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Association between Positron Emission Tomography (18F) Fluorodeoxyglucose Uptake and Pain Response to Palliative Radiotherapy in Patients with Bone Metastasis
I. J. Radiation Oncology d Biology d Physics
S580
Volume 78, Number 3, Supplement, 2010
impact of 3D vs. 2D planning in palliative RT for bone metastases, and assess factors associated with changes between 2D and 3D plans. Materials/Methods: Patients (pts) undergoing palliative RT for bone metastases suitable for simple techniques were enrolled (n = 81). A 2D field definition was created using digital radiograph and all diagnostic information available. The 3D planning CT dataset was then reviewed, target outlined, a 3D plan created and used for treatment. Target coverage was assessed for both plans using PTV coverage factor (% PTV covered by 95% isodose, PTV CF). Normal tissue dose was assessed using healthy tissue overdosage factor (HT OF). Changes to PTV and/or field borders (from 2D to 3D plans) were recorded, and classified as ‘major’ if adjustment involved .1 vertebral body, .3 cm move or altered shielding to avoid an organ at risk. Factors potentially predictive of major change were explored, including availability and timing of diagnostic CT/MRI, presence of soft tissue disease in association with bone metastasis, and treatment site. Results: A total of 81 pts receiving RT to 92 bone sites [48 (52%) spine, 31 (34%) pelvis/hip] formed the study cohort. Using 2D approach, oncologists employed single fields more often than in 3D plans [23/92 (25%) vs. 8/92 (9%) in 3D plans], and less parallel pairs [69/92 (75%) vs. 82/92 (89%) in 3D plans; p = 0.003]. 3D plans had smaller treatment volumes [mean V95 = 1250 cc3 (3D) vs. 1557 cc3 (2D); p = 0.0085], superior PTV coverage [mean PTV CF 93% (3D) vs. 74% (2D); p\0.0001], and improved healthy tissue sparing [mean HT OF 2.5 (3D) vs. 4.1 (2D); p = 0.046]. After 3D planning information was reviewed, PTV and/or field borders were changed in 48/92 (52%) cases, mainly due to local disease extent (42/48, 88%). Changes were major in 25/92 (27%) cases. 3D diagnostic imaging (CT/MRI) was available in 60% of pts with major change vs. 80% of pts with no change; p = 0.25. Median time between diagnostic CT/MRI and simulation was similar [13 days (major change) vs. 18 days (no change); p = 0.09]. The presence of associated soft tissue tumor was more common in the pts with major change [8/25 (32%) vs. 2/44 (5%) in pts with no major change; p\0.05]. The distribution of treated sites was not different [14/25 (56%) spine, 9/25 (36%) hip/pelvis in major change group], compared to the overall cohort. Conclusions: The 3D planning for palliative bone RT provided superior PTV coverage, improved healthy tissue sparing and lead to a smaller irradiated area, compared to 2D planning. Presence of soft tissue disease was associated with a higher likelihood of major change from 2D to 3D plans. Author Disclosure: K.L. Pope, None; M. Holwell, None; M. Lau, None; L. Wang, None; A. Bezjak, None; M. McLean, None; W. Levin, None; L. Zurawel-Balaura, None; R. Wong, None.
2843
Association between Positron Emission Tomography (18F) Fluorodeoxyglucose Uptake and Pain Response to Palliative Radiotherapy in Patients with Bone Metastasis
M. Adli1, A. Kuzhan1, M. Yilmaz2, H. Alkis1, F. Andic1 1 Department of Radiation Oncology, Gaziantep University Medical School, Gaziantep, Turkey, 2Department of Nuclear Medicine, Gaziantep University Medical School, Gaziantep, Turkey
Purpose/Objective(s): To analyze the relationship between (18F) fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) SUVmax maximum standardized uptake value) and pain response to radiotherapy (RT) in patients with bone metastasis. Materials/Methods: Twenty patients with bone metastases were included. Median patient age was 51 (24-68). All patients have had pre-radiotherapy FDG PET/CT scans and referred for palliative radiotherapy for bone pain. Patients were diagnosed with lung (n = 10), breast (n = 5), stomach (n = 1), oral cavity (n = 1), parotid cancers (n = 1), and unknown primary tumor (n = 2). Forty-seven different sites with metastatic bone pain (two sites in four patients, three sites in one patient, four sites in two patients, five sites in one patient, six sites in one patient and seven sites in one patient) were evaluated. Pain scores using visual analog scale (VAS) or FACES pain rating scale and SUVmax were recorded for each site before radiotherapy. All patients were treated with single fraction 8 Gy external beam radiotherapy. Post-radiotherapy pain scores were assessed and recorded at weeks 2, 4, 8, 12 and 16. Treatment response for each site was evaluated as complete response (CR), partial response (PR) or stable disease (no response). Pre-treatment pain scores and response of pain to radiotherapy were compared with FDG PET SUVmax of the pain site. Results: Mean SUVmax was 7.74 (range, 2.5-16). Median follow-up time was 16 (range, 3-50) weeks. SUVmax was correlated with pre-treatment pain scores (p = 0.0001) and pain response to radiotherapy (p\0.005). Pretreatment mean SUVmax were 4.78, 5.52, 9.11 and 9.91 for initial pain scores 2 (n = 8), 4 (n = 11), 6 (n = 16) and 8 (n = 12), respectively (p = 0.0001). Mean SUVmax at week 2 were 5.10, 9.18 and 10.8 for patients with CR (n = 17), PR (n = 29) and no response (n = 1), respectively (p = 0.0002). Mean SUVmax at week 4 were 5.36 and 9.37 for patients with CR (n = 17) and PR (n = 27), respectively (p = 0.0006). Mean SUVmax at week 8 were 5.29 and 11.20 for patients with CR (n = 14) and PR (n = 9), respectively (p = 0.0004). Mean SUVmax at week 12 were 5.29 and 11.32 for patients with CR (n = 14) and PR (n = 4), respectively (p = 0.004). Mean SUVmax at week 16 were 5.40 and 11.32 for patients with CR (n = 13) and PR (n = 4), respectively (p = 0.005). Conclusions: SUVmax is correlated with initial pain severity and response of pain to palliative radiotherapy in patients with bone metastasis. FDG PET SUVmax can be used as a predictive factor for treatment response in patients with bone metastasis treated with radiotherapy. Author Disclosure: M. Adli, None; A. Kuzhan, None; M. Yilmaz, None; H. Alkis, None; F. Andic, None.
2844
The Effects of Splenic Irradiation in Chronic Myeloid Leukemia
D. Lee1, J. Kim1, B. Choi1, Y. Lee1, D. Kim2, J. Park2, C. Han2, W. Min2, C. Min2, S. Chung1 1 2
Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Purpose/Objective(s): With the emergence of new effective drugs, splenic irradiation (SI) seems to be used in the restricted cases in recent years. However, SI has been used as an efficient treatment modality in hematologic diseases for the palliation of severe symptomatic splenomegaly. We performed a retrospective study to identify treatment outcomes, toxicities and potential benefits of SI in chronic myeloid leukemia (CML) patients.
S580
Volume 78, Number 3, Supplement, 2010
impact of 3D vs. 2D planning in palliative RT for bone metastases, and assess factors associated with changes between 2D and 3D plans. Materials/Methods: Patients (pts) undergoing palliative RT for bone metastases suitable for simple techniques were enrolled (n = 81). A 2D field definition was created using digital radiograph and all diagnostic information available. The 3D planning CT dataset was then reviewed, target outlined, a 3D plan created and used for treatment. Target coverage was assessed for both plans using PTV coverage factor (% PTV covered by 95% isodose, PTV CF). Normal tissue dose was assessed using healthy tissue overdosage factor (HT OF). Changes to PTV and/or field borders (from 2D to 3D plans) were recorded, and classified as ‘major’ if adjustment involved .1 vertebral body, .3 cm move or altered shielding to avoid an organ at risk. Factors potentially predictive of major change were explored, including availability and timing of diagnostic CT/MRI, presence of soft tissue disease in association with bone metastasis, and treatment site. Results: A total of 81 pts receiving RT to 92 bone sites [48 (52%) spine, 31 (34%) pelvis/hip] formed the study cohort. Using 2D approach, oncologists employed single fields more often than in 3D plans [23/92 (25%) vs. 8/92 (9%) in 3D plans], and less parallel pairs [69/92 (75%) vs. 82/92 (89%) in 3D plans; p = 0.003]. 3D plans had smaller treatment volumes [mean V95 = 1250 cc3 (3D) vs. 1557 cc3 (2D); p = 0.0085], superior PTV coverage [mean PTV CF 93% (3D) vs. 74% (2D); p\0.0001], and improved healthy tissue sparing [mean HT OF 2.5 (3D) vs. 4.1 (2D); p = 0.046]. After 3D planning information was reviewed, PTV and/or field borders were changed in 48/92 (52%) cases, mainly due to local disease extent (42/48, 88%). Changes were major in 25/92 (27%) cases. 3D diagnostic imaging (CT/MRI) was available in 60% of pts with major change vs. 80% of pts with no change; p = 0.25. Median time between diagnostic CT/MRI and simulation was similar [13 days (major change) vs. 18 days (no change); p = 0.09]. The presence of associated soft tissue tumor was more common in the pts with major change [8/25 (32%) vs. 2/44 (5%) in pts with no major change; p\0.05]. The distribution of treated sites was not different [14/25 (56%) spine, 9/25 (36%) hip/pelvis in major change group], compared to the overall cohort. Conclusions: The 3D planning for palliative bone RT provided superior PTV coverage, improved healthy tissue sparing and lead to a smaller irradiated area, compared to 2D planning. Presence of soft tissue disease was associated with a higher likelihood of major change from 2D to 3D plans. Author Disclosure: K.L. Pope, None; M. Holwell, None; M. Lau, None; L. Wang, None; A. Bezjak, None; M. McLean, None; W. Levin, None; L. Zurawel-Balaura, None; R. Wong, None.
2843
Association between Positron Emission Tomography (18F) Fluorodeoxyglucose Uptake and Pain Response to Palliative Radiotherapy in Patients with Bone Metastasis
M. Adli1, A. Kuzhan1, M. Yilmaz2, H. Alkis1, F. Andic1 1 Department of Radiation Oncology, Gaziantep University Medical School, Gaziantep, Turkey, 2Department of Nuclear Medicine, Gaziantep University Medical School, Gaziantep, Turkey
Purpose/Objective(s): To analyze the relationship between (18F) fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) SUVmax maximum standardized uptake value) and pain response to radiotherapy (RT) in patients with bone metastasis. Materials/Methods: Twenty patients with bone metastases were included. Median patient age was 51 (24-68). All patients have had pre-radiotherapy FDG PET/CT scans and referred for palliative radiotherapy for bone pain. Patients were diagnosed with lung (n = 10), breast (n = 5), stomach (n = 1), oral cavity (n = 1), parotid cancers (n = 1), and unknown primary tumor (n = 2). Forty-seven different sites with metastatic bone pain (two sites in four patients, three sites in one patient, four sites in two patients, five sites in one patient, six sites in one patient and seven sites in one patient) were evaluated. Pain scores using visual analog scale (VAS) or FACES pain rating scale and SUVmax were recorded for each site before radiotherapy. All patients were treated with single fraction 8 Gy external beam radiotherapy. Post-radiotherapy pain scores were assessed and recorded at weeks 2, 4, 8, 12 and 16. Treatment response for each site was evaluated as complete response (CR), partial response (PR) or stable disease (no response). Pre-treatment pain scores and response of pain to radiotherapy were compared with FDG PET SUVmax of the pain site. Results: Mean SUVmax was 7.74 (range, 2.5-16). Median follow-up time was 16 (range, 3-50) weeks. SUVmax was correlated with pre-treatment pain scores (p = 0.0001) and pain response to radiotherapy (p\0.005). Pretreatment mean SUVmax were 4.78, 5.52, 9.11 and 9.91 for initial pain scores 2 (n = 8), 4 (n = 11), 6 (n = 16) and 8 (n = 12), respectively (p = 0.0001). Mean SUVmax at week 2 were 5.10, 9.18 and 10.8 for patients with CR (n = 17), PR (n = 29) and no response (n = 1), respectively (p = 0.0002). Mean SUVmax at week 4 were 5.36 and 9.37 for patients with CR (n = 17) and PR (n = 27), respectively (p = 0.0006). Mean SUVmax at week 8 were 5.29 and 11.20 for patients with CR (n = 14) and PR (n = 9), respectively (p = 0.0004). Mean SUVmax at week 12 were 5.29 and 11.32 for patients with CR (n = 14) and PR (n = 4), respectively (p = 0.004). Mean SUVmax at week 16 were 5.40 and 11.32 for patients with CR (n = 13) and PR (n = 4), respectively (p = 0.005). Conclusions: SUVmax is correlated with initial pain severity and response of pain to palliative radiotherapy in patients with bone metastasis. FDG PET SUVmax can be used as a predictive factor for treatment response in patients with bone metastasis treated with radiotherapy. Author Disclosure: M. Adli, None; A. Kuzhan, None; M. Yilmaz, None; H. Alkis, None; F. Andic, None.
2844
The Effects of Splenic Irradiation in Chronic Myeloid Leukemia
D. Lee1, J. Kim1, B. Choi1, Y. Lee1, D. Kim2, J. Park2, C. Han2, W. Min2, C. Min2, S. Chung1 1 2
Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Purpose/Objective(s): With the emergence of new effective drugs, splenic irradiation (SI) seems to be used in the restricted cases in recent years. However, SI has been used as an efficient treatment modality in hematologic diseases for the palliation of severe symptomatic splenomegaly. We performed a retrospective study to identify treatment outcomes, toxicities and potential benefits of SI in chronic myeloid leukemia (CML) patients.