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Does Concurrent Chemoradiotherapy Compromise the Delivery of Subsequent Sequential Gemcitabine in Locally Advanced Pancreatic Cancer?
Proceedings of the 51st Annual ASTRO Meeting
2241
Does Concurrent Chemoradiotherapy Compromise the Delivery of Subsequent Sequential Gemcitabine in Locally Advanced Pancreatic Cancer?
Z. Symon1, T. Rabin1, Y. Kundel2, I. Gluck1, I. Wolf1, D. Aderka1, M. Ben-David1, R. Catane1, M. Pfeffer1 1
Sheba Medical Center, Ramat Gan 52621, Israel, 2Davidoff Cancer Center, Petach Tikva, Israel
Purpose/Objective(s): Gemcitabine has become the mainstay of chemotherapy in the treatment of pancreatic cancer. Whether concurrent chemoradiotherapy is detrimental or provides any benefit over treatment with gemcitabine alone in the treatment of locally advanced pancreatic cancer is controversial. The aim of this study is to determine whether concurrent chemoradiation compromises the ability to deliver sequential chemotherapy in clinical practice. Materials/Methods: Pharmacy and medical records of 42 consecutive patients treated with conformal 3-D radiation and concurrent gemcitabine for locally advanced pancreatic cancer were examined. Gemcitabine was given intravenously at 1000 mg/m2 weekly during radiation, and continued weekly at 1000 mg/m2 following radiation for 3 weeks on, one week off until disease progression. A subset of six patients had received 3 or more weekly cycles of gemcitabine prior to radiation therapy (mean of 8.5 cycles, range 3-17) The gross tumor volume (GTV) was defined as the primary tumor identifiable on CT scan, including enlarged nodes greater than 1 cm. Clinically uninvolved regional lymph node basins were not included. The clinical target volume (CTV) was the GTV plus 0.5 cm, or the tumor bed and was extended by an additional 0.5 cm for the PTV. Radiation dose was either 15 fractions of 2.4 Gy or 25 fractions of 1.8Gy. Results: During radiotherapy, 34 patients (79%) received weekly gemcitabine as prescribed and 8 patients received fewer cycles. Following radiation, 22 patients (51.1%) continued to receive sequential chemotherapy for at least 3 cycles (mean of 9.5 cycles range 3-36). The median absolute dose of gemcitabine was 1749 mg/ cycle for patients receiving chemotherapy prior to chemo-radiation vs. 1990 mg/cycle for patients who received subsequent chemotherapy following chemo-radiation (p = ns). The median survival was 12.4 months. Grade III-IV gastrointestinal toxicity was observed in 6 patients (17.6%) with 2 patients requiring surgery for small bowel obstruction. One patient developed grade III thrombocytopenia after 15 cycles of gemcitabine. Conclusions: The delivery of sequential weekly gemcitabine until disease progression, following reduced volume conformal chemo-radiation, is feasible and tolerable. The median survival in this cohort was comparable or superior to that reported in contemporary studies. Concurrent conformal chemo-radiation is a valid treatment option and does not compromise the tolerability of subsequent sequential chemotherapy. Author Disclosure: Z. Symon, None; T. Rabin, None; Y. Kundel, None; I. Gluck, None; I. Wolf, None; D. Aderka, None; M. BenDavid, None; R. Catane, None; M. Pfeffer, None.
2242
Analysis of the Factors Which Affect on the Nodal Area Irradiation for Esophageal Cancer: Results of the Patterns of Care Study in Japan
M. Kenjo1, Y. Murakami1, T. Tomita2, S. Saito2, H. Numasaki2, T. Teshima2, M. Mitsumori3 1
Hiroshima University, Hiroshima, Japan, 2Osaka University, Osaka, Japan, 3Kyoto University, Kyoto, Japan
Purpose/Objective(s): The benefit of the prophylactic nodal irradiation for esophageal cancer is unknown. The purpose of this study is to reveal the executing rates and to investigate the factors which affect on the regional radiotherapy (RT) for esophageal cancer patients. This study is based on data of the two Patterns of Care Studies in Japan (1999-2001 and 2003-2005). Materials/Methods: Detail records of 651 patients with thoracic esophageal cancer were accumulated from nationwide 109 facilities including academic (55) and nonacademic (54) institutions using the two-stage cluster random sampling. Inclusion criteria are as follows; thoracic esophageal cancer, Karnofsky Performance Status (KPS) score .=60, without distant metastasis, without prior or concurrent malignancies, treated with external beam radiotherapy and without surgery. Median age was 70 years and median KPS score was 80. 98% had squamous cell carcinoma histology. Main primary tumor was located on upper-thoracic esophagus (Ut) in 19% of the patients, mid-thoracic (Mt) in 55% and lower-thoracic (Lt) in 23%. 19% had T1 disease, 49% had T2-3 and 26 % had T4. 51% had clinically N1 disease. Length of main tumor was 5cm in 63%. 63% received chemotherapy. 56% of the patients received 3-dimmentional (3-D) RT planning and 70% were treated with multi-leaf-collimator (MLC) equipped machine. Results: Median longitudinal field size of RT was 18cm. Supraclavicular, mediastinal and upper abdominal nodal area irradiation were done in 28%, 77% and 27% of the all patients, Each nodal area RT was done in 61%, 90%, 12% of the patients who had primary site in Ut, respectively, in 23%, 81%, 24% of Mt patients and in 14%, 62%, 45% in Lt. The ratios of supraclavicular RT for Mt were 36% of the patients = 75 y/o (p\0.01); 17% of T1 patients, 23% of T2-3 and 28% of T4 (p = 0.15); 14% of N0 patients and 34% of N1 (p \ 0.01); 28% of the patients treated in academic institutions and 18% in nonacademic (p = 0.02); 29% of the patients who received 3-D planning and 16% of 2-D planning (p \ 0.01); 29% of the patients who used MLC and 17% of fixed block (p = 0.04). The ratios of upper abdominal RT for Lt were 60% of the patients = 75 y/o (p \ 0.01); 18% of T1 patients, 52% of T2-3 and 52% of T4 (p = 0.01); 29% of N0 patients and 60% of N1 (p \ 0.01); 48% of the patients treated in academic institutions and 42% in nonacademic (p = 0.44); 57% of the patients who received 3-D planning and 29% of 2-D planning (p \ 0.01); 56% of the patients who used MLC and 38% of fixed block (p = 0.06). 83% of the all patients completed planned treatment. Conclusions: This study revealed that the patients’ age affected on the decision making of nodal RT. Clinical target volume settings might be influenced not only by the tumor status but also by the RT planning processes. Author Disclosure: M. Kenjo, None; Y. Murakami, None; T. Tomita, None; S. Saito, None; H. Numasaki, None; T. Teshima, None; M. Mitsumori, None.
2243
Concurrent Chemotherapy and Proton Beam Therapy for Esophageal Cancer
G. Xiaomao1, Z. X. Liao2, R. Komaki2, H. Wen2, J. Y. Chang2, M. O’Reilly2, M. Jeter2, K. Bucci2, J. Ajani2, J. D. Cox2 1
Fudan University, Cancer Hospital, Shanghai, China, 2The University of Texas M. D. Anderson Cancer Center, Houston, TX
Purpose/Objective(s): Concurrent chemoradiation with or without surgery is the treatment of choice for patients with esophageal cancer. Proton beam therapy has been used as a single modality for inoperable patients. However, there has no experience
S289
2241
Does Concurrent Chemoradiotherapy Compromise the Delivery of Subsequent Sequential Gemcitabine in Locally Advanced Pancreatic Cancer?
Z. Symon1, T. Rabin1, Y. Kundel2, I. Gluck1, I. Wolf1, D. Aderka1, M. Ben-David1, R. Catane1, M. Pfeffer1 1
Sheba Medical Center, Ramat Gan 52621, Israel, 2Davidoff Cancer Center, Petach Tikva, Israel
Purpose/Objective(s): Gemcitabine has become the mainstay of chemotherapy in the treatment of pancreatic cancer. Whether concurrent chemoradiotherapy is detrimental or provides any benefit over treatment with gemcitabine alone in the treatment of locally advanced pancreatic cancer is controversial. The aim of this study is to determine whether concurrent chemoradiation compromises the ability to deliver sequential chemotherapy in clinical practice. Materials/Methods: Pharmacy and medical records of 42 consecutive patients treated with conformal 3-D radiation and concurrent gemcitabine for locally advanced pancreatic cancer were examined. Gemcitabine was given intravenously at 1000 mg/m2 weekly during radiation, and continued weekly at 1000 mg/m2 following radiation for 3 weeks on, one week off until disease progression. A subset of six patients had received 3 or more weekly cycles of gemcitabine prior to radiation therapy (mean of 8.5 cycles, range 3-17) The gross tumor volume (GTV) was defined as the primary tumor identifiable on CT scan, including enlarged nodes greater than 1 cm. Clinically uninvolved regional lymph node basins were not included. The clinical target volume (CTV) was the GTV plus 0.5 cm, or the tumor bed and was extended by an additional 0.5 cm for the PTV. Radiation dose was either 15 fractions of 2.4 Gy or 25 fractions of 1.8Gy. Results: During radiotherapy, 34 patients (79%) received weekly gemcitabine as prescribed and 8 patients received fewer cycles. Following radiation, 22 patients (51.1%) continued to receive sequential chemotherapy for at least 3 cycles (mean of 9.5 cycles range 3-36). The median absolute dose of gemcitabine was 1749 mg/ cycle for patients receiving chemotherapy prior to chemo-radiation vs. 1990 mg/cycle for patients who received subsequent chemotherapy following chemo-radiation (p = ns). The median survival was 12.4 months. Grade III-IV gastrointestinal toxicity was observed in 6 patients (17.6%) with 2 patients requiring surgery for small bowel obstruction. One patient developed grade III thrombocytopenia after 15 cycles of gemcitabine. Conclusions: The delivery of sequential weekly gemcitabine until disease progression, following reduced volume conformal chemo-radiation, is feasible and tolerable. The median survival in this cohort was comparable or superior to that reported in contemporary studies. Concurrent conformal chemo-radiation is a valid treatment option and does not compromise the tolerability of subsequent sequential chemotherapy. Author Disclosure: Z. Symon, None; T. Rabin, None; Y. Kundel, None; I. Gluck, None; I. Wolf, None; D. Aderka, None; M. BenDavid, None; R. Catane, None; M. Pfeffer, None.
2242
Analysis of the Factors Which Affect on the Nodal Area Irradiation for Esophageal Cancer: Results of the Patterns of Care Study in Japan
M. Kenjo1, Y. Murakami1, T. Tomita2, S. Saito2, H. Numasaki2, T. Teshima2, M. Mitsumori3 1
Hiroshima University, Hiroshima, Japan, 2Osaka University, Osaka, Japan, 3Kyoto University, Kyoto, Japan
Purpose/Objective(s): The benefit of the prophylactic nodal irradiation for esophageal cancer is unknown. The purpose of this study is to reveal the executing rates and to investigate the factors which affect on the regional radiotherapy (RT) for esophageal cancer patients. This study is based on data of the two Patterns of Care Studies in Japan (1999-2001 and 2003-2005). Materials/Methods: Detail records of 651 patients with thoracic esophageal cancer were accumulated from nationwide 109 facilities including academic (55) and nonacademic (54) institutions using the two-stage cluster random sampling. Inclusion criteria are as follows; thoracic esophageal cancer, Karnofsky Performance Status (KPS) score .=60, without distant metastasis, without prior or concurrent malignancies, treated with external beam radiotherapy and without surgery. Median age was 70 years and median KPS score was 80. 98% had squamous cell carcinoma histology. Main primary tumor was located on upper-thoracic esophagus (Ut) in 19% of the patients, mid-thoracic (Mt) in 55% and lower-thoracic (Lt) in 23%. 19% had T1 disease, 49% had T2-3 and 26 % had T4. 51% had clinically N1 disease. Length of main tumor was 5cm in 63%. 63% received chemotherapy. 56% of the patients received 3-dimmentional (3-D) RT planning and 70% were treated with multi-leaf-collimator (MLC) equipped machine. Results: Median longitudinal field size of RT was 18cm. Supraclavicular, mediastinal and upper abdominal nodal area irradiation were done in 28%, 77% and 27% of the all patients, Each nodal area RT was done in 61%, 90%, 12% of the patients who had primary site in Ut, respectively, in 23%, 81%, 24% of Mt patients and in 14%, 62%, 45% in Lt. The ratios of supraclavicular RT for Mt were 36% of the patients = 75 y/o (p\0.01); 17% of T1 patients, 23% of T2-3 and 28% of T4 (p = 0.15); 14% of N0 patients and 34% of N1 (p \ 0.01); 28% of the patients treated in academic institutions and 18% in nonacademic (p = 0.02); 29% of the patients who received 3-D planning and 16% of 2-D planning (p \ 0.01); 29% of the patients who used MLC and 17% of fixed block (p = 0.04). The ratios of upper abdominal RT for Lt were 60% of the patients = 75 y/o (p \ 0.01); 18% of T1 patients, 52% of T2-3 and 52% of T4 (p = 0.01); 29% of N0 patients and 60% of N1 (p \ 0.01); 48% of the patients treated in academic institutions and 42% in nonacademic (p = 0.44); 57% of the patients who received 3-D planning and 29% of 2-D planning (p \ 0.01); 56% of the patients who used MLC and 38% of fixed block (p = 0.06). 83% of the all patients completed planned treatment. Conclusions: This study revealed that the patients’ age affected on the decision making of nodal RT. Clinical target volume settings might be influenced not only by the tumor status but also by the RT planning processes. Author Disclosure: M. Kenjo, None; Y. Murakami, None; T. Tomita, None; S. Saito, None; H. Numasaki, None; T. Teshima, None; M. Mitsumori, None.
2243
Concurrent Chemotherapy and Proton Beam Therapy for Esophageal Cancer
G. Xiaomao1, Z. X. Liao2, R. Komaki2, H. Wen2, J. Y. Chang2, M. O’Reilly2, M. Jeter2, K. Bucci2, J. Ajani2, J. D. Cox2 1
Fudan University, Cancer Hospital, Shanghai, China, 2The University of Texas M. D. Anderson Cancer Center, Houston, TX
Purpose/Objective(s): Concurrent chemoradiation with or without surgery is the treatment of choice for patients with esophageal cancer. Proton beam therapy has been used as a single modality for inoperable patients. However, there has no experience
S289