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Fractionated Stereotactic Radiotherapy in the Treatment of Craniocervical Meningiomas
Proceedings of the 51st Annual ASTRO Meeting
2546
Fractionated Stereotactic Radiotherapy in the Treatment of Craniocervical Meningiomas
1
M. Kim , S. Fogh1, M. Werner-Wasik1, D. W. Andrews2 Thomas Jefferson University Department of Radiation Oncology, Philadelphia, PA, 2Thomas Jefferson University Department of Neurosurgery, Philadelphia, PA
1
Purpose/Objective(s): Craniocervical meningiomas, because of their proximity to critical neurovascular structures represent a treatment challenge. We analyzed the safety, tolerability and efficacy of high-precision fractionated stereotactic radiotherapy for the treatment of patients with craniocervical meningiomas. Materials/Methods: Thirty-five patients with benign craniocervical meningiomas were treated with stereotactic five conformal dynamic arc fractionated radiotherapy between 1998 and 2007. Patients received a course of radiotherapy as primary treatment, adjuvant therapy following subtotal resection, or for recurrent disease. The median target volume was 9.98 mL (range, 0.66 mL to 62.2 mL). The mean radiation dose was 52.7 Gy ± 1.7 Gy. Follow-up examinations, including MRI and physical exam, were performed first at one short 3-month post-treatment interval, then annually. Results: With a median follow-up of 52 months (range, 11–143 months) overall survival was 91% at 5 years and 86% at 10 years. Local tumor failure was observed in 4 of the 35 patients. A volume reduction was observed in 5 patients (14%). Preexisting cranial nerve symptoms resolved completely in 8 patients (23%) and partially in 20 patients (54%). Post treatment edema was observed in one patient that resolved with a short course of steroids. No other clinically significant treatment induced toxicity was observed. No treatment-related deaths occurred. Conclusion: Fractionated stereotactic radiotherapy is a safe and effective with minimal toxicity in the treatment of craniocervical meningiomas, including subtotally resected or unresectable meningiomas. In addition, this therapy demonstrated excellent symptom improvement. Overall morbidity and incidence of side effects using this approach are low. This is the largest study to examine the efficacy and tolerability in patients with craniocervical meningiomas. Author Disclosure: M. Kim, None; S. Fogh, None; M. Werner-Wasik, None; D.W. Andrews, None.
2547
Concurrent Chemoradiation with Carboplatin and Paclitaxel with or without Concomitant Boost in Advanced Inoperable Head and Neck Cancers - Efficacy and Toxicity
S. I. Temming1, M. Kocher1, J. Klussmann2, S. Preuss2, O. Guntinas-Lichius3, R. Semrau1, R. P. Mu¨ller1 1 3
Uniklinik Koeln - Radiation Oncology, Koeln, Germany, 2Uniklinik Koeln - Head and Neck Surgery, Koeln, Germany, University of Jena - Head and Neck Surgery, Jena, Germany
Purpose/Objective(s): Platin based radio - chemotherapy is the standard of care in advanced head and neck cancers. Optimal chemotherapy and radiotherapy regimes are not yet defined. The aim of this study was to prove the efficacy and toxicity profile of simultaneous paclitaxel, carboplatin and hyperfractionated-accelerated (CCB) or standard fractionated (SF) radiotherapy. Materials/Methods: This analysis included untreated advanced 67 oropharyngeal (64.4%), 19 hypopharyngeal (18.8%) and 17 nasopharyngeal carcinomas (16.8%). 64.4 % of the tumors were in Stage T4, 21.8% in Stage T3. 80,2% had N2 - or N3 - disease. Between January 2000 and October 2008, the patients were re-treated either with conventional fractionated radiotherapy to a total dose of 70–72 Gy or hyperfractionated accelerated RT to a total dose of 69.2 Gy in concomitant boost technique according to their performance status. Paclitaxel (40mg/m2) and carboplatin (AUC1) were administered once weekly. Results: The analysis is based on 101 patients: 79 patients were treated with hyperfractionated - accelerated radiotherapy (CCB) and 22 patients with standard fractionated RT (median-age 54.3 years; range, 27 to 76 years). The overall survival (OS) probability was 51.1.% after 2 years, the disease free survival (DFS) was 47.0% after 2 years. After a median follow-up of 23 months the 2 year OS for CCB - patients was 52.% and 46.9% for the SF-patients. The median DFS was 23 months for the CCB - group and 10 months for the SF- group (p = 0.68). Acute toxicity: 49% of patients had Grade 3 or 4 mucositis and 20.8% Grade 3 or 4 dermatitis. The acute mucosal toxicity (Grade 3 or 4) was higher in the hyperfractionated accelerated RT (58.2% vs. 22.7%; p = 0.004). The long-term mucosal toxicity Grade 3 or higher was 4% and the dermatitis Grade 3 or higher was 1%. Conclusions: The treatment protocol is feasible and efficient to the study population with very advanced head and neck tumors. Hyperfractionated - accelerated radiotherapy is not superior to standard fractionation in this group but longer follow-up is needed and there is a selection bias. Acute toxicity is substantial but manageable and more severe in the CCB group. Severe long-term toxicity is on average so far. Author Disclosure: S.I. Temming, None; M. Kocher, None; J. Klussmann, None; S. Preuss, None; O. Guntinas-Lichius, None; R. Semrau, None; R.P. Mu¨ller, None.
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The use of a Low Neck Field (LNF) and Intensity-Modulated Radiation Therapy (IMRT): No Clinical Detriment of IMRT to an Anterior LNF during the Treatment of Head and Neck Cancer
A. Turaka, T. Li, N. Nicolaou, M. N. Lango, B. Burtness, E. M. Horwitz, J. A. Ridge, S. J. Feigenberg Fox Chase Cancer Center, Philadelphia, PA Purpose/Objective(s): Appropriate treatment of the lower neck when using IMRT is controversial. Matching an anterior LNF with a larynx block decreases the dose to larynx while increasing the uncertainty of dose delivery at the match. This study tried to determine differences in clinical outcomes using IMRT or a standard LNF to treat the low neck. Materials/Methods: Between May 2001 and June 2008, 153 patients with head and neck cancer were treated with IMRT at Fox Chase Cancer Center. Among these, 91 (59.5%) were squamous cell carcinoma (nasopharynx 7%, oropharynx 48%, hypopharynx 2%, larynx 7%, oral cavity 24% and others 12%) and treated with curative intent. In patients treated with definitive radiation therapy (RT), the high-risk PTV (PTV1) was prescribed to 70 Gy and the low risk PTV (PTV2) to 56 Gy. In the postoperative radiotherapy (PORT) setting, PTV1 was prescribed to 60–66 Gy and PTV2 to 54 Gy. Based on physician preference some patients were
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2546
Fractionated Stereotactic Radiotherapy in the Treatment of Craniocervical Meningiomas
1
M. Kim , S. Fogh1, M. Werner-Wasik1, D. W. Andrews2 Thomas Jefferson University Department of Radiation Oncology, Philadelphia, PA, 2Thomas Jefferson University Department of Neurosurgery, Philadelphia, PA
1
Purpose/Objective(s): Craniocervical meningiomas, because of their proximity to critical neurovascular structures represent a treatment challenge. We analyzed the safety, tolerability and efficacy of high-precision fractionated stereotactic radiotherapy for the treatment of patients with craniocervical meningiomas. Materials/Methods: Thirty-five patients with benign craniocervical meningiomas were treated with stereotactic five conformal dynamic arc fractionated radiotherapy between 1998 and 2007. Patients received a course of radiotherapy as primary treatment, adjuvant therapy following subtotal resection, or for recurrent disease. The median target volume was 9.98 mL (range, 0.66 mL to 62.2 mL). The mean radiation dose was 52.7 Gy ± 1.7 Gy. Follow-up examinations, including MRI and physical exam, were performed first at one short 3-month post-treatment interval, then annually. Results: With a median follow-up of 52 months (range, 11–143 months) overall survival was 91% at 5 years and 86% at 10 years. Local tumor failure was observed in 4 of the 35 patients. A volume reduction was observed in 5 patients (14%). Preexisting cranial nerve symptoms resolved completely in 8 patients (23%) and partially in 20 patients (54%). Post treatment edema was observed in one patient that resolved with a short course of steroids. No other clinically significant treatment induced toxicity was observed. No treatment-related deaths occurred. Conclusion: Fractionated stereotactic radiotherapy is a safe and effective with minimal toxicity in the treatment of craniocervical meningiomas, including subtotally resected or unresectable meningiomas. In addition, this therapy demonstrated excellent symptom improvement. Overall morbidity and incidence of side effects using this approach are low. This is the largest study to examine the efficacy and tolerability in patients with craniocervical meningiomas. Author Disclosure: M. Kim, None; S. Fogh, None; M. Werner-Wasik, None; D.W. Andrews, None.
2547
Concurrent Chemoradiation with Carboplatin and Paclitaxel with or without Concomitant Boost in Advanced Inoperable Head and Neck Cancers - Efficacy and Toxicity
S. I. Temming1, M. Kocher1, J. Klussmann2, S. Preuss2, O. Guntinas-Lichius3, R. Semrau1, R. P. Mu¨ller1 1 3
Uniklinik Koeln - Radiation Oncology, Koeln, Germany, 2Uniklinik Koeln - Head and Neck Surgery, Koeln, Germany, University of Jena - Head and Neck Surgery, Jena, Germany
Purpose/Objective(s): Platin based radio - chemotherapy is the standard of care in advanced head and neck cancers. Optimal chemotherapy and radiotherapy regimes are not yet defined. The aim of this study was to prove the efficacy and toxicity profile of simultaneous paclitaxel, carboplatin and hyperfractionated-accelerated (CCB) or standard fractionated (SF) radiotherapy. Materials/Methods: This analysis included untreated advanced 67 oropharyngeal (64.4%), 19 hypopharyngeal (18.8%) and 17 nasopharyngeal carcinomas (16.8%). 64.4 % of the tumors were in Stage T4, 21.8% in Stage T3. 80,2% had N2 - or N3 - disease. Between January 2000 and October 2008, the patients were re-treated either with conventional fractionated radiotherapy to a total dose of 70–72 Gy or hyperfractionated accelerated RT to a total dose of 69.2 Gy in concomitant boost technique according to their performance status. Paclitaxel (40mg/m2) and carboplatin (AUC1) were administered once weekly. Results: The analysis is based on 101 patients: 79 patients were treated with hyperfractionated - accelerated radiotherapy (CCB) and 22 patients with standard fractionated RT (median-age 54.3 years; range, 27 to 76 years). The overall survival (OS) probability was 51.1.% after 2 years, the disease free survival (DFS) was 47.0% after 2 years. After a median follow-up of 23 months the 2 year OS for CCB - patients was 52.% and 46.9% for the SF-patients. The median DFS was 23 months for the CCB - group and 10 months for the SF- group (p = 0.68). Acute toxicity: 49% of patients had Grade 3 or 4 mucositis and 20.8% Grade 3 or 4 dermatitis. The acute mucosal toxicity (Grade 3 or 4) was higher in the hyperfractionated accelerated RT (58.2% vs. 22.7%; p = 0.004). The long-term mucosal toxicity Grade 3 or higher was 4% and the dermatitis Grade 3 or higher was 1%. Conclusions: The treatment protocol is feasible and efficient to the study population with very advanced head and neck tumors. Hyperfractionated - accelerated radiotherapy is not superior to standard fractionation in this group but longer follow-up is needed and there is a selection bias. Acute toxicity is substantial but manageable and more severe in the CCB group. Severe long-term toxicity is on average so far. Author Disclosure: S.I. Temming, None; M. Kocher, None; J. Klussmann, None; S. Preuss, None; O. Guntinas-Lichius, None; R. Semrau, None; R.P. Mu¨ller, None.
2548
The use of a Low Neck Field (LNF) and Intensity-Modulated Radiation Therapy (IMRT): No Clinical Detriment of IMRT to an Anterior LNF during the Treatment of Head and Neck Cancer
A. Turaka, T. Li, N. Nicolaou, M. N. Lango, B. Burtness, E. M. Horwitz, J. A. Ridge, S. J. Feigenberg Fox Chase Cancer Center, Philadelphia, PA Purpose/Objective(s): Appropriate treatment of the lower neck when using IMRT is controversial. Matching an anterior LNF with a larynx block decreases the dose to larynx while increasing the uncertainty of dose delivery at the match. This study tried to determine differences in clinical outcomes using IMRT or a standard LNF to treat the low neck. Materials/Methods: Between May 2001 and June 2008, 153 patients with head and neck cancer were treated with IMRT at Fox Chase Cancer Center. Among these, 91 (59.5%) were squamous cell carcinoma (nasopharynx 7%, oropharynx 48%, hypopharynx 2%, larynx 7%, oral cavity 24% and others 12%) and treated with curative intent. In patients treated with definitive radiation therapy (RT), the high-risk PTV (PTV1) was prescribed to 70 Gy and the low risk PTV (PTV2) to 56 Gy. In the postoperative radiotherapy (PORT) setting, PTV1 was prescribed to 60–66 Gy and PTV2 to 54 Gy. Based on physician preference some patients were
S427