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Esophageal carcinoma treated with nerve-sparing operation, intra-operative radiotherapy, and postoperative external radiotherapy
S426
I. J. Radiation Oncology
● Biology ● Physics
Volume 60, Number 1, Supplement, 2004
Results: In 87% (58/67 pts.) tumour progression was visualized by PET/CT confirming the formerly by clinical symptoms and/or radiological imaging modalities suspected recurrence. In 13% (9/67 pts.) recurrence was unveiled only by PET/CT. A total number of 84 tumour manifestations was observed in these 67 pts. (14 local recurrences, 21 lymph node involvements, 22 liver metastases (mets), 20 lung mets, 3 bone mets, 3 adrenal gland mets, one brain metastasis). In 18/67 pts. a histological specimen was obtained. In 77.8% (14/18 pts.) of these pts. PET/CT result was histological confirmed. Only in 22.2 % (4/18) PET/CT was false true. In 46% (31/67) treatment decision was changed due to the result of PET/CT examination compared to treatment intention after conventional diagnostics. (surgery n ⫽ 16, radiation therapy n ⫽ 10, chemotherapy n ⫽ 5). Conclusions: F-18-FDG-PET/CT in patients with suspected local recurrence of colorectal cancer lead to a highly percentage (46%) of changes in disease management. Therefore F-18-FDG-PET/CT should be introduced into routine restaging procedures.
2153
Esophageal Carcinoma Treated with Nerve-Sparing Operation, Intra-Operative Radiotherapy, and Postoperative External Radiotherapy
S. Shimizu,1,2 M. Hosokawa,1 H. Shirato,2 T. Kusumi1 Keiyukai Sapporo Hospital, Sapporo, Japan, 2Department of Radiology, Hokkaido University School of Medicine, Sapporo, Hokkaido, Japan
1
Purpose/Objective: Metastasis to upper-mediastinal lymph nodes is one of the most common events in patients with esophageal cancer. Radical three field dissections may result in recurrent nerve palsy or postoperative pulmonary complications. We have used nerve-sparing operation with postoperative external radiotherapy (PORT) with intra-operative radiotherapy (IORT). Previously, we have reported that IORT 12 Gy or more was effective but could induce severe late complications. Long-term treatment results were analyzed to see the outcome of 6Gy IORT followed by 45 - 46 Gy PORT in this study. Materials/Methods: Patients with esophageal squamous cell carcinoma (excluding mucosal carcinoma) were candidates for radical esophagectomy and nerve-sparing lymphadenectory. If the patient was younger than 75 years old and R0 resection (grossly non-residual curative operation) was possible, 6Gy IORT followed by PORT of 45Gy in 18 fraction or 46 Gy in 23 fractions was indicated. Informed consent for the possibility of IORT was obtained before surgery. Results: Two-hundred seventy-six patients (median 63, range 42 to 74) were eligible for this treatment between 1995 and 2001. There were 240 males and 36 females. Clinical stage (cS) was 1 in 63, 2 in 58, 85 in 3, and 70 in 4. Because of the limitation in the availability of surgical room for IORT, 173 of 276 patients were not treated with IORT followed by PORT. Thirty-two were treated with IORT without PORT and 62 were treated PORT without IORT. Seventy-nine patients were treated with operation only. Overall survival rate at 5 years of all 276 patients was 82.2, 65.9, 36.3, and 27.4 % respectively for cS1, cS2, cS3, and cS 4 respectively. Progression-free survival was 93.7, 76.1, 44.5, and 28.5% respectively for cS1, cS2, cS3, and cS4 respectively. For 171 patients with N1 diseases, there was significant difference in survival in favor of IORT (p ⫽ 0.04), PORT (p ⫽ 0.0001), and IORT⫹PORT (p ⫽ 0.0009) comparing to operation only, respectively. For patient with cT3 diseases, overall survival was significantly better in patients with PORT (0.009) and in patients with IORT ⫹ PORT (p ⫽ 0.011). There were no severe late complications in these patients. Conclusions: 6 Gy IORT followed by 45- 46 Gy PORT was effective and much safer than previous our protocol. Esophageal carcinoma treated with nerve-sparing operation with IORT and PORT was feasible and effective treatment, especially for cN1 disease and cT3 diseases. Real benefit of IORT should be investigated in a phase III trial.
2154
Hypofractionated Three-Dimensional Conformal Radiation Therapy (3DCRT) for Primary Liver Carcinoma (PLC)
S. Liang,1 G. Jiang,1 X. Zhu,2 X. Fu1 Radiation Oncology, Fudan University Cancer Hospital, Shanghai, China, 2Radiation Oncology, Cancer Hospital, Guangxi Medical University, Nanning, China
1
Purpose/Objective: To investigate the side-effects, toxicities, and efficacy of hypofractionated 3DCRT for PLC. Materials/Methods: From April 1999 to August 2003, 128 patients with PLC received hypofractionated 3DCRT at cancer hospital, Guangxi Medical University. All patients were technical unresectable or medical inoperable due to poor liver function or cardiovascular diseases. The clinical characteristics of these patients were as follows: 113 male, 15 female; median age of 48.2 (27–72); with portal vein thrombosis (PVT) in 34 cases, and without it in 94 cases; hepatitis B virus (HBV) positive in 93 cases, negative in 35 cases; liver cirrhosis of Child-Pugh grade A in 108 cases, Child-Pugh grade B in 20 cases. 3DCRT was carried out by 8MV x-ray with Topslane treatment planning system. Multiple coplanar or non-coplanar fields were used to implement hypofractionated 3DCRT. In 48 patients transarterial chemoembolization (TACE) was performed prior to 3DCRT with DDP,ADM and MMC. 3DCRT was delivered by 4.88 ⫾ 0.47Gy(4-8Gy)/fraction, three fractions per week (Mon., Wed. and Fri.) with a median total dose of 53.6Gy ⫾ 6.6Gy. The mean value of gross target volume (GTV) was 458.92 ⫾ 429.8cm3. Results: The mean follow-up time was 14.2(1–53)months. The most severe complication was radiation-induced liver disease (RILD), which occurred in 19 cases (15%) with 16 deaths due to RILD (detailed analysis of RILD had been present in another paper). The other side-effects included ulcerations in stomach as well as nausea, vomiting and fatigue, but not severe. As to immediate responses, 7 cases died within 3 months after treatment, were not evaluated. The response rate (CR⫹PR) was 55% (67/121). Stable disease was observed in 17 cases (14%), and progressive disease, in 37 patients (31%), which included 34 cases of intrahepatic metastasis and 3 cases of local progression. The median survival time was 14.2 months for entire group. The overall survival rates at 1, 2, and 3 years were 65%, 43% and 33%, respectively. Prognostic factors evaluated included gender, age, GTV, alpha-fetoprotein (AFP) level, infection of hepatitis B virus (HBV), PVT, use of TACE, Child-Pugh grade of liver cirrhosis. Univariate analyses demonstrated that GTV, PVT and liver cirrhosis of Child-Pugh grade had significant impact on the overall survival (p ⫽ 0.0000, 0.0001and 0.0000, respectively). Large GTV, exist of PVT and Child-Pugh B were the
I. J. Radiation Oncology
● Biology ● Physics
Volume 60, Number 1, Supplement, 2004
Results: In 87% (58/67 pts.) tumour progression was visualized by PET/CT confirming the formerly by clinical symptoms and/or radiological imaging modalities suspected recurrence. In 13% (9/67 pts.) recurrence was unveiled only by PET/CT. A total number of 84 tumour manifestations was observed in these 67 pts. (14 local recurrences, 21 lymph node involvements, 22 liver metastases (mets), 20 lung mets, 3 bone mets, 3 adrenal gland mets, one brain metastasis). In 18/67 pts. a histological specimen was obtained. In 77.8% (14/18 pts.) of these pts. PET/CT result was histological confirmed. Only in 22.2 % (4/18) PET/CT was false true. In 46% (31/67) treatment decision was changed due to the result of PET/CT examination compared to treatment intention after conventional diagnostics. (surgery n ⫽ 16, radiation therapy n ⫽ 10, chemotherapy n ⫽ 5). Conclusions: F-18-FDG-PET/CT in patients with suspected local recurrence of colorectal cancer lead to a highly percentage (46%) of changes in disease management. Therefore F-18-FDG-PET/CT should be introduced into routine restaging procedures.
2153
Esophageal Carcinoma Treated with Nerve-Sparing Operation, Intra-Operative Radiotherapy, and Postoperative External Radiotherapy
S. Shimizu,1,2 M. Hosokawa,1 H. Shirato,2 T. Kusumi1 Keiyukai Sapporo Hospital, Sapporo, Japan, 2Department of Radiology, Hokkaido University School of Medicine, Sapporo, Hokkaido, Japan
1
Purpose/Objective: Metastasis to upper-mediastinal lymph nodes is one of the most common events in patients with esophageal cancer. Radical three field dissections may result in recurrent nerve palsy or postoperative pulmonary complications. We have used nerve-sparing operation with postoperative external radiotherapy (PORT) with intra-operative radiotherapy (IORT). Previously, we have reported that IORT 12 Gy or more was effective but could induce severe late complications. Long-term treatment results were analyzed to see the outcome of 6Gy IORT followed by 45 - 46 Gy PORT in this study. Materials/Methods: Patients with esophageal squamous cell carcinoma (excluding mucosal carcinoma) were candidates for radical esophagectomy and nerve-sparing lymphadenectory. If the patient was younger than 75 years old and R0 resection (grossly non-residual curative operation) was possible, 6Gy IORT followed by PORT of 45Gy in 18 fraction or 46 Gy in 23 fractions was indicated. Informed consent for the possibility of IORT was obtained before surgery. Results: Two-hundred seventy-six patients (median 63, range 42 to 74) were eligible for this treatment between 1995 and 2001. There were 240 males and 36 females. Clinical stage (cS) was 1 in 63, 2 in 58, 85 in 3, and 70 in 4. Because of the limitation in the availability of surgical room for IORT, 173 of 276 patients were not treated with IORT followed by PORT. Thirty-two were treated with IORT without PORT and 62 were treated PORT without IORT. Seventy-nine patients were treated with operation only. Overall survival rate at 5 years of all 276 patients was 82.2, 65.9, 36.3, and 27.4 % respectively for cS1, cS2, cS3, and cS 4 respectively. Progression-free survival was 93.7, 76.1, 44.5, and 28.5% respectively for cS1, cS2, cS3, and cS4 respectively. For 171 patients with N1 diseases, there was significant difference in survival in favor of IORT (p ⫽ 0.04), PORT (p ⫽ 0.0001), and IORT⫹PORT (p ⫽ 0.0009) comparing to operation only, respectively. For patient with cT3 diseases, overall survival was significantly better in patients with PORT (0.009) and in patients with IORT ⫹ PORT (p ⫽ 0.011). There were no severe late complications in these patients. Conclusions: 6 Gy IORT followed by 45- 46 Gy PORT was effective and much safer than previous our protocol. Esophageal carcinoma treated with nerve-sparing operation with IORT and PORT was feasible and effective treatment, especially for cN1 disease and cT3 diseases. Real benefit of IORT should be investigated in a phase III trial.
2154
Hypofractionated Three-Dimensional Conformal Radiation Therapy (3DCRT) for Primary Liver Carcinoma (PLC)
S. Liang,1 G. Jiang,1 X. Zhu,2 X. Fu1 Radiation Oncology, Fudan University Cancer Hospital, Shanghai, China, 2Radiation Oncology, Cancer Hospital, Guangxi Medical University, Nanning, China
1
Purpose/Objective: To investigate the side-effects, toxicities, and efficacy of hypofractionated 3DCRT for PLC. Materials/Methods: From April 1999 to August 2003, 128 patients with PLC received hypofractionated 3DCRT at cancer hospital, Guangxi Medical University. All patients were technical unresectable or medical inoperable due to poor liver function or cardiovascular diseases. The clinical characteristics of these patients were as follows: 113 male, 15 female; median age of 48.2 (27–72); with portal vein thrombosis (PVT) in 34 cases, and without it in 94 cases; hepatitis B virus (HBV) positive in 93 cases, negative in 35 cases; liver cirrhosis of Child-Pugh grade A in 108 cases, Child-Pugh grade B in 20 cases. 3DCRT was carried out by 8MV x-ray with Topslane treatment planning system. Multiple coplanar or non-coplanar fields were used to implement hypofractionated 3DCRT. In 48 patients transarterial chemoembolization (TACE) was performed prior to 3DCRT with DDP,ADM and MMC. 3DCRT was delivered by 4.88 ⫾ 0.47Gy(4-8Gy)/fraction, three fractions per week (Mon., Wed. and Fri.) with a median total dose of 53.6Gy ⫾ 6.6Gy. The mean value of gross target volume (GTV) was 458.92 ⫾ 429.8cm3. Results: The mean follow-up time was 14.2(1–53)months. The most severe complication was radiation-induced liver disease (RILD), which occurred in 19 cases (15%) with 16 deaths due to RILD (detailed analysis of RILD had been present in another paper). The other side-effects included ulcerations in stomach as well as nausea, vomiting and fatigue, but not severe. As to immediate responses, 7 cases died within 3 months after treatment, were not evaluated. The response rate (CR⫹PR) was 55% (67/121). Stable disease was observed in 17 cases (14%), and progressive disease, in 37 patients (31%), which included 34 cases of intrahepatic metastasis and 3 cases of local progression. The median survival time was 14.2 months for entire group. The overall survival rates at 1, 2, and 3 years were 65%, 43% and 33%, respectively. Prognostic factors evaluated included gender, age, GTV, alpha-fetoprotein (AFP) level, infection of hepatitis B virus (HBV), PVT, use of TACE, Child-Pugh grade of liver cirrhosis. Univariate analyses demonstrated that GTV, PVT and liver cirrhosis of Child-Pugh grade had significant impact on the overall survival (p ⫽ 0.0000, 0.0001and 0.0000, respectively). Large GTV, exist of PVT and Child-Pugh B were the