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62 SINGLE FRACTION STEREOTACTIC BODY RADIATION THERAPY (SBRT) AND SEQUENTIAL GEMCITABINE FOR THE TREATMENT OF LOCALLY ADVANCED PANCREATIC CANCER
S20 Materials and Methods: Gastric cell lines, N87 and 746T, were treated at 4 Gy and at 0 Gy over a dose range of Nu7026 from 0 to 100 uM. Cell viability after treatment with Nu7026 was determined using the MTT assay. Fluorescence-Activated Cell Sorting (FACS) analysis was performed to determine cell cycle distribution. Clonogenic assays are planned to further explore the effects of Nu7026 on radio-enhancement and cell survival. Results: N87 had IC50 doses when treated with Nu7026 alone and Nu7026 and 4 Gy were of 17.5 and 12.5 uM respectively. When treated with combined modality, N87 demonstrated a significant decrease in cell viability when compared to radiation alone (P = 0.001). 746T demonstrated IC50s of 39 uM and 19 uM when treated with Nu7026 alone and Nu7026 and radiation respectively. Cell viability was significantly less when 746T was treated with Nu7026 and radiation compared to radiation alone (p=0.0003). FACS analysis of N87 demonstrated a peak in G2 after radiation. When radiation was combined with Nu7026 the G2 peak was persistent compared to nonirradiated controls. Conclusion: Nu7026 appears to enhance the cytotoxic effect of ionizing radiation on gastric cancer cell lines when assessed with cell viability assays. FACS analysis shows a predominant G2 peak in cells treated with Nu7026 and radiation. These results suggest that the combination of DNA-PK inhibition and radiation may cause cell cycle arrest at G2. The results of the clonogenic assays will be included in the final results. 62 SINGLE FRACTION STEREOTACTIC BODY RADIATION THERAPY (SBRT) AND SEQUENTIAL GEMCITABINE FOR THE TREATMENT OF LOCALLY ADVANCED PANCREATIC CANCER D. Schellenberg1, J. Kim2, L.-A. Columbo2, G. Fisher2, A. Quon2, T. Desser2, P. Maxim2, K. Goodman3, D. Chang2, A. Koong2, 1 British Columbia Cancer Agency, Vancouver, BC 2 Stanford University, Stanford, CA 3 Memorial Sloan Kettering, New York, NY Purpose: Conventionally delivered radiation therapy over five to six weeks in conjunction with chemotherapy achieves only modest local control and survival in locally advanced pancreas cancer. This Phase II trial evaluates the toxicity, local control and survival of patients treated with sequential gemcitabine and single fraction stereotactic body radiotherapy (SBRT) delivered by the Varian Trilogy linear accelerator. Materials and Methods: Twenty patients with locally advanced, non-metastatic pancreatic adenocarcinoma were enrolled on this single institution, IRB approved study. Gemcitabine was administered on day one, eight, and 15 with radiation on day 29 and gemcitabine restarting on day 43 and continuing for three to five cycles. SBRT of 25 Gy in a single fraction was delivered to the internal target volume (ITV) with a 2-3mm margin using a 9 field IMRT technique and respiratory gating. Follow up evaluations occurred at four to six weeks, 1012 weeks, and every three months after SBRT. Results: All patients completed SBRT and a median of five cycles of chemotherapy was delivered. Median follow up was 11.8 months overall and 23.2 months in living patients. No acute grade 3 toxicity was observed. Grade 2 late toxicities arose in four patients (20%) and consisted of two duodenal ulcers, one gastric ulcer and one duodenal perforation. Median survival was 11.8 months with one-year survival of 50% and two-year survival of 24%. The local control rate was 94% at one year. Conclusion: Linear accelerator delivered SBRT with sequential gemcitabine is a well tolerated treatment which results in excellent local control of non-resectable pancreatic cancer. Overall survival results are encouraging.
CARO 2009 63 DYSPAREUNIA AFTER CHEMORADIATION (CHEMO-RT) FOR ANAL CARCINOMA - AN UNDER REPORTED COMPLICATION H. McCarty1, R. Wong1, B. Cummings1, K. Gilhooly2, W. Levin1 1 University of Toronto, Princess Margaret Hospital, Toronto, ON 2 Princess Margaret Hospital, Toronto, ON Purpose: Anal carcinoma can be cured with timely anal sphincter conserving chemo-RT and many patients resume a full lifestyle after treatment. Female survivors however may have radiation induced vaginal toxicity that impacts greatly on their ability to maintain sexual activity. Whilst this is a known complication, the extent of the problem has not been well documented. Materials and Method: The host institution has an established clinic for all cancer patients with radiation late effects. Patients are assessed and managed by a dedicated team using consult with physical examination and quality of life questionnaires. The characteristics of the patients referred with dyspareunia over an eight year period have been analyzed. Results: Twenty-nine patients with vaginal dysfunction were seen at the clinic. Fifteen patients (52%) had chemo-RT for anal carcinoma. This represents 8.5% of the 176 female anal carcinoma patients treated during that period. The median age at referral was 55 years. All patients had been treated with radical intent using concurrent chemo-RT with a median dose of 63 Gy. Forty-three of 176 patients were treated with intensity modulated radiation therapy (IMRT), of these, six patients (14%) developed dyspareunia. Median time from completion of therapy to onset of symptoms was four months (range 0-85) and median duration of symptoms when referred was eight months (1–104). The reason for dyspareunia was multifactorial. Eight patients had grade 2 EORTC CTCv3.0 vaginal stenosis and one had a grade 3 stenosis. Six had dyspareunia without clinically detectable stenosis. Conclusion: Dyspareunia is a real and pertinent issue for many sexually active survivors of anal cancer. The extent of the problem may still be underestimated as only the more symptomatic cases were likely referred. Symptoms often start within weeks of completing treatment suggesting that patient education and preventative interventions should be considered during anal cancer therapy. 64 PELVIC RADIATION IN PATIENTS WITH A PELVIC KIDNEY: NO LONGER PLAYING WITH FIRE D. Berlach, M. Brodeur, F. Cury McGill University Health Centre, Montréal, QC Purpose: With improvements in surgical techniques and better control of post-transplantation complications, there are a growing number of long-term kidney transplantation survivors. This has spawned a new subpopulation of patients with pelvic kidneys who are surviving long enough to develop prostate cancer. Classically, radiation therapy (RT) was contraindicated for these patients due to the high sensitivity of the transplanted organ and its proximity to the prostate. With advances in RT over the past few decades, namely intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT), a pelvic kidney may no longer be a contraindication to pelvic RT. Materials and Methods: We present a series of treatment plans for patients with renal transplantation who developed prostate cancer and were treated with radical RT using IMRT technique delivered via helical tomotherapy (HT). Seven plans per patient were developed to illustrate circumstances when the pelvic nodes are or are not included in the treatment plan. We then compared the dosimetric aspects of the HT plans to 2Dconventional EBRT, 3D-CRT and LinAc-based IMRT. We treated the prostate, with or without the proximal seminal vesicles, using 0.7 cm margins to PTV, to a dose of 72 Gy delivered in 36
CARO 2009 63 DYSPAREUNIA AFTER CHEMORADIATION (CHEMO-RT) FOR ANAL CARCINOMA - AN UNDER REPORTED COMPLICATION H. McCarty1, R. Wong1, B. Cummings1, K. Gilhooly2, W. Levin1 1 University of Toronto, Princess Margaret Hospital, Toronto, ON 2 Princess Margaret Hospital, Toronto, ON Purpose: Anal carcinoma can be cured with timely anal sphincter conserving chemo-RT and many patients resume a full lifestyle after treatment. Female survivors however may have radiation induced vaginal toxicity that impacts greatly on their ability to maintain sexual activity. Whilst this is a known complication, the extent of the problem has not been well documented. Materials and Method: The host institution has an established clinic for all cancer patients with radiation late effects. Patients are assessed and managed by a dedicated team using consult with physical examination and quality of life questionnaires. The characteristics of the patients referred with dyspareunia over an eight year period have been analyzed. Results: Twenty-nine patients with vaginal dysfunction were seen at the clinic. Fifteen patients (52%) had chemo-RT for anal carcinoma. This represents 8.5% of the 176 female anal carcinoma patients treated during that period. The median age at referral was 55 years. All patients had been treated with radical intent using concurrent chemo-RT with a median dose of 63 Gy. Forty-three of 176 patients were treated with intensity modulated radiation therapy (IMRT), of these, six patients (14%) developed dyspareunia. Median time from completion of therapy to onset of symptoms was four months (range 0-85) and median duration of symptoms when referred was eight months (1–104). The reason for dyspareunia was multifactorial. Eight patients had grade 2 EORTC CTCv3.0 vaginal stenosis and one had a grade 3 stenosis. Six had dyspareunia without clinically detectable stenosis. Conclusion: Dyspareunia is a real and pertinent issue for many sexually active survivors of anal cancer. The extent of the problem may still be underestimated as only the more symptomatic cases were likely referred. Symptoms often start within weeks of completing treatment suggesting that patient education and preventative interventions should be considered during anal cancer therapy. 64 PELVIC RADIATION IN PATIENTS WITH A PELVIC KIDNEY: NO LONGER PLAYING WITH FIRE D. Berlach, M. Brodeur, F. Cury McGill University Health Centre, Montréal, QC Purpose: With improvements in surgical techniques and better control of post-transplantation complications, there are a growing number of long-term kidney transplantation survivors. This has spawned a new subpopulation of patients with pelvic kidneys who are surviving long enough to develop prostate cancer. Classically, radiation therapy (RT) was contraindicated for these patients due to the high sensitivity of the transplanted organ and its proximity to the prostate. With advances in RT over the past few decades, namely intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT), a pelvic kidney may no longer be a contraindication to pelvic RT. Materials and Methods: We present a series of treatment plans for patients with renal transplantation who developed prostate cancer and were treated with radical RT using IMRT technique delivered via helical tomotherapy (HT). Seven plans per patient were developed to illustrate circumstances when the pelvic nodes are or are not included in the treatment plan. We then compared the dosimetric aspects of the HT plans to 2Dconventional EBRT, 3D-CRT and LinAc-based IMRT. We treated the prostate, with or without the proximal seminal vesicles, using 0.7 cm margins to PTV, to a dose of 72 Gy delivered in 36