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Fractionated Proton Radiation Therapy for Optic Nerve Sheath Meningiomas
Volume 93 Number 3S Supplement 2015 trials. Larger data sets are required to validate this finding and will permit correlation with clinical outcome measures. Author Disclosure: T. Yanagihara: None. A. Chu: None. M. Garrett: None. K. Salah: None. J. Grinband: None. A. Jani: None. S.R. Isaacson: None. M.B. Sisti: None. J.N. Bruce: None. G.M. Mckhann: None. F.M. Iwamoto: None. A.B. Lassman: None. T.J. Wang: None.
2139 Pattern of Care of Anaplastic Oligodendroglioma and Oligoastrocytoma in a Korean Population: The Korean Radiation Oncology Group Study 13-12 T. Yu,1 H.C. Kang,2 D.H. Lim,3 I.H. Kim,1 W.K. Chung,4 C.O. Suh,5 B.O. Choi,6 K.H. Cho,7 J.H. Cho,8 J.H. Kim,9 C.K. Park,1 Y.K. Hong,6 and I.A. Kim10; 1Seoul National University College of Medicine, Seoul, South Korea, 2Dongnam Institute of Radiological & Medical Sciences, Busan, South Korea, 3Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, 4Chonnam National University Hwasun Hospital, Hwasun, South Korea, 5Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea, 6The Catholic University of Korea, College of Medicine, Seoul, South Korea, 7Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, South Korea, 8Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, South Korea, 9Keimyung University Dongsan Medical Center, Daegu, South Korea, 10Seoul National University, Seoul, South Korea Purpose/Objective(s): This study investigated the treatment of anaplastic oligodendroglial tumors across nine Korean institutions. Materials/Methods: We reviewed the medical records from 381 patients with histologically confirmed anaplastic oligodentroglioma (AO) or anaplastic oligoastrocytoma (AOA) from 2000 to 2010. Clinical factors and treatment patterns were analyzed for each year. Results: Post-operative therapy was performed in 354 patients (94.1%), of which 133 received radiation therapy (RT) alone and 189 received both RT and chemotherapy. RT alone was the preferred treatment toward the end of the study period (29.4% in 2000-2001 versus 56.3% in 2010, PZ0.005). The use of procarbazine, lomustine, and vincristine (PCV) decreased (57.6% in 2000-2001 versus 28.6% in 2010, PZ0.001) and the use of temozolomide (TMZ) increased (0% in 2000-2001 versus 61.9% in 2010, P<0.001) over the study period. A combination of chemotherapy and RT was used more often than RT alone in young patients (PZ0.036) and patients with a good performance status (PZ0.023). The 1p/19q codeletion status and O-6-methyguanine-DNA methyltransferase methylation were analyzed since 2004 but were not significant factors for determining whether to administer chemotherapy. Among the patients who received chemotherapy, TMZ was used more often in patients with AOA (PZ0.007) and PCV was used more often in patients with either multiple lesions (PZ0.027) or the 1p/19q co-deletion (PZ0.026). Conclusion: Our results demonstrate that the treatment pattern for oligodendroglial tumors changed significantly across the study period. In particular, TMZ has replaced PCV, and the use of molecular markers as well as RT alone has increased, but a unified protocol remains to be established. Author Disclosure: T. Yu: None. H. Kang: None. D. Lim: None. I. Kim: None. W. Chung: None. C. Suh: None. B. Choi: None. K. Cho: None. J. Cho: None. J. Kim: None. C. Park: None. Y. Hong: None. I. Kim: None.
2140 Molecular Characteristics and Overall Survival for Grade III Gliomas V. Jairam,1 C.E. Rutter,2 J.B. Yu,2 J.N. Contessa,3 and R.S. Bindra2; 1Yale University School of Medicine, New Haven, CT, 2Yale School of Medicine, New Haven, CT, 3Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT Purpose/Objective(s): The WHO Grade III classification of gliomas includes anaplastic astrocytomas (AA), anaplastic oligodendrogliomas (AOD), and anaplastic oligoastrocytomas (AOA). These represent a
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heterogeneous group of tumors with varying survival rates based on inherent tumor and patient characteristics. Therefore, we sought to identify factors that were prognostic of overall survival in this tumor type. Materials/Methods: Our institutional database was queried for WHO Grade III glioma patients treated between 2000 and 2013. All patients underwent prior surgical resection. Overall survival (OS) was the primary endpoint and progression-free survival (PFS) and survival after treatment were secondary endpoints. Variables investigated included extent of surgery (gross total vs. subtotal vs. biopsy), first adjuvant treatment (radiation therapy vs. chemotherapy vs. concurrent chemoradiation), treatment era (2000-2003, 20042007, 2007-2013), gender, as well as IDH1 mutational status, MGMT methylation, and Ki-67 index where available. Kaplan Meier and Cox-proportional hazards models were used to estimate survival and identify factors prognostic of overall survival on both univariate and multivariate analysis. Results: Chart records of 166 patients were included in analysis. Median age Z 46 (range 0-85). 65% were men. Histologies included 73 anaplastic astrocytoma (AA), 44 anaplastic oligoastrocytoma (AOA), 42 anaplastic oligodendroglioma, and 1 mixed glioma. Ki-67 index was available for 123/166 patients. Median overall survival was 20 months. 8 variables were found to adversely affect overall survival on univariate analysis (female gender, age >Z 60, less extent of resection, AA or AOA histology, IDH1 wild type, 1p:19q wild type, high Ki-67 score (continuous variable), and type of first adjuvant treatment). MGMT status (only known in 14 patients), treatment era, and 1p:19q status (known in 59 patients) was not prognostic of overall survival in the cohort. Histology (HR 0.28 [95% CI 0.14-0.55] for AOA vs. AA, HR 0.34 [95% CI 0.17-0.66] for AOD vs. AA), age (HR 4.70 [95% CI 2.45-8.85] for >60 vs. <60) and Ki-67 score (HR 1.034 [95% CI 1.01-1.06]) were the only factors found to be significant on multivariate analysis. IDH1 wild type and MGMT status were significant predictors of PFS on univariate analysis. Conclusion: WHO Grade III gliomas represent a diverse group of tumors. In our cohort, histology, age >Z 60, and Ki-67 score were most associated with OS. Ki-67 is valuable in stratifying survival outcomes from anaplastic glioma, particularly if other molecular markers are not available from historical records. Author Disclosure: V. Jairam: None. C.E. Rutter: None. J.B. Yu: Research Grant; 21st Century Oncology. J.N. Contessa: None. R.S. Bindra: None.
2142 Fractionated Proton Radiation Therapy for Optic Nerve Sheath Meningiomas A.S. Chung, L.N. Loredo, J.D. Slater, R. Grove, and D.A. Bush; Loma Linda University Medical Center, Loma Linda, CA Purpose/Objective(s): To evaluate the safety and efficacy of fractionated proton radiation therapy for patients with optic nerve sheath meningiomas. Materials/Methods: Between 1992 and 2007, 13 evaluable patients with a total of 14 lesions were treated at our institution with fractionated proton therapy for optic nerve sheath meningiomas. Two patients had a biopsy prior to radiation therapy for histologic verification; 2 other patients had prior surgical resection of the tumor. Four eyes were blind as a result of the tumor, and 1 was blind as a result of surgery; 9 eyes had some vision at the time of radiation. The median dose for patients with vision was 54 Gy; if the eye was blind the median dose was 56.7 Gy. Mean and median followup periods were 12.7 and 13.9 years, respectively. Results: Complete local control was achieved in all patients. Vision was preserved or improved in 8 of the 9 patients that had pre-treatment vision (89%). The one patient with worsened vision after treatment had very poor vision prior to radiation. Two patients had toxicity related to radiation treatment: one patient developed pituitary dysfunction, and another who had tumor that was extending into the globe, developed macular edema and retinopathy. Conclusion: Fractionated proton radiation therapy for optic nerve sheath meningioma achieves excellent control with minimal toxicity. Vision preservation is excellent with this modality, and is an effective treatment option for patients with optic nerve sheath meningioma. Author Disclosure: A.S. Chung: None. L.N. Loredo: None. J.D. Slater: None. R. Grove: None. D.A. Bush: None.
2139 Pattern of Care of Anaplastic Oligodendroglioma and Oligoastrocytoma in a Korean Population: The Korean Radiation Oncology Group Study 13-12 T. Yu,1 H.C. Kang,2 D.H. Lim,3 I.H. Kim,1 W.K. Chung,4 C.O. Suh,5 B.O. Choi,6 K.H. Cho,7 J.H. Cho,8 J.H. Kim,9 C.K. Park,1 Y.K. Hong,6 and I.A. Kim10; 1Seoul National University College of Medicine, Seoul, South Korea, 2Dongnam Institute of Radiological & Medical Sciences, Busan, South Korea, 3Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, 4Chonnam National University Hwasun Hospital, Hwasun, South Korea, 5Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea, 6The Catholic University of Korea, College of Medicine, Seoul, South Korea, 7Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, South Korea, 8Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, South Korea, 9Keimyung University Dongsan Medical Center, Daegu, South Korea, 10Seoul National University, Seoul, South Korea Purpose/Objective(s): This study investigated the treatment of anaplastic oligodendroglial tumors across nine Korean institutions. Materials/Methods: We reviewed the medical records from 381 patients with histologically confirmed anaplastic oligodentroglioma (AO) or anaplastic oligoastrocytoma (AOA) from 2000 to 2010. Clinical factors and treatment patterns were analyzed for each year. Results: Post-operative therapy was performed in 354 patients (94.1%), of which 133 received radiation therapy (RT) alone and 189 received both RT and chemotherapy. RT alone was the preferred treatment toward the end of the study period (29.4% in 2000-2001 versus 56.3% in 2010, PZ0.005). The use of procarbazine, lomustine, and vincristine (PCV) decreased (57.6% in 2000-2001 versus 28.6% in 2010, PZ0.001) and the use of temozolomide (TMZ) increased (0% in 2000-2001 versus 61.9% in 2010, P<0.001) over the study period. A combination of chemotherapy and RT was used more often than RT alone in young patients (PZ0.036) and patients with a good performance status (PZ0.023). The 1p/19q codeletion status and O-6-methyguanine-DNA methyltransferase methylation were analyzed since 2004 but were not significant factors for determining whether to administer chemotherapy. Among the patients who received chemotherapy, TMZ was used more often in patients with AOA (PZ0.007) and PCV was used more often in patients with either multiple lesions (PZ0.027) or the 1p/19q co-deletion (PZ0.026). Conclusion: Our results demonstrate that the treatment pattern for oligodendroglial tumors changed significantly across the study period. In particular, TMZ has replaced PCV, and the use of molecular markers as well as RT alone has increased, but a unified protocol remains to be established. Author Disclosure: T. Yu: None. H. Kang: None. D. Lim: None. I. Kim: None. W. Chung: None. C. Suh: None. B. Choi: None. K. Cho: None. J. Cho: None. J. Kim: None. C. Park: None. Y. Hong: None. I. Kim: None.
2140 Molecular Characteristics and Overall Survival for Grade III Gliomas V. Jairam,1 C.E. Rutter,2 J.B. Yu,2 J.N. Contessa,3 and R.S. Bindra2; 1Yale University School of Medicine, New Haven, CT, 2Yale School of Medicine, New Haven, CT, 3Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT Purpose/Objective(s): The WHO Grade III classification of gliomas includes anaplastic astrocytomas (AA), anaplastic oligodendrogliomas (AOD), and anaplastic oligoastrocytomas (AOA). These represent a
Poster Viewing Session
E57
heterogeneous group of tumors with varying survival rates based on inherent tumor and patient characteristics. Therefore, we sought to identify factors that were prognostic of overall survival in this tumor type. Materials/Methods: Our institutional database was queried for WHO Grade III glioma patients treated between 2000 and 2013. All patients underwent prior surgical resection. Overall survival (OS) was the primary endpoint and progression-free survival (PFS) and survival after treatment were secondary endpoints. Variables investigated included extent of surgery (gross total vs. subtotal vs. biopsy), first adjuvant treatment (radiation therapy vs. chemotherapy vs. concurrent chemoradiation), treatment era (2000-2003, 20042007, 2007-2013), gender, as well as IDH1 mutational status, MGMT methylation, and Ki-67 index where available. Kaplan Meier and Cox-proportional hazards models were used to estimate survival and identify factors prognostic of overall survival on both univariate and multivariate analysis. Results: Chart records of 166 patients were included in analysis. Median age Z 46 (range 0-85). 65% were men. Histologies included 73 anaplastic astrocytoma (AA), 44 anaplastic oligoastrocytoma (AOA), 42 anaplastic oligodendroglioma, and 1 mixed glioma. Ki-67 index was available for 123/166 patients. Median overall survival was 20 months. 8 variables were found to adversely affect overall survival on univariate analysis (female gender, age >Z 60, less extent of resection, AA or AOA histology, IDH1 wild type, 1p:19q wild type, high Ki-67 score (continuous variable), and type of first adjuvant treatment). MGMT status (only known in 14 patients), treatment era, and 1p:19q status (known in 59 patients) was not prognostic of overall survival in the cohort. Histology (HR 0.28 [95% CI 0.14-0.55] for AOA vs. AA, HR 0.34 [95% CI 0.17-0.66] for AOD vs. AA), age (HR 4.70 [95% CI 2.45-8.85] for >60 vs. <60) and Ki-67 score (HR 1.034 [95% CI 1.01-1.06]) were the only factors found to be significant on multivariate analysis. IDH1 wild type and MGMT status were significant predictors of PFS on univariate analysis. Conclusion: WHO Grade III gliomas represent a diverse group of tumors. In our cohort, histology, age >Z 60, and Ki-67 score were most associated with OS. Ki-67 is valuable in stratifying survival outcomes from anaplastic glioma, particularly if other molecular markers are not available from historical records. Author Disclosure: V. Jairam: None. C.E. Rutter: None. J.B. Yu: Research Grant; 21st Century Oncology. J.N. Contessa: None. R.S. Bindra: None.
2142 Fractionated Proton Radiation Therapy for Optic Nerve Sheath Meningiomas A.S. Chung, L.N. Loredo, J.D. Slater, R. Grove, and D.A. Bush; Loma Linda University Medical Center, Loma Linda, CA Purpose/Objective(s): To evaluate the safety and efficacy of fractionated proton radiation therapy for patients with optic nerve sheath meningiomas. Materials/Methods: Between 1992 and 2007, 13 evaluable patients with a total of 14 lesions were treated at our institution with fractionated proton therapy for optic nerve sheath meningiomas. Two patients had a biopsy prior to radiation therapy for histologic verification; 2 other patients had prior surgical resection of the tumor. Four eyes were blind as a result of the tumor, and 1 was blind as a result of surgery; 9 eyes had some vision at the time of radiation. The median dose for patients with vision was 54 Gy; if the eye was blind the median dose was 56.7 Gy. Mean and median followup periods were 12.7 and 13.9 years, respectively. Results: Complete local control was achieved in all patients. Vision was preserved or improved in 8 of the 9 patients that had pre-treatment vision (89%). The one patient with worsened vision after treatment had very poor vision prior to radiation. Two patients had toxicity related to radiation treatment: one patient developed pituitary dysfunction, and another who had tumor that was extending into the globe, developed macular edema and retinopathy. Conclusion: Fractionated proton radiation therapy for optic nerve sheath meningioma achieves excellent control with minimal toxicity. Vision preservation is excellent with this modality, and is an effective treatment option for patients with optic nerve sheath meningioma. Author Disclosure: A.S. Chung: None. L.N. Loredo: None. J.D. Slater: None. R. Grove: None. D.A. Bush: None.