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An Analysis of 126 Patients Treated With Stereotactic Radiosurgery for Brain Metastases
E94
International Journal of Radiation Oncology Biology Physics
addition, 72.0% had an ECOG 0-1, and 64.0% had a Mib-1 index >5%. Of the cohort, 38.0% received adjuvant RT, which was predominantly given to patients who underwent STR. The three year RFS for males vs. females was 100% vs. 86.1% (pZ0.047). The three year RFS for GTR vs. STR was 96.6% vs. 67.5% (pZ0.025). The three year RFS for size <4.5cm vs. >4.5cm was 100% vs. 85.4% (pZ0.019). The three year RFS Mib-1 index <5% vs. >5% was 100% vs 86.8% (pZ0.244). The three year OS for STR vs. GTR was 70.0% vs. 100% (p<0.001). The three year OS for Mib-1 index <5% vs. >5% was 100% vs. 89.7% (pZ0.008). The three year OS for ECOG 0-1 vs. ECOG 2-4 was 100% vs 66.7% (p<0.001). There was no difference in survival by gender. Conclusion: Characteristics which were strongly associated with a significantly higher rate of recurrence in patients with grade II meningiomas included female sex, subtotal resection and tumors greater than 4.5cm. Further studies are needed to confirm these findings and determine whether patients without any of these risk factors can undergo surgical resection without adjuvant radiation therapy. Author Disclosure: C. Fernandez: None. H. Engelhard: None. M.K. Nicholas: None. K. Slavin: None. M. Koshy: None.
Author Disclosure: K.B. Harris: None. M. Corbett: None. M. Henry: None. K.S. Lee: Stock; Amedica, Critical Diagnostics, Remedy Pharmaceuticals. H.H. Arastu: None. C. Leinweber: None. A.W. Ju: None.
2239 An Analysis of 126 Patients Treated With Stereotactic Radiosurgery for Brain Metastases K.B. Harris,1 M. Corbett,2 M. Henry,1 K.S. Lee,1 H.H. Arastu,3 C. Leinweber,3 and A.W. Ju2; 1East Carolina University, Greenville, NC, 2 East Carolina University Brody School of Medicine, Greenville, NC, 3East Carolina University Brody School of Medicine, Greenville, NC Purpose/Objective(s): To report our institutional experience with stereotactic radiosurgery (SRS) in the treatment of patients with brain metastases. Materials/Methods: We retrospectively collected and reviewed demographic and clinical data on 126 patients with intracranial metastases treated with single-fraction stereotactic radiosurgery between 2009 and 2014 at our institution. The log-rank test was used to compare overall survival based on clinical characteristics. A Cox-proportional hazards model was used for our multivariate analysis. Results: The median age of the patient population was 62 years. Our series is unique in that 34% of our patient population was African-American, 15% of the population is on Medicaid, and 51% on Medicare. The most common tumor histologies were non-small cell lung cancer (50%), breast cancer (12.7%) and melanoma (11.9%). The median overall survival for all patients was 5.8 months. Patients with breast cancer had the longest median survival of 9.15 months, while patients with melanoma had the shortest median survival of 2.86 months. On univariate analysis, predictors for improved overall survival included ECOG performance status (PS) 0-1 versus >Z2 (17.0 vs 1.8 months, p<0.001), controlled vs uncontrolled extracranial disease (17.4 vs 4.6 months, p<0.001), recursive partitioning analysis (RPA) Stage I vs II-III (18.2 vs 6.2 months, p<0.001), prior brain SRS vs no prior SRS (31.0 vs 7.0 months, pZ0.002), prior brain metastectomy vs none (median not reached vs 7.1 months, pZ0.012), and prior chemotherapy vs none (15.3 vs 5.2 months, pZ0.021). The number of metastatic lesions of 1-3 versus >Z4 approached significance (15.2 vs 6.6 months, pZ0.051). Previous external beam radiation therapy, concurrent chemotherapy, hemorrhagic metastases, gender, and age were not significant predictors of overall survival. Ethnicity (white vs non-white, pZ0.89) and insurance status (Medicare/Medicaid vs commercial insurance, pZ0.14) were not significant predictors of overall survival. On multivariate analysis, ECOG PS 0-1, prior SRS, prior brain metastectomy, and control of extracranial disease remained significant predictors of survival, while RPA Stage and prior chemotherapy did not remain significant. Conclusion: ECOG PS 0-1, control of extracranial disease, prior SRS, and prior brain metastectomy are predictors of longer median overall survival following SRS for metastatic brain lesions. Ethnicity and insurance status are not predictors of worse outcome following SRS. SRS is an effective palliative treatment for brain metastases, and these factors may influence patient selection for SRS.
2240 A Pilot Study on Imaging of 18F-Alfatide-RGD PET/CT in Patients With Glioma N. Liu,1 S. Gao,1 W. Zhao,1 X. Hu,2 S. Wang,1 Q. Yu,1 S. Zhu,1 W. Hou,2 H. Lu,1 J. Yu,2 and S. Yuan2; 1Shandong Cancer Hospital & Institute, Jinan, China, 2Shandong Cancer Hospital and Institute, Jinan, China Purpose/Objective(s): Angiogenesis is an essential step for tumor development and metastasis. Glioma is one of the most aggressive cancers and is associated with high levels of angiogenesis. The cell adhesion molecule avb3 integrin is a specific marker of tumor angiogenesis and diagnosis. A new tracer,18F-AL-NOTA-PRGD2, denoted as 18F-Alfatide, has been developed for PET imaging of integrin avb3. Therefore, we design this study to explore the safety and explore whether 18F-AlfatideRGD PET/CT imaging can be used in glioma pathological grading. Materials/Methods: Our Institutional Review Board approved this study. Thirteen patients with newly diagnosed histopathologically confirmed glioma after surgery will be enrolled in the study. All patients signed the informed consent. 18F-Alfatide-RGD PET/CT scans were acquired within 1 week before surgery or RT. The Standard uptake values (SUVmean, SUVmax), tumor/non tumor (T/NT), were measured in tumors after RGD PET/ CT scan. Surgery and pathology were performed to confirm the diagnosis. Results: (1) RGD PET-CT with 18F-Alfatide was performed successfully in all patients and no clinically significant adverse events were observed. (2) Among the thirteen patients, 3 patients were WHO II on pathologic examination, with the median of SUVmax SUVmean and T/NT is 0.86, 0.4 and 5.722, respectively. Three patients were WHO III with the median of SUVmax SUVmean and T/NT is 1.942, 0.86 and 31.2, respectively. 7 patients were WHO IV with the median of SUVmax SUVmean and T/NT is 1.845, 0.658 and 21.41 in the RGD PET imaging, In high grade gliomas, the SUVmax (p Z 0.028), SUVmean (p Z 0.042), T/NT (p Z 0.011) were significantly higher than those in low grade gliomas. There was no statistical significance between grade III and IV. Conclusion: Our results suggest RGD PET-CT with the new tracer 18 F-Alfatide is safe and effective. It is associated with the malignant degree of glioma, further study with a larger number of patients is needed to validate our findings Author Disclosure: N. Liu: None. S. Gao: None. W. Zhao: None. X. Hu: None. S. Wang: None. Q. Yu: None. S. Zhu: None. W. Hou: None. H. Lu: None. J. Yu: None. S. Yuan: None.
2241 Adjuvant Stereotactic Radiosurgery to the Tumor Bed Improves Local Control and Progression Free Survival Following Gross Total Resection of Brain Metastases A. Yaeh,1 T. Nanda,1 A. Jani,2 S. Saad,3 Y.H. Qureshi,4 K. Cauley,2 S.R. Isaacson,3,5 M.B. Sisti,5,6 J.N. Bruce,5,6 G.M. McKhann,5,6 A.B. Lassman,5,7 and T.J. Wang2,5; 1Columbia University College of Physicians and Surgeons, New York, NY, 2Columbia University Medical Center, New York, NY, 3Department of Radiation Oncology, Columbia University Medical Center, New York, NY, 4The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, 5Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, 6Department of Neurological Surgery, Columbia University Medical Center, New York, NY, 7 Department of Neurology, Columbia University Medical Center, New York, NY Purpose/Objective(s): Options for the local treatment of brain metastases (BM) include surgical resection, whole-brain radiation therapy (WBRT), and stereotactic radiosurgery (SRS). Adjuvant WBRT after surgery is known to improve local control, but not overall survival (OS). The neurotoxicity associated with WBRT, however, has led to reservations
International Journal of Radiation Oncology Biology Physics
addition, 72.0% had an ECOG 0-1, and 64.0% had a Mib-1 index >5%. Of the cohort, 38.0% received adjuvant RT, which was predominantly given to patients who underwent STR. The three year RFS for males vs. females was 100% vs. 86.1% (pZ0.047). The three year RFS for GTR vs. STR was 96.6% vs. 67.5% (pZ0.025). The three year RFS for size <4.5cm vs. >4.5cm was 100% vs. 85.4% (pZ0.019). The three year RFS Mib-1 index <5% vs. >5% was 100% vs 86.8% (pZ0.244). The three year OS for STR vs. GTR was 70.0% vs. 100% (p<0.001). The three year OS for Mib-1 index <5% vs. >5% was 100% vs. 89.7% (pZ0.008). The three year OS for ECOG 0-1 vs. ECOG 2-4 was 100% vs 66.7% (p<0.001). There was no difference in survival by gender. Conclusion: Characteristics which were strongly associated with a significantly higher rate of recurrence in patients with grade II meningiomas included female sex, subtotal resection and tumors greater than 4.5cm. Further studies are needed to confirm these findings and determine whether patients without any of these risk factors can undergo surgical resection without adjuvant radiation therapy. Author Disclosure: C. Fernandez: None. H. Engelhard: None. M.K. Nicholas: None. K. Slavin: None. M. Koshy: None.
Author Disclosure: K.B. Harris: None. M. Corbett: None. M. Henry: None. K.S. Lee: Stock; Amedica, Critical Diagnostics, Remedy Pharmaceuticals. H.H. Arastu: None. C. Leinweber: None. A.W. Ju: None.
2239 An Analysis of 126 Patients Treated With Stereotactic Radiosurgery for Brain Metastases K.B. Harris,1 M. Corbett,2 M. Henry,1 K.S. Lee,1 H.H. Arastu,3 C. Leinweber,3 and A.W. Ju2; 1East Carolina University, Greenville, NC, 2 East Carolina University Brody School of Medicine, Greenville, NC, 3East Carolina University Brody School of Medicine, Greenville, NC Purpose/Objective(s): To report our institutional experience with stereotactic radiosurgery (SRS) in the treatment of patients with brain metastases. Materials/Methods: We retrospectively collected and reviewed demographic and clinical data on 126 patients with intracranial metastases treated with single-fraction stereotactic radiosurgery between 2009 and 2014 at our institution. The log-rank test was used to compare overall survival based on clinical characteristics. A Cox-proportional hazards model was used for our multivariate analysis. Results: The median age of the patient population was 62 years. Our series is unique in that 34% of our patient population was African-American, 15% of the population is on Medicaid, and 51% on Medicare. The most common tumor histologies were non-small cell lung cancer (50%), breast cancer (12.7%) and melanoma (11.9%). The median overall survival for all patients was 5.8 months. Patients with breast cancer had the longest median survival of 9.15 months, while patients with melanoma had the shortest median survival of 2.86 months. On univariate analysis, predictors for improved overall survival included ECOG performance status (PS) 0-1 versus >Z2 (17.0 vs 1.8 months, p<0.001), controlled vs uncontrolled extracranial disease (17.4 vs 4.6 months, p<0.001), recursive partitioning analysis (RPA) Stage I vs II-III (18.2 vs 6.2 months, p<0.001), prior brain SRS vs no prior SRS (31.0 vs 7.0 months, pZ0.002), prior brain metastectomy vs none (median not reached vs 7.1 months, pZ0.012), and prior chemotherapy vs none (15.3 vs 5.2 months, pZ0.021). The number of metastatic lesions of 1-3 versus >Z4 approached significance (15.2 vs 6.6 months, pZ0.051). Previous external beam radiation therapy, concurrent chemotherapy, hemorrhagic metastases, gender, and age were not significant predictors of overall survival. Ethnicity (white vs non-white, pZ0.89) and insurance status (Medicare/Medicaid vs commercial insurance, pZ0.14) were not significant predictors of overall survival. On multivariate analysis, ECOG PS 0-1, prior SRS, prior brain metastectomy, and control of extracranial disease remained significant predictors of survival, while RPA Stage and prior chemotherapy did not remain significant. Conclusion: ECOG PS 0-1, control of extracranial disease, prior SRS, and prior brain metastectomy are predictors of longer median overall survival following SRS for metastatic brain lesions. Ethnicity and insurance status are not predictors of worse outcome following SRS. SRS is an effective palliative treatment for brain metastases, and these factors may influence patient selection for SRS.
2240 A Pilot Study on Imaging of 18F-Alfatide-RGD PET/CT in Patients With Glioma N. Liu,1 S. Gao,1 W. Zhao,1 X. Hu,2 S. Wang,1 Q. Yu,1 S. Zhu,1 W. Hou,2 H. Lu,1 J. Yu,2 and S. Yuan2; 1Shandong Cancer Hospital & Institute, Jinan, China, 2Shandong Cancer Hospital and Institute, Jinan, China Purpose/Objective(s): Angiogenesis is an essential step for tumor development and metastasis. Glioma is one of the most aggressive cancers and is associated with high levels of angiogenesis. The cell adhesion molecule avb3 integrin is a specific marker of tumor angiogenesis and diagnosis. A new tracer,18F-AL-NOTA-PRGD2, denoted as 18F-Alfatide, has been developed for PET imaging of integrin avb3. Therefore, we design this study to explore the safety and explore whether 18F-AlfatideRGD PET/CT imaging can be used in glioma pathological grading. Materials/Methods: Our Institutional Review Board approved this study. Thirteen patients with newly diagnosed histopathologically confirmed glioma after surgery will be enrolled in the study. All patients signed the informed consent. 18F-Alfatide-RGD PET/CT scans were acquired within 1 week before surgery or RT. The Standard uptake values (SUVmean, SUVmax), tumor/non tumor (T/NT), were measured in tumors after RGD PET/ CT scan. Surgery and pathology were performed to confirm the diagnosis. Results: (1) RGD PET-CT with 18F-Alfatide was performed successfully in all patients and no clinically significant adverse events were observed. (2) Among the thirteen patients, 3 patients were WHO II on pathologic examination, with the median of SUVmax SUVmean and T/NT is 0.86, 0.4 and 5.722, respectively. Three patients were WHO III with the median of SUVmax SUVmean and T/NT is 1.942, 0.86 and 31.2, respectively. 7 patients were WHO IV with the median of SUVmax SUVmean and T/NT is 1.845, 0.658 and 21.41 in the RGD PET imaging, In high grade gliomas, the SUVmax (p Z 0.028), SUVmean (p Z 0.042), T/NT (p Z 0.011) were significantly higher than those in low grade gliomas. There was no statistical significance between grade III and IV. Conclusion: Our results suggest RGD PET-CT with the new tracer 18 F-Alfatide is safe and effective. It is associated with the malignant degree of glioma, further study with a larger number of patients is needed to validate our findings Author Disclosure: N. Liu: None. S. Gao: None. W. Zhao: None. X. Hu: None. S. Wang: None. Q. Yu: None. S. Zhu: None. W. Hou: None. H. Lu: None. J. Yu: None. S. Yuan: None.
2241 Adjuvant Stereotactic Radiosurgery to the Tumor Bed Improves Local Control and Progression Free Survival Following Gross Total Resection of Brain Metastases A. Yaeh,1 T. Nanda,1 A. Jani,2 S. Saad,3 Y.H. Qureshi,4 K. Cauley,2 S.R. Isaacson,3,5 M.B. Sisti,5,6 J.N. Bruce,5,6 G.M. McKhann,5,6 A.B. Lassman,5,7 and T.J. Wang2,5; 1Columbia University College of Physicians and Surgeons, New York, NY, 2Columbia University Medical Center, New York, NY, 3Department of Radiation Oncology, Columbia University Medical Center, New York, NY, 4The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, 5Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, 6Department of Neurological Surgery, Columbia University Medical Center, New York, NY, 7 Department of Neurology, Columbia University Medical Center, New York, NY Purpose/Objective(s): Options for the local treatment of brain metastases (BM) include surgical resection, whole-brain radiation therapy (WBRT), and stereotactic radiosurgery (SRS). Adjuvant WBRT after surgery is known to improve local control, but not overall survival (OS). The neurotoxicity associated with WBRT, however, has led to reservations