- Email: [email protected]
929 poster CANCER OF THE PELVIS: DEFINITIVE RADIOTHERAPY FOR THE PATIENTS WITH ISOLATED RECURRENCE OF ABDOMINAL PARAAORTIC LYMPH NODE
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927 poster ASSESSMENT OF PLANNING TARGET VOLUME MARGINS BASED ON RANDOM AND SYSTEMATIC ERRORS: WITH AND WITHOUT CORRECTION PROTOCOLS M. Djordjevic1 , B. Sorcini1 1 K AROLINSKA U NIVERSITY H OSPITAL, Department of Medical Physics and Radiation Safety, Stockholm, Sweden
Purpose: To determine the impact of correction strategies on required planning target volume margins. Data from daily on-line image registrations were used to evaluate correction protocols. Materials: Setup correction data for daily kilo-voltage 2D/2D on-line image registrations with Varian On-Board Imager (OBI) were used to analyse random and patient systematic variations. The study includes data from 100 prostate, 64 cervical and 46 HeadandNeck cancer patients. The most important anatomical structures were outlined in the DRR images by physicians to accurately match the target sites. Gold marker implants were used for daily localisation of the prostate. Required PTV margins based on random and systematic setup errors were estimated according to the margin formula M = 2.5Σ + 0.7σ . Corrections of the patient systematic error based on the three to five first fractions were simulated on the data set. The data was also compared with clinical correction protocols in terms of number of isocenter corrections, frequency of corrected directions and frequency of out-of-tolerance in remaining part of treatment. Results: The required margins for Head-and-Neck patients were 5.8 mm, 7.2 mm, and 5.8 mm in the lateral (LR), anterior-posterior (AP) and superiorinferior (SI) directions. With corrections based on the mean value of the five initial fractions and a correction action level of 2 mm, the required margins were reduced to 3.8 mm (LR), 4.6 mm (AP) and 4.0 mm (SI). Decreasing the action level from 3 mm to 2 mm, did only show a small additional reduction of the systematic error. For cervix cancers the required margins were reduced from (13.2, 9.5, 8.3) mm to (9.9, 7.6, 7.8) mm in the (LR, AP, SI) directions, with an action level of 4 mm. Without applying corrections, the systematic and random components were equal, Σ = σ , in the pelvis region, while for Head-and-Neck the systematic components was larger, Σ > σ , in all directions.Table 1. PTV margins, with no setup correction and with correction of the systematic error based on the mean value of the five initial treatment fractions. The margin for the prostate includes internal movement and setup error according to implanted gold markers.
geographical contributions to cancer nanotechnology research via biometric literature search. Materials: On 6 October 2010, a Medline search was conducted using the National Library of Medicine’s search service "PubMed" to retrieve research reports in cancer nanotechnology. Retrieval was limited to papers published from 1 January 2000 to 6 October 2010. "Nano", "Cancer", "radiation", "radiotherapy" and the country of interest were used as search phrases. Each search was limited to a specific year using the "Limits" function incorporated in the search engine. Data pertaining to the number of articles, date of publication and country of origin were analyzed. The number of published reports was considered an index of research productivity. Results: Five hundred and twenty three reports addressing cancer nanotechnology research were published from 2000 to 2010. The United States had the greatest gross productivity of over the years with 196 (37.5%), followed by China with 60 (11.5%), South Korea with 50 (9.6%), Japan with 35 (6.7%), Germany with 24 (4.6%), United Kingdom with 15 (2.9%), Canada with 14 (2.7%), followed by India and Australia both with 11 published reports compromising 2.1% of global publication. Other world countries with less than 10 published reports include Sweden, The Netherlands, Spain, Denmark, Greece, Turkey, Singapore, Egypt, South Africa, Brazil, Iran and Chile. The world output of cancer nanotechnology research increased progressively over the years from 4 (0.8%) in 2000, 6 (1.1%) in 2001, 8 (1.5%) in 2002, 18 (3.4%) in 2003, 31 (5.9%) in 2004, 47 (9%) in 2005 and 2006, 66 (12.6%) in 2007, 77 (14.7%) in 2008, 109 (20.8%) in 2009 and 110 (21%) in 2010 to the time of this study. The research outputs of China and Korea have increased substantially over the past 3 years with 78% and 80% of the respective total number of reports published between 2007 and 2010. Thirty three reports addressing radiotherapy-related cancer nanotechnology were retrieved. Among those; radiobiology-related research was narrated in 6 reports (18%), radiation-related imaging strategies in 4 (12%), novel radiotherapy delivery techniques in 3 (9%), radiation toxicity studies in 2 (6%), chemotherapy-radiotherapy interactions in 1 (3%) and radiation dosimetry in 1 (3%) report. The remaining 16 (49%) reports narrated various radiotherapyrelated nanotechnological advances. Conclusions: These results provide crucial information on the worldwide geography of nano-related cancer research. The United States continues to play the leading role in advancement of this branch of biomedical research possibly reflecting the huge resources involved in this field. China and South Korea provide major and rapidly increasing research contributions. Lack of basic research infrastructure, human expertise and funding appear to be significant issues pertaining to the lag of widespread boom in radiotherapy-related nanotechnology research. Our study shows that cancer nanotechnology research is growing indicating strong global commitment, however, the inadequacy of funding -at least in some nations- appears to hinder more comprehensive global participation. 929 poster CANCER OF THE PELVIS: DEFINITIVE RADIOTHERAPY FOR THE PATIENTS WITH ISOLATED RECURRENCE OF ABDOMINAL PARAAORTIC LYMPH NODE K. Yahara1 1 UOEH, Department of Radiology, Kitakyusyu, Japan
Conclusions: Correction protocols, aimed to correct the mean error of the patient, allow a reduction of the setup margin with a small amount of workload. However, image verification with appropriate intervals during the remaining part of the treatment is required to account for anatomical changes and the uncertainty in the estimated mean error. 928 poster BIBLOMETRIC ANALYSIS OF CANCER NANOTECHNOLOGY RESEARCH: ARE RADIOTHERAPY-RELATED APPLICATIONS LAGGING BEHIND A. Salem1 , J. Khader1 , L. Y. I. Mula-Hussain1 , I. Jaradat1 , I. Mohammed2 , S. Hashem1 , A. Al Mousa1 1 K ING H USSEIN C ANCER C ENTER, Amman, Jordan 2 K ING H USSEIN C ANCER C ENTER, Department of Radiation Oncology, Amman, Jordan Purpose: Nanotechnology is the science addressing manipulations of matter in the range of 1-100 nanometers. While the roots of this branch of science stretch back many years; the explosion of research activity has only occurred within the last ten to fifteen years. Today, there is increasing optimism that nanotechnology -applied to oncology research- will bring significant advances in the diagnosis and treatment of cancer. As a consequence, cancer nanotechnology has been under intense development for applications in cancer imaging, molecular diagnosis and targeted therapy. Analysis of cancer-related nanomedical publications could be used to monitor research progress and overall trends. This study provides an overview of the research performance of major world countries in cancer nanotechnology with special reference to radiotherapy-related nanotechnology publications. We intend to evaluate the overall scientific research output and assess worldwide
Purpose: Some positive results have been reported for curative surgical resection in the patients with isolated abdominal paraaortic lymph node (PALN) recurrence of pelvic cancer. However, the efficacy of definitive radiotherapy as a salvage therapy has scarcely been reported in these patients. The purpose of our study was to evaluate the outcome of definitive radiotherapy for isolated abdominal PALN recurrence in the patients with primary controlled cancer of the pelvis. Materials: Consecutive 24 patients with isolated abdominal PALN recurrence who were treated between May 1993 and March 2009 were retrospectively analyzed. The patients were included in this study if they were eligible to receive definitive radiotherapy for abdominal PALN recurrence with primary controlled cancer of the pelvis without other distant/recurrent diseases. The sites of the primary lesion were as follows: cervical cancer (n=11), endometrial cancer (n= 1), ovarian cancer (n=8), rectal cancer (n=1) and bladder cancer (n=1). Median time between the front-line therapy and radiotherapy for isolated PALN metastases was 26 months. Median total irradiation dose of radiotherapy was 50Gy (range, 5061). Nine (38%) of 24 patients received concurrent chemotherapy, and 6 (25%) of 24 patients also underwent adjuvant chemotherapy after the radiotherapy. Results: Twenty-two (79%) patients had an objective tumor response (CR in 14 patients, PR in 5). The infield or marginal failure occurred in 3 patients (13%), while failure of outside of the irradiated field was recognized in 11 (46%). Overall, progression-free and local control survivals at 5 years were 65%, 25%, and 47%, respectively. Statistically significant prognostic indicators of overall survival rate were irradiation dose (more than or equal 51Gy) (p<0.0001), chemotherapy (p<0.0001), and time between front-line therapy and radiotherapy (more than or equal 24 months) (p=0.03). The toxicities were mild; neutropenia of Grade 3 was detected in one patient, and Grade 3 or higher non-hematologic toxicity was not observed. Conclusions: Definitive radiotherapy for isolated abdominal PALN recurrence in the patients with primary controlled cancer of the pelvis may be
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feasible with a relatively longer-term survival. The results justify further investigation of higher dose radiotherapy using intensity modulated radiotherapy. 930 poster CHEMO-RADIOTHERAPY IN GLIOBLASTOMA MULTIFORME. THE EFFECT OF MGMT PROMOTER HYPERMETHYLATION ON SURVIVAL P. R. Jampana1 , C. Blesing2 , N. Warner1 , O. Ansorge3 1 OXFORD C ANCER C ENTRE , C HURCHILL H OSPITAL, Oxford, United Kingdom 2 OXFORD C ANCER C ENTRE , C HURCHILL H OSPITAL, Clinical Oncology, Oxford, United Kingdom 3 OXFORD R ADCLIFFE H OSPITALS NHS T RUST, Department of NeuroPathology, Oxford, United Kingdom
Purpose: Glioblastoma Multiforme is a common and aggressive primary brain tumour. The overall prognosis for patients with this tumour is poor. Chemo-radiotherapy with concomitant and adjuvant Temozolomide gives patients the best chance of longer survival. The presence of MGMT promoter hypermethylation has been shown to influence survival in these patients. Our objective was to look at Overall Survival in patients having Radical Chemoradiotherapy and in particular those that were MGMT promoter positive. Materials: We retrospectively looked at the survival of 59 patients treated in our centre, who received Radical chemo-radiotherapy over a period of 3 years from March 2006 to March 2009. Patients received Temozolomide(75mg/m2) daily during standard fractionation radiotherapy of 60Gy, followed by adjuvant Temozolomide at a dose of 150-200 mg/m2, for 5 days of every 28 day cycle, for 6 cycles. The 59 patients were divided into 2 groups.Group 1 (20 patients) consisted of patients who were treated between March 2006 and June 2007. During this period, in our centre, due to funding constraints, radical chemo-radiotherapy was mainly given to patients who were MGMT positive while others had either radical radiotherapy alone or palliative radiotherapy or best supportive care. We report those who received radical chemo radiotherapy, 75% of whom were MGMT positive. Group 2 (39 patients) were treated between July 2007 and March 2009. In this group, MGMT status was not analysed as Chemo-radiotherapy was given to all patients who were considered fit enough to receive it. Results: We looked at the overall survival, one year survival and two year survival for these patients.Group 1- The median survival for patients in this group was 21.9 months with a 1 year survival of 75% and a 2 year survival of 50%. For comparison, during the same period, the median survival for MGMT negative patients having radical radiotherapy alone was 12.5 months, with a one year survival of 50% and no one surviving more than 18 months.Group 2- The median survival for patients in this group was 12 months with a 1 year survival of 48% and a 2 year survival of 25.6%.
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REGIONAL LYMPH NODE METASTASIS J. Wang1 , Y. Wang1 , Y. Wang1 , D. Tian1 , J. Yang1 , S. Zhu1 , C. Han1 1 T HE F OURTH H OSPITAL OF H EBEI M EDICAL U NIVERSITY, Radiation Oncology, Shijiazhuang, China
Purpose: To explore the prognosis factors of 3-dimensional conformal radiotherapy (3D-CRT) versus intensity modulated radiation therapy(IMRT) for esopageal carcinoma with regional lymph node metastasis. Materials: From January 2001 to December 2008, 112 patients with cervical or thoracic esophageal carcinoma with regional lymph node metastasis were retrospectively analyzed, 60 patients were in 3D-CRT group and 52 patients were in IMRT group, with a total dosage of 56Gy70Gy/2835 fx /5.67 weeks ( median 60Gy). Simultaneous integrated boost (SIB) technique was used in 35 patients in IMRT group, with a prescribed GTV dosage was 2.2Gy/fx, prescribed CTV dosage was 2.1Gy/ fx, prescribed PTV dosage was 2.0Gy/fx. Concurrent chemoradiotherapy was given in 23 patients in 3D-CRT group and 35 patients in IMRT group(χ2 =9.37p=0.002). It was given on the first week of irradiation: Calcium Folinate 200mg at days 1-5, 5-fluorouracil 500mg/m2 at days 1-5, cisplatin 12mg/m2 at days 1-5 or 25mg/m2 at days 1-3 (LFP regiments), and repeated in every 4 weeks to a total 1-2 cycles during the irradiation. Survival rates and itsrelated prognotic factors were evaluated restrospectively with SSPS 11.5 software. Results: After the irradiation , as for short-term efficacy evaluation, complete response (CR) rate, partial response (PR) rate and no response (NR) rate were 33.9% (38/112), 64.3% (72/112) and 1.8% (2/112) respectively, the rate of total efficiency(CR+PR) was 98.2%. In all the patients , the 1-,2-,3-year overall survival rates were 62.49%, 39.37%, 23.67%, respectively; the median survival time was 17 months. The 1-,2-,3-year survival rates and median survival were 51.67%, 32.80%, 18.61% and 12.4months in 3D-CRT group and 75.00%, 46.73%, 40.05% and 17months in IMRT group, respectively(χ2 =4.74p=0.030). The 1-,2-,3-year free-recurrence survival rates were 64.41%, 45.02% and 45.02% in 3D-CRT group and 72.21%, 58.67% and 58.67% in IMRT group (χ2 =2.27p=0.132). With uninvariate analysis, for patients with female, ages≤65, tumor located in cervical and upperthoracic, >5cm lesion length in barium esophagogram, ≤4cm the largest diameter of lesion in CT scaning image, T4 stage, or semi-liquid or liquid diet before the irradiation, survival rate were higher in IMRT group than in 3D-CRT group(p<0.05); but in patients with male, ages>65, tumor located in middle and lower-thoracic, ≤5cm lesion length in barium esophagogram, >4cm the largest diameter of lesion in CT scaning image, T1-3 stage, or normal diet before the treatment, concurrent chemotherapy and prescribed dose of irradiation, survival rate were not different between IMRT group and 3D-CRT group (p>0.05). Multivariate analysis revealed that the different diet and T stage were independent prognostic factors. Conclusions: Stage of primary tumor is still the most important prognostic factor in esopageal carcinoma patients with regional lymph node metastasis treated by 3D-CRT or IMRT technics. It seems that IMRT has some advantage for part of esophageal carcinoma patients in subgroup when compared with 3D-CRT. IMRT-SIB technique should be studied further to confirm that it could improve efficacy by expanding sample size and accumulating clinical experience. 932 poster COMPARISON OF PENUMBRA IN THE SMALL RADIOSURGERY FIELD SIZES BASED ON CIRCULAR CONE AND LINAC’S JAW WITH PIN POINT CHAMBER M. Yarahmadi1 , M. Allahverdi2 , H. A. Nedaie3 , S. A. Vaezzadeh3 1 T EHRAN U NIVERSITY OF M EDICAL S CIENCES, Medical Physics and Engineering, Tehran, Iran Islamic Republic of 2 T EHRAN U NIVERSITY OF M EDICAL S CIENCES R ADIATION O N, Tehran, Iran Islamic Republic of 3 T EHRAN U NIVERSITY OF M EDICAL S CIENCES, Tehran, Iran Islamic Republic of
Conclusions: The results show the effectiveness of chemo-radiotherapy improving survival in patients with Glioblastoma Multiforme, in particular those patients whose tumours express methylated MGMT promoter. Our results compare favourably with those of Stupp et al. (2005) who showed a 26% 2 year survival in those treated with chemo RT (regardless of MGMT status). Routine checking of MGMT status should be practised as this will provide valuable prognostic information.Stupp et al. NEJM. 2005 Mar 10;352(10):987-96 931 poster COMPARE THE PROGNOSIS OF THREE-DIMENSIONAL CONFORMAL RADIOTHERAPY (3D-CRT) VERSUS INTENSITY MODULATED RADIATION THERAPY (IMRT) FOR ESOPAGEAL CARCINOMA WITH
Purpose: In stereotactic radiosurgery (SRS), a narrow beam penumbra is often desired for producing steep dose fall-off between the target volume and adjacent critical structures. Due to limited source sizes, scattering effects and the partial blocking of the beam source, the physical penumbra of the X-Knife is often produced therefore measuring beam penumbra is more important. In this work we report experimental measurements of beam penumbra of the small radiosurgery field sizes based on circular cone and Linac’s Jaw. Materials: The small field sizes were produced by Varian Clinac-2100 accelerator’s Jaws and circular cone coupled to this linear accelerator. The side length of square fields and diameter of circular fields were 5, 10, 20 and 30 mm. PTW Pinpoint was used for measured 80-20% and 90-10% beam penumbra at a source to surface distance of 100 cm in water at 5cm depth. The 6MV photon beam was investigated using 200 monitor units. Results: The 90-10% beam penumbra for circular fields were obtained 2.71% - 1.73% - 4.04 and 26.33% smaller than square fields for field sizes 5 - 10 20 and 30 mm respectively. The 80-20% beam penumbra for circular fields were obtained 5.32% - 2.48% - 4.52 and 31.72% smaller than Square fields for field sizes 5 - 10 - 20 and 30 mm respectively. Conclusions: It is found that circular cones reduced beam penumbra in all of
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927 poster ASSESSMENT OF PLANNING TARGET VOLUME MARGINS BASED ON RANDOM AND SYSTEMATIC ERRORS: WITH AND WITHOUT CORRECTION PROTOCOLS M. Djordjevic1 , B. Sorcini1 1 K AROLINSKA U NIVERSITY H OSPITAL, Department of Medical Physics and Radiation Safety, Stockholm, Sweden
Purpose: To determine the impact of correction strategies on required planning target volume margins. Data from daily on-line image registrations were used to evaluate correction protocols. Materials: Setup correction data for daily kilo-voltage 2D/2D on-line image registrations with Varian On-Board Imager (OBI) were used to analyse random and patient systematic variations. The study includes data from 100 prostate, 64 cervical and 46 HeadandNeck cancer patients. The most important anatomical structures were outlined in the DRR images by physicians to accurately match the target sites. Gold marker implants were used for daily localisation of the prostate. Required PTV margins based on random and systematic setup errors were estimated according to the margin formula M = 2.5Σ + 0.7σ . Corrections of the patient systematic error based on the three to five first fractions were simulated on the data set. The data was also compared with clinical correction protocols in terms of number of isocenter corrections, frequency of corrected directions and frequency of out-of-tolerance in remaining part of treatment. Results: The required margins for Head-and-Neck patients were 5.8 mm, 7.2 mm, and 5.8 mm in the lateral (LR), anterior-posterior (AP) and superiorinferior (SI) directions. With corrections based on the mean value of the five initial fractions and a correction action level of 2 mm, the required margins were reduced to 3.8 mm (LR), 4.6 mm (AP) and 4.0 mm (SI). Decreasing the action level from 3 mm to 2 mm, did only show a small additional reduction of the systematic error. For cervix cancers the required margins were reduced from (13.2, 9.5, 8.3) mm to (9.9, 7.6, 7.8) mm in the (LR, AP, SI) directions, with an action level of 4 mm. Without applying corrections, the systematic and random components were equal, Σ = σ , in the pelvis region, while for Head-and-Neck the systematic components was larger, Σ > σ , in all directions.Table 1. PTV margins, with no setup correction and with correction of the systematic error based on the mean value of the five initial treatment fractions. The margin for the prostate includes internal movement and setup error according to implanted gold markers.
geographical contributions to cancer nanotechnology research via biometric literature search. Materials: On 6 October 2010, a Medline search was conducted using the National Library of Medicine’s search service "PubMed" to retrieve research reports in cancer nanotechnology. Retrieval was limited to papers published from 1 January 2000 to 6 October 2010. "Nano", "Cancer", "radiation", "radiotherapy" and the country of interest were used as search phrases. Each search was limited to a specific year using the "Limits" function incorporated in the search engine. Data pertaining to the number of articles, date of publication and country of origin were analyzed. The number of published reports was considered an index of research productivity. Results: Five hundred and twenty three reports addressing cancer nanotechnology research were published from 2000 to 2010. The United States had the greatest gross productivity of over the years with 196 (37.5%), followed by China with 60 (11.5%), South Korea with 50 (9.6%), Japan with 35 (6.7%), Germany with 24 (4.6%), United Kingdom with 15 (2.9%), Canada with 14 (2.7%), followed by India and Australia both with 11 published reports compromising 2.1% of global publication. Other world countries with less than 10 published reports include Sweden, The Netherlands, Spain, Denmark, Greece, Turkey, Singapore, Egypt, South Africa, Brazil, Iran and Chile. The world output of cancer nanotechnology research increased progressively over the years from 4 (0.8%) in 2000, 6 (1.1%) in 2001, 8 (1.5%) in 2002, 18 (3.4%) in 2003, 31 (5.9%) in 2004, 47 (9%) in 2005 and 2006, 66 (12.6%) in 2007, 77 (14.7%) in 2008, 109 (20.8%) in 2009 and 110 (21%) in 2010 to the time of this study. The research outputs of China and Korea have increased substantially over the past 3 years with 78% and 80% of the respective total number of reports published between 2007 and 2010. Thirty three reports addressing radiotherapy-related cancer nanotechnology were retrieved. Among those; radiobiology-related research was narrated in 6 reports (18%), radiation-related imaging strategies in 4 (12%), novel radiotherapy delivery techniques in 3 (9%), radiation toxicity studies in 2 (6%), chemotherapy-radiotherapy interactions in 1 (3%) and radiation dosimetry in 1 (3%) report. The remaining 16 (49%) reports narrated various radiotherapyrelated nanotechnological advances. Conclusions: These results provide crucial information on the worldwide geography of nano-related cancer research. The United States continues to play the leading role in advancement of this branch of biomedical research possibly reflecting the huge resources involved in this field. China and South Korea provide major and rapidly increasing research contributions. Lack of basic research infrastructure, human expertise and funding appear to be significant issues pertaining to the lag of widespread boom in radiotherapy-related nanotechnology research. Our study shows that cancer nanotechnology research is growing indicating strong global commitment, however, the inadequacy of funding -at least in some nations- appears to hinder more comprehensive global participation. 929 poster CANCER OF THE PELVIS: DEFINITIVE RADIOTHERAPY FOR THE PATIENTS WITH ISOLATED RECURRENCE OF ABDOMINAL PARAAORTIC LYMPH NODE K. Yahara1 1 UOEH, Department of Radiology, Kitakyusyu, Japan
Conclusions: Correction protocols, aimed to correct the mean error of the patient, allow a reduction of the setup margin with a small amount of workload. However, image verification with appropriate intervals during the remaining part of the treatment is required to account for anatomical changes and the uncertainty in the estimated mean error. 928 poster BIBLOMETRIC ANALYSIS OF CANCER NANOTECHNOLOGY RESEARCH: ARE RADIOTHERAPY-RELATED APPLICATIONS LAGGING BEHIND A. Salem1 , J. Khader1 , L. Y. I. Mula-Hussain1 , I. Jaradat1 , I. Mohammed2 , S. Hashem1 , A. Al Mousa1 1 K ING H USSEIN C ANCER C ENTER, Amman, Jordan 2 K ING H USSEIN C ANCER C ENTER, Department of Radiation Oncology, Amman, Jordan Purpose: Nanotechnology is the science addressing manipulations of matter in the range of 1-100 nanometers. While the roots of this branch of science stretch back many years; the explosion of research activity has only occurred within the last ten to fifteen years. Today, there is increasing optimism that nanotechnology -applied to oncology research- will bring significant advances in the diagnosis and treatment of cancer. As a consequence, cancer nanotechnology has been under intense development for applications in cancer imaging, molecular diagnosis and targeted therapy. Analysis of cancer-related nanomedical publications could be used to monitor research progress and overall trends. This study provides an overview of the research performance of major world countries in cancer nanotechnology with special reference to radiotherapy-related nanotechnology publications. We intend to evaluate the overall scientific research output and assess worldwide
Purpose: Some positive results have been reported for curative surgical resection in the patients with isolated abdominal paraaortic lymph node (PALN) recurrence of pelvic cancer. However, the efficacy of definitive radiotherapy as a salvage therapy has scarcely been reported in these patients. The purpose of our study was to evaluate the outcome of definitive radiotherapy for isolated abdominal PALN recurrence in the patients with primary controlled cancer of the pelvis. Materials: Consecutive 24 patients with isolated abdominal PALN recurrence who were treated between May 1993 and March 2009 were retrospectively analyzed. The patients were included in this study if they were eligible to receive definitive radiotherapy for abdominal PALN recurrence with primary controlled cancer of the pelvis without other distant/recurrent diseases. The sites of the primary lesion were as follows: cervical cancer (n=11), endometrial cancer (n= 1), ovarian cancer (n=8), rectal cancer (n=1) and bladder cancer (n=1). Median time between the front-line therapy and radiotherapy for isolated PALN metastases was 26 months. Median total irradiation dose of radiotherapy was 50Gy (range, 5061). Nine (38%) of 24 patients received concurrent chemotherapy, and 6 (25%) of 24 patients also underwent adjuvant chemotherapy after the radiotherapy. Results: Twenty-two (79%) patients had an objective tumor response (CR in 14 patients, PR in 5). The infield or marginal failure occurred in 3 patients (13%), while failure of outside of the irradiated field was recognized in 11 (46%). Overall, progression-free and local control survivals at 5 years were 65%, 25%, and 47%, respectively. Statistically significant prognostic indicators of overall survival rate were irradiation dose (more than or equal 51Gy) (p<0.0001), chemotherapy (p<0.0001), and time between front-line therapy and radiotherapy (more than or equal 24 months) (p=0.03). The toxicities were mild; neutropenia of Grade 3 was detected in one patient, and Grade 3 or higher non-hematologic toxicity was not observed. Conclusions: Definitive radiotherapy for isolated abdominal PALN recurrence in the patients with primary controlled cancer of the pelvis may be
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feasible with a relatively longer-term survival. The results justify further investigation of higher dose radiotherapy using intensity modulated radiotherapy. 930 poster CHEMO-RADIOTHERAPY IN GLIOBLASTOMA MULTIFORME. THE EFFECT OF MGMT PROMOTER HYPERMETHYLATION ON SURVIVAL P. R. Jampana1 , C. Blesing2 , N. Warner1 , O. Ansorge3 1 OXFORD C ANCER C ENTRE , C HURCHILL H OSPITAL, Oxford, United Kingdom 2 OXFORD C ANCER C ENTRE , C HURCHILL H OSPITAL, Clinical Oncology, Oxford, United Kingdom 3 OXFORD R ADCLIFFE H OSPITALS NHS T RUST, Department of NeuroPathology, Oxford, United Kingdom
Purpose: Glioblastoma Multiforme is a common and aggressive primary brain tumour. The overall prognosis for patients with this tumour is poor. Chemo-radiotherapy with concomitant and adjuvant Temozolomide gives patients the best chance of longer survival. The presence of MGMT promoter hypermethylation has been shown to influence survival in these patients. Our objective was to look at Overall Survival in patients having Radical Chemoradiotherapy and in particular those that were MGMT promoter positive. Materials: We retrospectively looked at the survival of 59 patients treated in our centre, who received Radical chemo-radiotherapy over a period of 3 years from March 2006 to March 2009. Patients received Temozolomide(75mg/m2) daily during standard fractionation radiotherapy of 60Gy, followed by adjuvant Temozolomide at a dose of 150-200 mg/m2, for 5 days of every 28 day cycle, for 6 cycles. The 59 patients were divided into 2 groups.Group 1 (20 patients) consisted of patients who were treated between March 2006 and June 2007. During this period, in our centre, due to funding constraints, radical chemo-radiotherapy was mainly given to patients who were MGMT positive while others had either radical radiotherapy alone or palliative radiotherapy or best supportive care. We report those who received radical chemo radiotherapy, 75% of whom were MGMT positive. Group 2 (39 patients) were treated between July 2007 and March 2009. In this group, MGMT status was not analysed as Chemo-radiotherapy was given to all patients who were considered fit enough to receive it. Results: We looked at the overall survival, one year survival and two year survival for these patients.Group 1- The median survival for patients in this group was 21.9 months with a 1 year survival of 75% and a 2 year survival of 50%. For comparison, during the same period, the median survival for MGMT negative patients having radical radiotherapy alone was 12.5 months, with a one year survival of 50% and no one surviving more than 18 months.Group 2- The median survival for patients in this group was 12 months with a 1 year survival of 48% and a 2 year survival of 25.6%.
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REGIONAL LYMPH NODE METASTASIS J. Wang1 , Y. Wang1 , Y. Wang1 , D. Tian1 , J. Yang1 , S. Zhu1 , C. Han1 1 T HE F OURTH H OSPITAL OF H EBEI M EDICAL U NIVERSITY, Radiation Oncology, Shijiazhuang, China
Purpose: To explore the prognosis factors of 3-dimensional conformal radiotherapy (3D-CRT) versus intensity modulated radiation therapy(IMRT) for esopageal carcinoma with regional lymph node metastasis. Materials: From January 2001 to December 2008, 112 patients with cervical or thoracic esophageal carcinoma with regional lymph node metastasis were retrospectively analyzed, 60 patients were in 3D-CRT group and 52 patients were in IMRT group, with a total dosage of 56Gy70Gy/2835 fx /5.67 weeks ( median 60Gy). Simultaneous integrated boost (SIB) technique was used in 35 patients in IMRT group, with a prescribed GTV dosage was 2.2Gy/fx, prescribed CTV dosage was 2.1Gy/ fx, prescribed PTV dosage was 2.0Gy/fx. Concurrent chemoradiotherapy was given in 23 patients in 3D-CRT group and 35 patients in IMRT group(χ2 =9.37p=0.002). It was given on the first week of irradiation: Calcium Folinate 200mg at days 1-5, 5-fluorouracil 500mg/m2 at days 1-5, cisplatin 12mg/m2 at days 1-5 or 25mg/m2 at days 1-3 (LFP regiments), and repeated in every 4 weeks to a total 1-2 cycles during the irradiation. Survival rates and itsrelated prognotic factors were evaluated restrospectively with SSPS 11.5 software. Results: After the irradiation , as for short-term efficacy evaluation, complete response (CR) rate, partial response (PR) rate and no response (NR) rate were 33.9% (38/112), 64.3% (72/112) and 1.8% (2/112) respectively, the rate of total efficiency(CR+PR) was 98.2%. In all the patients , the 1-,2-,3-year overall survival rates were 62.49%, 39.37%, 23.67%, respectively; the median survival time was 17 months. The 1-,2-,3-year survival rates and median survival were 51.67%, 32.80%, 18.61% and 12.4months in 3D-CRT group and 75.00%, 46.73%, 40.05% and 17months in IMRT group, respectively(χ2 =4.74p=0.030). The 1-,2-,3-year free-recurrence survival rates were 64.41%, 45.02% and 45.02% in 3D-CRT group and 72.21%, 58.67% and 58.67% in IMRT group (χ2 =2.27p=0.132). With uninvariate analysis, for patients with female, ages≤65, tumor located in cervical and upperthoracic, >5cm lesion length in barium esophagogram, ≤4cm the largest diameter of lesion in CT scaning image, T4 stage, or semi-liquid or liquid diet before the irradiation, survival rate were higher in IMRT group than in 3D-CRT group(p<0.05); but in patients with male, ages>65, tumor located in middle and lower-thoracic, ≤5cm lesion length in barium esophagogram, >4cm the largest diameter of lesion in CT scaning image, T1-3 stage, or normal diet before the treatment, concurrent chemotherapy and prescribed dose of irradiation, survival rate were not different between IMRT group and 3D-CRT group (p>0.05). Multivariate analysis revealed that the different diet and T stage were independent prognostic factors. Conclusions: Stage of primary tumor is still the most important prognostic factor in esopageal carcinoma patients with regional lymph node metastasis treated by 3D-CRT or IMRT technics. It seems that IMRT has some advantage for part of esophageal carcinoma patients in subgroup when compared with 3D-CRT. IMRT-SIB technique should be studied further to confirm that it could improve efficacy by expanding sample size and accumulating clinical experience. 932 poster COMPARISON OF PENUMBRA IN THE SMALL RADIOSURGERY FIELD SIZES BASED ON CIRCULAR CONE AND LINAC’S JAW WITH PIN POINT CHAMBER M. Yarahmadi1 , M. Allahverdi2 , H. A. Nedaie3 , S. A. Vaezzadeh3 1 T EHRAN U NIVERSITY OF M EDICAL S CIENCES, Medical Physics and Engineering, Tehran, Iran Islamic Republic of 2 T EHRAN U NIVERSITY OF M EDICAL S CIENCES R ADIATION O N, Tehran, Iran Islamic Republic of 3 T EHRAN U NIVERSITY OF M EDICAL S CIENCES, Tehran, Iran Islamic Republic of
Conclusions: The results show the effectiveness of chemo-radiotherapy improving survival in patients with Glioblastoma Multiforme, in particular those patients whose tumours express methylated MGMT promoter. Our results compare favourably with those of Stupp et al. (2005) who showed a 26% 2 year survival in those treated with chemo RT (regardless of MGMT status). Routine checking of MGMT status should be practised as this will provide valuable prognostic information.Stupp et al. NEJM. 2005 Mar 10;352(10):987-96 931 poster COMPARE THE PROGNOSIS OF THREE-DIMENSIONAL CONFORMAL RADIOTHERAPY (3D-CRT) VERSUS INTENSITY MODULATED RADIATION THERAPY (IMRT) FOR ESOPAGEAL CARCINOMA WITH
Purpose: In stereotactic radiosurgery (SRS), a narrow beam penumbra is often desired for producing steep dose fall-off between the target volume and adjacent critical structures. Due to limited source sizes, scattering effects and the partial blocking of the beam source, the physical penumbra of the X-Knife is often produced therefore measuring beam penumbra is more important. In this work we report experimental measurements of beam penumbra of the small radiosurgery field sizes based on circular cone and Linac’s Jaw. Materials: The small field sizes were produced by Varian Clinac-2100 accelerator’s Jaws and circular cone coupled to this linear accelerator. The side length of square fields and diameter of circular fields were 5, 10, 20 and 30 mm. PTW Pinpoint was used for measured 80-20% and 90-10% beam penumbra at a source to surface distance of 100 cm in water at 5cm depth. The 6MV photon beam was investigated using 200 monitor units. Results: The 90-10% beam penumbra for circular fields were obtained 2.71% - 1.73% - 4.04 and 26.33% smaller than square fields for field sizes 5 - 10 20 and 30 mm respectively. The 80-20% beam penumbra for circular fields were obtained 5.32% - 2.48% - 4.52 and 31.72% smaller than Square fields for field sizes 5 - 10 - 20 and 30 mm respectively. Conclusions: It is found that circular cones reduced beam penumbra in all of