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374 poster workshop Tumor volume as predictive determinant on survival in esophageal cancer treated with chemoradiotherapy
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Wednesday, October 27, 2004
treatment fraction. In 10 patients, CT resimulation was performed before the last boost fraction in order to assess for repositioning reproducibility via CT-to-CT registration and to estimate PTV safety margins around the CTV. Finally a comparative treatment planning study between BT and SRT was undertaken in two patients with an operated endometrial stage I cancer.
Results: No patient developed severe acute urinary or lowintestinal toxicity. No patient developed urinary late effects (>6 months). One patient with a vaginal relapse previously irradiated to the vaginal vault presented with grade-3 rectal bleeding 18 months after retreatment. A second patient known to suffer from irritable bowel syndrome, presented with grade-1 abdominal pain after treatment. The estimated PTV margins around the CTV were 9-10 mm with CT-to-CT IR marker registration. Both dynamic-arc and IMRT optimization succeeded to improve dose homogeneity to the PTV and to reduce the maximum dose to the rectum, when compared to BT. Conclusions: These results suggest that the use of external SRT in order to deliver a final boost to the areas at higher risk for relapse in endometrial or cervical cancer is feasible, well tolerated, and may be considered an acceptable alternative to BT.
Gastro-intestinal tumours 374 poster workshop
Tumor volume as predictive determinant on survival in esophageal cancer treated with chemoradiotherapy
G. Crehan.~e ~, M. Bosset ~, F. Lorchef, L. Chaigneau 3, M. Puyraveau , M. MercieP, P. Maingon 4, J. Bosset 1 ~University Hospital, Radiotherapy, Besangon cedex, France 2University of Franche Comt6, Biostatistics, Besangon cedex, France 3University Hospital, Medical Oncology, Besangon cedex, France 4Centre GF Leclerc, Radiotherapy, Dijon, France Background: Chemoradiotherapy (CTRT) is the standard treatment of locally advanced carcinomas. The TNM stage, as proposed by UICC, is generally not applicable. Purpose: We report on the results of a retrospective study about exclusive CTRT with analysis of prognostic factors for survival. Material & Methods: Between January 1993 and December 2001, 387 patients (pts) with esophageal cancer were registered in our 2 institutions. Patients with distant metastasis, second cancer, treated with palliative intent or with preoperative CTRT were excluded. One hundred forty eight pts were analysed. Median age: 65.7 years (y) (range 35.5-85.5y). SCC: 125 pts (85%), ADK: 19 pts (12.9%), other histology: 3 pts (2%). Tumor location: above carina 52pts (35.1%), at level of carina or beyond: 96 pts (64.9%). TNM following the 1978 UICC classification was: 21 T1 (14.2%), 57 T2 (38.5%), 55 T3 (37.2%), 14 Tx (9.5%), 18 NO (12.2%), 1 N1 (0.7%), 123 Nx (83.1%). CT classification used: TI: < 10 mm, T2:11-30 mm, T3: > 30 mm, T4: invades adjacent structures. According to the CT-scan classification, tumors were recorded as follows: 1 T1 (0.7%), 42 T2 (28.4%), 93 T3 (62.8%), 6 T4 (4.1%), 2 Nx (1.4%), 72 NO (48.6%), 74 N1 (50.0%). Tumor volume was calculated from the diagnostic CT-scan as following: M I = great dimension of the esophagus on the first slide identifying the tumor, M3= great dimension of the esophagus on the last slide identifying the tumor, M2= greatest dimension of the esophagus existing in the middle of the tumor and H= height between first and last slides. Thus, volume (V) formula considers the tumor as the sum of two truncated-cones: V= [(=. H)/16 ] x (M12 +
Poster workshops
2.M22 + M32). Median tumoral volume was 57.5 cm 3 (range 0.6288 cm3). The radiotherapy schemes were either continuous RT: 121 pts (81.8%), or a split-course RT: 27 pts (18.2%). Median total dose was 54.2 Gy (range 15-66 Gy). Concurrent chemotherapy was either 5-FU/CDDP combination or CDDP alone.
Results: Median follow-up of 68 months (range 16 - 124 mths). Overall survival (OS) rates at 1, 2 and 3 y were respectively 42.5%, 21.6% and 8%. Univariate analysis found five significant prognostic factors, as follows: dysphagia grade 2-4 (p=0.022), other histology than SCC (p= 0.016), location at the carina or beyond (p= 0.010), age < 65 y. (p=0.046) and tumor volume > 100cm 3 (p=0.031). Multivariate analysis was performed, and found four independent prognostic factors: dysphagia gr. > 2 (p=0.013), weight loss> 10% (p=0.047), location at the carina or beyond (p= 0.002) and tumor volume > 100 cm 3 (p= 0.041 ). Conclusion: In these patients where the TNM staging system is not applicable, tumor volume appears to be a powerful determinant on OS. That should be validated prospectively. 375 poster workshop The UWO prognostic index for stage I1-111rectal carcinoma patients treated with post-operative chemoradiation
C..~-eLqhton1, E. Brecevic ~, L. Stitt ~, F. Perera ~, B. Fisher ~, /. Kerr 2, M. Vincent 2, B. Dingle 2, D. Logan 2 ~University of Western Ontario, Radiation Oncology, London, Canada 2University of Westem Ontario, Medical Oncology, London, Canada Purpose: A Prognostic Index was devised on a comprehensive database of Stage I1-111rectal cancer patients treated uniformly with post-operative radiation and 5-Fluouracil chemotherapy at the University of Western Ontario from 1993-2002. Methods: All 314 rectal cancer patients treated according to arm 2 of the RTOG 9403 protocol were analyzed. Patients had post-operative bolus 5-Fluouracil (5-FU, 2 courses), followed by concurrent pelvic radiation and continuous infusion 5-FU, followed by additional 5-FU (2 courses). A prognostic survival model was devised according to the method of Collett: i) Univariate survival analysis of the following prognostic factors was completed (a=0.10): High Risk (T4 or N2), RT breaks, Male Gender, Age> 65, Surgical Approach, Tumor Size > 5cm, Distal tumor extent, Positive Margins, Teaching Hospital, Chemotherapy dose reduction/breaks, RT breaks/delays, RT dose>5040 cGy, Interval between Surgery + R T > 120 days. ii) Multivariate analysis of all significant variables was completed by initial backward elimination (a=0.01). Forward selection (a=0.01) was then completed, including the variables n o t significant in the univariate analysis, to test if any of these variable may enter the reduced model created by backward elimination, iii) A prognostic scoring system was generated based on the estimated log hazard ratios for the prognostic factors in the final model. Survival analysis based on the constructed model was then completed on our patient population. Results: Three prognostic factors comprised the model: High pathologic risk (T4 or N2, Hazard ratio, HZR 3.93 (2.49, 6.19), p< 0.001); Male Gender (HZR 1.92 (1.17, 3.16), p=0.01); Age > 65 years (HZR 2.08 (1.32, 3.29), p=0.02). Construction of the prognostic index was based on a scoring system of 0-4, with High pathologic risk = 2, Male Gender = 1, and Age>65 years = 1. Four-year survival time for scores of 0-1, 2-3, and 4 were 82%, 64%, and 13%. Conclusions: The formulated model categorizes prognostic classes of patients with stage II-III rectal carcinoma and may be helpful in making treatment recommendations to those
Wednesday, October 27, 2004
treatment fraction. In 10 patients, CT resimulation was performed before the last boost fraction in order to assess for repositioning reproducibility via CT-to-CT registration and to estimate PTV safety margins around the CTV. Finally a comparative treatment planning study between BT and SRT was undertaken in two patients with an operated endometrial stage I cancer.
Results: No patient developed severe acute urinary or lowintestinal toxicity. No patient developed urinary late effects (>6 months). One patient with a vaginal relapse previously irradiated to the vaginal vault presented with grade-3 rectal bleeding 18 months after retreatment. A second patient known to suffer from irritable bowel syndrome, presented with grade-1 abdominal pain after treatment. The estimated PTV margins around the CTV were 9-10 mm with CT-to-CT IR marker registration. Both dynamic-arc and IMRT optimization succeeded to improve dose homogeneity to the PTV and to reduce the maximum dose to the rectum, when compared to BT. Conclusions: These results suggest that the use of external SRT in order to deliver a final boost to the areas at higher risk for relapse in endometrial or cervical cancer is feasible, well tolerated, and may be considered an acceptable alternative to BT.
Gastro-intestinal tumours 374 poster workshop
Tumor volume as predictive determinant on survival in esophageal cancer treated with chemoradiotherapy
G. Crehan.~e ~, M. Bosset ~, F. Lorchef, L. Chaigneau 3, M. Puyraveau , M. MercieP, P. Maingon 4, J. Bosset 1 ~University Hospital, Radiotherapy, Besangon cedex, France 2University of Franche Comt6, Biostatistics, Besangon cedex, France 3University Hospital, Medical Oncology, Besangon cedex, France 4Centre GF Leclerc, Radiotherapy, Dijon, France Background: Chemoradiotherapy (CTRT) is the standard treatment of locally advanced carcinomas. The TNM stage, as proposed by UICC, is generally not applicable. Purpose: We report on the results of a retrospective study about exclusive CTRT with analysis of prognostic factors for survival. Material & Methods: Between January 1993 and December 2001, 387 patients (pts) with esophageal cancer were registered in our 2 institutions. Patients with distant metastasis, second cancer, treated with palliative intent or with preoperative CTRT were excluded. One hundred forty eight pts were analysed. Median age: 65.7 years (y) (range 35.5-85.5y). SCC: 125 pts (85%), ADK: 19 pts (12.9%), other histology: 3 pts (2%). Tumor location: above carina 52pts (35.1%), at level of carina or beyond: 96 pts (64.9%). TNM following the 1978 UICC classification was: 21 T1 (14.2%), 57 T2 (38.5%), 55 T3 (37.2%), 14 Tx (9.5%), 18 NO (12.2%), 1 N1 (0.7%), 123 Nx (83.1%). CT classification used: TI: < 10 mm, T2:11-30 mm, T3: > 30 mm, T4: invades adjacent structures. According to the CT-scan classification, tumors were recorded as follows: 1 T1 (0.7%), 42 T2 (28.4%), 93 T3 (62.8%), 6 T4 (4.1%), 2 Nx (1.4%), 72 NO (48.6%), 74 N1 (50.0%). Tumor volume was calculated from the diagnostic CT-scan as following: M I = great dimension of the esophagus on the first slide identifying the tumor, M3= great dimension of the esophagus on the last slide identifying the tumor, M2= greatest dimension of the esophagus existing in the middle of the tumor and H= height between first and last slides. Thus, volume (V) formula considers the tumor as the sum of two truncated-cones: V= [(=. H)/16 ] x (M12 +
Poster workshops
2.M22 + M32). Median tumoral volume was 57.5 cm 3 (range 0.6288 cm3). The radiotherapy schemes were either continuous RT: 121 pts (81.8%), or a split-course RT: 27 pts (18.2%). Median total dose was 54.2 Gy (range 15-66 Gy). Concurrent chemotherapy was either 5-FU/CDDP combination or CDDP alone.
Results: Median follow-up of 68 months (range 16 - 124 mths). Overall survival (OS) rates at 1, 2 and 3 y were respectively 42.5%, 21.6% and 8%. Univariate analysis found five significant prognostic factors, as follows: dysphagia grade 2-4 (p=0.022), other histology than SCC (p= 0.016), location at the carina or beyond (p= 0.010), age < 65 y. (p=0.046) and tumor volume > 100cm 3 (p=0.031). Multivariate analysis was performed, and found four independent prognostic factors: dysphagia gr. > 2 (p=0.013), weight loss> 10% (p=0.047), location at the carina or beyond (p= 0.002) and tumor volume > 100 cm 3 (p= 0.041 ). Conclusion: In these patients where the TNM staging system is not applicable, tumor volume appears to be a powerful determinant on OS. That should be validated prospectively. 375 poster workshop The UWO prognostic index for stage I1-111rectal carcinoma patients treated with post-operative chemoradiation
C..~-eLqhton1, E. Brecevic ~, L. Stitt ~, F. Perera ~, B. Fisher ~, /. Kerr 2, M. Vincent 2, B. Dingle 2, D. Logan 2 ~University of Western Ontario, Radiation Oncology, London, Canada 2University of Westem Ontario, Medical Oncology, London, Canada Purpose: A Prognostic Index was devised on a comprehensive database of Stage I1-111rectal cancer patients treated uniformly with post-operative radiation and 5-Fluouracil chemotherapy at the University of Western Ontario from 1993-2002. Methods: All 314 rectal cancer patients treated according to arm 2 of the RTOG 9403 protocol were analyzed. Patients had post-operative bolus 5-Fluouracil (5-FU, 2 courses), followed by concurrent pelvic radiation and continuous infusion 5-FU, followed by additional 5-FU (2 courses). A prognostic survival model was devised according to the method of Collett: i) Univariate survival analysis of the following prognostic factors was completed (a=0.10): High Risk (T4 or N2), RT breaks, Male Gender, Age> 65, Surgical Approach, Tumor Size > 5cm, Distal tumor extent, Positive Margins, Teaching Hospital, Chemotherapy dose reduction/breaks, RT breaks/delays, RT dose>5040 cGy, Interval between Surgery + R T > 120 days. ii) Multivariate analysis of all significant variables was completed by initial backward elimination (a=0.01). Forward selection (a=0.01) was then completed, including the variables n o t significant in the univariate analysis, to test if any of these variable may enter the reduced model created by backward elimination, iii) A prognostic scoring system was generated based on the estimated log hazard ratios for the prognostic factors in the final model. Survival analysis based on the constructed model was then completed on our patient population. Results: Three prognostic factors comprised the model: High pathologic risk (T4 or N2, Hazard ratio, HZR 3.93 (2.49, 6.19), p< 0.001); Male Gender (HZR 1.92 (1.17, 3.16), p=0.01); Age > 65 years (HZR 2.08 (1.32, 3.29), p=0.02). Construction of the prognostic index was based on a scoring system of 0-4, with High pathologic risk = 2, Male Gender = 1, and Age>65 years = 1. Four-year survival time for scores of 0-1, 2-3, and 4 were 82%, 64%, and 13%. Conclusions: The formulated model categorizes prognostic classes of patients with stage II-III rectal carcinoma and may be helpful in making treatment recommendations to those