- Email: [email protected]
EP-1255 POSTOPERATIVE RADIATION THERAPY IN CHILDREN WITH WILMS' TUMOR
S480
Purpose/Objective: In this study comparison of different planning techniques for bilateral lung irradiation was done. Evaluation of 'out of field' dose for each planning technique was measured with TLD. We aimed to select clinically the most appropriate treatment model for pediatric whole lung irradiation. Materials and Methods: 4 different techniques (AP-PA, feKT, feIMRT and IMRT) treatment plans were made for diagnosed with Wilms’ tumor with lung metastases for pediatric patient. All treatment plans were compared by taking target volume coverage, critical organ doses, treatment time and out of field dose measured by TLD into consideration. Results: Both right and left lung volume which received 12 Gy for APPA, feKT, IMRT and feIMRT treatment plans were obtained 82%, 88%, 82%, 83% and 80%, 85%, 75%, 80%, respectively. The maximum doses for AP-PA, feKT, IMRT and feIMRT were found 1319 cGy, 1317 cGy, 1618 cGy and 1560 cGy, respectively. In AP-PA, feKT, IMRT and feIMRT plans, volumes of heart which received 1000 cGy dose were found 66%, 49%, 27% and 29%, respectively. The TLD readings of brain and thyroid at the feIMRT were higher than the others. Conclusions: In the planning of pediatric whole lung irradiation, two IMRT plans results in significantly reduced heart dose. Although we achieved better lung coverage with feKT plan, heart sparing was not successful as much as IMRT plans. However, in pediatric patients when selecting the most appropriate treatment modality, clinical assessment is very important in patients with longer expected survival. The late side effects and risks of secondary malignancy should not be ignored while selecting treatment model for pediatric cases. EP-1255 POSTOPERATIVE RADIATION THERAPY IN CHILDREN WITH WILMS' TUMOR A. Daidone1, A. Grillo1, G. Caminiti1, G. Evangelista2, P. Montemaggi2 1 Scuola di Specializzazione in Radioterapia- Istituto di Radiologia Policlinico Università di Palermo, Università degli studi di Palermo, Palermo, Italy 2 U.O. Radioterapia M.Ascoli-ARNAS-Palermo, Regiolnal Cancer Center, Palermo, Italy Purpose/Objective: Wilm’s tumour (WT) is a rare mesenchymal neoplasm that constitutes less than 10% of all pediatric malignancies, it is predominant in children during the last 2 years of life.The longterm result of the surgical treatment of this tumor with adjuvant chemotherapy and radiation has been reported from many cancer centers. However, there is paucity of literature on the long-term outcome of treatment for this tumor from the developing world.The radiotherapy (RT) treatment prevents a relatively rare event, flank the recurrence which tends to occur shortly after treatment. We can evaluate the efficacy of RT treatment in pts with diagnosis of WT treated in our institution Materials and Methods: We have reviewed 26 cases of WT treated in between February 2004 and February 2010. The median age was 26 months (range 2-7 years). The histological diagnosis was clear cells carcinoma of kidney in 18 pts and rabdoid tumour of kidney in 8 pts. One patient had a bilateral localization. All pts underwent to surgical resection followed by adjuvant RT. The RT was administered using photon beams with a linear accelerator. The median dose was 15 Gy (range 12-19.8 Gy) administered with a conventional fractionation of 1.5-1.8 Gy / die, not later than 9 days after surgery. Results: At present 4 pts had a local relapse; 17 pts was a complete remission and 5 pts had partial remission. The salvage treatment consisted in RT or chemotherapy with ifosfamide, carboplatin and etoposide. Conclusions: The RT appears improve local control in children with diagnosis of WT, although the pts treated for Wilms' tumour as children must continue to be monitored for possible recurrence, longterm sequelae as adults including secondary malignancies as well as treatment-related toxicity. EP-1256 HELICAL TOMOTHERAPY FOR PEDIATRIC CRANIOSPINAL IRRADIATION: EVALUATION OF FEASIBILITY, TOXICITY, AND DOSIMETRY R. Matute Martín1, J.L. Lopez Guerra1, D. Sevillano1, M. Bruna1, C. Sole1, A. Sanchez-Reyes1, F. Puebla1, G. Garcia1, C. Beltran1, H. Marsiglia1 1 Grupo IMO, Radiation Oncology, Madrid, Spain Purpose/Objective: Radiation therapy plays a central role in the multidisciplinary management of many childhood malignancies and
ESTRO 31
helical tomotherapy (HT) provides potential to decrease toxicity by limiting the radiation dose to normal structures. The purpose of this study was to evaluate the feasibility, tolerance, and dosimetry in pediatric patients who underwent craniospinal irradiation (CSI) with HT. Materials and Methods: From December 2006 to August 2011, 30 consecutive children (14 male; 17 female) underwent CSI with HT. Median age was 5 years old (range, 2 to 14). The most histological types were: medulloblastoma (N = 21), pineoblastoma (N = 3), teratoid tumor (N = 1), choroid plexus tumor (N = 1), ependymoma (N = 3), and ependymoblastoma (N = 1). All patients were treated with once-daily fractions of 1.8 Gy, except for two children who received twice-daily fractionated radiotherapy (1.3 Gy b.i.d). The acute and late toxicity was defined and graded according to the Radiation Therapy Oncology Group criteria. Results: The median follow-up was 24 months (25th-75th interquartile range, 5 to 42). The total dose delivered to the cerebrospinal axis was 23.4 Gy (N = 16), 36 Gy (N = 12), or 39 Gy (N = 2). The tumor bed was boosted up to 54 Gy, except for the two patients who underwent bifractionated HT (60 Gy). All patients received their treatment without interruption. Mean homogeneity index for the brain and the spine were 0.96 and 0.89, respectively. The average dose received by the critical organs in the 23,4 Gy (CSI) + 30.6 Gy (tumor bed) group were: 12.6 Gy on the eyes, 6.5 Gy on the cristalline lens, 24.7 Gy on the optic nerves, 26.4 Gy to the cochleae, 19 Gy on the temporo-mandibular joint, 12.6 Gy to the thyroid gland, 6.8 Gy to the heart (median V20 0%), 6.6 Gy to each lung (median V20 1%), 6.2 Gy to the liver (median V20 0.01%), 7.8 Gy to each kidney (median V20 0.1%), and 8.4 Gy to the bowel (median V20 1%). For the group of 36/39 Gy (CSI) + 18/21 Gy (tumor bed), the average dose were: 18.1 Gy on the eyes, 6.6 Gy on the cristalline lens, 35.7 Gy on the optic nerves, 41.1 Gy to the cochleae, 42.2 Gy on the temporomandibular joint, 21.2 Gy to the thyroid gland, 12 Gy to the heart (median V20 3%), 9.9 Gy to each lung (median V20 8%), 9.1 Gy to the liver (median V20 1%), 9.9 Gy to each kidney (median V20 4%), and 11.4 Gy to the bowel (median V20 4%). Early severe (grade ≥ 3) toxicity was mostly hematologic (50% of patients) with 6 grade IV neutropenia, and 3 grade IV thrombopenia. No patient experienced any severe long-term toxicity. Overall survival rate was 87 % at last contact date. There were 3 local failures, 3 distant failures, and 4 both local and distant failures. Conclusions: HT for CSI is feasible and has a good tolerance. In addition, no patient in this group developed grade ≥ 3 long-term toxicity. HT allows for a better comfort for the patient and is favourable in terms of dose homogeneity, conformity, and organs at risk sparing.
ELECTRONIC POSTER: CLINICAL TRACK: PALLIATION/SUPPORTIVE CARE/PATIENT SUPPORT EP-1257 PALLIATIVE RADIOTHERAPY IN THE TREATMENT OF GASTRIC AND GASTROESOPHAGIC UNION CANCER P. Cáceres1, J. Zamora2 1 Instituto Cancerología Guatemala, Radiotherapy, Guatemala, Guatemala 2 Instituto Nacional de Cancerología de México, Radiotherapy, Mexico D.F., Mexico Purpose/Objective: Review the experience and the outcome of patients with gastric and gastroesophagueal union cancer, treated with palliative radiotherapy with a dose fractionation of 23 Gy given in 4 fractions and 35.5 Gy in 14 fractions. Materials and Methods: 47 Patients with advanced gastric and gastroesophagueal union cancer, with obstruction, pain or bleeding, treated with palliative radiation therapy from 1,997 to 2007 in the Mexican Cancer National Institute, retrospectively reviewed, with or without chemotherapy. The endpoints included relief of pain, bleeding, obstruction and also median survival and toxicity. Results: The pain, obstruction and bleeding were relief in 71%, 95% and 86% respectively. Toxicity recorded in a retrospective review was Grade 1 and 2 gastrointestinal, Grade 2 and 3 hematologic. An addional finding was the pathologic complete response in a control endoscopy of 29% of the patients that were treated with radiotherapy alone or with chemoradiation. Median survival was 14.4 months, and the median survival was better in men (17.6 months) than in women (7.75 months). The median survival in patients with Clinical Stage III was better than in those with metastatic disease. Pathologic findings
Purpose/Objective: In this study comparison of different planning techniques for bilateral lung irradiation was done. Evaluation of 'out of field' dose for each planning technique was measured with TLD. We aimed to select clinically the most appropriate treatment model for pediatric whole lung irradiation. Materials and Methods: 4 different techniques (AP-PA, feKT, feIMRT and IMRT) treatment plans were made for diagnosed with Wilms’ tumor with lung metastases for pediatric patient. All treatment plans were compared by taking target volume coverage, critical organ doses, treatment time and out of field dose measured by TLD into consideration. Results: Both right and left lung volume which received 12 Gy for APPA, feKT, IMRT and feIMRT treatment plans were obtained 82%, 88%, 82%, 83% and 80%, 85%, 75%, 80%, respectively. The maximum doses for AP-PA, feKT, IMRT and feIMRT were found 1319 cGy, 1317 cGy, 1618 cGy and 1560 cGy, respectively. In AP-PA, feKT, IMRT and feIMRT plans, volumes of heart which received 1000 cGy dose were found 66%, 49%, 27% and 29%, respectively. The TLD readings of brain and thyroid at the feIMRT were higher than the others. Conclusions: In the planning of pediatric whole lung irradiation, two IMRT plans results in significantly reduced heart dose. Although we achieved better lung coverage with feKT plan, heart sparing was not successful as much as IMRT plans. However, in pediatric patients when selecting the most appropriate treatment modality, clinical assessment is very important in patients with longer expected survival. The late side effects and risks of secondary malignancy should not be ignored while selecting treatment model for pediatric cases. EP-1255 POSTOPERATIVE RADIATION THERAPY IN CHILDREN WITH WILMS' TUMOR A. Daidone1, A. Grillo1, G. Caminiti1, G. Evangelista2, P. Montemaggi2 1 Scuola di Specializzazione in Radioterapia- Istituto di Radiologia Policlinico Università di Palermo, Università degli studi di Palermo, Palermo, Italy 2 U.O. Radioterapia M.Ascoli-ARNAS-Palermo, Regiolnal Cancer Center, Palermo, Italy Purpose/Objective: Wilm’s tumour (WT) is a rare mesenchymal neoplasm that constitutes less than 10% of all pediatric malignancies, it is predominant in children during the last 2 years of life.The longterm result of the surgical treatment of this tumor with adjuvant chemotherapy and radiation has been reported from many cancer centers. However, there is paucity of literature on the long-term outcome of treatment for this tumor from the developing world.The radiotherapy (RT) treatment prevents a relatively rare event, flank the recurrence which tends to occur shortly after treatment. We can evaluate the efficacy of RT treatment in pts with diagnosis of WT treated in our institution Materials and Methods: We have reviewed 26 cases of WT treated in between February 2004 and February 2010. The median age was 26 months (range 2-7 years). The histological diagnosis was clear cells carcinoma of kidney in 18 pts and rabdoid tumour of kidney in 8 pts. One patient had a bilateral localization. All pts underwent to surgical resection followed by adjuvant RT. The RT was administered using photon beams with a linear accelerator. The median dose was 15 Gy (range 12-19.8 Gy) administered with a conventional fractionation of 1.5-1.8 Gy / die, not later than 9 days after surgery. Results: At present 4 pts had a local relapse; 17 pts was a complete remission and 5 pts had partial remission. The salvage treatment consisted in RT or chemotherapy with ifosfamide, carboplatin and etoposide. Conclusions: The RT appears improve local control in children with diagnosis of WT, although the pts treated for Wilms' tumour as children must continue to be monitored for possible recurrence, longterm sequelae as adults including secondary malignancies as well as treatment-related toxicity. EP-1256 HELICAL TOMOTHERAPY FOR PEDIATRIC CRANIOSPINAL IRRADIATION: EVALUATION OF FEASIBILITY, TOXICITY, AND DOSIMETRY R. Matute Martín1, J.L. Lopez Guerra1, D. Sevillano1, M. Bruna1, C. Sole1, A. Sanchez-Reyes1, F. Puebla1, G. Garcia1, C. Beltran1, H. Marsiglia1 1 Grupo IMO, Radiation Oncology, Madrid, Spain Purpose/Objective: Radiation therapy plays a central role in the multidisciplinary management of many childhood malignancies and
ESTRO 31
helical tomotherapy (HT) provides potential to decrease toxicity by limiting the radiation dose to normal structures. The purpose of this study was to evaluate the feasibility, tolerance, and dosimetry in pediatric patients who underwent craniospinal irradiation (CSI) with HT. Materials and Methods: From December 2006 to August 2011, 30 consecutive children (14 male; 17 female) underwent CSI with HT. Median age was 5 years old (range, 2 to 14). The most histological types were: medulloblastoma (N = 21), pineoblastoma (N = 3), teratoid tumor (N = 1), choroid plexus tumor (N = 1), ependymoma (N = 3), and ependymoblastoma (N = 1). All patients were treated with once-daily fractions of 1.8 Gy, except for two children who received twice-daily fractionated radiotherapy (1.3 Gy b.i.d). The acute and late toxicity was defined and graded according to the Radiation Therapy Oncology Group criteria. Results: The median follow-up was 24 months (25th-75th interquartile range, 5 to 42). The total dose delivered to the cerebrospinal axis was 23.4 Gy (N = 16), 36 Gy (N = 12), or 39 Gy (N = 2). The tumor bed was boosted up to 54 Gy, except for the two patients who underwent bifractionated HT (60 Gy). All patients received their treatment without interruption. Mean homogeneity index for the brain and the spine were 0.96 and 0.89, respectively. The average dose received by the critical organs in the 23,4 Gy (CSI) + 30.6 Gy (tumor bed) group were: 12.6 Gy on the eyes, 6.5 Gy on the cristalline lens, 24.7 Gy on the optic nerves, 26.4 Gy to the cochleae, 19 Gy on the temporo-mandibular joint, 12.6 Gy to the thyroid gland, 6.8 Gy to the heart (median V20 0%), 6.6 Gy to each lung (median V20 1%), 6.2 Gy to the liver (median V20 0.01%), 7.8 Gy to each kidney (median V20 0.1%), and 8.4 Gy to the bowel (median V20 1%). For the group of 36/39 Gy (CSI) + 18/21 Gy (tumor bed), the average dose were: 18.1 Gy on the eyes, 6.6 Gy on the cristalline lens, 35.7 Gy on the optic nerves, 41.1 Gy to the cochleae, 42.2 Gy on the temporomandibular joint, 21.2 Gy to the thyroid gland, 12 Gy to the heart (median V20 3%), 9.9 Gy to each lung (median V20 8%), 9.1 Gy to the liver (median V20 1%), 9.9 Gy to each kidney (median V20 4%), and 11.4 Gy to the bowel (median V20 4%). Early severe (grade ≥ 3) toxicity was mostly hematologic (50% of patients) with 6 grade IV neutropenia, and 3 grade IV thrombopenia. No patient experienced any severe long-term toxicity. Overall survival rate was 87 % at last contact date. There were 3 local failures, 3 distant failures, and 4 both local and distant failures. Conclusions: HT for CSI is feasible and has a good tolerance. In addition, no patient in this group developed grade ≥ 3 long-term toxicity. HT allows for a better comfort for the patient and is favourable in terms of dose homogeneity, conformity, and organs at risk sparing.
ELECTRONIC POSTER: CLINICAL TRACK: PALLIATION/SUPPORTIVE CARE/PATIENT SUPPORT EP-1257 PALLIATIVE RADIOTHERAPY IN THE TREATMENT OF GASTRIC AND GASTROESOPHAGIC UNION CANCER P. Cáceres1, J. Zamora2 1 Instituto Cancerología Guatemala, Radiotherapy, Guatemala, Guatemala 2 Instituto Nacional de Cancerología de México, Radiotherapy, Mexico D.F., Mexico Purpose/Objective: Review the experience and the outcome of patients with gastric and gastroesophagueal union cancer, treated with palliative radiotherapy with a dose fractionation of 23 Gy given in 4 fractions and 35.5 Gy in 14 fractions. Materials and Methods: 47 Patients with advanced gastric and gastroesophagueal union cancer, with obstruction, pain or bleeding, treated with palliative radiation therapy from 1,997 to 2007 in the Mexican Cancer National Institute, retrospectively reviewed, with or without chemotherapy. The endpoints included relief of pain, bleeding, obstruction and also median survival and toxicity. Results: The pain, obstruction and bleeding were relief in 71%, 95% and 86% respectively. Toxicity recorded in a retrospective review was Grade 1 and 2 gastrointestinal, Grade 2 and 3 hematologic. An addional finding was the pathologic complete response in a control endoscopy of 29% of the patients that were treated with radiotherapy alone or with chemoradiation. Median survival was 14.4 months, and the median survival was better in men (17.6 months) than in women (7.75 months). The median survival in patients with Clinical Stage III was better than in those with metastatic disease. Pathologic findings