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Dosimetric Predictors for Gastrointestinal Toxicity in Pancreatic Cancer After Hypofractionated Radiation Therapy
Poster Viewing Session E149
Volume 93 Number 3S Supplement 2015
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Survival in Patients Aged 75 Years and Older Receiving Adjuvant Chemoradiation for Resected Pancreatic Adenocarcinoma: A Multicenter, Multinational Pooled Analysis B.W. Maidment, III,1 G.C. Mattiucci,2 M. Falconi,3 R.G.P.M. van Stiphout,4 S. Alfieri,5 F.A. Calvo,6 J.M. Herman,7 R.C. Miller,8 W.F. Regine,9 M. Reni,10 N.K. Sharma,11 S. Partelli,12 D. Genovesi,13 M. Balducci,14 F. Deodato,15 V. Valentini,16 and A.G. Morganti17; 1 University of Virginia, Charlottesville, VA, 2Universita Cattolica S. Cuore, Rome, Italy, 3Department of Surgery, Universita Politecnica delle Marche, Ancona, Italy, 4(MAASTRO), GROW, University Medical Centre, Maastricht, Netherlands, 5Department of Surgery, Universita Cattolica S. Cuore, Rome, Italy, 6Hospital General Universitario Gregorio Maranon, Madrid, Spain, 7Johns Hopkins University School of Medicine, Baltimore, MD, 8Mayo Clinic, Jacksonville, FL, 9University of Maryland School of Medicine, Baltimore, MD, 10Department of Oncology, S. Raffaele Scientific Institute, Milan, Italy, 11University of Maryland School of Medicine, Baltimore, MD, 123. Department of Surgery, Universita` Politecnica delle Marche, Ancona, Italy, Roma, Italy, 13“SS Annunziata” Hospital, “G. D’Annunzio” University, Chieti, Italy, 14Universita` Cattolica S. Cuore, Rome, Italy, Rome, Italy, 15Fondazione Giovanni Paolo II, Campobasso, Italy, Campobasso, Italy, 16Sacred Heart Catholic University of Rome, Rome, Italy, 17Radiation Oncology Unit, Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
Dosimetric Predictors for Gastrointestinal Toxicity in Pancreatic Cancer After Hypofractionated Radiation Therapy X. Liu,1 G. Ren,1 T. Xia,2 Y. Di,1 and D. Chang1; 1Department of Radiation Oncology, Chinese PLA Air General Hospital, Beijing, China, 2 Chinese PLA Air General Hospital, Beijing, China
Purpose/Objective(s): More than one third of patients with pancreatic cancer are at least 75 years of age at the time of diagnosis. However, relatively few such individuals were enrolled in existing Phase III randomized trials which employed postoperative chemoradiation (POCR). We sought to determine the impact of POCR on overall survival (OS) after resection of pancreatic adenocarcinoma (PAC) in patients aged 75 years and older. Materials/Methods: A retrospective review of 1248 patients who underwent complete resection with macroscopically negative margins (R0-1) for invasive PAC at 10 institutions in 5 countries from 1995-2008 was performed. All T-stages (T1-4) and N-stages (N0-1) were permitted. Exclusion criteria were age < 75 years, metastatic disease at time of surgery, postoperative death within 60 days of surgery, non-adenocarcinoma histology, or treatment with intraoperative radiation therapy (IORT). Results: A total of 98 patients were included in this analysis (M: 39.8%, F: 60.2%; R1 resections: 33.7%; pN1: 61.2%). Sixty-three patients received POCR, while 35 did not. Among those who did not receive POCR, 26 received adjuvant chemotherapy alone. Median follow-up was 25.6 months. The mean age for the entire cohort of patients was 78.1 2.9 (SD) years. No significant differences were observed between patients who received POCR and those who did not in terms of age (p Z 0.081), tumor diameter (p Z 0.412), rate of R1 resection (p Z 0.331) and incidence of lymph node-positive disease (p Z 0.078). On univariate analysis, the only factor predicting for OS was POCR (p Z 0.008). Receipt of POCR remained a significant predictor for OS using a multivariate Cox proportional-hazards analysis (HR: 0.449; 95% CI: 0.212-0.950; p Z 0.036). Conclusion: This study represents the largest survival analysis of patients over 75 years of age receiving POCR after resection of PAC, and is the first such multi-institutional, multinational analysis. OS was significantly higher in patients who received POCR as compared to those who did not. Author Disclosure: B.W. Maidment: None. G. Mattiucci: None. M. Falconi: None. R.G. van Stiphout: None. S. Alfieri: None. F.A. Calvo: None. J.M. Herman: None. R.C. Miller: Stock; Tekcapital Europe. Board member; Rare Cancer Network. Board of Trustees; Mayo Clinic Health System Albert Lea Austin. W.F. Regine: None. M. Reni: None. N.K. Sharma: None. S. Partelli: None. D. Genovesi: None. M. Balducci: None. F. Deodato: None. V. Valentini: None. A.G. Morganti: None.
Purpose/Objective(s): To identify dosimetric predictors for the gastrointestinal (GI) toxicity in pancreatic cancer treated with hypofractionated radiation therapy. Materials/Methods: From June 2013 to October 2014, the dosimetric parameters of 14 pancreatic cancer patients treated with hypofractionated radiation therapy were analyzed. Dose-volume histogram (DVH) parameters included GTV, Dmax, Dmean, D1, D3, D5, D10 of the stomach and duodenum. Perform gastroscopy regularly after radiation therapy. Endoscopic findings were graded as I-IV. I : The mucosa is smooth, no distortion, no villi damage; II: The mucosa is mild hyperemia and edematous with vascular network showed and villi damaged; III: The mucosa is apparently hyperemic and edematous with mucosal tissue fragile and contact hemorrhages; IV: The mucosa is anabrotic and ulcer or lumen stenosis observed. Univariate analysis (UVA) was performed to identify risk factors associated with GI toxicity. The receiver operating characteristic (ROC) curve and the area under the receiver operating characteristic curve (AUC) were used to determine the best DVH parameter to predict for GI toxicity. Results: The prescribed dose of GTV ranged from 60 to 70Gy, and CTV ranged from 50 to 60Gy in 15 to 20 fractions. The median Dmax, Dmean, D1, D3, D5, D10 of stomach were 50.88Gy (range, 7.8-64.14Gy), 15.735Gy (range, 0.51-17.09Gy), 45.85Gy (range, 6-54 Gy), 42.95 Gy (range, 4.749.5Gy), 41.15Gy (range, 4.1-46.8 Gy), 37.95Gy (range, 2.7-42.6 Gy), respectively. The median Dmax, Dmean, D1, D3, D5, D10 of duodenum were 57.92Gy (range, 20.41-73.6Gy), 19.53Gy (range, 11.06-35 Gy), 47.8Gy (range, 17.1-72.2Gy), 43.4Gy (range, 13.5-70.8 Gy), 40.7Gy (range, 10.365.3 Gy), 34.55Gy (range, 0-52.3 Gy), respectively. Endoscopic findings in the stomach included grade I in 3 patients, grade II in 6 patients, grade III in 2 patients, grade IV in 3 patients. Findings in the duodenum included grade I in 3 patients, grade II in 5 patients, grade IV in 6 patients. There was no grade III duodenal toxicity observed. The D1, D3, D5, D10 of stomach were significantly associated with gastric toxicity (p all 0.05). No duodenal dosevolume relationships were associated with the risk of duodenal toxicity(p all >0.05). The D5 of stomach provided the best predictive value for gastric toxicity (AUCZ0.911), and the 6-month gastric toxicity rate was 0% vs. 75% for D5>40.85Gy and D540.85Gy, respectively (pZ0.033). Conclusion: DVH parameters of stomach may predict Grade 3 or higher gastric toxicity after hypofractionated radiation therapy for pancreatic cancer. Author Disclosure: X. Liu: None. G. Ren: None. T. Xia: None. Y. Di: None. D. Chang: None.
2380 Hypofractionated and Simultaneous Integrated Boost Radiation Therapy for Locally Advanced Pancreatic Cancer With Helical Tomotherapy G. Ren,1 T. Xia,2 Y. Di,1 D. Chang,1 Y. Wang,2 and X. Liu1; 1Department of Radiation Oncology, Chinese PLA Air General Hospital, Beijing, China, 2 Chinese PLA Air General Hospital, Beijing, China Purpose/Objective(s): To evaluate efficacy and safety of hypofractionated and simultaneous integrated boost (SIB) mode for locally advanced pancreatic cancer (LAPC) with helical tomotherapy (HT). Materials/Methods: LAPC patients with HT were retrospectively enrolled between Sep. 2011 and Jun. 2014. The total dose of 50/60/70Gy was respectively mainly delivered to PTV, CTV, GTV in 15-20 fractions. All patients were evaluated for efficacy and side effects. Treatment-related adverse effects were evaluated by NCI-CTCAE 4.02. Use Kaplan-Meier method for survival estimate. Cox regression was used for multivariate analysis. Results: Until Sep. 30 2014, 106 patients with LAPC were treated with HT. The follow-up rate was 93.40%. 19.2% underwent concurrent chemotherapy. The median biological equivalent dose (BED) (a/bZ10) of the
Volume 93 Number 3S Supplement 2015
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Survival in Patients Aged 75 Years and Older Receiving Adjuvant Chemoradiation for Resected Pancreatic Adenocarcinoma: A Multicenter, Multinational Pooled Analysis B.W. Maidment, III,1 G.C. Mattiucci,2 M. Falconi,3 R.G.P.M. van Stiphout,4 S. Alfieri,5 F.A. Calvo,6 J.M. Herman,7 R.C. Miller,8 W.F. Regine,9 M. Reni,10 N.K. Sharma,11 S. Partelli,12 D. Genovesi,13 M. Balducci,14 F. Deodato,15 V. Valentini,16 and A.G. Morganti17; 1 University of Virginia, Charlottesville, VA, 2Universita Cattolica S. Cuore, Rome, Italy, 3Department of Surgery, Universita Politecnica delle Marche, Ancona, Italy, 4(MAASTRO), GROW, University Medical Centre, Maastricht, Netherlands, 5Department of Surgery, Universita Cattolica S. Cuore, Rome, Italy, 6Hospital General Universitario Gregorio Maranon, Madrid, Spain, 7Johns Hopkins University School of Medicine, Baltimore, MD, 8Mayo Clinic, Jacksonville, FL, 9University of Maryland School of Medicine, Baltimore, MD, 10Department of Oncology, S. Raffaele Scientific Institute, Milan, Italy, 11University of Maryland School of Medicine, Baltimore, MD, 123. Department of Surgery, Universita` Politecnica delle Marche, Ancona, Italy, Roma, Italy, 13“SS Annunziata” Hospital, “G. D’Annunzio” University, Chieti, Italy, 14Universita` Cattolica S. Cuore, Rome, Italy, Rome, Italy, 15Fondazione Giovanni Paolo II, Campobasso, Italy, Campobasso, Italy, 16Sacred Heart Catholic University of Rome, Rome, Italy, 17Radiation Oncology Unit, Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
Dosimetric Predictors for Gastrointestinal Toxicity in Pancreatic Cancer After Hypofractionated Radiation Therapy X. Liu,1 G. Ren,1 T. Xia,2 Y. Di,1 and D. Chang1; 1Department of Radiation Oncology, Chinese PLA Air General Hospital, Beijing, China, 2 Chinese PLA Air General Hospital, Beijing, China
Purpose/Objective(s): More than one third of patients with pancreatic cancer are at least 75 years of age at the time of diagnosis. However, relatively few such individuals were enrolled in existing Phase III randomized trials which employed postoperative chemoradiation (POCR). We sought to determine the impact of POCR on overall survival (OS) after resection of pancreatic adenocarcinoma (PAC) in patients aged 75 years and older. Materials/Methods: A retrospective review of 1248 patients who underwent complete resection with macroscopically negative margins (R0-1) for invasive PAC at 10 institutions in 5 countries from 1995-2008 was performed. All T-stages (T1-4) and N-stages (N0-1) were permitted. Exclusion criteria were age < 75 years, metastatic disease at time of surgery, postoperative death within 60 days of surgery, non-adenocarcinoma histology, or treatment with intraoperative radiation therapy (IORT). Results: A total of 98 patients were included in this analysis (M: 39.8%, F: 60.2%; R1 resections: 33.7%; pN1: 61.2%). Sixty-three patients received POCR, while 35 did not. Among those who did not receive POCR, 26 received adjuvant chemotherapy alone. Median follow-up was 25.6 months. The mean age for the entire cohort of patients was 78.1 2.9 (SD) years. No significant differences were observed between patients who received POCR and those who did not in terms of age (p Z 0.081), tumor diameter (p Z 0.412), rate of R1 resection (p Z 0.331) and incidence of lymph node-positive disease (p Z 0.078). On univariate analysis, the only factor predicting for OS was POCR (p Z 0.008). Receipt of POCR remained a significant predictor for OS using a multivariate Cox proportional-hazards analysis (HR: 0.449; 95% CI: 0.212-0.950; p Z 0.036). Conclusion: This study represents the largest survival analysis of patients over 75 years of age receiving POCR after resection of PAC, and is the first such multi-institutional, multinational analysis. OS was significantly higher in patients who received POCR as compared to those who did not. Author Disclosure: B.W. Maidment: None. G. Mattiucci: None. M. Falconi: None. R.G. van Stiphout: None. S. Alfieri: None. F.A. Calvo: None. J.M. Herman: None. R.C. Miller: Stock; Tekcapital Europe. Board member; Rare Cancer Network. Board of Trustees; Mayo Clinic Health System Albert Lea Austin. W.F. Regine: None. M. Reni: None. N.K. Sharma: None. S. Partelli: None. D. Genovesi: None. M. Balducci: None. F. Deodato: None. V. Valentini: None. A.G. Morganti: None.
Purpose/Objective(s): To identify dosimetric predictors for the gastrointestinal (GI) toxicity in pancreatic cancer treated with hypofractionated radiation therapy. Materials/Methods: From June 2013 to October 2014, the dosimetric parameters of 14 pancreatic cancer patients treated with hypofractionated radiation therapy were analyzed. Dose-volume histogram (DVH) parameters included GTV, Dmax, Dmean, D1, D3, D5, D10 of the stomach and duodenum. Perform gastroscopy regularly after radiation therapy. Endoscopic findings were graded as I-IV. I : The mucosa is smooth, no distortion, no villi damage; II: The mucosa is mild hyperemia and edematous with vascular network showed and villi damaged; III: The mucosa is apparently hyperemic and edematous with mucosal tissue fragile and contact hemorrhages; IV: The mucosa is anabrotic and ulcer or lumen stenosis observed. Univariate analysis (UVA) was performed to identify risk factors associated with GI toxicity. The receiver operating characteristic (ROC) curve and the area under the receiver operating characteristic curve (AUC) were used to determine the best DVH parameter to predict for GI toxicity. Results: The prescribed dose of GTV ranged from 60 to 70Gy, and CTV ranged from 50 to 60Gy in 15 to 20 fractions. The median Dmax, Dmean, D1, D3, D5, D10 of stomach were 50.88Gy (range, 7.8-64.14Gy), 15.735Gy (range, 0.51-17.09Gy), 45.85Gy (range, 6-54 Gy), 42.95 Gy (range, 4.749.5Gy), 41.15Gy (range, 4.1-46.8 Gy), 37.95Gy (range, 2.7-42.6 Gy), respectively. The median Dmax, Dmean, D1, D3, D5, D10 of duodenum were 57.92Gy (range, 20.41-73.6Gy), 19.53Gy (range, 11.06-35 Gy), 47.8Gy (range, 17.1-72.2Gy), 43.4Gy (range, 13.5-70.8 Gy), 40.7Gy (range, 10.365.3 Gy), 34.55Gy (range, 0-52.3 Gy), respectively. Endoscopic findings in the stomach included grade I in 3 patients, grade II in 6 patients, grade III in 2 patients, grade IV in 3 patients. Findings in the duodenum included grade I in 3 patients, grade II in 5 patients, grade IV in 6 patients. There was no grade III duodenal toxicity observed. The D1, D3, D5, D10 of stomach were significantly associated with gastric toxicity (p all 0.05). No duodenal dosevolume relationships were associated with the risk of duodenal toxicity(p all >0.05). The D5 of stomach provided the best predictive value for gastric toxicity (AUCZ0.911), and the 6-month gastric toxicity rate was 0% vs. 75% for D5>40.85Gy and D540.85Gy, respectively (pZ0.033). Conclusion: DVH parameters of stomach may predict Grade 3 or higher gastric toxicity after hypofractionated radiation therapy for pancreatic cancer. Author Disclosure: X. Liu: None. G. Ren: None. T. Xia: None. Y. Di: None. D. Chang: None.
2380 Hypofractionated and Simultaneous Integrated Boost Radiation Therapy for Locally Advanced Pancreatic Cancer With Helical Tomotherapy G. Ren,1 T. Xia,2 Y. Di,1 D. Chang,1 Y. Wang,2 and X. Liu1; 1Department of Radiation Oncology, Chinese PLA Air General Hospital, Beijing, China, 2 Chinese PLA Air General Hospital, Beijing, China Purpose/Objective(s): To evaluate efficacy and safety of hypofractionated and simultaneous integrated boost (SIB) mode for locally advanced pancreatic cancer (LAPC) with helical tomotherapy (HT). Materials/Methods: LAPC patients with HT were retrospectively enrolled between Sep. 2011 and Jun. 2014. The total dose of 50/60/70Gy was respectively mainly delivered to PTV, CTV, GTV in 15-20 fractions. All patients were evaluated for efficacy and side effects. Treatment-related adverse effects were evaluated by NCI-CTCAE 4.02. Use Kaplan-Meier method for survival estimate. Cox regression was used for multivariate analysis. Results: Until Sep. 30 2014, 106 patients with LAPC were treated with HT. The follow-up rate was 93.40%. 19.2% underwent concurrent chemotherapy. The median biological equivalent dose (BED) (a/bZ10) of the