- Email: [email protected]
545 Poster In vivo imaging of radiation-induced apoptosis by 99mTc-Annexin-V scintigraphy in follicular lymphoma patients
Posters
Wednesday/Thursday, 18-19 September 2002 $171
Conclusion: This study shows for the first time the high efficacy of this low dose RT regimen in NLPHL and demonstrates an 83% CR rate after 4 Gy IF-RT. Further follow-up and more patients are needed to confirm the clinical valueof this regimen and the duration of response. A new EORTC trial will be initiated to study this radiation regimen in NLPHL.
Total skin electron irradiation (TSEI) in mycosis fungoides (MF): comparison between a modified Christie Hospital recumbent translational technique and the Stanford tech-
presence of apoptotic cells as visualised on the post-treatment scintigraphic images. In 1 patient the cytology was positive for apoptosis whereas the scan was negative. None of the post-irradiation images showed false-positive results. Conclusion: Radiation-induced apoptosis in follicular lymphoma patients can be visualised at early stages in vivo by TAV scintigraphy. We find that the optimal timing for apoptosis assessment by FNAC (or biopsy) and TAV scintigraphy in the setting of this radiation regimen is on day 4. TAV scintigraphy may prove an easy and rapid predictive assay for treatment outcome in follicular lymphoma patients.
~ique
546
A. Kuten,~ Y. Anacak, Z. Arican, K. Drumea, E. Rosenblatt, A. Tamir, L. Chetver, M. Stein, R. Bar Deroma Dept. of Oncology, Rambam Med. Ctr. Faculty of Medicine, Technion, Haifa, Israel
Radiotherapy (RT) or combined chemotherapy (CT) and
543
Poster
Purpose: to compare the success and complication rates of TSEI in MF using the Stanford method vs a modified Christie Hospital recumbent translational technique. Patients and methods: between 1979-1999, 71 pts received TSEI in MF using the Stanford method vs a modified Christie Hospital recumbent translational technique (1979-1992, 44 pts, 62%) or the 6 dual field Stanford technique (1992-1999, 27 pts, 38%). The following total doses and doses per fraction were given: the modified Christie HQspitat technique: total dose; median: 32 Gy, Range 16-44 Gy. Dose/fraction; Median: 4 Gy, Range: 1.54 Gy. Fractions/month: 2-8. The Stanford Technique: Total dose; median: 30 Gy, Range 15-36 Gy. Dose/fraction; Median: 2.5 Gy, Range 1.2-3.3 Gy. Fractions/month: 5-28. Results: 64 pts (90%) achieved CR and 4 (5.5%) PR, with no difference in RR between the two techniques. With a median follow-up of 61 months, 43 pts developed recurrence. The 5-year OS and DSF were 63% and 25% with the modified Christie Hospital recumbent technique and 45% and 18% with the Stanford technique (p=0.88; 0.87). total dose and fractionation parameters did not influence DFS. Moderate/severe skin reactions appeared in 26 pts (41.5%). Severe skin toxicity was uncommon with the Stanford technique (p=0.026) dose/fraction <4 Gy (p=0.32) and when more than 6frs/montl3 were given (0.032). Conclusion: the Stanford method is superior to the modified Christie Hospital method in terms of skin toxicity, however there is no significant difference in RR, DSF and OS between the two techniques. 545 Poster In vivo imaging of radiation-induced apoptosis by 99mTc-
Annexin-V scintigraphy in follicular lymphoma patients R.L.M. Haas 1, D. de Jong 2, R.A. Va/des-O/mos 3, S.F. Zerp 1, I. van den Heuvei3, H. Bartelink 1, M. Verheij 1 1The Netherlands Cancer Institute, Radiotherapy, Amsterdam, The Netherlands 2The Netherlands Cancer Institute, Pathology, Amsterdam, The Netherlands 3The Netherlands Cancer Institute, Nuclear Medecin, Amsterdam, The Netherlands Purpose: To study whether radiation-induced apoptosis in follicular lymphoma patients can be visualised in vivo by 99mTc-Annexin-V (TAV) scintigraphy. Annexin V is an endogenous human peptide with a high affinity for membrane-bound phosphatidylserine, which becomes exposed at the outer leaflet of the plasma membrane at an early stage of the apoptotic process.
Methods and patients: 7 recurrent follicularlymphoma patients scheduled for local palliative irradiation were imaged by TAV scintigraphy within 1 week before treatment. Patients were irradiated by 2 fractions of 2 Gy on days 1 and 3, and rescanned on day 4. Fine needle aspiration cytology (FNAC) was performed on days 1,2, 3, 4 and 5 to characterise the cellular response and to investigate the optimal timing for apoptosis assessment. Cells were studied for morphological evidence of apoptosis by standard H&E and bisbenzimide staining. The study was approved by the local ethical committee. Results: All patients received a baseline and post-treatment scan. In 5/7 patients baseline scans were negative. In 2 patients with minimal T~.V uptake at the tu~nour site on the baseline scan, the pretreatment histopathological specimens confirmed th.e presence of sporadic spontaneous apoptosis. In 5/7 patients po.st-treatmefit scans showed a strong increase in TAV uptake at:the irradiated tumour sites as compared with the baseline scans. ih 2 patients the post-treatment scan remained unchanged (1 negative; 1 weakly positive). In 6/7 patients the cytological response confirmed the
Poster
radiotherapy to treat primary extranodal Non-Hodgkin's L y m p h o m a (NHL) o f the head and neck: a retrospective analysis o f 107 p a t i e n t s (pts) S.M. Maarini 1, M. Buglione 1, P. Frata 1, A. Somensari 1, N. Pietta 1, G: Rossi2 llstituto del Radio O. Alberti, Radiation Oncology, Brescia, Italy 2Ematologia, Spedali Civili, Brescia, Italy Introduction: NHL arising in the head and neck district are the second most frequent presentation of localised extranodal lymphomas. Treatment options usually include both exclusive RT as well as combined modality approach, using an antracycline-based CT followed by involved fields (IF) radiotherapy. In order to clarify the role of radiotherapy in this particular subset of extranodal lymphomas, we retrospectively analysed clinical characteristics and treatment outcome in a series of pts with primary extranodal NHL of the head and neck. Patients and methods: From 1985 to 2000, t07 pts with a new diagnosis of head and neck extranodal NHL were sequentially treated at our Institution. Median age at diagnosis was 63 yrs (17-86). First site of localization was Waldeyer's ring in 88 pts (82,3%) and other head and neck sites in 19 pts (17,7%). 50 pts had stage I and 57 stage II disease. 86 pts (80%) had a high grade histology and 21 pts (20%) had a low grade NHL. 53 pts (49,5%) had only extranodal disease (E) and 54 .(50,4%) had both nodal and extranodal Iocalizatiens (N+E). International Prognostic Index (IPI) was: Low, 76 pts (71%), Low-intermediate, 26 pts (24,2%), Intermediate-High, 5 pts (4,7%). Treatment consisted of radical RT in 59 pts (55,2%) -34 pts with E and 25 pts with E+N disease - and in combined antracycline-containing CT and IFRT in 48 pts (44,8%)-19 E and 29 E+N disease. 66% of the pts who were treated with radical RT was >65 years old; 88% had PS-ECOG 1 or 2 (respectively 61% and 27%). Results: CR- and PR- ratio were respectively 86,4% and 13,5% after RT alone; 54% and 35% after CT and 87,5% and 8,3% after RT in the RT+CT group. After a median follow-up of 43,4 months (2,9-201,9) the 5-year actuarial overall survival rate (OS), disease specific survival (DSS) and disease free survival (DFS) were respectively 60,71%, 67,5% and 61,2%. OS, DSS and DFS were significantly better after CT+RT for pts with stage II and high grade disease (respectively 63%, 66%, 68% vs 38%, 48%, 38% and 66%, 74%, 69% vs 49%, 54%, 54%). Conclusion: These preliminary data confirm the role of radiotherapy as effective and safe therapeutic approach for both local disease control and curative intention in limited stage Waldeyer's ring NHL patients. RT may have a unique role in specific subsets of older patients who are not eligible for aggressive regimens of chemotherapy. 547
Poster
Stages I and II aggressive non-Hodgkin's lymphomas of the head and neck: radiotherapy alone as a treatment option and the usefulness of the new prognostic index B-ALPS N. Hayabuchi 1, Y. Shibamoto 2, K. Nakamura 3, Y. Onizuka 4, E. Ogo 1, G. Suzuki 1, Y. Toda 1 1Kurume University Medical School, Radiology, Kurume, Japan 2Nagoya City University Medical School, Radiology, Nagoya, Japan 3Kyushu University, Radiology, Fukuoka, Japan 4Kyushu University, Health Sciences, Fukuoka, Japan Purpose: To evaluate outcome according to treatment modality and prognostic factors in clinical stages t and II intermediate- or high-grade lymphomas of the head and neck. Materials and Methods: We analyzed 201 patients treated between 1983 and 1997, excluding those with the Working Formulation low-grade lymphomas. Of these patients, 114 had stage I and 87 had stage II diseases. Forty-nine patients were treated with radiotherapy alone, whereas 152
Wednesday/Thursday, 18-19 September 2002 $171
Conclusion: This study shows for the first time the high efficacy of this low dose RT regimen in NLPHL and demonstrates an 83% CR rate after 4 Gy IF-RT. Further follow-up and more patients are needed to confirm the clinical valueof this regimen and the duration of response. A new EORTC trial will be initiated to study this radiation regimen in NLPHL.
Total skin electron irradiation (TSEI) in mycosis fungoides (MF): comparison between a modified Christie Hospital recumbent translational technique and the Stanford tech-
presence of apoptotic cells as visualised on the post-treatment scintigraphic images. In 1 patient the cytology was positive for apoptosis whereas the scan was negative. None of the post-irradiation images showed false-positive results. Conclusion: Radiation-induced apoptosis in follicular lymphoma patients can be visualised at early stages in vivo by TAV scintigraphy. We find that the optimal timing for apoptosis assessment by FNAC (or biopsy) and TAV scintigraphy in the setting of this radiation regimen is on day 4. TAV scintigraphy may prove an easy and rapid predictive assay for treatment outcome in follicular lymphoma patients.
~ique
546
A. Kuten,~ Y. Anacak, Z. Arican, K. Drumea, E. Rosenblatt, A. Tamir, L. Chetver, M. Stein, R. Bar Deroma Dept. of Oncology, Rambam Med. Ctr. Faculty of Medicine, Technion, Haifa, Israel
Radiotherapy (RT) or combined chemotherapy (CT) and
543
Poster
Purpose: to compare the success and complication rates of TSEI in MF using the Stanford method vs a modified Christie Hospital recumbent translational technique. Patients and methods: between 1979-1999, 71 pts received TSEI in MF using the Stanford method vs a modified Christie Hospital recumbent translational technique (1979-1992, 44 pts, 62%) or the 6 dual field Stanford technique (1992-1999, 27 pts, 38%). The following total doses and doses per fraction were given: the modified Christie HQspitat technique: total dose; median: 32 Gy, Range 16-44 Gy. Dose/fraction; Median: 4 Gy, Range: 1.54 Gy. Fractions/month: 2-8. The Stanford Technique: Total dose; median: 30 Gy, Range 15-36 Gy. Dose/fraction; Median: 2.5 Gy, Range 1.2-3.3 Gy. Fractions/month: 5-28. Results: 64 pts (90%) achieved CR and 4 (5.5%) PR, with no difference in RR between the two techniques. With a median follow-up of 61 months, 43 pts developed recurrence. The 5-year OS and DSF were 63% and 25% with the modified Christie Hospital recumbent technique and 45% and 18% with the Stanford technique (p=0.88; 0.87). total dose and fractionation parameters did not influence DFS. Moderate/severe skin reactions appeared in 26 pts (41.5%). Severe skin toxicity was uncommon with the Stanford technique (p=0.026) dose/fraction <4 Gy (p=0.32) and when more than 6frs/montl3 were given (0.032). Conclusion: the Stanford method is superior to the modified Christie Hospital method in terms of skin toxicity, however there is no significant difference in RR, DSF and OS between the two techniques. 545 Poster In vivo imaging of radiation-induced apoptosis by 99mTc-
Annexin-V scintigraphy in follicular lymphoma patients R.L.M. Haas 1, D. de Jong 2, R.A. Va/des-O/mos 3, S.F. Zerp 1, I. van den Heuvei3, H. Bartelink 1, M. Verheij 1 1The Netherlands Cancer Institute, Radiotherapy, Amsterdam, The Netherlands 2The Netherlands Cancer Institute, Pathology, Amsterdam, The Netherlands 3The Netherlands Cancer Institute, Nuclear Medecin, Amsterdam, The Netherlands Purpose: To study whether radiation-induced apoptosis in follicular lymphoma patients can be visualised in vivo by 99mTc-Annexin-V (TAV) scintigraphy. Annexin V is an endogenous human peptide with a high affinity for membrane-bound phosphatidylserine, which becomes exposed at the outer leaflet of the plasma membrane at an early stage of the apoptotic process.
Methods and patients: 7 recurrent follicularlymphoma patients scheduled for local palliative irradiation were imaged by TAV scintigraphy within 1 week before treatment. Patients were irradiated by 2 fractions of 2 Gy on days 1 and 3, and rescanned on day 4. Fine needle aspiration cytology (FNAC) was performed on days 1,2, 3, 4 and 5 to characterise the cellular response and to investigate the optimal timing for apoptosis assessment. Cells were studied for morphological evidence of apoptosis by standard H&E and bisbenzimide staining. The study was approved by the local ethical committee. Results: All patients received a baseline and post-treatment scan. In 5/7 patients baseline scans were negative. In 2 patients with minimal T~.V uptake at the tu~nour site on the baseline scan, the pretreatment histopathological specimens confirmed th.e presence of sporadic spontaneous apoptosis. In 5/7 patients po.st-treatmefit scans showed a strong increase in TAV uptake at:the irradiated tumour sites as compared with the baseline scans. ih 2 patients the post-treatment scan remained unchanged (1 negative; 1 weakly positive). In 6/7 patients the cytological response confirmed the
Poster
radiotherapy to treat primary extranodal Non-Hodgkin's L y m p h o m a (NHL) o f the head and neck: a retrospective analysis o f 107 p a t i e n t s (pts) S.M. Maarini 1, M. Buglione 1, P. Frata 1, A. Somensari 1, N. Pietta 1, G: Rossi2 llstituto del Radio O. Alberti, Radiation Oncology, Brescia, Italy 2Ematologia, Spedali Civili, Brescia, Italy Introduction: NHL arising in the head and neck district are the second most frequent presentation of localised extranodal lymphomas. Treatment options usually include both exclusive RT as well as combined modality approach, using an antracycline-based CT followed by involved fields (IF) radiotherapy. In order to clarify the role of radiotherapy in this particular subset of extranodal lymphomas, we retrospectively analysed clinical characteristics and treatment outcome in a series of pts with primary extranodal NHL of the head and neck. Patients and methods: From 1985 to 2000, t07 pts with a new diagnosis of head and neck extranodal NHL were sequentially treated at our Institution. Median age at diagnosis was 63 yrs (17-86). First site of localization was Waldeyer's ring in 88 pts (82,3%) and other head and neck sites in 19 pts (17,7%). 50 pts had stage I and 57 stage II disease. 86 pts (80%) had a high grade histology and 21 pts (20%) had a low grade NHL. 53 pts (49,5%) had only extranodal disease (E) and 54 .(50,4%) had both nodal and extranodal Iocalizatiens (N+E). International Prognostic Index (IPI) was: Low, 76 pts (71%), Low-intermediate, 26 pts (24,2%), Intermediate-High, 5 pts (4,7%). Treatment consisted of radical RT in 59 pts (55,2%) -34 pts with E and 25 pts with E+N disease - and in combined antracycline-containing CT and IFRT in 48 pts (44,8%)-19 E and 29 E+N disease. 66% of the pts who were treated with radical RT was >65 years old; 88% had PS-ECOG 1 or 2 (respectively 61% and 27%). Results: CR- and PR- ratio were respectively 86,4% and 13,5% after RT alone; 54% and 35% after CT and 87,5% and 8,3% after RT in the RT+CT group. After a median follow-up of 43,4 months (2,9-201,9) the 5-year actuarial overall survival rate (OS), disease specific survival (DSS) and disease free survival (DFS) were respectively 60,71%, 67,5% and 61,2%. OS, DSS and DFS were significantly better after CT+RT for pts with stage II and high grade disease (respectively 63%, 66%, 68% vs 38%, 48%, 38% and 66%, 74%, 69% vs 49%, 54%, 54%). Conclusion: These preliminary data confirm the role of radiotherapy as effective and safe therapeutic approach for both local disease control and curative intention in limited stage Waldeyer's ring NHL patients. RT may have a unique role in specific subsets of older patients who are not eligible for aggressive regimens of chemotherapy. 547
Poster
Stages I and II aggressive non-Hodgkin's lymphomas of the head and neck: radiotherapy alone as a treatment option and the usefulness of the new prognostic index B-ALPS N. Hayabuchi 1, Y. Shibamoto 2, K. Nakamura 3, Y. Onizuka 4, E. Ogo 1, G. Suzuki 1, Y. Toda 1 1Kurume University Medical School, Radiology, Kurume, Japan 2Nagoya City University Medical School, Radiology, Nagoya, Japan 3Kyushu University, Radiology, Fukuoka, Japan 4Kyushu University, Health Sciences, Fukuoka, Japan Purpose: To evaluate outcome according to treatment modality and prognostic factors in clinical stages t and II intermediate- or high-grade lymphomas of the head and neck. Materials and Methods: We analyzed 201 patients treated between 1983 and 1997, excluding those with the Working Formulation low-grade lymphomas. Of these patients, 114 had stage I and 87 had stage II diseases. Forty-nine patients were treated with radiotherapy alone, whereas 152