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Evolution of the Incidence of Cervical Cancer Among Hispanics and Asians in California Between 1990 and 2004
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Volume 87 Number 2S Supplement 2013 plane of Point A. Therefore, the use of conventional tandem/ring or ovoids brachytherapy will be challenge for adequate tumor coverage of large tumor without interstitial implant. Additionally, several anatomical factors were noticed which could affect the D2 cc in OARs. Author Disclosure: R.Y. Kim: None. A. Whitley: None. A. Dragovic: None. S. Shen: None.
2530 Evolution of the Incidence of Cervical Cancer Among Hispanics and Asians in California Between 1990 and 2004 M. Froment,1 A. Roux,1 M.C. DeRouen,2 S.L. Gomez,2 and E.A. Kidd1; 1 Stanford University, Stanford, CA, 2Cancer Prevention Institute of California, Fremont, CA Purpose/Objective(s): This study aimed to evaluate the evolution of the invasive cervical cancer (CCa) incidence among Hispanics and Asians in California. Materials/Methods: Using data from the California Cancer Registry, comprising four of the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program registries, information on all primary CCa diagnosed in California from January 1, 1990, through December 31, 2004 was obtained. We analyzed the influence of ethnicity and nativity on the evolution of CCa incidence. Results: Among the 22,189 CCa cases diagnosed between 1990 and 2004, 50% were non-Hispanic white (NHW), 39% Hispanic and 11% Asian women. Among Hispanic and Asian women, 74% were foreign-born (FB). For the entire population, 70% were squamous cell carcinoma (SCC), 19% adenocarcinoma and 11% other histologies. Compared to NHW, there was a higher incidence of CCa in United States born Hispanics and FB Hispanics, Japanese, Filipino and Korean women (Incidence rate ratio [IRR]; 95% CI: 1.6 [1.5-1.7], 2.6 [2.5-2.7], 1.4 [1.2-1.7], 1.5 [1.4-1.6],and 1.8 [1.6-2.1], respectively). However, FB-South Asian, FB-Chinese and US-born Japanese had lower rates than NHW (IRR (95% CI): 0.8 (0.7-1.0), 0.9 (0.8-1.0), 0.6 (0.5-0.7), respectively). From 1990 to 2004, the incidence of CCa declined significantly for all groups of women except for United States-born Asian for whom the incidence remained stable (average percent of change [APC] were 2.44, 1.40 [1990-2002], 4.64 and 7.32 [1994-2004] for NHW, United States and FB-Hispanics and FBAsians, respectively). There was a reduction of the SCC incidence for all groups of women (APC: 6.37 [1990-1994] and 5.03 [1997-2004], 5.15 [1990-1995] and 9.84 [2000-2004], 5.07, 3.62, 8.07 [19932004] for NHW, United States-and FB-Hispanics, United States and FBAsian, respectively). The incidence of adenocarcinoma did not show a significant decrease with the exception of FB-Asian women, which showed a significant decrease for adenocarcinoma (APC: 3.95 [1990 -2004]). Local and regional disease declined significantly over the 14 years period for NHW, FB-and United States-born Hispanics and FB-Asian (APC: 2.58, 4.39, 12.42 [2000-2004], 5.62 for local disease and 2.06, 3.96, 2.27 and 6.73 for regional disease respectively). The incidence of distant disease has only decreased significantly in FBHispanics and FB-Asian (APC: 5.71 and 4.40, respectively). Conclusions: The incidence of CCa declined in NHW, Hispanics and Asian women in California from 1990 through 2004. The SCC incidence declined and the adenocarcinoma incidence remained stable. This difference between these histologies could be caused by less sensitivity for detecting endocervical glandular dysplasia and adenocarcinoma than for detecting squamous malignancy with pap smear. Author Disclosure: M. Froment: None. A. Roux: None. M.C. DeRouen: None. S.L. Gomez: None. E.A. Kidd: None.
2531 Geometric Factors Predicting High D2 cc Values in Organs at Risk in Patients With Cervical Cancer Treated With Image Guided Brachytherapy G. Kasuya, T. Toita, T. Ariga, Y. Kakinohana, and S. Murayama; University of the Ryukyus School of Medicine, Nishihara-Cho, Okinawa, Japan
Purpose/Objective(s): To determine the geometric factors which predict high D2 cc values in organs at risk (OARs) in patients with cervical cancer treated with image-guided brachytherapy (IGBT). Materials/Methods: Forty-five IGBT sessions in 19 cervical cancer patients (stages Ib1, Ib2, IIa2, IIb, and IIIb [n Z 1, 4, 1, 6, and 7, respectively]) were analyzed. All treatments were performed with a tandem-ovoid applicator. Treatment planning was formulated by a treatment planning system using 2.5-mm-thick CT images. Two radiation oncologists contoured and confirmed the outlines of the OARs. Doses were prescribed for 6 Gy at point A in all sessions. Factors which led to demonstrate high D2 cc values in OARs (D2 cc >5 Gy for bladder, and D2 cc >4 Gy for rectum/sigmoid colon/small intestine) were investigated. The minimum distance between the outline of the OAR and the center of the tandem was defined as the organ-tandem distance (OTD). The point on the tandem for the OTD was defined as point T. Results: Of the 45 sessions, high D2 cc values at OARs were observed in 13 (28%) for the bladder, 5 (11%) for the rectum, 31 (68%) for the sigmoid colon, and 16 (35%) for the small intestine. In the cases with high D2 cc for the bladder, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the anterior wall thickness of the uterine cervix (AWTU) <15 mm were 100%, 68%, 56%, and 100%, respectively. For 10 sessions which demonstrated D2 cc 5 Gy for the bladder despite short AWTU (<15 mm), further analysis was performed to determine whether the craniocaudal geometric relationship between the inferior border of the cervix (IBC) and the bladder base (BB) affected the value of D2 cc. The average D2 cc of the bladder was 3.2 Gy (range, 2.93.7 Gy) in 5 cases whose IBC located cranially, and 4.6 Gy (range, 4.5-4.8 Gy) in 5 cases whose BB located cranially. For the cases with high D2 cc values of the rectum, sigmoid, and small intestine, the sensitivity, specificity, PPV, and NPV of an OTD <20 mm was as follows: 100%, 97%, 83%, and 100%; 80%, 92%, 96%, and 68%; 87%, 93%, 93%, and 95%, respectively. When dividing the 45 sessions into 2 groups of OTDs (20 mm and <20 mm), the average D2 cc was statistically lower in the former group than the latter group (p < 0.001) for the rectum, sigmoid colon and small intestine. Of 8 sessions with high D2 cc in the sigmoid colon and small intestine despite long OTD (20 mm), the point T tended to locate near the flange (average, 8 mm; range, 5-12 mm). Conclusions: Present analyses demonstrated some geometric factors which predicted a high D2 cc value in OARs in patients with cervical cancer treated with IGBT. The significant factors included an AWTU <15 mm for bladder, and an OTD <20 mm for the rectum, sigmoid colon, and small intestine. Author Disclosure: G. Kasuya: None. T. Toita: None. T. Ariga: None. Y. Kakinohana: None. S. Murayama: None.
2532 Carbon Ion Radiation Therapy for Locally-Advanced Adenocarcinoma of the Uterine Cervix M. Wakatsuki,1 S. Kato,2 T. Ohno,3 K. Karasawa,1 K. Ando,3 H. Kiyohara,3 I. Daisuke,1 T. Nakano,3 T. Kamada,1 and M. Shozu4; 1 National Institute of Radiological Sciences, Chiba, Japan, 2Saitama Medical University International Medical Center, Saitama, Japan, 3Gunma University Graduate School of Medicine, Gunma, Japan, 4Chiba University School of Medicine, Chiba, Japan Purpose/Objective(s): The authors performed phase I / II clinical trial to evaluate the toxicity and efficacy of carbon ion radiation therapy (C-ion RT) for locally advanced adenocarcinoma of the uterine cervix. Materials/Methods: The eligibility criteria for enrollment in this study were (1) histologically proven adeno or adenosquamous cell carcinoma, (2) FIGO stage IIB - IVA, (3) no prior treatment, and (4) a expected prognosis of more than 6 months. The treatment consisted of whole pelvic irradiation of 36.0 gray equivalents (GyE) with 12 fractions and extended local boost with dose escalation from 26.4 GyE to 38.4 GyE in 8 fractions with 2.4 or 3.6 GyE increments of fraction dose. The dose escalation was performed with careful observation of acute normal tissue responses. Total dose to the cervical tumor was 62.4 - 74.4 GyE for 20 fractions. Sixty-one
Volume 87 Number 2S Supplement 2013 plane of Point A. Therefore, the use of conventional tandem/ring or ovoids brachytherapy will be challenge for adequate tumor coverage of large tumor without interstitial implant. Additionally, several anatomical factors were noticed which could affect the D2 cc in OARs. Author Disclosure: R.Y. Kim: None. A. Whitley: None. A. Dragovic: None. S. Shen: None.
2530 Evolution of the Incidence of Cervical Cancer Among Hispanics and Asians in California Between 1990 and 2004 M. Froment,1 A. Roux,1 M.C. DeRouen,2 S.L. Gomez,2 and E.A. Kidd1; 1 Stanford University, Stanford, CA, 2Cancer Prevention Institute of California, Fremont, CA Purpose/Objective(s): This study aimed to evaluate the evolution of the invasive cervical cancer (CCa) incidence among Hispanics and Asians in California. Materials/Methods: Using data from the California Cancer Registry, comprising four of the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program registries, information on all primary CCa diagnosed in California from January 1, 1990, through December 31, 2004 was obtained. We analyzed the influence of ethnicity and nativity on the evolution of CCa incidence. Results: Among the 22,189 CCa cases diagnosed between 1990 and 2004, 50% were non-Hispanic white (NHW), 39% Hispanic and 11% Asian women. Among Hispanic and Asian women, 74% were foreign-born (FB). For the entire population, 70% were squamous cell carcinoma (SCC), 19% adenocarcinoma and 11% other histologies. Compared to NHW, there was a higher incidence of CCa in United States born Hispanics and FB Hispanics, Japanese, Filipino and Korean women (Incidence rate ratio [IRR]; 95% CI: 1.6 [1.5-1.7], 2.6 [2.5-2.7], 1.4 [1.2-1.7], 1.5 [1.4-1.6],and 1.8 [1.6-2.1], respectively). However, FB-South Asian, FB-Chinese and US-born Japanese had lower rates than NHW (IRR (95% CI): 0.8 (0.7-1.0), 0.9 (0.8-1.0), 0.6 (0.5-0.7), respectively). From 1990 to 2004, the incidence of CCa declined significantly for all groups of women except for United States-born Asian for whom the incidence remained stable (average percent of change [APC] were 2.44, 1.40 [1990-2002], 4.64 and 7.32 [1994-2004] for NHW, United States and FB-Hispanics and FBAsians, respectively). There was a reduction of the SCC incidence for all groups of women (APC: 6.37 [1990-1994] and 5.03 [1997-2004], 5.15 [1990-1995] and 9.84 [2000-2004], 5.07, 3.62, 8.07 [19932004] for NHW, United States-and FB-Hispanics, United States and FBAsian, respectively). The incidence of adenocarcinoma did not show a significant decrease with the exception of FB-Asian women, which showed a significant decrease for adenocarcinoma (APC: 3.95 [1990 -2004]). Local and regional disease declined significantly over the 14 years period for NHW, FB-and United States-born Hispanics and FB-Asian (APC: 2.58, 4.39, 12.42 [2000-2004], 5.62 for local disease and 2.06, 3.96, 2.27 and 6.73 for regional disease respectively). The incidence of distant disease has only decreased significantly in FBHispanics and FB-Asian (APC: 5.71 and 4.40, respectively). Conclusions: The incidence of CCa declined in NHW, Hispanics and Asian women in California from 1990 through 2004. The SCC incidence declined and the adenocarcinoma incidence remained stable. This difference between these histologies could be caused by less sensitivity for detecting endocervical glandular dysplasia and adenocarcinoma than for detecting squamous malignancy with pap smear. Author Disclosure: M. Froment: None. A. Roux: None. M.C. DeRouen: None. S.L. Gomez: None. E.A. Kidd: None.
2531 Geometric Factors Predicting High D2 cc Values in Organs at Risk in Patients With Cervical Cancer Treated With Image Guided Brachytherapy G. Kasuya, T. Toita, T. Ariga, Y. Kakinohana, and S. Murayama; University of the Ryukyus School of Medicine, Nishihara-Cho, Okinawa, Japan
Purpose/Objective(s): To determine the geometric factors which predict high D2 cc values in organs at risk (OARs) in patients with cervical cancer treated with image-guided brachytherapy (IGBT). Materials/Methods: Forty-five IGBT sessions in 19 cervical cancer patients (stages Ib1, Ib2, IIa2, IIb, and IIIb [n Z 1, 4, 1, 6, and 7, respectively]) were analyzed. All treatments were performed with a tandem-ovoid applicator. Treatment planning was formulated by a treatment planning system using 2.5-mm-thick CT images. Two radiation oncologists contoured and confirmed the outlines of the OARs. Doses were prescribed for 6 Gy at point A in all sessions. Factors which led to demonstrate high D2 cc values in OARs (D2 cc >5 Gy for bladder, and D2 cc >4 Gy for rectum/sigmoid colon/small intestine) were investigated. The minimum distance between the outline of the OAR and the center of the tandem was defined as the organ-tandem distance (OTD). The point on the tandem for the OTD was defined as point T. Results: Of the 45 sessions, high D2 cc values at OARs were observed in 13 (28%) for the bladder, 5 (11%) for the rectum, 31 (68%) for the sigmoid colon, and 16 (35%) for the small intestine. In the cases with high D2 cc for the bladder, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the anterior wall thickness of the uterine cervix (AWTU) <15 mm were 100%, 68%, 56%, and 100%, respectively. For 10 sessions which demonstrated D2 cc 5 Gy for the bladder despite short AWTU (<15 mm), further analysis was performed to determine whether the craniocaudal geometric relationship between the inferior border of the cervix (IBC) and the bladder base (BB) affected the value of D2 cc. The average D2 cc of the bladder was 3.2 Gy (range, 2.93.7 Gy) in 5 cases whose IBC located cranially, and 4.6 Gy (range, 4.5-4.8 Gy) in 5 cases whose BB located cranially. For the cases with high D2 cc values of the rectum, sigmoid, and small intestine, the sensitivity, specificity, PPV, and NPV of an OTD <20 mm was as follows: 100%, 97%, 83%, and 100%; 80%, 92%, 96%, and 68%; 87%, 93%, 93%, and 95%, respectively. When dividing the 45 sessions into 2 groups of OTDs (20 mm and <20 mm), the average D2 cc was statistically lower in the former group than the latter group (p < 0.001) for the rectum, sigmoid colon and small intestine. Of 8 sessions with high D2 cc in the sigmoid colon and small intestine despite long OTD (20 mm), the point T tended to locate near the flange (average, 8 mm; range, 5-12 mm). Conclusions: Present analyses demonstrated some geometric factors which predicted a high D2 cc value in OARs in patients with cervical cancer treated with IGBT. The significant factors included an AWTU <15 mm for bladder, and an OTD <20 mm for the rectum, sigmoid colon, and small intestine. Author Disclosure: G. Kasuya: None. T. Toita: None. T. Ariga: None. Y. Kakinohana: None. S. Murayama: None.
2532 Carbon Ion Radiation Therapy for Locally-Advanced Adenocarcinoma of the Uterine Cervix M. Wakatsuki,1 S. Kato,2 T. Ohno,3 K. Karasawa,1 K. Ando,3 H. Kiyohara,3 I. Daisuke,1 T. Nakano,3 T. Kamada,1 and M. Shozu4; 1 National Institute of Radiological Sciences, Chiba, Japan, 2Saitama Medical University International Medical Center, Saitama, Japan, 3Gunma University Graduate School of Medicine, Gunma, Japan, 4Chiba University School of Medicine, Chiba, Japan Purpose/Objective(s): The authors performed phase I / II clinical trial to evaluate the toxicity and efficacy of carbon ion radiation therapy (C-ion RT) for locally advanced adenocarcinoma of the uterine cervix. Materials/Methods: The eligibility criteria for enrollment in this study were (1) histologically proven adeno or adenosquamous cell carcinoma, (2) FIGO stage IIB - IVA, (3) no prior treatment, and (4) a expected prognosis of more than 6 months. The treatment consisted of whole pelvic irradiation of 36.0 gray equivalents (GyE) with 12 fractions and extended local boost with dose escalation from 26.4 GyE to 38.4 GyE in 8 fractions with 2.4 or 3.6 GyE increments of fraction dose. The dose escalation was performed with careful observation of acute normal tissue responses. Total dose to the cervical tumor was 62.4 - 74.4 GyE for 20 fractions. Sixty-one