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Evaluation of the Effects of Blood Flow on 64Cu-ATSM Uptake in a Rodent Tumour Model
S50
CLINICAL ONCOLOGY
Purpose: To assess the effectiveness of split course chemoradiotherapy (CRT) in the radical treatment of anal cancer in patients in whom poor performance status, co-morbidity, advanced age or a combination thereof precluded full-dose CRT. Patients and methods: A retrospective review of patients with biopsy-proven squamous cell carcinoma of the anus. Patients were treated with 26 Gy in 13 fractions, followed by a minimum 2 week break, then 26 Gy in 13 fractions, with concurrent chemotherapy of 5-fluorouracil 1000 mg/m2/day on days 1e4 and mitomycin C 10 mg/m2 bolus on day 1 in each phase. All 19 patients treated at Addenbrooke’s Hospital from 1995 to 2005 with this regimen were included. Results: The median age of the 19 patients was 78 years (range 46e 92 years). Seven patients (37%) were male. Sixteen (84%) had stage 2 and 4 (16%) stage 3 disease. The median overall treatment time was 58 days (range 48e70 days). The median follow up time was 2.6 years (range 0.5e7.1 years). For the whole group the 5 year results were as follows: overall survival 51.1%, cause specific survival 60.6% and relapse free survival 33.0%. For the larger stage 2 subgroup, the 5 year results were: overall survival 63.3%, cause specific survival 70.3% and relapse free survival 39.9%. Using the log rank test, we demonstrated statistically significant differences in overall survival (P ¼ 0.03) and relapse free survival (P ¼ 0.003) but not in cause specific survival (P ¼ 0.12) between stage 2 and stage 3 patients in this series. Conclusion: This alternative regimen of split-course radiotherapy with concurrent chemotherapy is an effective treatment for anal cancer in the poor performance status or elderly population. P100 The Impact of New Ways of Working on the Job Satisfaction of Radiotherapy Treatment Radiographers K. Williamson Cardiff University, Cardiff, UK Purpose: To explore the impact of specialisation and new ways of working within radiotherapy on the skills and job satisfaction of radiotherapy treatment radiographers. Method: An interpretive approach was utilised in order to explore perceptions, views and opinions of radiotherapy radiographers and to examine the ‘real world’ as experienced by these professionals. Sample: The study involved three radiotherapy departments and a non-random, purposive method was employed explicitly selecting participants who would generate the required data for the study. The sample consisted of 12 therapeutic radiographers, estimated as 15% of the total available population for the study. These radiographers were of a range of grades and years post-qualification and identified by their managers as having non-specialist roles within their departments. Semi-structured, face to face interviews were used and thematic content analysis applied to analyse transcript data. Results: The study revealed a significant correlation between job satisfaction and valence of radiographers working within traditional professional boundaries. This was predominant in staff whose expectations were for vocational rather than for professional rewards. Of particular significance was the identification of reframing tendencies among radiographers whose expectations and valence were not aligned with personal experience. Skills and abilities of specialist radiographers were recognised and acknowledged. However, an increasing reliance on specialist roles, as a consequence of workload pressures, prompted expressions of fear for loss of established skills among non-specialist staff. Conclusion: There was evidence of a perception of devaluation of the traditional role of radiotherapy treatment radiographer with consequential issues for retention of more experienced staff. Managers need to address the implications of this issue in order to avoid a potential and significant impact on patient care and service delivery. This study highlights the need to move away from the current emphasis on role development to a more balanced rhetoric, raising managers’ awareness of the needs of nonspecialist staff.
P101 Evaluation of the Effects of Blood Flow on 64Cu-ATSM Uptake in a Rodent Tumour Model K. A. Wood*y, D. J. Honessy, R. J. Maxwelly, J. Wilsony, R. L. Paulz, M. J. O’Dohertyz, P. K. Marsdenz, P. J. Blowerz, B. Sangherax, W. L. Wongx, M. I. Saunders*y *University College Hospital, London, UK; Marie Curie Research Wing, Mount Vernon Cancer Centre, Northwood, Middlesex, UK; yUniversity of Oxford Gray Cancer Institute, Northwood, Middlesex, UK; zGuy’s, King’s, St Thomas’ School of Medicine, London, UK; xPaul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Middlesex, UK Aim: Hypoxia remains a significant cause of treatment failure in head and neck cancer. The identification of hypoxic areas within tumour may allow radiotherapy dose escalation to hypoxic subvolumes using intensity modulated radiotherapy (IMRT). 64CuATSM PET is being evaluated for imaging tumour hypoxia. We performed a pre-clinical study to investigate the correlation of blood flow to the distribution of 64Cu-ATSM within a tumour. Methods: Eight BD-9 rats bearing syngeneic P22 carcinosarcoma allografts were imaged using PET and gadolinium-enhanced MRI. MRI was performed immediately prior to dynamic MicroPET . 64CuATSM (10e35 MBq) was administered by iv bolus at the start of PET scanning and data were acquired for 1 hour. PET data were segmented into 10 minute time frames. A mean standardised uptake value (SUV) was determined for each central axial tumour slice at 0e10 minutes (SUV0e10) and 50-60 minutes (SUV50e60) post 64 Cu-ATSM. MRI data were processed using Varian software and Matlab. The AUC90 (area under the gadolinium uptake curve in the first 90 seconds, a robust indicator of tumour blood flow) was calculated for each central axial tumour slice. Correlation coefficients were obtained for AUC90 and SUV0e10 and AUC90 and SUV50e60. Results: The correlation coefficient for AUC90 and SUV0e10 was statistically significant, 0.75 (P ¼ 0.034) but for AUC90 and SUV50e60 the correlation coefficient was not significant, 0.44 (P ¼ 0.27). Conclusion: We found a good correlation between blood flow and 64 Cu-ATSM in the first 10 minutes after administration of 64CuATSM, demonstrating that 64Cu-ATSM uptake is dependent on tumour blood flow initially. At 50e60 minutes there was no statistically significant correlation. 64Cu-ATSM PET imaging of hypoxia should not be performed immediately after 64Cu-ATSM administration as a time interval is needed for the tracer to distribute in order to give an image more likely to represent tumour hypoxia.
P102 Multi-institutional UK Prostate Brachytherapy Database J. P. Wylie*, P. Mandall*, D. Bottomleyy, P. J. Hoskinz *Christie Hospital, Manchester, UK; yCookridge Hospital, Leeds, UK; zMount Vernon Centre for Cancer Treatment, Northwood, Middlesex, UK Introduction: Prostate brachytherapy (BT) is an accepted curative option for men with localised prostate cancer. Published UK series report only single centre experiences and large UK multi-institutional databases detailing patient selection and outcome following BT are lacking. We report an ongoing collaboration between Christie, Cookridge, and Mount Vernon Hospitals prospectively collecting demographic and outcome data on patients undergoing I-125 implants. Method: Since April 2003 all patients undergoing BT at the three centres have been registered on a central database. Information on presenting demographics, baseline international prostate symptom score (IPSS) and PSA, use of hormone therapy, additional use of external beam radiotherapy (EBRT), pre- and post-implant dosimetry, and follow up IPSS and PSA have been collected. A single data manager (PM) is responsible for the data collection. Results: 1449 patients are currently registered with a median follow up of 412 days. Patient selection between centres has been similar. Median age 64 years (range 40e82 years), 65% T1c, median PSA 5.7 (0.1e23), median Gleason score 6 (3e9), median
CLINICAL ONCOLOGY
Purpose: To assess the effectiveness of split course chemoradiotherapy (CRT) in the radical treatment of anal cancer in patients in whom poor performance status, co-morbidity, advanced age or a combination thereof precluded full-dose CRT. Patients and methods: A retrospective review of patients with biopsy-proven squamous cell carcinoma of the anus. Patients were treated with 26 Gy in 13 fractions, followed by a minimum 2 week break, then 26 Gy in 13 fractions, with concurrent chemotherapy of 5-fluorouracil 1000 mg/m2/day on days 1e4 and mitomycin C 10 mg/m2 bolus on day 1 in each phase. All 19 patients treated at Addenbrooke’s Hospital from 1995 to 2005 with this regimen were included. Results: The median age of the 19 patients was 78 years (range 46e 92 years). Seven patients (37%) were male. Sixteen (84%) had stage 2 and 4 (16%) stage 3 disease. The median overall treatment time was 58 days (range 48e70 days). The median follow up time was 2.6 years (range 0.5e7.1 years). For the whole group the 5 year results were as follows: overall survival 51.1%, cause specific survival 60.6% and relapse free survival 33.0%. For the larger stage 2 subgroup, the 5 year results were: overall survival 63.3%, cause specific survival 70.3% and relapse free survival 39.9%. Using the log rank test, we demonstrated statistically significant differences in overall survival (P ¼ 0.03) and relapse free survival (P ¼ 0.003) but not in cause specific survival (P ¼ 0.12) between stage 2 and stage 3 patients in this series. Conclusion: This alternative regimen of split-course radiotherapy with concurrent chemotherapy is an effective treatment for anal cancer in the poor performance status or elderly population. P100 The Impact of New Ways of Working on the Job Satisfaction of Radiotherapy Treatment Radiographers K. Williamson Cardiff University, Cardiff, UK Purpose: To explore the impact of specialisation and new ways of working within radiotherapy on the skills and job satisfaction of radiotherapy treatment radiographers. Method: An interpretive approach was utilised in order to explore perceptions, views and opinions of radiotherapy radiographers and to examine the ‘real world’ as experienced by these professionals. Sample: The study involved three radiotherapy departments and a non-random, purposive method was employed explicitly selecting participants who would generate the required data for the study. The sample consisted of 12 therapeutic radiographers, estimated as 15% of the total available population for the study. These radiographers were of a range of grades and years post-qualification and identified by their managers as having non-specialist roles within their departments. Semi-structured, face to face interviews were used and thematic content analysis applied to analyse transcript data. Results: The study revealed a significant correlation between job satisfaction and valence of radiographers working within traditional professional boundaries. This was predominant in staff whose expectations were for vocational rather than for professional rewards. Of particular significance was the identification of reframing tendencies among radiographers whose expectations and valence were not aligned with personal experience. Skills and abilities of specialist radiographers were recognised and acknowledged. However, an increasing reliance on specialist roles, as a consequence of workload pressures, prompted expressions of fear for loss of established skills among non-specialist staff. Conclusion: There was evidence of a perception of devaluation of the traditional role of radiotherapy treatment radiographer with consequential issues for retention of more experienced staff. Managers need to address the implications of this issue in order to avoid a potential and significant impact on patient care and service delivery. This study highlights the need to move away from the current emphasis on role development to a more balanced rhetoric, raising managers’ awareness of the needs of nonspecialist staff.
P101 Evaluation of the Effects of Blood Flow on 64Cu-ATSM Uptake in a Rodent Tumour Model K. A. Wood*y, D. J. Honessy, R. J. Maxwelly, J. Wilsony, R. L. Paulz, M. J. O’Dohertyz, P. K. Marsdenz, P. J. Blowerz, B. Sangherax, W. L. Wongx, M. I. Saunders*y *University College Hospital, London, UK; Marie Curie Research Wing, Mount Vernon Cancer Centre, Northwood, Middlesex, UK; yUniversity of Oxford Gray Cancer Institute, Northwood, Middlesex, UK; zGuy’s, King’s, St Thomas’ School of Medicine, London, UK; xPaul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Middlesex, UK Aim: Hypoxia remains a significant cause of treatment failure in head and neck cancer. The identification of hypoxic areas within tumour may allow radiotherapy dose escalation to hypoxic subvolumes using intensity modulated radiotherapy (IMRT). 64CuATSM PET is being evaluated for imaging tumour hypoxia. We performed a pre-clinical study to investigate the correlation of blood flow to the distribution of 64Cu-ATSM within a tumour. Methods: Eight BD-9 rats bearing syngeneic P22 carcinosarcoma allografts were imaged using PET and gadolinium-enhanced MRI. MRI was performed immediately prior to dynamic MicroPET . 64CuATSM (10e35 MBq) was administered by iv bolus at the start of PET scanning and data were acquired for 1 hour. PET data were segmented into 10 minute time frames. A mean standardised uptake value (SUV) was determined for each central axial tumour slice at 0e10 minutes (SUV0e10) and 50-60 minutes (SUV50e60) post 64 Cu-ATSM. MRI data were processed using Varian software and Matlab. The AUC90 (area under the gadolinium uptake curve in the first 90 seconds, a robust indicator of tumour blood flow) was calculated for each central axial tumour slice. Correlation coefficients were obtained for AUC90 and SUV0e10 and AUC90 and SUV50e60. Results: The correlation coefficient for AUC90 and SUV0e10 was statistically significant, 0.75 (P ¼ 0.034) but for AUC90 and SUV50e60 the correlation coefficient was not significant, 0.44 (P ¼ 0.27). Conclusion: We found a good correlation between blood flow and 64 Cu-ATSM in the first 10 minutes after administration of 64CuATSM, demonstrating that 64Cu-ATSM uptake is dependent on tumour blood flow initially. At 50e60 minutes there was no statistically significant correlation. 64Cu-ATSM PET imaging of hypoxia should not be performed immediately after 64Cu-ATSM administration as a time interval is needed for the tracer to distribute in order to give an image more likely to represent tumour hypoxia.
P102 Multi-institutional UK Prostate Brachytherapy Database J. P. Wylie*, P. Mandall*, D. Bottomleyy, P. J. Hoskinz *Christie Hospital, Manchester, UK; yCookridge Hospital, Leeds, UK; zMount Vernon Centre for Cancer Treatment, Northwood, Middlesex, UK Introduction: Prostate brachytherapy (BT) is an accepted curative option for men with localised prostate cancer. Published UK series report only single centre experiences and large UK multi-institutional databases detailing patient selection and outcome following BT are lacking. We report an ongoing collaboration between Christie, Cookridge, and Mount Vernon Hospitals prospectively collecting demographic and outcome data on patients undergoing I-125 implants. Method: Since April 2003 all patients undergoing BT at the three centres have been registered on a central database. Information on presenting demographics, baseline international prostate symptom score (IPSS) and PSA, use of hormone therapy, additional use of external beam radiotherapy (EBRT), pre- and post-implant dosimetry, and follow up IPSS and PSA have been collected. A single data manager (PM) is responsible for the data collection. Results: 1449 patients are currently registered with a median follow up of 412 days. Patient selection between centres has been similar. Median age 64 years (range 40e82 years), 65% T1c, median PSA 5.7 (0.1e23), median Gleason score 6 (3e9), median