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CT-Guidance Interstitial 125iodine Seed Brachytherapy as a Salvage Therapy for Recurrent Spinal Primary Tumors
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Abstracts / Brachytherapy 14 (2015) S11eS106 Israel, New York, NY, USA; 2Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA; 3Radiation Oncology, Maimonides Cancer Center, New York, NY, USA; 4Radiation Oncology, NYU Langone Medical Center, New York, NY, USA.
Figure 1. Overall survival of EBRT and RI. Five year OS 83.3% EBRT vs. 82.5% RI log rank (Mantel-Cox) p 5 0.688
MSOR03 Presentation Time: 4:08 PM CT-Guidance Interstitial 125iodine Seed Brachytherapy as a Salvage Therapy for Recurrent Spinal Primary Tumors Qian Q. Cao, PhD, Jie J. Wang, PhD, Hao Wang, PhD, Na Meng, PhD, Ping Jiang, PhD, Liang Y. Jiang, PhD, Qing S. Tian, PhD, Chen Liu, MD. Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, China. Purpose: Management of spinal neoplasms has relied on open surgery and external beam radiotherapy (EBRT). Although primary spinal tumors are rare, their treatment remains a pervasive problem. This analysis sought to evaluate the safety and efficacy of CT-guided 125I seed brachytherapy for recurrent paraspinous and vertebral primary tumors. Materials and Methods: From November 2002 to June 2014, 17 patients who met the inclusion criteria were retrospectively reviewed. 14 (82.4%) had previously undergone surgery, 15 (88.2%) had received conventional EBRT and 3 (17.6%) had chosen chemotherapy. The number of 125I seeds implanted ranged from 7 to 122 (median 79) with specific activity of 0.5-0.8 mCi (median 0.7 mCi). The post-plan showed that the actuarial D90 of 125I seeds were 90-183 Gy (median 137 Gy). The follow-up period ranged from 2 to 69 (median 19 months). The local control probabilities were calculated by the Kaplan-Meier method. Results: For 5 Chondrosarcomas, the 1, 2, 3 year local control rate were 75%, 37.5%, and 37.5% respectively, with a median of 34 months (range, 4-39 months). For 4 chordomas, the olcal control rate was 50% with a median follow-up of 13 months (range, 3-17 months). For 3 fibromatosis, all of them were survival without local recurrence at the end of follow-up. During the follow-up period, 35.3% (6/17) died from metastases, 17.6% (3/17) developed local recurrence by 8, 14 and 34 months while 64.7% (11/17) remained alive. 100% experienced pain relief and normal or improved ambulation without more than Frankel grade 3 radiation myelopathy. Conclusions: Percutaneous 125I seed implantation can be an alternative or retreatment for recurrent spinal primary tumors.
MSOR04 Presentation Time: 4:12 PM High-Dose-Rate Intraoperative Radiotherapy Combined With Neck Dissection to Salvage Isolated Cervical Nodal Recurrences Robert Stewart, MD1, Kenneth Hu, MD1, David Berlach, MD3, Mark Persky, MD4, Theresa Tran, MD1, Mark Urken, MD1, Adam Jacobson, MD4, Louis Harrison, MD2. 1Radiation Oncology, Mount Sinai Beth
Purpose: Nodal recurrences following treatment for head and neck (H&N) malignancies are difficult to salvage and require complex expertise. High dose-rate intraoperative radiotherapy (HDR-IORT) allows for immediate targeted treatment while maximally sparing of adjacent tissue. Flap reconstruction with unirradiated tissue minimizes complications and provides form and function after maximal resection of disease. Materials and Methods: 47 pts underwent HDR-IORT after gross total resection for cervical nodal recurrence using the Harrison-Anderson-Mick applicator from 3/01 to 2/14. Mean age was 62 years (range 38-87), male72% and female 28%. Primary sites: oral cavity 36.2%, oropharynx 25.5%, larynx 12.8%, skin 8.5%, salivary gland 6.4%, hypopharynx 4.3% and other 6.3%. The histology was SCC in 91%. 23% of pts had positive surgical margins. 96% received previous radiotherapy. The median IORT treatment time was 20 minutes (range 4-80) and median IORT field size was 7cm 5cm. Mean IORT dose was 13.4Gy (range 10-17.5). 32 pts (68%) had flap reconstructions of which 89% were pectoralis rotational flaps. 26 pts received postoperative radiotherapy (55%) with a range 34.2 to 64.8Gy, and 14 pts (30%) received concurrent chemotherapy. Results: Mean follow-up was 20 months (range 1-62) and 31% of patients followed for more than 2 years. There were no intraoperative complications related to HDR-IORT. One pt required surgery at 2 years for skin breakdown, 1 pt developed vagal neuropathy, and one pt developed osteoradionecrosis. The 1- and 2- yr OS were 71% and 53%. The 1- and 2- year IFC were 60% and 57%. The 1- and 2- year regional control (RC) rates were 65% and 55%.The 1- and 2- yr OS for pts with infield control (IFC) was 78/74% vs 60/24% in patients with infield failure (p!0.001). The 1- and 2-year distant metastasis (DM) rates were 21% and 25%. The 1- year IFC was 64% for those with negative margins and 42% with positive margins (p50.017). The 2- year OS was 62% for those with negative margins and 24% with positive margins (p50.059). The 1- and 2- year OS for pts with no DM were 77%/63% vs 51%/20% in those with DM (p50.011). The 1-yr DM rate in pts with IFC was 12% vs 35% in pts with infield failure (p50.031). Conclusion: HDR-IORT combined with surgical salvage and reconstruction is safe and is associated with a high rate of IFC for isolated nodal recurrences if negative margins are obtained. The low complication rate may be attributable to the use of flap reconstruction. IFC was associated with improved OS and lower rates of DM. Negative margin status may be associated with improved OS with p-value approaching significance. Additional strategies to improve IFC are needed for pts with positive margins which may translate into improved OS.
MSOR05 Presentation Time: 4:16 PM Cs131 Head and Neck Brachytherapy: FMEA Quality Assessment Emily Kremmel, MMP, Voichita Bar-Ad, MD, Yan Yu, PhD, MBA, Amy S. Harrison, MS, Laura Doyle, MS. Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA. Purpose: Failure mode effect analysis (FMEA) is a useful tool for predicting risk elements of a new procedure. FMEA includes the potential failure modes, causes of failure, and effects of failure for each step of a process. Once risk elements are identified by the FMEA, they can be mitigated through changes in the process and/or additional safety measures. This study describes the utilization of FMEA during the implementation of low-dose-rate (LDR) permanent seed implant using Cs131 to treat recurrent head and neck cancers. Materials and Methods: A multidisciplinary implementation team collaborated to develop a detailed process map for this new procedure using similar existing brachytherapy procedures. This process map outlined each task to understand the steps as well as the responsibilities and roles of staff members in the procedure. To facilitate implementation of the procedure and identify preventable errors, a FMEA was performed based on this process map. From the 22 steps on the process map, 75 potential failure modes were identified. This table of failure modes was
Abstracts / Brachytherapy 14 (2015) S11eS106 Israel, New York, NY, USA; 2Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA; 3Radiation Oncology, Maimonides Cancer Center, New York, NY, USA; 4Radiation Oncology, NYU Langone Medical Center, New York, NY, USA.
Figure 1. Overall survival of EBRT and RI. Five year OS 83.3% EBRT vs. 82.5% RI log rank (Mantel-Cox) p 5 0.688
MSOR03 Presentation Time: 4:08 PM CT-Guidance Interstitial 125iodine Seed Brachytherapy as a Salvage Therapy for Recurrent Spinal Primary Tumors Qian Q. Cao, PhD, Jie J. Wang, PhD, Hao Wang, PhD, Na Meng, PhD, Ping Jiang, PhD, Liang Y. Jiang, PhD, Qing S. Tian, PhD, Chen Liu, MD. Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, China. Purpose: Management of spinal neoplasms has relied on open surgery and external beam radiotherapy (EBRT). Although primary spinal tumors are rare, their treatment remains a pervasive problem. This analysis sought to evaluate the safety and efficacy of CT-guided 125I seed brachytherapy for recurrent paraspinous and vertebral primary tumors. Materials and Methods: From November 2002 to June 2014, 17 patients who met the inclusion criteria were retrospectively reviewed. 14 (82.4%) had previously undergone surgery, 15 (88.2%) had received conventional EBRT and 3 (17.6%) had chosen chemotherapy. The number of 125I seeds implanted ranged from 7 to 122 (median 79) with specific activity of 0.5-0.8 mCi (median 0.7 mCi). The post-plan showed that the actuarial D90 of 125I seeds were 90-183 Gy (median 137 Gy). The follow-up period ranged from 2 to 69 (median 19 months). The local control probabilities were calculated by the Kaplan-Meier method. Results: For 5 Chondrosarcomas, the 1, 2, 3 year local control rate were 75%, 37.5%, and 37.5% respectively, with a median of 34 months (range, 4-39 months). For 4 chordomas, the olcal control rate was 50% with a median follow-up of 13 months (range, 3-17 months). For 3 fibromatosis, all of them were survival without local recurrence at the end of follow-up. During the follow-up period, 35.3% (6/17) died from metastases, 17.6% (3/17) developed local recurrence by 8, 14 and 34 months while 64.7% (11/17) remained alive. 100% experienced pain relief and normal or improved ambulation without more than Frankel grade 3 radiation myelopathy. Conclusions: Percutaneous 125I seed implantation can be an alternative or retreatment for recurrent spinal primary tumors.
MSOR04 Presentation Time: 4:12 PM High-Dose-Rate Intraoperative Radiotherapy Combined With Neck Dissection to Salvage Isolated Cervical Nodal Recurrences Robert Stewart, MD1, Kenneth Hu, MD1, David Berlach, MD3, Mark Persky, MD4, Theresa Tran, MD1, Mark Urken, MD1, Adam Jacobson, MD4, Louis Harrison, MD2. 1Radiation Oncology, Mount Sinai Beth
Purpose: Nodal recurrences following treatment for head and neck (H&N) malignancies are difficult to salvage and require complex expertise. High dose-rate intraoperative radiotherapy (HDR-IORT) allows for immediate targeted treatment while maximally sparing of adjacent tissue. Flap reconstruction with unirradiated tissue minimizes complications and provides form and function after maximal resection of disease. Materials and Methods: 47 pts underwent HDR-IORT after gross total resection for cervical nodal recurrence using the Harrison-Anderson-Mick applicator from 3/01 to 2/14. Mean age was 62 years (range 38-87), male72% and female 28%. Primary sites: oral cavity 36.2%, oropharynx 25.5%, larynx 12.8%, skin 8.5%, salivary gland 6.4%, hypopharynx 4.3% and other 6.3%. The histology was SCC in 91%. 23% of pts had positive surgical margins. 96% received previous radiotherapy. The median IORT treatment time was 20 minutes (range 4-80) and median IORT field size was 7cm 5cm. Mean IORT dose was 13.4Gy (range 10-17.5). 32 pts (68%) had flap reconstructions of which 89% were pectoralis rotational flaps. 26 pts received postoperative radiotherapy (55%) with a range 34.2 to 64.8Gy, and 14 pts (30%) received concurrent chemotherapy. Results: Mean follow-up was 20 months (range 1-62) and 31% of patients followed for more than 2 years. There were no intraoperative complications related to HDR-IORT. One pt required surgery at 2 years for skin breakdown, 1 pt developed vagal neuropathy, and one pt developed osteoradionecrosis. The 1- and 2- yr OS were 71% and 53%. The 1- and 2- year IFC were 60% and 57%. The 1- and 2- year regional control (RC) rates were 65% and 55%.The 1- and 2- yr OS for pts with infield control (IFC) was 78/74% vs 60/24% in patients with infield failure (p!0.001). The 1- and 2-year distant metastasis (DM) rates were 21% and 25%. The 1- year IFC was 64% for those with negative margins and 42% with positive margins (p50.017). The 2- year OS was 62% for those with negative margins and 24% with positive margins (p50.059). The 1- and 2- year OS for pts with no DM were 77%/63% vs 51%/20% in those with DM (p50.011). The 1-yr DM rate in pts with IFC was 12% vs 35% in pts with infield failure (p50.031). Conclusion: HDR-IORT combined with surgical salvage and reconstruction is safe and is associated with a high rate of IFC for isolated nodal recurrences if negative margins are obtained. The low complication rate may be attributable to the use of flap reconstruction. IFC was associated with improved OS and lower rates of DM. Negative margin status may be associated with improved OS with p-value approaching significance. Additional strategies to improve IFC are needed for pts with positive margins which may translate into improved OS.
MSOR05 Presentation Time: 4:16 PM Cs131 Head and Neck Brachytherapy: FMEA Quality Assessment Emily Kremmel, MMP, Voichita Bar-Ad, MD, Yan Yu, PhD, MBA, Amy S. Harrison, MS, Laura Doyle, MS. Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA. Purpose: Failure mode effect analysis (FMEA) is a useful tool for predicting risk elements of a new procedure. FMEA includes the potential failure modes, causes of failure, and effects of failure for each step of a process. Once risk elements are identified by the FMEA, they can be mitigated through changes in the process and/or additional safety measures. This study describes the utilization of FMEA during the implementation of low-dose-rate (LDR) permanent seed implant using Cs131 to treat recurrent head and neck cancers. Materials and Methods: A multidisciplinary implementation team collaborated to develop a detailed process map for this new procedure using similar existing brachytherapy procedures. This process map outlined each task to understand the steps as well as the responsibilities and roles of staff members in the procedure. To facilitate implementation of the procedure and identify preventable errors, a FMEA was performed based on this process map. From the 22 steps on the process map, 75 potential failure modes were identified. This table of failure modes was