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367 poster workshop The prognostic role of treatment related factors in locally advanced cervix cancer patients treated with radical radiotherapy
Poster workshops
Gynaecology 366 poster workshop Study of prognostic factors in stage I-II uterine sarcomas A. Rovirosa 1, C. Ascaso 2, J. Ordl~, A. Arenas ~, S. Jorcano ~, J.A. Lejarcegu~~, Mellado B. 5, R. Molina ~, X. Iglesias 4, A. Biete,
I Hospital Clinic i Universitari, Radiation Oncology, Barcelona,
Spain 2Dpts. Biostatistics Unit 3pathology 4Gynaecology 5Medical Oncology ~Molecular Biology Purpose: To evaluate retrospectively the influence of prognostic factors on specific overall survival (OS), disease-free survival (DFS), local relapse-free survival (LRFS) and distant metastasis-free survival (DMFS) in 54 early stages uterine sarcomas diagnosed and treated at our Hospital from 1979 to 2003. Patients and methods: 54 Patients diagnosed and staged after surgery for uterine sarcomas. The mean and maximum follow-up of the entire series was 27 and 60 months (m) respectively. 8/54 patients were lost from follow-up. Figo stages: 48 stage I and 6 stage I1. 29/46 received postoperative irradiation. Variables analyzed: sarcoma type, myometrial invasion (MI), mitotic index, Uni/Multicentricity, necrosis, tumoral size, vascular and lymphatic space invasion (VLSI) and radiotherapy. Statistical study: Log-rank and Cox model of proportional risk; Hazard Ratio (HR) 95% CI. Results: Pathology. 1) Sarcoma type: 24 carcinosarcoma, 4 endometrial stromal sarcoma, 10 adenosarcoma and 8 leiomyosarcoma; 2) Mh 33 yes, 9 no, 4 not available (NA); 3) mitotic index (Min): <10 in 9, >10 in 30, NA in 7; 4) Uni/Multicentricity: 29 unicentric, 3 multicentric, 15 NA; 4) necrosis:'9 no, 26 yes, 11 NA; 5) tumoral size:< 8 cm. 24, >8cm. 12, NA 10; 6) VLSh 22 no, 12 yes, 12 NA; radiotherapy (29 yes,17 no). Tumoral size > 8 cm. was the only prognostic fa6tor which affected the different survivals. Mean values of survivals depending on the tumoral size < 8 cm. vs > 8 cm: OS 34m. vs 23m. (HR 2.52), DFS 31m. vs 17m. (HR 3.1), LRFS 311m. vs 18 m. (HR 3.1), DMFS 32m. vs 20m. (HR 2.63). Nevertheless, there was a high incidence of bad prognostic fa(~tors in these tumours: 72% had MI, 65% had high Min, 63% had multicentricity, 56% had necrosis, 26% tumour size >8cm., 26% had VLSI. Conclusions: Uterine sarcomas are tumours with an aggressive behaviour despite of the early stages. In the present series only tumour size > 8 cm. had impact on OS, DFS, LRFS and DMFS. 367 poster workshop The prognostic role of treatment related factors in locally advanced cervix cancer patients treated with radical radiotherapy G. Kosicka, A. Roszak, K. Bratos, H. Wlodarczyk, A. Wojciechowska-Lacka, M. Bogusz-Osawa Gread Poland Cancer Centre, Radiotherapy and Gynecological Oncology, Poznan, Poland introduction: staging, grading, histopatho!ogy, tumor volume, Hb level are commonly used prognostic factors in locally advanced (IIB-IVA) cervix cancer. There are also therapeutic factors predicting prognosis in radical radiotherapy treatment, such as overall treatment time and total dose delivered to the irradiated volume. The aim of this study is to estimate the influence of total tele- and brachytherapy radiation dose and overall treatment time on the overall survival.
Wednesday, October 27, 2004
$165
Materials and methods: In the group of 207 patients with squamous cell cervix cancer in IIIB stage influence of doses delivered with tele- and brachytherapy (brachytherapy fraction number), total dose and overall treatment time on overall survival were estimated. Cut-off values were estimated for each factor. Survival curves for each analysed group after considering cut-oft values were plotted and compared (KaplanMeier method, Wilcoxon test). Multivariate analysis (Cox proportional hazards model) was performed. Results: In univariate analysis correlations with survival and: (1) brachytherapy dose to point A (cut-oft value - 50 Gy), p=0,005 (2) number of brachytherapy fractions (1->2) p=0,002 (3) teletherapy dose (44Gy) p=o,o25 and (4) total dose to parametria (59 Gy) p=0,057 were confirmed. In the multivariate analysis the strongest survival prognostic factor was the dose delivered with brachytherapy to the point A. Conclusion: The strongest survival prognostic factor for pts with locally advanced cervix cancer (IIIB) appeared to be the dose delivered to the point A with brachytherapy. 368 poster workshop Carcinoma of the uterine cervix: a single institution experience using PDF brachytherapy in 125 consecutive patients O. Olszvk 1, Y. Belkac6mi 1, E. Leblanc 2 , T. Lacomerie 1, F. Narducci 2, M. Ozsahin 3, E. Lartigau 1, B. Castelain ~ ~Oscar Lambret Center, Department of Radiation Therapy, Lille, France 20scar Lambret, Department of Gynecological Surgery, Lille, France 3Centre H. du Vaudois, Lausanne, Switzerland Purpose: Controversy continues between advocates of radical surgery and radiation therapy (RT). In all cases rigorous tumor staging before treatment is mandatory. The combination of external beam radiation therapy (EBRT) + chemotherapy (CT), brachytherapy (BCT) and surgery is the standard of care in the management of carcinoma of the cervix. According to the tumor stage BCT is indicated before (or after) surgery or is associated to exclusive EBRT. Intracavitary BCT is delivered using variety of applicators. Pulsed dose rate (PDR) BCT presents potential advantages of the low dose rate (LDR) and radiation protection of HDR afterloading technology. In this study, we evaluated toxicity, local control and survival of PDR BCT as a part of the therapeutic management of uterine cervix carcinoma. Materials and Methods: Data from 125 patients with cervix carcinoma treated by PDR BCT between 1995 and 2003 were retrospectively analysed. Median age was 50 years (29-87). Histology was squamous cell carcinoma in 103 patients (83%), adenocarcinoma in 16 patients (13%). Tumor size was < 2 cm in 12 patients (10%), 2-3.9cm in 35 patients (29%), > 4 cm in 72 patients (60%). Most of patients had an MRI at the diagnostic and had a surgical node staging according to our protocols. According to FIGO staging there were 37 (30%) stages IB1, and 88 (70%) > IB2-111 (20 stages IB2, 11 stages IIA, 25 stages liB, 3 stages IliA, 18 stages IIIB, 2 stages IVA. Therapeutic strategy consisted of a pre-operative or post-operative BCT in 27 patients, EBRT associated to BCT in 24 patients, and concurrent chemo-radiotherapy (CisPlatinum 40mg/m 2 weekly) in 74 patients. Median duration of BCT was 40 hours (4.8-130); the median dose at the envelope isodose was 20Gy (6-63). Pelvic EBRT was delivered in 98 patients. The median dose was 50.4 Gy (40-60 Gy). The dose per fraction was 1.8Gy in 82 patients; 4 fields box technique was used in 73 patients. Paraaortic EBRT was delivered in 12 patients at a median dose of 45 Gy (44-50gy). Results: In this series including 70% of patients with >IB2-111 tumor stages, the median follow-up was 17 (range: 6-58)
Gynaecology 366 poster workshop Study of prognostic factors in stage I-II uterine sarcomas A. Rovirosa 1, C. Ascaso 2, J. Ordl~, A. Arenas ~, S. Jorcano ~, J.A. Lejarcegu~~, Mellado B. 5, R. Molina ~, X. Iglesias 4, A. Biete,
I Hospital Clinic i Universitari, Radiation Oncology, Barcelona,
Spain 2Dpts. Biostatistics Unit 3pathology 4Gynaecology 5Medical Oncology ~Molecular Biology Purpose: To evaluate retrospectively the influence of prognostic factors on specific overall survival (OS), disease-free survival (DFS), local relapse-free survival (LRFS) and distant metastasis-free survival (DMFS) in 54 early stages uterine sarcomas diagnosed and treated at our Hospital from 1979 to 2003. Patients and methods: 54 Patients diagnosed and staged after surgery for uterine sarcomas. The mean and maximum follow-up of the entire series was 27 and 60 months (m) respectively. 8/54 patients were lost from follow-up. Figo stages: 48 stage I and 6 stage I1. 29/46 received postoperative irradiation. Variables analyzed: sarcoma type, myometrial invasion (MI), mitotic index, Uni/Multicentricity, necrosis, tumoral size, vascular and lymphatic space invasion (VLSI) and radiotherapy. Statistical study: Log-rank and Cox model of proportional risk; Hazard Ratio (HR) 95% CI. Results: Pathology. 1) Sarcoma type: 24 carcinosarcoma, 4 endometrial stromal sarcoma, 10 adenosarcoma and 8 leiomyosarcoma; 2) Mh 33 yes, 9 no, 4 not available (NA); 3) mitotic index (Min): <10 in 9, >10 in 30, NA in 7; 4) Uni/Multicentricity: 29 unicentric, 3 multicentric, 15 NA; 4) necrosis:'9 no, 26 yes, 11 NA; 5) tumoral size:< 8 cm. 24, >8cm. 12, NA 10; 6) VLSh 22 no, 12 yes, 12 NA; radiotherapy (29 yes,17 no). Tumoral size > 8 cm. was the only prognostic fa6tor which affected the different survivals. Mean values of survivals depending on the tumoral size < 8 cm. vs > 8 cm: OS 34m. vs 23m. (HR 2.52), DFS 31m. vs 17m. (HR 3.1), LRFS 311m. vs 18 m. (HR 3.1), DMFS 32m. vs 20m. (HR 2.63). Nevertheless, there was a high incidence of bad prognostic fa(~tors in these tumours: 72% had MI, 65% had high Min, 63% had multicentricity, 56% had necrosis, 26% tumour size >8cm., 26% had VLSI. Conclusions: Uterine sarcomas are tumours with an aggressive behaviour despite of the early stages. In the present series only tumour size > 8 cm. had impact on OS, DFS, LRFS and DMFS. 367 poster workshop The prognostic role of treatment related factors in locally advanced cervix cancer patients treated with radical radiotherapy G. Kosicka, A. Roszak, K. Bratos, H. Wlodarczyk, A. Wojciechowska-Lacka, M. Bogusz-Osawa Gread Poland Cancer Centre, Radiotherapy and Gynecological Oncology, Poznan, Poland introduction: staging, grading, histopatho!ogy, tumor volume, Hb level are commonly used prognostic factors in locally advanced (IIB-IVA) cervix cancer. There are also therapeutic factors predicting prognosis in radical radiotherapy treatment, such as overall treatment time and total dose delivered to the irradiated volume. The aim of this study is to estimate the influence of total tele- and brachytherapy radiation dose and overall treatment time on the overall survival.
Wednesday, October 27, 2004
$165
Materials and methods: In the group of 207 patients with squamous cell cervix cancer in IIIB stage influence of doses delivered with tele- and brachytherapy (brachytherapy fraction number), total dose and overall treatment time on overall survival were estimated. Cut-off values were estimated for each factor. Survival curves for each analysed group after considering cut-oft values were plotted and compared (KaplanMeier method, Wilcoxon test). Multivariate analysis (Cox proportional hazards model) was performed. Results: In univariate analysis correlations with survival and: (1) brachytherapy dose to point A (cut-oft value - 50 Gy), p=0,005 (2) number of brachytherapy fractions (1->2) p=0,002 (3) teletherapy dose (44Gy) p=o,o25 and (4) total dose to parametria (59 Gy) p=0,057 were confirmed. In the multivariate analysis the strongest survival prognostic factor was the dose delivered with brachytherapy to the point A. Conclusion: The strongest survival prognostic factor for pts with locally advanced cervix cancer (IIIB) appeared to be the dose delivered to the point A with brachytherapy. 368 poster workshop Carcinoma of the uterine cervix: a single institution experience using PDF brachytherapy in 125 consecutive patients O. Olszvk 1, Y. Belkac6mi 1, E. Leblanc 2 , T. Lacomerie 1, F. Narducci 2, M. Ozsahin 3, E. Lartigau 1, B. Castelain ~ ~Oscar Lambret Center, Department of Radiation Therapy, Lille, France 20scar Lambret, Department of Gynecological Surgery, Lille, France 3Centre H. du Vaudois, Lausanne, Switzerland Purpose: Controversy continues between advocates of radical surgery and radiation therapy (RT). In all cases rigorous tumor staging before treatment is mandatory. The combination of external beam radiation therapy (EBRT) + chemotherapy (CT), brachytherapy (BCT) and surgery is the standard of care in the management of carcinoma of the cervix. According to the tumor stage BCT is indicated before (or after) surgery or is associated to exclusive EBRT. Intracavitary BCT is delivered using variety of applicators. Pulsed dose rate (PDR) BCT presents potential advantages of the low dose rate (LDR) and radiation protection of HDR afterloading technology. In this study, we evaluated toxicity, local control and survival of PDR BCT as a part of the therapeutic management of uterine cervix carcinoma. Materials and Methods: Data from 125 patients with cervix carcinoma treated by PDR BCT between 1995 and 2003 were retrospectively analysed. Median age was 50 years (29-87). Histology was squamous cell carcinoma in 103 patients (83%), adenocarcinoma in 16 patients (13%). Tumor size was < 2 cm in 12 patients (10%), 2-3.9cm in 35 patients (29%), > 4 cm in 72 patients (60%). Most of patients had an MRI at the diagnostic and had a surgical node staging according to our protocols. According to FIGO staging there were 37 (30%) stages IB1, and 88 (70%) > IB2-111 (20 stages IB2, 11 stages IIA, 25 stages liB, 3 stages IliA, 18 stages IIIB, 2 stages IVA. Therapeutic strategy consisted of a pre-operative or post-operative BCT in 27 patients, EBRT associated to BCT in 24 patients, and concurrent chemo-radiotherapy (CisPlatinum 40mg/m 2 weekly) in 74 patients. Median duration of BCT was 40 hours (4.8-130); the median dose at the envelope isodose was 20Gy (6-63). Pelvic EBRT was delivered in 98 patients. The median dose was 50.4 Gy (40-60 Gy). The dose per fraction was 1.8Gy in 82 patients; 4 fields box technique was used in 73 patients. Paraaortic EBRT was delivered in 12 patients at a median dose of 45 Gy (44-50gy). Results: In this series including 70% of patients with >IB2-111 tumor stages, the median follow-up was 17 (range: 6-58)