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EP-1246 THE ROLE OF HDR BRACHYTHERAPY IN NON-MELANOMA SKIN CANCER TREATMENT
ESTRO 31
treated with electron therapy and 2 with X-ray. Mean follow-up were 96.4 months (range: 2.4-369.2 months). Results: The 5-year local control, lymph node metastasis-free, and distant metastasis-free survival rates for all patients were 70.1%, 78.4% and 91.0% respectively. Seven lymph node metastases were observed in 11 regions (parotid gland lymph node: 4, periauricular: 3, upper cervical: 1, middle cervical: 1, posterior cervical: 1, submandibular: 1). The 5-year overall, and cause-specific survival rates were 77.0% and 96.8% respectively. Regarding local control, small size less than 30 mm, more than 56 Gy in EQD 2 Gy and T1/T2 had a tendency for good control (p=0.08, 0.11 and 0.01). Regarding OS, lymph node metastasis were worse prognostic factor(p=0.0001). Severe late toxicity which was grade 3 or more toxicity (CTCAE ver4.0) was observed in 9 patients and 11 events. Cataract was in 5 patients, eyelid dysfunction was in one patient, glaucoma was in one patient, keratitis was in 3 patients and sympathetic ophthalmitis was in one patient. Conclusions: Radical radiotherapy for SCC of the eyelid yields good results and could be a treatment option. Tumor size more than 30mm and advanced T stages (T3 and T4) are worse local control. More than 56 Gy in EQD 2 Gy is required to control local tumors. The patients with a positive N show a worse overall survival rate. EP-1246 THE ROLE OF HDR BRACHYTHERAPY IN NON-MELANOMA SKIN CANCER TREATMENT M. Arguis1, M. Murcia-Mejía1, I. Henríquez1, D. Gómez1, A. Lafuerza1, C. Esteban1, R. León1, Y. Polo1, I. Grau1, M. Arenas1 1 Hospital Universitari Sant Joan de Reus, Radiotherapy, Reus, Spain Purpose/Objective: Non melanoma skin cancer is the most frequent cancer in human. It arise in sun exposed areas like face, and have a high risk of local recurrence. Treatment options included surgery and radiotherapy. The aim of this study is to analyze the role of HDR Ir192 Brachytherapy in patients treat for non-melanoma skin cancer, in terms of local control and toxicity. Materials and Methods: Patients diagnosed of non-melanoma skin cancer treated at HUSJR were analyzed. All locations were included. The treatment was delivered by HDR Brachytherapy (Ir-192). Fixed diameter surface applicator (Leipzig applicator 2-3 cm) was used for regular small lesions and a customized mould in raised areas or larger lesions. Standard hipofractioned (3Gy per fraction 3 times weekly) treatment was delivered. CT-based dosimetry was utilized for customized moulds. Dose was prescribed at 0.3-0.5cm below the skin surface for Leipzig applicator. Acute skin toxicity was evaluated weekly during radiation and one month after treatment using RTOG morbidity criteria. Late toxicity was evaluated at 6 months and annually using LENT-SOMA scale. Local response was monitored at the end of the treatment. Results: From November 2006 to December 2011, 141 skin carcinomas in 115 patients were treated. 69 were male and 46 were female, median age was 77.8 years (range 36-96). 112 were primary tumors and 29 were recurrent tumors. 67,4% basal cell carcinomas, 30,5% squamous cell carcinoma and 2,1% other histology. 67 lesions were located in Area H (mask area: central face, nose, chin), 53 in Area M (scalp, cheeks and forehead), and 21 in Area L (trunk and extremities). Mean diameter of lesions was 13 mm (range 5-65mm). 123 lesions were T1, 14 were T2 and 4 were T3. In thirty-two (22,7%) skin cancers lesions HDR Brachytherapy was administered after local excision due to positive margins. In 106 (75%) lesions a Leipzig applicator was used and in the other 35 lesions a flap mould was used. Mean treatment dose was 48.7 Gy (40-54Gy) for basal cell carcinoma and 50.1 Gy (45-57 Gy) for squamous cell. Sixty-one lesions presented acute grade 2 skin toxicity and fourty-nine lesions grade 3. Six patients had to stopped the treatment for skin toxicity but can completed the treatment. At the end of the treatment, 96.5% of the lesions achieved a complete regression. With a median follow up of 39 months (3m-174m), the recurrence free survivals at one year was 92.4 %. Late toxicity was 52.4% grade 0 and 37,9% grade 1. Nine failures of treatment were detected: two partial responses, four persistent disease and three marginal field recurrences. All failure patients were treated with salvage surgery without evidence of disease at the moment of evaluation. Conclusions: HDR Brachytherapy with Ir- 192 is a feasible, well tolerated and effective treatment in non-melanoma skin cancer. It represented an excellent alternative to surgery, because its good local control and cosmesis outcome. Brachytherapy must to be account in the treatment of skin cancer.
S477
EP-1247 A RETROSPECTIVE AUDIT OF ADJUVANT NODAL RADIOTHERAPY FOR MALIGNANT MELANOMA J. Sherriff1, A. Zarkar1 1 Hall-Edwards Radiotherapy Research Group Queen Elizabeth Hospital, Cancer Centre, Birmingham, United Kingdom Purpose/Objective: Adjuvant radiotherapy is increasingly being utilised following lymph node block dissection for regional recurrence of malignant melanoma. Little data is currently available regarding the effect of advancing radiotherapy techniques on the efficacy of adjuvant radiotherapy. Materials and Methods: All patients receiving adjuvant radiotherapy following nodal block dissection between 1999 and 2011 were identified. Baseline characteristics including the number and size of lymph nodes involved, the presence of extra-nodal spread and the distance to surgical margins were identified. The radiotherapy technique and dose/fractionation schedules used were reviewed. Outcome data, for each technique identified, including the rate of local recurrence, the site of local recurrence and the time to local recurrence, was collected for all patients. Distant recurrence and survival rates were also calculated. Results: Forty nine patients receiving adjuvant nodal radiotherapy were identified. Seventeen were planned with conventional simulation and 32 with CT-planned conformal radiotherapy. The majority of patients received either 50Gy or 48Gy in 20 fractions over 4 weeks for disease with a high risk of post-operative local recurrence. The median follow up was 35 (range: 3-140) months in surviving patients. Local recurrence occurred in 5 (29.4%) and 6 (18.8%) of those treated with conventional and conformal techniques respectively. Of the 5 patients with local recurrence treated conventionally: 2 developed in-field nodal recurrence; 1 out of field recurrence in an adjacent nodal group; 1 developed subcutaneous metastases both within and outside the radiotherapy field and 1 developed nodal recurrence at the edge of the field. Of the 6 treated conformally: 4 developed in-field nodal recurrence; 1 developed subcutaneous in-field metastases and 1 developed nodal recurrence during the radiotherapy with no response to treatment. Conclusions: The local recurrence rates in the cohort presented are consistent with previous retrospective studies. The rates of local recurrence following adjuvant radiotherapy post-nodal block dissection for melanoma are lower with the use of conformal compared to conventional radiotherapy techniques. Patterns of local recurrence should be continually assessed with the introduction of more advanced radiotherapy techniques. EP-1248 HYPOFRACTIONATED RADIOTHERAPY AFTER LYMPHADENECTOMY FOR NODAL INVOLVEMENT OF MALIGNANT MELANOMA. A. Mañes1, J. Jové1, R. Ballester1, V. Tuset1, M. Caro1, I. Planas1, J.L. Manzano2, A. Boada3, A. Arellano1 1 ICO Badalona, Radiation Oncology, Barcelona, Spain 2 ICO Badalona, Medical Oncology, Barcelona, Spain 3 H. U. Germans Trias i Pujol, Dermatology, Barcelona, Spain Purpose/Objective: Role of radiation therapy (RT) after lymphadenectomy for patients with nodal involvement of malignant melanoma (MM) remains controversial. During ASCO 2009, preliminary results of the ANZMTG 01.02/TROG 02.01 randomized study were presented, showing that postoperative radiotherapy (48 Gy in 20 fractions), significantly improves regional control in MM patients at high risk of regional relapse after lymphadenectomy although an effect on survival was not demonstrated. Moreover, role of hypofractionated RT has not been well evaluated in randomized studies. The aim of this retrospective study is to assess our results with respect to regional control, survival and acute and late toxicity for the hypofractionated adjuvant RT in patients with proven nodal metastases of MM. Materials and Methods: Between March 2001 and May 2011, 37 patients (pts) were treated with regional RT after lymphadenectomy: 15 with node metastases diagnosed synchronously to primary tumor and 22 as a recurrent disease. Hypofractionated schedules of radiotherapy were used: 31 pts were treated with a median total dose (TD) of 30 Gy at 6 Gy per fraction, twice weekly, and 6 pts with TD of 24 Gy at 8 Gy per fraction, once weekly. Adjuvant high doses of Interferon were administered in 21 pts. We have analyzed overall survival (OS), progression free survival (PFS) and regional progression free survival (RPFS) from lymphadenectomy date, regional control (RC), and acute and late toxicity rates.
treated with electron therapy and 2 with X-ray. Mean follow-up were 96.4 months (range: 2.4-369.2 months). Results: The 5-year local control, lymph node metastasis-free, and distant metastasis-free survival rates for all patients were 70.1%, 78.4% and 91.0% respectively. Seven lymph node metastases were observed in 11 regions (parotid gland lymph node: 4, periauricular: 3, upper cervical: 1, middle cervical: 1, posterior cervical: 1, submandibular: 1). The 5-year overall, and cause-specific survival rates were 77.0% and 96.8% respectively. Regarding local control, small size less than 30 mm, more than 56 Gy in EQD 2 Gy and T1/T2 had a tendency for good control (p=0.08, 0.11 and 0.01). Regarding OS, lymph node metastasis were worse prognostic factor(p=0.0001). Severe late toxicity which was grade 3 or more toxicity (CTCAE ver4.0) was observed in 9 patients and 11 events. Cataract was in 5 patients, eyelid dysfunction was in one patient, glaucoma was in one patient, keratitis was in 3 patients and sympathetic ophthalmitis was in one patient. Conclusions: Radical radiotherapy for SCC of the eyelid yields good results and could be a treatment option. Tumor size more than 30mm and advanced T stages (T3 and T4) are worse local control. More than 56 Gy in EQD 2 Gy is required to control local tumors. The patients with a positive N show a worse overall survival rate. EP-1246 THE ROLE OF HDR BRACHYTHERAPY IN NON-MELANOMA SKIN CANCER TREATMENT M. Arguis1, M. Murcia-Mejía1, I. Henríquez1, D. Gómez1, A. Lafuerza1, C. Esteban1, R. León1, Y. Polo1, I. Grau1, M. Arenas1 1 Hospital Universitari Sant Joan de Reus, Radiotherapy, Reus, Spain Purpose/Objective: Non melanoma skin cancer is the most frequent cancer in human. It arise in sun exposed areas like face, and have a high risk of local recurrence. Treatment options included surgery and radiotherapy. The aim of this study is to analyze the role of HDR Ir192 Brachytherapy in patients treat for non-melanoma skin cancer, in terms of local control and toxicity. Materials and Methods: Patients diagnosed of non-melanoma skin cancer treated at HUSJR were analyzed. All locations were included. The treatment was delivered by HDR Brachytherapy (Ir-192). Fixed diameter surface applicator (Leipzig applicator 2-3 cm) was used for regular small lesions and a customized mould in raised areas or larger lesions. Standard hipofractioned (3Gy per fraction 3 times weekly) treatment was delivered. CT-based dosimetry was utilized for customized moulds. Dose was prescribed at 0.3-0.5cm below the skin surface for Leipzig applicator. Acute skin toxicity was evaluated weekly during radiation and one month after treatment using RTOG morbidity criteria. Late toxicity was evaluated at 6 months and annually using LENT-SOMA scale. Local response was monitored at the end of the treatment. Results: From November 2006 to December 2011, 141 skin carcinomas in 115 patients were treated. 69 were male and 46 were female, median age was 77.8 years (range 36-96). 112 were primary tumors and 29 were recurrent tumors. 67,4% basal cell carcinomas, 30,5% squamous cell carcinoma and 2,1% other histology. 67 lesions were located in Area H (mask area: central face, nose, chin), 53 in Area M (scalp, cheeks and forehead), and 21 in Area L (trunk and extremities). Mean diameter of lesions was 13 mm (range 5-65mm). 123 lesions were T1, 14 were T2 and 4 were T3. In thirty-two (22,7%) skin cancers lesions HDR Brachytherapy was administered after local excision due to positive margins. In 106 (75%) lesions a Leipzig applicator was used and in the other 35 lesions a flap mould was used. Mean treatment dose was 48.7 Gy (40-54Gy) for basal cell carcinoma and 50.1 Gy (45-57 Gy) for squamous cell. Sixty-one lesions presented acute grade 2 skin toxicity and fourty-nine lesions grade 3. Six patients had to stopped the treatment for skin toxicity but can completed the treatment. At the end of the treatment, 96.5% of the lesions achieved a complete regression. With a median follow up of 39 months (3m-174m), the recurrence free survivals at one year was 92.4 %. Late toxicity was 52.4% grade 0 and 37,9% grade 1. Nine failures of treatment were detected: two partial responses, four persistent disease and three marginal field recurrences. All failure patients were treated with salvage surgery without evidence of disease at the moment of evaluation. Conclusions: HDR Brachytherapy with Ir- 192 is a feasible, well tolerated and effective treatment in non-melanoma skin cancer. It represented an excellent alternative to surgery, because its good local control and cosmesis outcome. Brachytherapy must to be account in the treatment of skin cancer.
S477
EP-1247 A RETROSPECTIVE AUDIT OF ADJUVANT NODAL RADIOTHERAPY FOR MALIGNANT MELANOMA J. Sherriff1, A. Zarkar1 1 Hall-Edwards Radiotherapy Research Group Queen Elizabeth Hospital, Cancer Centre, Birmingham, United Kingdom Purpose/Objective: Adjuvant radiotherapy is increasingly being utilised following lymph node block dissection for regional recurrence of malignant melanoma. Little data is currently available regarding the effect of advancing radiotherapy techniques on the efficacy of adjuvant radiotherapy. Materials and Methods: All patients receiving adjuvant radiotherapy following nodal block dissection between 1999 and 2011 were identified. Baseline characteristics including the number and size of lymph nodes involved, the presence of extra-nodal spread and the distance to surgical margins were identified. The radiotherapy technique and dose/fractionation schedules used were reviewed. Outcome data, for each technique identified, including the rate of local recurrence, the site of local recurrence and the time to local recurrence, was collected for all patients. Distant recurrence and survival rates were also calculated. Results: Forty nine patients receiving adjuvant nodal radiotherapy were identified. Seventeen were planned with conventional simulation and 32 with CT-planned conformal radiotherapy. The majority of patients received either 50Gy or 48Gy in 20 fractions over 4 weeks for disease with a high risk of post-operative local recurrence. The median follow up was 35 (range: 3-140) months in surviving patients. Local recurrence occurred in 5 (29.4%) and 6 (18.8%) of those treated with conventional and conformal techniques respectively. Of the 5 patients with local recurrence treated conventionally: 2 developed in-field nodal recurrence; 1 out of field recurrence in an adjacent nodal group; 1 developed subcutaneous metastases both within and outside the radiotherapy field and 1 developed nodal recurrence at the edge of the field. Of the 6 treated conformally: 4 developed in-field nodal recurrence; 1 developed subcutaneous in-field metastases and 1 developed nodal recurrence during the radiotherapy with no response to treatment. Conclusions: The local recurrence rates in the cohort presented are consistent with previous retrospective studies. The rates of local recurrence following adjuvant radiotherapy post-nodal block dissection for melanoma are lower with the use of conformal compared to conventional radiotherapy techniques. Patterns of local recurrence should be continually assessed with the introduction of more advanced radiotherapy techniques. EP-1248 HYPOFRACTIONATED RADIOTHERAPY AFTER LYMPHADENECTOMY FOR NODAL INVOLVEMENT OF MALIGNANT MELANOMA. A. Mañes1, J. Jové1, R. Ballester1, V. Tuset1, M. Caro1, I. Planas1, J.L. Manzano2, A. Boada3, A. Arellano1 1 ICO Badalona, Radiation Oncology, Barcelona, Spain 2 ICO Badalona, Medical Oncology, Barcelona, Spain 3 H. U. Germans Trias i Pujol, Dermatology, Barcelona, Spain Purpose/Objective: Role of radiation therapy (RT) after lymphadenectomy for patients with nodal involvement of malignant melanoma (MM) remains controversial. During ASCO 2009, preliminary results of the ANZMTG 01.02/TROG 02.01 randomized study were presented, showing that postoperative radiotherapy (48 Gy in 20 fractions), significantly improves regional control in MM patients at high risk of regional relapse after lymphadenectomy although an effect on survival was not demonstrated. Moreover, role of hypofractionated RT has not been well evaluated in randomized studies. The aim of this retrospective study is to assess our results with respect to regional control, survival and acute and late toxicity for the hypofractionated adjuvant RT in patients with proven nodal metastases of MM. Materials and Methods: Between March 2001 and May 2011, 37 patients (pts) were treated with regional RT after lymphadenectomy: 15 with node metastases diagnosed synchronously to primary tumor and 22 as a recurrent disease. Hypofractionated schedules of radiotherapy were used: 31 pts were treated with a median total dose (TD) of 30 Gy at 6 Gy per fraction, twice weekly, and 6 pts with TD of 24 Gy at 8 Gy per fraction, once weekly. Adjuvant high doses of Interferon were administered in 21 pts. We have analyzed overall survival (OS), progression free survival (PFS) and regional progression free survival (RPFS) from lymphadenectomy date, regional control (RC), and acute and late toxicity rates.