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Do Elderly Patients with Cervical Cancer Fare Worse with Radiotherapy Compared to Their Younger Counterparts?
Proceedings of the 47th Annual ASTRO Meeting
Table 1. Average doses to OARs for PTV prescription of 45 Gy; Helax vs. TOMO:
2198
Development of an Interactive, Web-based, Radiological Anatomy Learning Module for Radiation Oncology Residents: A Pilot
J. Alfieri,1 L. Portelance,1 L. Souhami,1 G. Artho,2 F. Gallant3 Department of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada, 2Department of Radiology, McGill University Health Centre, Montreal, QC, Canada, 3McGill University, Montreal, QC, Canada 1
Purpose/Objective: Radiation oncologists are continuously faced with the challenge of how to treat tumours while limiting toxicity to healthy surrounding tissues. In order to do this, an adequate knowledge of radiological anatomy is necessary. Educational resources of this nature are lacking and there are no web-based teaching materials on this subject. The objective was to design and develop a web-based, interactive module that could be used by radiation oncology residents to learn and apply key concepts in radiological anatomy pertinent to treatment planning. We developed a model for gynecological malignancies. Materials/Methods: A web-based module on radiological anatomy was developed using a rapid-prototyping design model. Meaningful content, authentic graphics and valuable practice exercises specifically targeted to radiation oncology residents were created. A multidisciplinary team of subject matter experts in Anatomy, Radiation Oncology, Radiology, Instructional Design, and Multimedia Programming collaborated to create the module. Macromedia Director software was used for final authoring. The module was designed with built-in flexibility to support updates. Results: This feasibility study was completed successfully and it is now available on the World Wide Web. The next phase will involve efficacy testing of this learning module. We hypothesize that the interactive nature and the high degree of learner control will help promote self-directed learning. Conclusions: We have successfully produced an interactive radiological anatomy learning module. The development of this sophisticated teaching tool is technically feasible with current technology. We plan to use the pilot module design as a template to support additional modules encompassing malignancies in other sites.
Sample page from web-based, radiological anatomy learning module.
2199
Do Elderly Patients with Cervical Cancer Fare Worse with Radiotherapy Compared to Their Younger Counterparts?
J.S. Low,1 F. Gao,2 T. Yu,1 J. Tuan,1 I. Tham,1 H. Khoo Tan,1 T. Khor3 Radiation Oncology, National Cancer Centre, Singapore, Singapore, 2Division of Clinical Trials & Epidemiological Sciences, National Cancer Centre, Singapore, Singapore, 3Radiation Oncology, Mt Elizabeth Hospital, Singapore, Singapore
1
Purpose/Objective: To evaluate the treatment outcome of elderly patients receiving radiotherapy for cervical cancer.
S347
S348
I. J. Radiation Oncology
● Biology ● Physics
Volume 63, Number 2, Supplement, 2005
Materials/Methods: The is a retrospective review of all cervical cancer patients treated with radiotherapy in 2 major cancer centers in Singapore from January 1990 to September 2004. Patients were divided into non-elderly (⬍70) and elderly (⬎/⫽70). Patient characteristics, disease presentation, treatment, complications and disease control for the 2 groups were compared using Chi square analysis and t-test as appropriate. Overall survival (OS), Disease-free survival (DFS), Local-recurrence-free survival (LRFS), Distant-metastasis-free survival (DMFS) and complication rates were calculated from the start date of radiotherapy and analyzed using the Kaplan-Meier Method. Cox regression was used to estimate the hazard ratio (HR) between the 2 groups with adjustment for stage, histology, grade and treatment duration. Results: Of the 272 patients with cervix cancer treated with radiotherapy between Jan 1990 - September 2004, 163 were ⬍70 years (59.9%) and 109 were ⬎/⫽70 years (40.1%). The median age of the patients was 65 years (range 32– 88). In this group of patients, 73.9% had FIGO stage II-III disease. 263 patients (96.7%) received both External Beam Radiotherapy (EBRT) and brachytherapy, 7 had EBRT alone and 1 received brachytherapy alone. The median dose of EBRT and brachytherapy were 50Gy and 18Gy respectively. Tumor stage (p ⫽ 0.003), histology (p ⫽ 0.850) and grade (p ⫽ 0.385) were compared between the 2 groups. There were no statistically significant difference between the 2 groups in terms of overall treatment time, pelvic EBRT and brachytherapy doses (p ⫽ 0.487). The median follow-up was 2.5-years (range 0.05–13.6). The treatment outcome between the 2 groups (⬍70 vs. ⬎/⫽70): 5-year OS (70.4% vs. 40.9%, p⬍0.001), DFS (65.4% vs. 55.8%, p⫽0.015), LRFS (84.5% vs. 76.6%, p⫽0.030) and DMFS (75.2% vs. 70.8%, p⫽0.198) all favored those non-elderly patients (⬍70). However, when patient’s age, stage, histology, grade and treatment time were adjusted using Cox regression, the DFS between patients (⬍ 70) and those (⬎/⫽70) did not reached statistically significance (p ⫽ 0.240) but the OS between the 2 groups was still significant statistically (p ⫽ 0.002). The risk of dying in elderly patients is higher than younger patients (HR ⫽ 1.56, 95% CI 1.169 to 2.07) but the risk of having disease-relapse were approximately the same (HR ⫽ 1.19, 95% CI 0.894 to 1.57). This may be due to that of the 13 patients who died of unrelated causes, 11(84.6%) were ⬎/⫽70. The overall 5-year late complication rate was 20.3% (17.1% in ⬍70 and 27.7% in ⬎/⫽70), there were only 3 patients with RTOG grade 3/4 toxicity who required surgical intervention (1 in ⬍70 group, 2 in ⬎/⫽ 70). The difference in late toxicity between the groups was not statistically significant (p⫽0.056). Conclusions: Elderly patients (⬎/⫽70) tend to have concomitant illness and hence a poorer overall survival outcome compared to younger patients (⬍70). However, when all other variables were taken into consideration, elderly patients did not fare any worse compare to their younger counterparts in terms of disease-free survival and the radiotherapy treatment was also well tolerated in both groups.
2200
Outcome in Surgically Staged Papillary Serous and Clear Cell Carcinoma of the Uterus: A Single Institution Experience
S.L. Harris,1 M.E. Randall,3 K.Y. Look,2 D.H. Moore,2 A.J. Fakiris,1 S. Lo,1 H. Cardenes1 Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, 2Gynecologic Oncology, Indiana University School of Medicine, Indianapolis, IN, 3Leo W. Jenkins Cancer Center, Brody School of Medicine at East Carolina University, Greenville, NC 1
Purpose/Objective: To determine the outcomes of surgically staged patients with I-IIIA uterine papillary serous carcinoma (UPSC) and clear cell carcinoma (CCC) of the uterus treated at Indiana University and compare their outcomes to patients treated on the Hoosier Oncology Group (HOG) 97-01 protocol involving intraperitoneal 32P and vaginal brachytherapy for a similar patient population. Materials/Methods: Twenty-six patients with surgically staged FIGO stage I-IIIA UPSC or CCC were treated with standard, non-protocol adjuvant therapies at Indiana University Cancer Center between 1997 and 2003. Modality and distribution of therapies given to these patients included: no therapy (8), whole abdomen radiotherapy (WAR) (10), pelvic radiotherapy (5), and intraperitoneal 32P with vaginal brachytherapy per HOG 97-01 protocol (3). An additional 21 patients were treated on the Hoosier Oncology Group 97-01 protocol during the same time period. Clinic charts, hospital records and pathology reports were reviewed for each patient. Patients treated on protocol received, in addition to complete surgical staging, 15 mCi of 32P administered intraperitoneally, followed by high dose-rate or low dose-rate vaginal cuff brachytherapy. Clinical factors identified for both groups included age at diagnosis, date of surgical staging, FIGO stage, dates and modalities of therapy, recurrences, follow-up, and status. Pathologic factors identified included histological type, depth of uterine invasion, presence of lymphovascular space invasion, peritoneal cytology, and lymph node status. The Kaplan-Meier method was used to generate overall survival (OS) and disease-free survival (DFS) data. Factors predictive of outcome were analyzed using the log-rank test and Cox regression analysis. Results: A total of 26 patients treated off HOG 97-01 protocol were reviewed and compared with the 21 patients who were treated on protocol. Patient characteristics and survival and recurrence data are listed in the following table. Stage distribution of those patients that recurred in the review group was: Stage I (6), Stage II (3), and Stage III (1). Stage distribution of those patients that recurred in the protocol group was: Stage I (3), Stage III (1), and Stage IV (1). Conclusions: This population of limited-stage UPSC and CCC patients treated with conventional therapies faired worse than their HOG 97-01 counterparts. In particular, recurrences in the abdomen and pelvis were much less common in the group treated with intraperitoneal 32P. Therefore, further investigation using intraperitoneal radiocolloids combined with intracavitary brachytherapy in the adjuvant setting as an alternative to radiation therapy or chemotherapy is warranted in this group of patients after comprehensive surgical staging.
Table 1. Average doses to OARs for PTV prescription of 45 Gy; Helax vs. TOMO:
2198
Development of an Interactive, Web-based, Radiological Anatomy Learning Module for Radiation Oncology Residents: A Pilot
J. Alfieri,1 L. Portelance,1 L. Souhami,1 G. Artho,2 F. Gallant3 Department of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada, 2Department of Radiology, McGill University Health Centre, Montreal, QC, Canada, 3McGill University, Montreal, QC, Canada 1
Purpose/Objective: Radiation oncologists are continuously faced with the challenge of how to treat tumours while limiting toxicity to healthy surrounding tissues. In order to do this, an adequate knowledge of radiological anatomy is necessary. Educational resources of this nature are lacking and there are no web-based teaching materials on this subject. The objective was to design and develop a web-based, interactive module that could be used by radiation oncology residents to learn and apply key concepts in radiological anatomy pertinent to treatment planning. We developed a model for gynecological malignancies. Materials/Methods: A web-based module on radiological anatomy was developed using a rapid-prototyping design model. Meaningful content, authentic graphics and valuable practice exercises specifically targeted to radiation oncology residents were created. A multidisciplinary team of subject matter experts in Anatomy, Radiation Oncology, Radiology, Instructional Design, and Multimedia Programming collaborated to create the module. Macromedia Director software was used for final authoring. The module was designed with built-in flexibility to support updates. Results: This feasibility study was completed successfully and it is now available on the World Wide Web. The next phase will involve efficacy testing of this learning module. We hypothesize that the interactive nature and the high degree of learner control will help promote self-directed learning. Conclusions: We have successfully produced an interactive radiological anatomy learning module. The development of this sophisticated teaching tool is technically feasible with current technology. We plan to use the pilot module design as a template to support additional modules encompassing malignancies in other sites.
Sample page from web-based, radiological anatomy learning module.
2199
Do Elderly Patients with Cervical Cancer Fare Worse with Radiotherapy Compared to Their Younger Counterparts?
J.S. Low,1 F. Gao,2 T. Yu,1 J. Tuan,1 I. Tham,1 H. Khoo Tan,1 T. Khor3 Radiation Oncology, National Cancer Centre, Singapore, Singapore, 2Division of Clinical Trials & Epidemiological Sciences, National Cancer Centre, Singapore, Singapore, 3Radiation Oncology, Mt Elizabeth Hospital, Singapore, Singapore
1
Purpose/Objective: To evaluate the treatment outcome of elderly patients receiving radiotherapy for cervical cancer.
S347
S348
I. J. Radiation Oncology
● Biology ● Physics
Volume 63, Number 2, Supplement, 2005
Materials/Methods: The is a retrospective review of all cervical cancer patients treated with radiotherapy in 2 major cancer centers in Singapore from January 1990 to September 2004. Patients were divided into non-elderly (⬍70) and elderly (⬎/⫽70). Patient characteristics, disease presentation, treatment, complications and disease control for the 2 groups were compared using Chi square analysis and t-test as appropriate. Overall survival (OS), Disease-free survival (DFS), Local-recurrence-free survival (LRFS), Distant-metastasis-free survival (DMFS) and complication rates were calculated from the start date of radiotherapy and analyzed using the Kaplan-Meier Method. Cox regression was used to estimate the hazard ratio (HR) between the 2 groups with adjustment for stage, histology, grade and treatment duration. Results: Of the 272 patients with cervix cancer treated with radiotherapy between Jan 1990 - September 2004, 163 were ⬍70 years (59.9%) and 109 were ⬎/⫽70 years (40.1%). The median age of the patients was 65 years (range 32– 88). In this group of patients, 73.9% had FIGO stage II-III disease. 263 patients (96.7%) received both External Beam Radiotherapy (EBRT) and brachytherapy, 7 had EBRT alone and 1 received brachytherapy alone. The median dose of EBRT and brachytherapy were 50Gy and 18Gy respectively. Tumor stage (p ⫽ 0.003), histology (p ⫽ 0.850) and grade (p ⫽ 0.385) were compared between the 2 groups. There were no statistically significant difference between the 2 groups in terms of overall treatment time, pelvic EBRT and brachytherapy doses (p ⫽ 0.487). The median follow-up was 2.5-years (range 0.05–13.6). The treatment outcome between the 2 groups (⬍70 vs. ⬎/⫽70): 5-year OS (70.4% vs. 40.9%, p⬍0.001), DFS (65.4% vs. 55.8%, p⫽0.015), LRFS (84.5% vs. 76.6%, p⫽0.030) and DMFS (75.2% vs. 70.8%, p⫽0.198) all favored those non-elderly patients (⬍70). However, when patient’s age, stage, histology, grade and treatment time were adjusted using Cox regression, the DFS between patients (⬍ 70) and those (⬎/⫽70) did not reached statistically significance (p ⫽ 0.240) but the OS between the 2 groups was still significant statistically (p ⫽ 0.002). The risk of dying in elderly patients is higher than younger patients (HR ⫽ 1.56, 95% CI 1.169 to 2.07) but the risk of having disease-relapse were approximately the same (HR ⫽ 1.19, 95% CI 0.894 to 1.57). This may be due to that of the 13 patients who died of unrelated causes, 11(84.6%) were ⬎/⫽70. The overall 5-year late complication rate was 20.3% (17.1% in ⬍70 and 27.7% in ⬎/⫽70), there were only 3 patients with RTOG grade 3/4 toxicity who required surgical intervention (1 in ⬍70 group, 2 in ⬎/⫽ 70). The difference in late toxicity between the groups was not statistically significant (p⫽0.056). Conclusions: Elderly patients (⬎/⫽70) tend to have concomitant illness and hence a poorer overall survival outcome compared to younger patients (⬍70). However, when all other variables were taken into consideration, elderly patients did not fare any worse compare to their younger counterparts in terms of disease-free survival and the radiotherapy treatment was also well tolerated in both groups.
2200
Outcome in Surgically Staged Papillary Serous and Clear Cell Carcinoma of the Uterus: A Single Institution Experience
S.L. Harris,1 M.E. Randall,3 K.Y. Look,2 D.H. Moore,2 A.J. Fakiris,1 S. Lo,1 H. Cardenes1 Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, 2Gynecologic Oncology, Indiana University School of Medicine, Indianapolis, IN, 3Leo W. Jenkins Cancer Center, Brody School of Medicine at East Carolina University, Greenville, NC 1
Purpose/Objective: To determine the outcomes of surgically staged patients with I-IIIA uterine papillary serous carcinoma (UPSC) and clear cell carcinoma (CCC) of the uterus treated at Indiana University and compare their outcomes to patients treated on the Hoosier Oncology Group (HOG) 97-01 protocol involving intraperitoneal 32P and vaginal brachytherapy for a similar patient population. Materials/Methods: Twenty-six patients with surgically staged FIGO stage I-IIIA UPSC or CCC were treated with standard, non-protocol adjuvant therapies at Indiana University Cancer Center between 1997 and 2003. Modality and distribution of therapies given to these patients included: no therapy (8), whole abdomen radiotherapy (WAR) (10), pelvic radiotherapy (5), and intraperitoneal 32P with vaginal brachytherapy per HOG 97-01 protocol (3). An additional 21 patients were treated on the Hoosier Oncology Group 97-01 protocol during the same time period. Clinic charts, hospital records and pathology reports were reviewed for each patient. Patients treated on protocol received, in addition to complete surgical staging, 15 mCi of 32P administered intraperitoneally, followed by high dose-rate or low dose-rate vaginal cuff brachytherapy. Clinical factors identified for both groups included age at diagnosis, date of surgical staging, FIGO stage, dates and modalities of therapy, recurrences, follow-up, and status. Pathologic factors identified included histological type, depth of uterine invasion, presence of lymphovascular space invasion, peritoneal cytology, and lymph node status. The Kaplan-Meier method was used to generate overall survival (OS) and disease-free survival (DFS) data. Factors predictive of outcome were analyzed using the log-rank test and Cox regression analysis. Results: A total of 26 patients treated off HOG 97-01 protocol were reviewed and compared with the 21 patients who were treated on protocol. Patient characteristics and survival and recurrence data are listed in the following table. Stage distribution of those patients that recurred in the review group was: Stage I (6), Stage II (3), and Stage III (1). Stage distribution of those patients that recurred in the protocol group was: Stage I (3), Stage III (1), and Stage IV (1). Conclusions: This population of limited-stage UPSC and CCC patients treated with conventional therapies faired worse than their HOG 97-01 counterparts. In particular, recurrences in the abdomen and pelvis were much less common in the group treated with intraperitoneal 32P. Therefore, further investigation using intraperitoneal radiocolloids combined with intracavitary brachytherapy in the adjuvant setting as an alternative to radiation therapy or chemotherapy is warranted in this group of patients after comprehensive surgical staging.