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Effect of Circumferential Resection Margin (CRM) on Local Recurrence and Distant Metastases in Patients Treated with Neoadjuvant Chemoradiation for Rectal Cancer
I. J. Radiation Oncology d Biology d Physics
S368
Volume 81, Number 2, Supplement, 2011
received IORT (dose range: 15-25 Gy) immediately after radical surgery followed by identical systemic chemotherapy (IORT group). Results: After a median follow-up of 71 months (range: 15.93-127.73 months), the 5-year locoregional control rates were 91% in the EBRT group, versus 87% in the IORT group, respectively (p.0.05); And the 5-year overall survival and disease-free survival were 85%% and 76% in the EBRT group versus 84% and 74% in the IORT group, respectively (p.0.05). Compare to EBRT group, the incidence of acute grade 3 toxicity was significantly lower in IORT group (p\0.05). Conclusions: IORT followed by chemotherapy as an adjuvant treatment for T3N0M0 rectal adenocarcinoma provided a similar outcome in terms of local control, overall survival, and disease free survival, as compared to concurrent chemoradiation therapy after surgery. However, no significant acute or late complications were observed in patients treated with IORT. Further investigation, preferably in prospective fashion, is warranted to confirm the efficacy of IORT in the treatment of non-metastatic rectal cancer. Author Disclosure: Q. Zhang: None. J. Lu: None. L. Peng: None. P. Li: None. Z. Yang: None. F. Xiong: None. R. Jiang: None. S. Fu: None.
2329
Patient Reported Toxicity after Colorectal Cancer (CRC) Treatment
J. M. Metz, C. Vachania, M. Hampshire, G. Di Lullo, C. Hill-Kayser University of Pennsylvania Medical Center, Philadelphia, PA Purpose/Objective(s): Colorectal cancer patients may be at risk for myriad late effects after multimodality therapy, the impact of which may difficult to evaluate using conventional methods. This Internet based study evaluates patient perceptions of toxicity after treatment for CRC. Materials/Methods: Patient-reported data was gathered via a convenience sample frame from CRC survivors voluntarily utilizing a publically available, free, Internet-based tool for creation of survivorship care plans. Available at www.livestrongcareplan.com and through the OncoLink website, the tool allows survivors to enter data regarding diagnosis, demographics, and treatments, and provides customized guidelines for future care. During use of the tool, CRC survivors are queried regarding late effects associated with specific treatments, and asked to answer ‘‘yes,’’ ‘‘no,’’ or ‘‘I don’t know.’’ They are also asked to score GI toxicity using WHO criteria. All data have been maintained with IRB approval. Results: 211 CRC survivors answered queries regarding late effects; 64% were female and 82% white. Median diagnosis age was 50 (24 - 76) and median current age 54 (24 - 77). Most reported having had multimodality therapy - 97% surgery, 89% chemotherapy, and 37% radiation. When queried regarding GI toxicity, 52% reported chronic changes in bowel patterns, 32% chronic diarrhea, 10% bowel obstruction, 19% hernia development, 8% radiation colitis, and 2% fistula formation. Of 18 survivors who graded GI toxicity, 27% reported 4-6 stools per day, and 22% . 6 stools per day or incontinence. When queried regarding sexual function, 32% of men reported worse erectile function than pre-treatment, and 39% of women reported sexual changes such as vaginal dryness. Perceived cognitive decline since diagnosis of cancer was reported by 57%. Conclusions: Survivors using this tool anonymously and voluntarily report significant GI toxicity after cancer treatment. Approximately 1/3 of male and female survivors report impact on sexual function, and more than 50% report perceived cognitive decline. This tool offers a unique way for survivors to report their perceived experiences; the data reported here may be of significant impact in future clinical trials evaluating quality of life with patient reported outcomes. Author Disclosure: J.M. Metz: None. C. Vachania: None. M. Hampshire: None. G. Di Lullo: None. C. Hill-Kayser: None.
2330
Effect of Circumferential Resection Margin (CRM) on Local Recurrence and Distant Metastases in Patients Treated with Neoadjuvant Chemoradiation for Rectal Cancer
A. A. Alsuhaibani1, T. Niazi2, S. Vakilian1, T. Vuong2 1 McGill University Health Centre, Montreal, QC, Canada, 2Jewish General Hospital, McGill University, Montreal, QC, Canada Purpose/Objective(s): To analyze the effect of circumferential resection margin (CRM) on the local recurrence and distant metastases for patients with rectal cancer treated with preoperative chemoradiation therapy. Materials/Methods: All patients (pts) treated with curative intent from September 2004-March 2008 were analyzed. Treatment consisted of 3D-CRT (3 fields) using 50.4Gy in 28 fractions for T3 or Intensity Modulated Radiation Therapy (IMRT) using 60 Gy in 25 fractions for T4 lesions with concurrent 5-Fluorouracil followed by Total mesorectal surgery and adjuvant chemotherapy if indicated. Patients were followed at regular intervals for evidence of recurrence or distant metastases. Local recurrence (LR) was defined by local examination, biopsy with MRI, PET or CT imaging either with or without distant metastases. Results: Of the 99 patients analyzed, 68 had their CRM status measured and for 31 patients the CRM was not assessed, as it was not standard in our department for that period of time. 35 pts (35.4%) were female and 64 pts (64.5%) were male. The median age was 64 years (range 32-88 yrs). Twenty patients had T4 lesions and 79 had T3 lesions. Twenty-three patients were treated with IMRT and 76 with 3DCRT. With a median follow up of 33 months (range 2-68 months). CRM was negative in 59 patients and positive in 9 pts. Of the 9 patients with positive CRM 3 developed LR (33.3%) and distant metastasis and one developed distant metastases only, whereas for the remaining 59 patients with negative CRM, 2 had developed LR (3.3%) and distant metastases and 9 had distant metastases only (15.3%). Median time to LR was 22 months (range 4-55 months) and the median time to distant metastases was 14 months (range 2-39 months). Conclusions: our results confirm that positive CRM for patients with rectal cancer treated with preoperative chemoradiation therapy carries higher risk for local recurrence (33.3%) and distant metastases (44.4%) and we recommend strongly that these patients should be considered for adjuvant systemic chemotherapy. Author Disclosure: A.A. Alsuhaibani: None. T. Niazi: None. S. Vakilian: None. T. Vuong: None.
S368
Volume 81, Number 2, Supplement, 2011
received IORT (dose range: 15-25 Gy) immediately after radical surgery followed by identical systemic chemotherapy (IORT group). Results: After a median follow-up of 71 months (range: 15.93-127.73 months), the 5-year locoregional control rates were 91% in the EBRT group, versus 87% in the IORT group, respectively (p.0.05); And the 5-year overall survival and disease-free survival were 85%% and 76% in the EBRT group versus 84% and 74% in the IORT group, respectively (p.0.05). Compare to EBRT group, the incidence of acute grade 3 toxicity was significantly lower in IORT group (p\0.05). Conclusions: IORT followed by chemotherapy as an adjuvant treatment for T3N0M0 rectal adenocarcinoma provided a similar outcome in terms of local control, overall survival, and disease free survival, as compared to concurrent chemoradiation therapy after surgery. However, no significant acute or late complications were observed in patients treated with IORT. Further investigation, preferably in prospective fashion, is warranted to confirm the efficacy of IORT in the treatment of non-metastatic rectal cancer. Author Disclosure: Q. Zhang: None. J. Lu: None. L. Peng: None. P. Li: None. Z. Yang: None. F. Xiong: None. R. Jiang: None. S. Fu: None.
2329
Patient Reported Toxicity after Colorectal Cancer (CRC) Treatment
J. M. Metz, C. Vachania, M. Hampshire, G. Di Lullo, C. Hill-Kayser University of Pennsylvania Medical Center, Philadelphia, PA Purpose/Objective(s): Colorectal cancer patients may be at risk for myriad late effects after multimodality therapy, the impact of which may difficult to evaluate using conventional methods. This Internet based study evaluates patient perceptions of toxicity after treatment for CRC. Materials/Methods: Patient-reported data was gathered via a convenience sample frame from CRC survivors voluntarily utilizing a publically available, free, Internet-based tool for creation of survivorship care plans. Available at www.livestrongcareplan.com and through the OncoLink website, the tool allows survivors to enter data regarding diagnosis, demographics, and treatments, and provides customized guidelines for future care. During use of the tool, CRC survivors are queried regarding late effects associated with specific treatments, and asked to answer ‘‘yes,’’ ‘‘no,’’ or ‘‘I don’t know.’’ They are also asked to score GI toxicity using WHO criteria. All data have been maintained with IRB approval. Results: 211 CRC survivors answered queries regarding late effects; 64% were female and 82% white. Median diagnosis age was 50 (24 - 76) and median current age 54 (24 - 77). Most reported having had multimodality therapy - 97% surgery, 89% chemotherapy, and 37% radiation. When queried regarding GI toxicity, 52% reported chronic changes in bowel patterns, 32% chronic diarrhea, 10% bowel obstruction, 19% hernia development, 8% radiation colitis, and 2% fistula formation. Of 18 survivors who graded GI toxicity, 27% reported 4-6 stools per day, and 22% . 6 stools per day or incontinence. When queried regarding sexual function, 32% of men reported worse erectile function than pre-treatment, and 39% of women reported sexual changes such as vaginal dryness. Perceived cognitive decline since diagnosis of cancer was reported by 57%. Conclusions: Survivors using this tool anonymously and voluntarily report significant GI toxicity after cancer treatment. Approximately 1/3 of male and female survivors report impact on sexual function, and more than 50% report perceived cognitive decline. This tool offers a unique way for survivors to report their perceived experiences; the data reported here may be of significant impact in future clinical trials evaluating quality of life with patient reported outcomes. Author Disclosure: J.M. Metz: None. C. Vachania: None. M. Hampshire: None. G. Di Lullo: None. C. Hill-Kayser: None.
2330
Effect of Circumferential Resection Margin (CRM) on Local Recurrence and Distant Metastases in Patients Treated with Neoadjuvant Chemoradiation for Rectal Cancer
A. A. Alsuhaibani1, T. Niazi2, S. Vakilian1, T. Vuong2 1 McGill University Health Centre, Montreal, QC, Canada, 2Jewish General Hospital, McGill University, Montreal, QC, Canada Purpose/Objective(s): To analyze the effect of circumferential resection margin (CRM) on the local recurrence and distant metastases for patients with rectal cancer treated with preoperative chemoradiation therapy. Materials/Methods: All patients (pts) treated with curative intent from September 2004-March 2008 were analyzed. Treatment consisted of 3D-CRT (3 fields) using 50.4Gy in 28 fractions for T3 or Intensity Modulated Radiation Therapy (IMRT) using 60 Gy in 25 fractions for T4 lesions with concurrent 5-Fluorouracil followed by Total mesorectal surgery and adjuvant chemotherapy if indicated. Patients were followed at regular intervals for evidence of recurrence or distant metastases. Local recurrence (LR) was defined by local examination, biopsy with MRI, PET or CT imaging either with or without distant metastases. Results: Of the 99 patients analyzed, 68 had their CRM status measured and for 31 patients the CRM was not assessed, as it was not standard in our department for that period of time. 35 pts (35.4%) were female and 64 pts (64.5%) were male. The median age was 64 years (range 32-88 yrs). Twenty patients had T4 lesions and 79 had T3 lesions. Twenty-three patients were treated with IMRT and 76 with 3DCRT. With a median follow up of 33 months (range 2-68 months). CRM was negative in 59 patients and positive in 9 pts. Of the 9 patients with positive CRM 3 developed LR (33.3%) and distant metastasis and one developed distant metastases only, whereas for the remaining 59 patients with negative CRM, 2 had developed LR (3.3%) and distant metastases and 9 had distant metastases only (15.3%). Median time to LR was 22 months (range 4-55 months) and the median time to distant metastases was 14 months (range 2-39 months). Conclusions: our results confirm that positive CRM for patients with rectal cancer treated with preoperative chemoradiation therapy carries higher risk for local recurrence (33.3%) and distant metastases (44.4%) and we recommend strongly that these patients should be considered for adjuvant systemic chemotherapy. Author Disclosure: A.A. Alsuhaibani: None. T. Niazi: None. S. Vakilian: None. T. Vuong: None.