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A Multidisciplinary Rapid Access Clinic – Providing More Than Just Rapid Access
S568
International Journal of Radiation Oncology Biology Physics
(p Z 0.01). Two-yr OS for lung site vs all others: 74% vs 43%. Median OS for single vs multi-target: not reached vs 27 months (p Z 0.06); Median OS for single SBRT vs multiple courses: 29 m vs 39 m (p Z 0.21). No grade 4 or 5 toxicity noted. Conclusions: In these highly selected patients with oligometastatic cancers, multiple courses of SBRT/IGAHRT were used with durable local control. Prolonged survival from original metastatic diagnosis suggests favorable selection bias. Patients with metastasis to lung had superior outcomes when compared to other sites. Patients with multiple lesions during single course tended to fair worse. Additional prospective study is warranted. Author Disclosure: D.N. Ayala-Peacock: None. A.W. Blackstock: None. W.T. Kearns: None. W.H. Hinson: None. M.T. Munley: None. A.A. Miller: None. W.J. Petty: None. J.J. Urbanic: None.
Purpose/Objective(s): Radiation therapy (RT) +/- chemotherapy (CT) is the main non-surgical treatment for head and neck cancer (HNC), with oral mucositis (OM) the most common dose limiting toxicity. Several strategies to manage OM have been investigated with limited success. L-lysine has been used in the prevention and healing of oral ulcers. A single-arm prospective pilot study to assess the safety and efficacy of L-lysine to improve healing of OM was proposed. Materials/Methods: Ten patients with HNC treated with RT +/- CT were accrued. Patients were enrolled at onset of RTOG grade 2 OM and were instructed to take L-lysine 1000 mg once daily until grade 0 OM. Patients underwent weekly evaluations of OM grade, creatinine level, and quality of life (QOL) assessment (Functional Living Index: Cancer (FLIC) questionnaire). The primary endpoint was to evaluate the efficacy of L-lysine in decreasing the severity or time to complete resolution of OM compared to historical experience of 2-4 weeks post-RT in 20% or more of the study population. The secondary endpoint was to demonstrate an improvement in QOL, via a 20% or greater mean improvement in weekly FLIC scores. IRB approval was obtained. IBM SPSS 19 was used for analysis. Results: Six males and 4 females were accrued; median age 59.5 years (range, 18 -76); median dose 65.2 Gy (range, 63-70). Median RT dose at grade 2 onset was 34.7 Gy (range, 16.8-56.4). Three patients received cisplatin-based CT. Eight patients received L-lysine per protocol; 2 patients stopped early - 1 due to inpatient admission for dehydration and pain related to RT; 1 due to low creatinine clearance likely related to cisplatin, which was given the week of initial decline and which recovered within 1 week. Median time from L-lysine start to grade 0 was 5 weeks (range, 2.7-8.4); median time post-RT to grade 0 was 2.1 weeks (range, 0.6-3.7). FLIC scores improved most significantly during the first 2 weeks, with a mean improvement of 11.2% (95% CI, 3.4-19.0) week 1 to 2; 13.0% (95% CI, 4.0-22.0) week 1 to 3; 6.8% (95% CI, 2.1-11.5) week 1 to resolution. Conclusions: L-lysine supplementation was tolerated with no adverse sequelae, and appeared to correlate with early improvement of QOL. Time to resolution of OM compares favorably with historical experience. Author Disclosure: W.M. Wong: None. J.J. Liao: None. G.E. Laramore: None. J.J. Valley: None. N.L. Polissar: None. U. Parvathaneni: None.
2959 A Multidisciplinary Rapid Access Clinic e Providing More Than Just Rapid Access S. Lefresne,1 K. Levy,1 R. Cashman,1 P. Santibanez,1 S. Tyldesley,1 and R.A. Olson1,2; 1BC Cancer Agency, Vancouver, BC, Canada, 2Center for the North, BC Cancer Agency, Prince George, BC, Canada Purpose/Objective(s): Patients with lung cancer frequently present with metastatic disease and require urgent palliative radiation therapy (RT) for symptom management. In May 2011, the Vancouver Cancer Center (VCC) opened a pilot, multidisciplinary clinic called the Vancouver Rapid Access (VARA) Clinic, which aimed to provide palliative RT to patients with newly diagnosed, incurable lung cancer on an urgent basis. The purpose of this study was to assess the general patient and treatment characteristics of the population served, as well as to compare the efficiency and level of care provided by VARA compared to standard practice. Materials/Methods: Patients referred to VARA are triaged and assessed by a nurse practitioner (NP), reviewed by a radiation oncologist (RO), and if appropriate, treated with RT on the same day. The NP and advanced practice nurse also address other holistic concerns the patient might have. VARA patient and treatment characteristics were prospectively collected over a 9-month period (May 2011-Jan 2012). Charts for similar patients in the ‘pre-VARA period,’ defined as the same 9 month period one year prior (May 2010-Jan 2011) were retrospectively reviewed. A comparison of the following was made between the VARA period and pre-VARA period: RT wait-times, referrals (BC Palliative benefits, home care, nutrition, pain and symptom management, and patient and family counseling) and number of double bookings for urgent patients. Results: During the first 9 months of VARA, 54 patients were assessed. The mean and median RT wait-times were 3 and 0 days, respectively, with the majority of VARA patients receiving RT on the same day as their consultation (71%). This is compared to only 41% of patients receiving same day RT in the pre-VARA period (p < 0.001). The majority of VARA patients (55%) received at least one referral to a supportive care service compared to only 31% of patients in the pre-VARA period (p Z 0.001). The proportion of urgent patients requiring a double booking for assessment decreased from 23% in the pre-VARA period to 13% in the VARA period (p < 0.001). Conclusions: This study suggests that the VARA clinic has shortened the wait time for palliative RT and connects a higher proportion of patients with supportive care services than the previous standard practice. The clinic has also improved RO workload by decreasing double bookings. These results highlight the value of the VARA clinic and suggest that the extension of this model to other tumor sites may be beneficial. Author Disclosure: S. Lefresne: None. K. Levy: None. R. Cashman: None. P. Santibanez: None. S. Tyldesley: None. R.A. Olson: None.
2960 L-lysine in the Treatment of Oral Mucositis in Head-and-Neck Cancer Patients: A Pilot Study W.M. Wong, J.J. Liao, G.E. Laramore, J.J. Valley, N.L. Polissar, and U. Parvathaneni; University of Washington Affiliated Hospitals, Seattle, WA
2961 Incidence and Risk Factors for Pain Flare Following Spine Radiosurgery D.L. Jung,1 E.H. Balagamwala,2 L. Angelov,2 J.H. Suh,2 C.A. Reddy,2 T. Djemil,2 A. Magnelli,2 S. Soeder,2 and S.T. Chao2; 1Case Western Reserve University School of Medicine, Cleveland, OH, 2Cleveland Clinic Foundation, Cleveland, OH Purpose/Objective(s): Understanding of pain flare (PFL) following spine stereotactic body radiation therapy (sSBRT) is lacking. This study seeks to determine the incidence and risk factors associated with PFL following single fraction sSBRT. Materials/Methods: An IRB-approved database was compiled to include patients (pts) who underwent sSBRT, typically for spine metastases. Gender, consult KPS, epidural disease (dz), thecal sac compression, histology, spine tumor location, and dosimetric factors (prescription dose, target volume, maximum target dose, maximum cord dose) were collected retrospectively. Pain relief post-sSBRT was prospectively collected using the Brief Pain Inventory. These factors were correlated to PFL (defined as an increase in pain within 7 days of treatment and resolved with steroids). Survival was calculated using Kaplan-Meier analysis and logistic regression was utilized to evaluate the association between the clinical factors and occurrence of PFL. Results: A total of 507 treatments (txs) in 348 pts were included. Only 15% of txs resulted in PFL. Median age and prescription dose were 59 yrs (range, 7-90) and 15 Gy (range, 7-18), respectively. Sixty-two percent were male; 74% had epidural dz and 43% had thecal sac compression. Renal cell carcinoma (24%), lung cancer (14%), and breast cancer (11%) were the most common histologies. Fifty-nine percent, 32%, and 9% of tumors were located in the cervical/thoracic (C/T), lumbar (lumb), and sacral (scr)
International Journal of Radiation Oncology Biology Physics
(p Z 0.01). Two-yr OS for lung site vs all others: 74% vs 43%. Median OS for single vs multi-target: not reached vs 27 months (p Z 0.06); Median OS for single SBRT vs multiple courses: 29 m vs 39 m (p Z 0.21). No grade 4 or 5 toxicity noted. Conclusions: In these highly selected patients with oligometastatic cancers, multiple courses of SBRT/IGAHRT were used with durable local control. Prolonged survival from original metastatic diagnosis suggests favorable selection bias. Patients with metastasis to lung had superior outcomes when compared to other sites. Patients with multiple lesions during single course tended to fair worse. Additional prospective study is warranted. Author Disclosure: D.N. Ayala-Peacock: None. A.W. Blackstock: None. W.T. Kearns: None. W.H. Hinson: None. M.T. Munley: None. A.A. Miller: None. W.J. Petty: None. J.J. Urbanic: None.
Purpose/Objective(s): Radiation therapy (RT) +/- chemotherapy (CT) is the main non-surgical treatment for head and neck cancer (HNC), with oral mucositis (OM) the most common dose limiting toxicity. Several strategies to manage OM have been investigated with limited success. L-lysine has been used in the prevention and healing of oral ulcers. A single-arm prospective pilot study to assess the safety and efficacy of L-lysine to improve healing of OM was proposed. Materials/Methods: Ten patients with HNC treated with RT +/- CT were accrued. Patients were enrolled at onset of RTOG grade 2 OM and were instructed to take L-lysine 1000 mg once daily until grade 0 OM. Patients underwent weekly evaluations of OM grade, creatinine level, and quality of life (QOL) assessment (Functional Living Index: Cancer (FLIC) questionnaire). The primary endpoint was to evaluate the efficacy of L-lysine in decreasing the severity or time to complete resolution of OM compared to historical experience of 2-4 weeks post-RT in 20% or more of the study population. The secondary endpoint was to demonstrate an improvement in QOL, via a 20% or greater mean improvement in weekly FLIC scores. IRB approval was obtained. IBM SPSS 19 was used for analysis. Results: Six males and 4 females were accrued; median age 59.5 years (range, 18 -76); median dose 65.2 Gy (range, 63-70). Median RT dose at grade 2 onset was 34.7 Gy (range, 16.8-56.4). Three patients received cisplatin-based CT. Eight patients received L-lysine per protocol; 2 patients stopped early - 1 due to inpatient admission for dehydration and pain related to RT; 1 due to low creatinine clearance likely related to cisplatin, which was given the week of initial decline and which recovered within 1 week. Median time from L-lysine start to grade 0 was 5 weeks (range, 2.7-8.4); median time post-RT to grade 0 was 2.1 weeks (range, 0.6-3.7). FLIC scores improved most significantly during the first 2 weeks, with a mean improvement of 11.2% (95% CI, 3.4-19.0) week 1 to 2; 13.0% (95% CI, 4.0-22.0) week 1 to 3; 6.8% (95% CI, 2.1-11.5) week 1 to resolution. Conclusions: L-lysine supplementation was tolerated with no adverse sequelae, and appeared to correlate with early improvement of QOL. Time to resolution of OM compares favorably with historical experience. Author Disclosure: W.M. Wong: None. J.J. Liao: None. G.E. Laramore: None. J.J. Valley: None. N.L. Polissar: None. U. Parvathaneni: None.
2959 A Multidisciplinary Rapid Access Clinic e Providing More Than Just Rapid Access S. Lefresne,1 K. Levy,1 R. Cashman,1 P. Santibanez,1 S. Tyldesley,1 and R.A. Olson1,2; 1BC Cancer Agency, Vancouver, BC, Canada, 2Center for the North, BC Cancer Agency, Prince George, BC, Canada Purpose/Objective(s): Patients with lung cancer frequently present with metastatic disease and require urgent palliative radiation therapy (RT) for symptom management. In May 2011, the Vancouver Cancer Center (VCC) opened a pilot, multidisciplinary clinic called the Vancouver Rapid Access (VARA) Clinic, which aimed to provide palliative RT to patients with newly diagnosed, incurable lung cancer on an urgent basis. The purpose of this study was to assess the general patient and treatment characteristics of the population served, as well as to compare the efficiency and level of care provided by VARA compared to standard practice. Materials/Methods: Patients referred to VARA are triaged and assessed by a nurse practitioner (NP), reviewed by a radiation oncologist (RO), and if appropriate, treated with RT on the same day. The NP and advanced practice nurse also address other holistic concerns the patient might have. VARA patient and treatment characteristics were prospectively collected over a 9-month period (May 2011-Jan 2012). Charts for similar patients in the ‘pre-VARA period,’ defined as the same 9 month period one year prior (May 2010-Jan 2011) were retrospectively reviewed. A comparison of the following was made between the VARA period and pre-VARA period: RT wait-times, referrals (BC Palliative benefits, home care, nutrition, pain and symptom management, and patient and family counseling) and number of double bookings for urgent patients. Results: During the first 9 months of VARA, 54 patients were assessed. The mean and median RT wait-times were 3 and 0 days, respectively, with the majority of VARA patients receiving RT on the same day as their consultation (71%). This is compared to only 41% of patients receiving same day RT in the pre-VARA period (p < 0.001). The majority of VARA patients (55%) received at least one referral to a supportive care service compared to only 31% of patients in the pre-VARA period (p Z 0.001). The proportion of urgent patients requiring a double booking for assessment decreased from 23% in the pre-VARA period to 13% in the VARA period (p < 0.001). Conclusions: This study suggests that the VARA clinic has shortened the wait time for palliative RT and connects a higher proportion of patients with supportive care services than the previous standard practice. The clinic has also improved RO workload by decreasing double bookings. These results highlight the value of the VARA clinic and suggest that the extension of this model to other tumor sites may be beneficial. Author Disclosure: S. Lefresne: None. K. Levy: None. R. Cashman: None. P. Santibanez: None. S. Tyldesley: None. R.A. Olson: None.
2960 L-lysine in the Treatment of Oral Mucositis in Head-and-Neck Cancer Patients: A Pilot Study W.M. Wong, J.J. Liao, G.E. Laramore, J.J. Valley, N.L. Polissar, and U. Parvathaneni; University of Washington Affiliated Hospitals, Seattle, WA
2961 Incidence and Risk Factors for Pain Flare Following Spine Radiosurgery D.L. Jung,1 E.H. Balagamwala,2 L. Angelov,2 J.H. Suh,2 C.A. Reddy,2 T. Djemil,2 A. Magnelli,2 S. Soeder,2 and S.T. Chao2; 1Case Western Reserve University School of Medicine, Cleveland, OH, 2Cleveland Clinic Foundation, Cleveland, OH Purpose/Objective(s): Understanding of pain flare (PFL) following spine stereotactic body radiation therapy (sSBRT) is lacking. This study seeks to determine the incidence and risk factors associated with PFL following single fraction sSBRT. Materials/Methods: An IRB-approved database was compiled to include patients (pts) who underwent sSBRT, typically for spine metastases. Gender, consult KPS, epidural disease (dz), thecal sac compression, histology, spine tumor location, and dosimetric factors (prescription dose, target volume, maximum target dose, maximum cord dose) were collected retrospectively. Pain relief post-sSBRT was prospectively collected using the Brief Pain Inventory. These factors were correlated to PFL (defined as an increase in pain within 7 days of treatment and resolved with steroids). Survival was calculated using Kaplan-Meier analysis and logistic regression was utilized to evaluate the association between the clinical factors and occurrence of PFL. Results: A total of 507 treatments (txs) in 348 pts were included. Only 15% of txs resulted in PFL. Median age and prescription dose were 59 yrs (range, 7-90) and 15 Gy (range, 7-18), respectively. Sixty-two percent were male; 74% had epidural dz and 43% had thecal sac compression. Renal cell carcinoma (24%), lung cancer (14%), and breast cancer (11%) were the most common histologies. Fifty-nine percent, 32%, and 9% of tumors were located in the cervical/thoracic (C/T), lumbar (lumb), and sacral (scr)