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Concurrent Immunotherapy and Stereotactic Radiosurgery for Brain Metastases Is Associated With a Decreased Incidence of New Intracranial Metastases
E102
International Journal of Radiation Oncology Biology Physics
2259
Materials/Methods: Patient-reported data were gathered via convenience sample frame from brain tumor survivors voluntarily using an Internet tool for creation of survivorship care plans. The tool requires entry of data regarding diagnosis, demographics, and treatments, and provides customized guidelines for future care. It is publically available and free, having >30,0000 total users since 2007. During use of the tool, survivors are queried regarding experience with late effects associated with specific treatments. Results: The tool was utilized by 254 survivors of primary brain tumors from 2011-14. Median age at diagnosis was 42y (18-82), median current age 45y (18-82), and median time since dx 1y (<1-18). Users were primarily white (88%) and resided in the US (86%). Only 10% had previously been offered survivorship information. Users reported having undergone surgical resection (85%), radiation therapy (80%), and chemotherapy (67%) as part of their definitive treatment, and over 50% reported currently living with metastatic or recurrent disease. Most common patient reported late effects were memory loss (75%), fatigue (71%), hair loss (60%), hearing loss (57%), impaired speech or walking difficulties (48%), loss of strength or limb paralysis (40%). In comparing side effects by age at diagnosis, 92% of patients diagnosed age 18 e 25 reported hearing loss, tinnitus and vertigo as compared to 45% in other age groups (p<0.03), but this age group also noted less memory loss (33% vs 50%, pZ0.052). Patients aged 51 to 60 demonstrated increased incidence of cognitive changes (93% vs 69%, pZ0.192) and fatigue (93 vs 69%, pZ0.05), compared to other age groups, both older and younger. Survivors diagnosed five or more years ago reported increased sexual dysfunction (32% v 19%, pZ0.07), while survivors less than five years after diagnosis were noted to have increased incidence of fatigue (76% v. 56%, pZ0.051), impaired speech or difficulty walking (52% v. 33%, p<0.03) and partial or full vision loss (22% v. 6.6%, p<0.03). Conclusion: Survivors of primary CNS malignancies remain interested in survivorship information, even in the setting of recurrent disease. Most common patient reported outcomes in this population are memory loss, fatigue, hair loss, hearing loss, impaired speech or walking, and loss of strength. Some variability was observed according to age and time from completion of treatment. These data may be of use in patient counseling and design of survivorship care programs for patients after treatment for brain tumors. Author Disclosure: K. Sloane: None. J.M. Metz: Travel Expenses; University of Pennsylvania Health System. C. Vachani: Employee; University of Pennsylvania Health System. Travel Expenses; University of Pennsylvania Health System. M.K. Hampshire: Travel Expenses; University of Pennsylvania Health System. C.E. Hill-Kayser: Employee; University of Pennsylvania Health System. Travel Expenses; University of Pennsylvania Health System.
Concurrent Immunotherapy and Stereotactic Radiosurgery for Brain Metastases Is Associated With a Decreased Incidence of New Intracranial Metastases L. Chen,1 J. Douglass,1 A.J. Walker,2 A.E. Marciscano,3 M. Lim,1 L.R. Kleinberg,1 P. Forde,1 T.R. McNutt,1 and K.J. Redmond1; 1Johns Hopkins University, Baltimore, MD, 2Johns Hopkins University, Baltimore, MD, 3Johns Hopkins School of Medicine, Baltimore, MD Purpose/Objective(s): Radiation is hypothesized to potentiate the efficacy of the immune response to tumor cells. Here, we aim to retrospectively characterize the treatment effect of stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) in a cohort of patients with intracranial metastases. Specifically we examined intracranial disease progression following radiation with and without concurrent immunotherapy. Materials/Methods: We identified metastatic non-small cell lung cancer (NSCLC) and metastatic melanoma patients who had intracranial metastases treated with radiation. Radiation treatments consisted of WBRT or SRS at a single institution from 2011-2014. We retrospectively reviewed patient demographics, pathology, oncologic treatment course, and radiographic imaging. Patients were defined as having concurrent immunotherapy if a cycle of Ipilimumab or Nivolumab was given within thirty days pre or post-radiation. Progression free survival (PFS) was defined from date of intracranial radiation to intracranial progression and overall survival (OS) was defined from date of intracranial radiation to date of death. Patients were categorized as having no intracranial progression, local progression within the treatment field, and/or new metastatic disease. The absolute number of new intracranial metastases was recorded following RT. Data was analyzed using Kaplan-Meier survival curves, unpaired two-tailed t-test and Fisher’s exact test. Results: We included 74 adults with metastatic melanoma (nZ51) or NSCLC (nZ23) treated for intracranial metastases with SRS (nZ46) or WBRT (nZ28). In total 23 patients were treated with Ipilimumab or Nivolumab and 17 of these patients were treated concurrently with radiation. PFS and OS for this cohort was a median of 15 months (range:1-51 mo) and 27 months (range:6-76 mo). At the time of intracranial progression, 93% of SRS patients who received SRS alone had new intracranial metastases compared to 53% in patients who received concurrent immunotherapy (pZ0.0006, OR 17.14, 95% CI:2.97-99.1). SRS patients who did not receive concurrent immunotherapy had a mean of 7 (range 0-35, SEM 1.49) subsequent brain metastases compared to a mean of 1 (range 0-5, SEM Z0.43) in patients who received concurrent immunotherapy (p<0.0001). Conclusion: The use of intracranial stereotactic radiosurgery with concurrent immunotherapy was associated with a decrease in the incidence and burden of new sites of intracranial disease. Although SRS is a local treatment modality, these findings suggest a potential abscopal effect when SRS for brain metastases is used in conjunction with immunotherapy. Author Disclosure: L. Chen: None. J. Douglass: None. A.J. Walker: None. A.E. Marciscano: None. M. Lim: None. L.R. Kleinberg: None. P. Forde: None. T.R. McNutt: None. K.J. Redmond: None.
2260 Patient Reported Outcomes After Radiation Therapy and Other Treatments for Primary Brain Tumors K. Sloane,1 J.M. Metz,2 C. Vachani,3 M.K. Hampshire,4 and C.E. HillKayser3; 1Temple University, Philadelphia, PA, 2University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA, 3 University of Pennsylvania, Philadelphia, PA, 4Oncolink University of Pennsylvania, Philadelphia, PA Purpose/Objective(s): Understanding of patient reported outcomes after radiation for primary brain tumors is limited; however, this survivor population is underserved and at risk for late effects. Here, we describe patient reported outcomes after radiation and other definitive or adjuvant treatments for tumors of the CNS.
2261 Local Control Following Postoperative Stereotactic Radiation Therapy for Brain Metastases K.M. Mani, N. Ohri, J.L. Fox, S. Kalnicki, P. Lasala, W.A. Tome, and M.K. Garg; Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY Purpose/Objective(s): Stereotactic radiosurgery (SRS) and fractionated stereotactic radiation therapy (FSRT) have emerged as viable alternatives to whole brain radiation therapy (WBRT) in patients with resected brain metastases. We performed a systematic review and quantitative analysis of the published experiences with adjuvant SRS and FSRT to determine local control (LC) rates and any relationship with dose-response, fractionation, and treatment delivery parameters. Materials/Methods: We identified published articles that reported local control rates following post-operative SRS or FSRT to the resection cavity in patients with brain metastases. For series in which uniform dosing schedules were used, biologically effective doses (BED) were calculated using the linear quadratic model and assuming an a/b ratio of 10 Gy. Local control data for the individual resection cavities treated in each study were extracted from actuarial survival curves and aggregated to form a single
International Journal of Radiation Oncology Biology Physics
2259
Materials/Methods: Patient-reported data were gathered via convenience sample frame from brain tumor survivors voluntarily using an Internet tool for creation of survivorship care plans. The tool requires entry of data regarding diagnosis, demographics, and treatments, and provides customized guidelines for future care. It is publically available and free, having >30,0000 total users since 2007. During use of the tool, survivors are queried regarding experience with late effects associated with specific treatments. Results: The tool was utilized by 254 survivors of primary brain tumors from 2011-14. Median age at diagnosis was 42y (18-82), median current age 45y (18-82), and median time since dx 1y (<1-18). Users were primarily white (88%) and resided in the US (86%). Only 10% had previously been offered survivorship information. Users reported having undergone surgical resection (85%), radiation therapy (80%), and chemotherapy (67%) as part of their definitive treatment, and over 50% reported currently living with metastatic or recurrent disease. Most common patient reported late effects were memory loss (75%), fatigue (71%), hair loss (60%), hearing loss (57%), impaired speech or walking difficulties (48%), loss of strength or limb paralysis (40%). In comparing side effects by age at diagnosis, 92% of patients diagnosed age 18 e 25 reported hearing loss, tinnitus and vertigo as compared to 45% in other age groups (p<0.03), but this age group also noted less memory loss (33% vs 50%, pZ0.052). Patients aged 51 to 60 demonstrated increased incidence of cognitive changes (93% vs 69%, pZ0.192) and fatigue (93 vs 69%, pZ0.05), compared to other age groups, both older and younger. Survivors diagnosed five or more years ago reported increased sexual dysfunction (32% v 19%, pZ0.07), while survivors less than five years after diagnosis were noted to have increased incidence of fatigue (76% v. 56%, pZ0.051), impaired speech or difficulty walking (52% v. 33%, p<0.03) and partial or full vision loss (22% v. 6.6%, p<0.03). Conclusion: Survivors of primary CNS malignancies remain interested in survivorship information, even in the setting of recurrent disease. Most common patient reported outcomes in this population are memory loss, fatigue, hair loss, hearing loss, impaired speech or walking, and loss of strength. Some variability was observed according to age and time from completion of treatment. These data may be of use in patient counseling and design of survivorship care programs for patients after treatment for brain tumors. Author Disclosure: K. Sloane: None. J.M. Metz: Travel Expenses; University of Pennsylvania Health System. C. Vachani: Employee; University of Pennsylvania Health System. Travel Expenses; University of Pennsylvania Health System. M.K. Hampshire: Travel Expenses; University of Pennsylvania Health System. C.E. Hill-Kayser: Employee; University of Pennsylvania Health System. Travel Expenses; University of Pennsylvania Health System.
Concurrent Immunotherapy and Stereotactic Radiosurgery for Brain Metastases Is Associated With a Decreased Incidence of New Intracranial Metastases L. Chen,1 J. Douglass,1 A.J. Walker,2 A.E. Marciscano,3 M. Lim,1 L.R. Kleinberg,1 P. Forde,1 T.R. McNutt,1 and K.J. Redmond1; 1Johns Hopkins University, Baltimore, MD, 2Johns Hopkins University, Baltimore, MD, 3Johns Hopkins School of Medicine, Baltimore, MD Purpose/Objective(s): Radiation is hypothesized to potentiate the efficacy of the immune response to tumor cells. Here, we aim to retrospectively characterize the treatment effect of stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) in a cohort of patients with intracranial metastases. Specifically we examined intracranial disease progression following radiation with and without concurrent immunotherapy. Materials/Methods: We identified metastatic non-small cell lung cancer (NSCLC) and metastatic melanoma patients who had intracranial metastases treated with radiation. Radiation treatments consisted of WBRT or SRS at a single institution from 2011-2014. We retrospectively reviewed patient demographics, pathology, oncologic treatment course, and radiographic imaging. Patients were defined as having concurrent immunotherapy if a cycle of Ipilimumab or Nivolumab was given within thirty days pre or post-radiation. Progression free survival (PFS) was defined from date of intracranial radiation to intracranial progression and overall survival (OS) was defined from date of intracranial radiation to date of death. Patients were categorized as having no intracranial progression, local progression within the treatment field, and/or new metastatic disease. The absolute number of new intracranial metastases was recorded following RT. Data was analyzed using Kaplan-Meier survival curves, unpaired two-tailed t-test and Fisher’s exact test. Results: We included 74 adults with metastatic melanoma (nZ51) or NSCLC (nZ23) treated for intracranial metastases with SRS (nZ46) or WBRT (nZ28). In total 23 patients were treated with Ipilimumab or Nivolumab and 17 of these patients were treated concurrently with radiation. PFS and OS for this cohort was a median of 15 months (range:1-51 mo) and 27 months (range:6-76 mo). At the time of intracranial progression, 93% of SRS patients who received SRS alone had new intracranial metastases compared to 53% in patients who received concurrent immunotherapy (pZ0.0006, OR 17.14, 95% CI:2.97-99.1). SRS patients who did not receive concurrent immunotherapy had a mean of 7 (range 0-35, SEM 1.49) subsequent brain metastases compared to a mean of 1 (range 0-5, SEM Z0.43) in patients who received concurrent immunotherapy (p<0.0001). Conclusion: The use of intracranial stereotactic radiosurgery with concurrent immunotherapy was associated with a decrease in the incidence and burden of new sites of intracranial disease. Although SRS is a local treatment modality, these findings suggest a potential abscopal effect when SRS for brain metastases is used in conjunction with immunotherapy. Author Disclosure: L. Chen: None. J. Douglass: None. A.J. Walker: None. A.E. Marciscano: None. M. Lim: None. L.R. Kleinberg: None. P. Forde: None. T.R. McNutt: None. K.J. Redmond: None.
2260 Patient Reported Outcomes After Radiation Therapy and Other Treatments for Primary Brain Tumors K. Sloane,1 J.M. Metz,2 C. Vachani,3 M.K. Hampshire,4 and C.E. HillKayser3; 1Temple University, Philadelphia, PA, 2University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA, 3 University of Pennsylvania, Philadelphia, PA, 4Oncolink University of Pennsylvania, Philadelphia, PA Purpose/Objective(s): Understanding of patient reported outcomes after radiation for primary brain tumors is limited; however, this survivor population is underserved and at risk for late effects. Here, we describe patient reported outcomes after radiation and other definitive or adjuvant treatments for tumors of the CNS.
2261 Local Control Following Postoperative Stereotactic Radiation Therapy for Brain Metastases K.M. Mani, N. Ohri, J.L. Fox, S. Kalnicki, P. Lasala, W.A. Tome, and M.K. Garg; Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY Purpose/Objective(s): Stereotactic radiosurgery (SRS) and fractionated stereotactic radiation therapy (FSRT) have emerged as viable alternatives to whole brain radiation therapy (WBRT) in patients with resected brain metastases. We performed a systematic review and quantitative analysis of the published experiences with adjuvant SRS and FSRT to determine local control (LC) rates and any relationship with dose-response, fractionation, and treatment delivery parameters. Materials/Methods: We identified published articles that reported local control rates following post-operative SRS or FSRT to the resection cavity in patients with brain metastases. For series in which uniform dosing schedules were used, biologically effective doses (BED) were calculated using the linear quadratic model and assuming an a/b ratio of 10 Gy. Local control data for the individual resection cavities treated in each study were extracted from actuarial survival curves and aggregated to form a single