technique, exceptions are small volumes (
$82
Posters
Besides the statistics it is necessary to check and to compare the doses in the organs at risk. In general the conformal technique gives lower doses to normal tissue, if tolerance doses are exceeded, alternatively rotational stereotactical dose distributions must be calculated.
COLORECTAL TUMOURS 299
poster
The treatment results of preoperative chemoradiation alone without definitive surgery in locally advanced rectal cancer J.S. Kim 1,4, G.Y. Jang 1, J.S. Kim I, W.H. Yoon2,4, K.S. Song 3,4, M.J. Cho 1,4 1College of Medicine, Chungnam National University, Therapeutic Radiology, Taejon, South Korea 2College of Medicine, Chungnam National University, General Surgery, Taejon, South Korea 3College of Medicine, Chungnam National University, Pathology, Taejon, South Korea 4Chungnam National University, Cancer Research Institute, Taejon, South Korea Purpose: To analysis the survival result of preoperative concurrent chemoradiation of patients who refused surgery in locally advanced rectal cancer. Methods: Eighteen patients with biopsy proven rectal cancer who received preoperative chemoradiation and refused surgery after neoadjuvant therapy were entered into this retrospective study. There were 13 males and 5 females with median age of 60 years. Tumor distance from the anal verge ranged from 0 to 8 cm (median 3 cm). The pretreatment TNM staging distributions were T2N0 in 6% (1), T3N0 in 33% (6), T3N1-2 in 61% (11). Radiation of 45 Gy was delivered to the whole pelvis followed by 5.4 Gy boost to primary site. Median total radiation dose was 50.4 Gy. All patients received concurrent 2 cycles of 5-fluorouracil (500 mg/m2/day) and leucovorin (20 mg/m2/day). All patients did not receive further treatment after chemoradiation. Results: Median follow-up was 28 months with a range of 8 to 81 months. Sixteen patients (89%) were candidates for Mile's operation. One patient had clinical complete response at 1 month after treatment. The 5-year overall survival and median survival were 27% and 31 months, respectively. Surprisingly, four of 18 patients (22%) survived over 5 years and considered as had achieved a pathologic complete response. Among 4 patients, 3 are still alive after 65 months and 1 died at 75 months with unknown cause. Acute treatment toxicity was acceptable. There was grade 3 leukopenia in 1 patient (6%) and grade 3 skin erythema in 9 patients (50%). Conclusions: Preoperative chemoradiation in the rectal cancer is known as increasing of tumor downstaging and the chance of sphincter preservation surgery. In this study, the 5-year survival was comparable with pathologic complete response rate in other chemoradiation studies. This result suggests that pathologic complete regression of tumor induced by preoperative chemoradiation has a potential of long-term survival 300
poster
Short-course preoperative radiation of rectal cancer: downstaging predictors J:. Kovner, D. Sarid, E. Brazovski, E. Ravid, G. Goldman, M. Rabau, B. Lifschitz-Mercer, M. Inbar TeI-Aviv Med Center, Oncology, TeI-Aviv, Israel TeI-Aiv Mad. Center, Pathology, TeI-Aviv, Israel TeI-Aviv Med. Center, Surgery, Tel-Aviv, Israel A short-course preoperative radiation can prolong overall survival of patients with rectal cancer (Swedish trial).ln present study downstaging observed as a result of such radiation was used as surrogate end point. We analyzed prognostic factors, which could predict downstaging and help to choose the patients for this treatment approach. Since 1997, forty-three patients with rectal cancer T3, ultrasonographically staged before radiation, received 25 Gy in 5 dally fractions about 2 weeks before operation.Pathological postoperative T stage was compared with the preradiation ultrasonographic one.The correlation of some treatment, tumor, and host-related features was examined. P 53 was examined by immune histochemical staining and evaluated as either negative, or positive (1+,2+,or 3+).Downstaging was observed in 37% of the time, pathological complete responce in 7%. Mean duration of radiation therapy was shorter in patients achieving downstaging:5.2 v. 6.4 days (p<0.001). Mean histologic grade was significantly lower in patients achieving downstaging:1.9 v. 2.3 (p<0.01). There was no lymph node involvement by metastases in
patients achieving downstaging: 0 v. 2 lymph nodes (p<0.01). In patients with downstaging tumor was located lower within rectum: 5.3 v. 7.1 cm (p=0.03).The patients achieving downstaging were younger than those who did not (49 v. 60 years), but age difference was not statistically significant (p=0.09). Time interval between radiation and operation was identical in groups of patients with and without downstaging (1,9 week).The number of lymph nodes examined during the operation did not differ in both groups (14.8 v. 14.4, p =0.45). P53 was positive in 100% of the time with a mean value 2.22 in the dowmstaging group v. 50% and 1.45 in the group, which did no achieve the downstaging (p=0.055) Conclusion: In short-course preoperative irradiation of rectal cancer downstaging is more frequent: when dose intensity is higher, in younger patients with more differentiated tumors with positive p 53, located lower in the rectum, without lymph nodes involvement. 301
poster
Preoperative chemoradiation using Capecitabine in locally advanced rectal cancer J.Y. Jang 1, J.S. Kim 1,4, J.S. Kim 1, W.H. Yoon2,4, K.S. Song 3,4, M.J. Cho 1,4 1College of Medicine, Chungnam National University, Therapeutic Radiology, Taejon, South Korea 2College of Medicine, Chungnam National University, General Surgery, Taejon, South Korea 3College of Medicine, Chungnam National University, Pathology, Taejon, South Korea 4Chungnam National University, Cancer Research Institute, Taejon, South Korea Purpose: Capecitabine(Xeloda) is a new fluoropyrimidine carbamate with antineoplastic activity. It is an orally administered systemic prodrug of 5'deoxy-5-fluorouridine(5'-dFUrd) which is converted to 5-fluorouracil by thymidine phosphorylase(dThdPase) selectively in tumor. Sawada et al. reported that single local irradiation with capecitabine increased dThdPase levels in WiDr human colon cancer cells implanted in nude mice by up to 13 fold at 9 days after irradiation and was much more effective than either radiation or chemotherapy. The purpose of this study is to evaluate early clinical results of preoperative chemoradiotherapy using Capecitabine in locally advanced rectal cancer. Methods: Seventeen patients with rectal cancer were treated with concurrent preoperative chemoradiotherapy for tumor downstaging and sphincter preservation. The pretreatment TNM staging distributions were T3N0 in 24% (4), T3N1-2 in 70% (12), T4N2 in 6% (1). Radiation of 45 Gy was delivered to the whole pelvis followed by 5.4 Gy boost to primary site. Median total radiation dose was 50.4 Gy. Chemotherapy consisted of concurrent 2 cycles of Xeloda (1650 mg/m2/day) and leucovorin (20 mg/m2/day) Definitive surgery was performed at six weeks after completion of preoperative treatment. Results: Excepts one patients who refused surgery, all patients received definitive surgery with negative resection margin. The pathologic tumor stage were T2N0 in 25% (4), T3N1-2 in 44% (7), T3N1 M1 in 6% (1). Pathologic complete response was achieved in 25% (4/16). The tumor and nodal downstaging was 63% and 85% on the basis of preopreative CT staging, respectively. Lymph node negative rate increased from 23% to 81% with preoperative chemoradiotherapy. Among the eight patients with tumors located below 5 cm from the anal verge, 87 %(7/8) received sphincter preservation, and tumor was downstaged in 5 patients (62%) and 4 of those (80%) received sphincter preservation. There was no significant hematologic and gastrointestinal toxicity. Grade 3 hand-foot syndrome developed in one patients(6%). There was no postoperative morbidity. Conclusions: This preliminary results suggest that preoperative chemoradiation with Capecitabine could be very safe, more tolerable and effective neoadjuvant modality. Also this treatment regimen affords to considerable downstaging, especially significant nodal downstaging and much improving sphincter preservation by tumor downstaging in distal rectal cancer. Supported by Roche Korea Co. 302
poster
The analysis of field errors by immobilization device in patients with rectal cancer Y.E. Ko 2, K,H. Kim 1, M.J. Cho 1,2, N.H. Kang 1, D.W. Kim 1, J.Y. Jang 1, J.S. Kim 1,2, J.S. Kim I I College of Medicine, Chungnam National University, Therapeutic Radiology, Taejon, South Korea 2Chungnam National University, Cancer Research Institute, Taejon, South