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Clinical Outcomes in Unresectable Cholangiocarcinoma Treated With Stereotactic Body Radiation Therapy
E140
International Journal of Radiation Oncology Biology Physics
respectively. As for late toxicity, only 1 of G3 pneumonitis and 2 of G2 pericarditis developed (2 in 2F method). There were neither G4 toxicities nor treatment related death. Conclusion: CCRT without elective nodal irradiation was believed to be successfully effective and safety treatment for SEC, even in elderlies. Author Disclosure: Y. Koide: None. K. Kimura: None. M. Yoshida: None. M. Ito: None. C. Makita: None. N. Tomita: None. H. Tachibana: None. T. Kodaira: None. T. Abe: None. K. Muro: None. M. Tajika: None. Y. Niwa: None.
carcinoma has been conducted. The purpose of the current study is to report the results of radiation therapy quality assurance (RTQA) program. Materials/Methods: Patients with cT1bN0M0, squamous cell carcinoma of the thoracic esophagus were included in this trial. After ER, additional treatment was indicated according to pathological findings as follows: no additional therapy for pT1a disease with negative resection margin and no vascular invasion (Group A), prophylactic CRT for pT1b with negative margin and pT1a with vascular invasion (Group B), and definitive CRT for pT1b with positive margin (Group C). CT-based 3-dimensional treatment planning was required. The clinical target volume (CTV) included the regional nodal area: the supra-clavicular, upper mediastinal and subcarinal nodal area for upper thoracic primary sites; the mediastinal and perigastric nodal area for the middle thoracic primary sites; and the mediastinal, perigastric and celiac nodal area for the lower thoracic primary sites. A delineation atlas for these regional nodal areas was provided in this trial. The initial planning target volume (PTV) was defined as the CTV plus 0.5 to 1 cm. In Group C, the PTV for the boost plan (PTVb) included the tumor bed only with adequate margins. Dose of 41.4 Gy/23 fr was delivered to the initial PTV in both Group B and C, and a booster dose of 9.0 Gy/5 fr was added to the PTVb in Group C. Three or 4 radiation portals were required for patients with the middle or lower primary site to avoid excessive dose to the heart. Chemotherapy consisted of 5-FU (700 mg/m2/day, days 1-4, 29-32), and CDDP (70 mg/ m2/day, day 1 and 29) in both Groups. Copies of pretreatment diagnostic CTs and endoscopy report, simulation and portal images, and radiation therapy charts were collected, and RTQA reviews were performed periodically. Results: From 2006 to 2012, 177 cases were registered in this study. After ER was done in 176 cases, they were divided into Group A (74), B (87), and C (15). RTQA were performed in 85 and 13 cases in Group B and C, respectively. RTQA data were found to be fully evaluable in all 98 cases. The results of RTQA are shown in Table 1. Among 10 cases assessed as unacceptable variation, anterior-posterior opposite portals were used in 9 cases for middle or lower thoracic primary site, and the CTV coverage was inadequate in 1 case. Conclusion: Unacceptable variation was observed in 10% of cases, but the results of RTQA have no influence on evaluating the efficacy of the trial. The effect on its long-term toxicity should be carefully assessed in the future.
2341 Clinical Outcomes in Unresectable Cholangiocarcinoma Treated With Stereotactic Body Radiation Therapy K.A. Sandler,1 D. Veruttipong,2 V. Agopian,2 R. Finn,2 J. Hong,2 F. Kaldas,2 S. Sadeghi,2 R. Busuttil,2 and P. Lee2; 1University of California Los Angeles, Los Angeles, CA, 2University of California, Los Angeles, Los Angeles, CA Purpose/Objective(s): We report single-institution clinical outcomes and toxicity for patients with unresectable locally advanced cholangiocarcinoma treated with SBRT, a subset of which received neoadjuvant SBRT and chemotherapy as part of a liver transplant protocol. Materials/Methods: From October 2008 to June 2015, 31 consecutive patients with unresectable extrahepatic (n Z 25) or intrahepatic (n Z 6) cholangiocarcinoma who were treated with SBRT were retrospectively analyzed. Four patients went on to undergo liver transplantation, and 1 underwent resection. SBRT was delivered in 5 fractions, with a median dose of 40 Gy (range 25 to 50 Gy). Toxicity was scored using CTCAE v4.0. Overall survival, time to progression, and local control were estimated with Kaplan-Meier analysis. Results: The median follow up time was 11.5 months. The 1-year and 2year overall survival rates were 59% and 33%, respectively, with a median survival of 15.7 months. The 1-year and 2-year freedom from progression rates were 67% and 34% respectively. The median time to progression was 16.8 months. A total of 9 patients had local failure. The actuarial 1-year and 2-year local control rates were 78% and 47%. Among patients who went on to have liver transplantation, the median overall survival was 31.3 months. Twenty-four patients (77%) experienced some form of acute Grade 1-2 toxicity, most commonly mild fatigue, or abdominal pain. Five patients (16%) experienced late Grade 3 toxicity. Three patients had duodenal ulcers with bleeding and two had duodenal obstruction. Conclusion: SBRT is a promising option for patients with unresectable or recurrent cholangiocarcinoma, either as neoadjuvant therapy prior to liver transplantation, or as definitive therapy for selected patients. Future investigation is needed in developing techniques to mitigate serious small bowel complications in order to further improve outcomes. Author Disclosure: K.A. Sandler: None. D. Veruttipong: None. V. Agopian: None. R. Finn: None. J. Hong: None. F. Kaldas: None. S. Sadeghi: None. R. Busuttil: None. P. Lee: None.
Abstract 2342; Table 1. Results of RTQA Evaluation of RTQA Patients Group B/C Group B Group C
Evaluable Acceptable e Acceptable Unacceptable variation variation Registered for RTQA per protocol 102 87 15
96 (100%) 83 13
79 (82.3%) 69 10
7 (7.3%) 4 3
10 (10.4%) 10 0
2342 A Phase II Study of Endoscopic Resection and Chemoradiation Therapy for Clinical Stage I Esophageal Carcinoma (JCOG 0508): A Report of Radiation Therapy Quality Assurance Program K. Nihei,1,2 K. Minashi,3,4 T. Yano,3,5 M. Muto,3,6 S. Ishikura,1,7 and K. Hayakawa1,8; 1Japan Clinical Oncology Group - Radiotherapy Committee, Tokyo, Japan, 2Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo, Japan, 3Japan Clinical Oncology Group - Gastrointestinal Endoscopy Study Group, Tokyo, Japan, 4 Chiba Cancer Center, Chiba, Japan, 5National Cancer Center Hospital East, Kashiwa, Japan, 6Kyoto University Hospital, Kyoto, Japan, 7 Koshigaya Municipal Hospital, Koshigaya, Japan, 8Kitasato University, Kanagawa, Japan Purpose/Objective(s): Single-arm study of endoscopic resection (ER) and chemoradiation therapy (CRT) for clinical stage I esophageal
Author Disclosure: K. Nihei: None. K. Minashi: None. T. Yano: None. M. Muto: None. S. Ishikura: None. K. Hayakawa: None.
2343 Efficacy and Dosimetry of 125I Radioactive Seed Implantation for Locally Recurrent Rectal Cancer H. Wang, J. Wang, H. Yuan, Y. Jiang, S. Tian, C. Liu, J. Li, R. Yang, and H. Sun; Peking University Third Hospital, Beijing, China Purpose/Objective(s): To evaluate the efficacy of 125I radioactive seed implantation for locally recurrent rectal cancer (LRRC), and analyze the relationship between the efficacy and dosimetry. Materials/Methods: From September 2003 to December 2011, 36 patients with locally recurrent rectal cancer received 125I seeds
International Journal of Radiation Oncology Biology Physics
respectively. As for late toxicity, only 1 of G3 pneumonitis and 2 of G2 pericarditis developed (2 in 2F method). There were neither G4 toxicities nor treatment related death. Conclusion: CCRT without elective nodal irradiation was believed to be successfully effective and safety treatment for SEC, even in elderlies. Author Disclosure: Y. Koide: None. K. Kimura: None. M. Yoshida: None. M. Ito: None. C. Makita: None. N. Tomita: None. H. Tachibana: None. T. Kodaira: None. T. Abe: None. K. Muro: None. M. Tajika: None. Y. Niwa: None.
carcinoma has been conducted. The purpose of the current study is to report the results of radiation therapy quality assurance (RTQA) program. Materials/Methods: Patients with cT1bN0M0, squamous cell carcinoma of the thoracic esophagus were included in this trial. After ER, additional treatment was indicated according to pathological findings as follows: no additional therapy for pT1a disease with negative resection margin and no vascular invasion (Group A), prophylactic CRT for pT1b with negative margin and pT1a with vascular invasion (Group B), and definitive CRT for pT1b with positive margin (Group C). CT-based 3-dimensional treatment planning was required. The clinical target volume (CTV) included the regional nodal area: the supra-clavicular, upper mediastinal and subcarinal nodal area for upper thoracic primary sites; the mediastinal and perigastric nodal area for the middle thoracic primary sites; and the mediastinal, perigastric and celiac nodal area for the lower thoracic primary sites. A delineation atlas for these regional nodal areas was provided in this trial. The initial planning target volume (PTV) was defined as the CTV plus 0.5 to 1 cm. In Group C, the PTV for the boost plan (PTVb) included the tumor bed only with adequate margins. Dose of 41.4 Gy/23 fr was delivered to the initial PTV in both Group B and C, and a booster dose of 9.0 Gy/5 fr was added to the PTVb in Group C. Three or 4 radiation portals were required for patients with the middle or lower primary site to avoid excessive dose to the heart. Chemotherapy consisted of 5-FU (700 mg/m2/day, days 1-4, 29-32), and CDDP (70 mg/ m2/day, day 1 and 29) in both Groups. Copies of pretreatment diagnostic CTs and endoscopy report, simulation and portal images, and radiation therapy charts were collected, and RTQA reviews were performed periodically. Results: From 2006 to 2012, 177 cases were registered in this study. After ER was done in 176 cases, they were divided into Group A (74), B (87), and C (15). RTQA were performed in 85 and 13 cases in Group B and C, respectively. RTQA data were found to be fully evaluable in all 98 cases. The results of RTQA are shown in Table 1. Among 10 cases assessed as unacceptable variation, anterior-posterior opposite portals were used in 9 cases for middle or lower thoracic primary site, and the CTV coverage was inadequate in 1 case. Conclusion: Unacceptable variation was observed in 10% of cases, but the results of RTQA have no influence on evaluating the efficacy of the trial. The effect on its long-term toxicity should be carefully assessed in the future.
2341 Clinical Outcomes in Unresectable Cholangiocarcinoma Treated With Stereotactic Body Radiation Therapy K.A. Sandler,1 D. Veruttipong,2 V. Agopian,2 R. Finn,2 J. Hong,2 F. Kaldas,2 S. Sadeghi,2 R. Busuttil,2 and P. Lee2; 1University of California Los Angeles, Los Angeles, CA, 2University of California, Los Angeles, Los Angeles, CA Purpose/Objective(s): We report single-institution clinical outcomes and toxicity for patients with unresectable locally advanced cholangiocarcinoma treated with SBRT, a subset of which received neoadjuvant SBRT and chemotherapy as part of a liver transplant protocol. Materials/Methods: From October 2008 to June 2015, 31 consecutive patients with unresectable extrahepatic (n Z 25) or intrahepatic (n Z 6) cholangiocarcinoma who were treated with SBRT were retrospectively analyzed. Four patients went on to undergo liver transplantation, and 1 underwent resection. SBRT was delivered in 5 fractions, with a median dose of 40 Gy (range 25 to 50 Gy). Toxicity was scored using CTCAE v4.0. Overall survival, time to progression, and local control were estimated with Kaplan-Meier analysis. Results: The median follow up time was 11.5 months. The 1-year and 2year overall survival rates were 59% and 33%, respectively, with a median survival of 15.7 months. The 1-year and 2-year freedom from progression rates were 67% and 34% respectively. The median time to progression was 16.8 months. A total of 9 patients had local failure. The actuarial 1-year and 2-year local control rates were 78% and 47%. Among patients who went on to have liver transplantation, the median overall survival was 31.3 months. Twenty-four patients (77%) experienced some form of acute Grade 1-2 toxicity, most commonly mild fatigue, or abdominal pain. Five patients (16%) experienced late Grade 3 toxicity. Three patients had duodenal ulcers with bleeding and two had duodenal obstruction. Conclusion: SBRT is a promising option for patients with unresectable or recurrent cholangiocarcinoma, either as neoadjuvant therapy prior to liver transplantation, or as definitive therapy for selected patients. Future investigation is needed in developing techniques to mitigate serious small bowel complications in order to further improve outcomes. Author Disclosure: K.A. Sandler: None. D. Veruttipong: None. V. Agopian: None. R. Finn: None. J. Hong: None. F. Kaldas: None. S. Sadeghi: None. R. Busuttil: None. P. Lee: None.
Abstract 2342; Table 1. Results of RTQA Evaluation of RTQA Patients Group B/C Group B Group C
Evaluable Acceptable e Acceptable Unacceptable variation variation Registered for RTQA per protocol 102 87 15
96 (100%) 83 13
79 (82.3%) 69 10
7 (7.3%) 4 3
10 (10.4%) 10 0
2342 A Phase II Study of Endoscopic Resection and Chemoradiation Therapy for Clinical Stage I Esophageal Carcinoma (JCOG 0508): A Report of Radiation Therapy Quality Assurance Program K. Nihei,1,2 K. Minashi,3,4 T. Yano,3,5 M. Muto,3,6 S. Ishikura,1,7 and K. Hayakawa1,8; 1Japan Clinical Oncology Group - Radiotherapy Committee, Tokyo, Japan, 2Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo, Japan, 3Japan Clinical Oncology Group - Gastrointestinal Endoscopy Study Group, Tokyo, Japan, 4 Chiba Cancer Center, Chiba, Japan, 5National Cancer Center Hospital East, Kashiwa, Japan, 6Kyoto University Hospital, Kyoto, Japan, 7 Koshigaya Municipal Hospital, Koshigaya, Japan, 8Kitasato University, Kanagawa, Japan Purpose/Objective(s): Single-arm study of endoscopic resection (ER) and chemoradiation therapy (CRT) for clinical stage I esophageal
Author Disclosure: K. Nihei: None. K. Minashi: None. T. Yano: None. M. Muto: None. S. Ishikura: None. K. Hayakawa: None.
2343 Efficacy and Dosimetry of 125I Radioactive Seed Implantation for Locally Recurrent Rectal Cancer H. Wang, J. Wang, H. Yuan, Y. Jiang, S. Tian, C. Liu, J. Li, R. Yang, and H. Sun; Peking University Third Hospital, Beijing, China Purpose/Objective(s): To evaluate the efficacy of 125I radioactive seed implantation for locally recurrent rectal cancer (LRRC), and analyze the relationship between the efficacy and dosimetry. Materials/Methods: From September 2003 to December 2011, 36 patients with locally recurrent rectal cancer received 125I seeds