- Email: [email protected]
Hyperbaric Oxygen Therapy for Reducing Adverse Events of Chemoradiation therapy for Esophageal Cancer
S304
International Journal of Radiation Oncology Biology Physics
was 9.7 months (range, 3 - 23.6) and 15.3 months (range, 2.9 - 39.7) in the no-prior WBRT and prior WBRT cohort, respectively. The most common primary site was non-small cell lung cancer and RPA class was 2. In the no prior WBRT and prior WBRT cohort, the median survival was 23.6 months and 39.7 months, the 12 month-cavity progression free survival (PFS) was 79% and 100%, the median time to progression was not reached and 17.7 months, and the 12 month-distant brain PFS was 63% and 52%, respectively (comparisons were not significantly different). Three patients (3/10) developed grade 3 radiation necrosis, and all in the prior WBRT cohort. Conclusion: We report favorable outcomes with HSCRT in patients with and without prior WBRT; however, as salvage therapy there is a moderate risk of radiation necrosis. Author Disclosure: H. Soliman: None. A. Al-Omair: None. W. Xu: None. A. Karotki: None. N. Phan: None. S. Das: None. J. Perry: None. M. Tsao: None. T. Mainprize: None. A. Sahgal: None.
2226
2225 Hyperbaric Oxygen Therapy for Reducing Adverse Events of Chemoradiation therapy for Esophageal Cancer Y. Kajiya,1 N. Uchiyama,1 and M. Nakajo2; 1Kagoshima municipal hospital, Kagoshima, Japan, 2Kagoshima University Hospital, Kagoshima, Japan Purpose/Objective(s): Acute esophagitis is a common complication of radiation therapy for esophageal cancer. The use of more effective regimens such as concurrent chemoradiation therapy (CRT) or hyperfractionation has resulted in an increased incidence (15-25%) of grade 3 or greater acute esophagitis, which may require meticulous management. Thus, it is valuable to reduce the grade of acute esophagitis and patient’s symptoms, which accompany such an intensive therapy. Hyperbaric oxygenation therapy (HBOT) improves the oxygen supply to hypoxic tumor cells and has been used as an adjuvant to enhance the therapeutic effect on malignant tumors. HBOT has also been used for treatment of late radiation tissue injury, but little is known whether HBOT can reduce the grade of iatrogenic acute esophagitis. The aim of our study was to examine whether HBOT can reduce the grade of acute esophagitis and symptoms of patients with esophageal cancer who received concurrent CRT. Materials/Methods: We reviewed 10 patients who had clinical stage I-IVB esophageal cancer and received CRT and HBOT. The prescribed total radiation dose ranged between 40 Gy and 60 Gy with concurrent chemotherapy of 1-2 courses of cisplatin and 5-fluorouracil. HBOT was performed in all patients at one session per day, 5 days per week. RT was performed within 30 minutes after completion of HBOT. The median number of total sessions was 20, and was started within 2 days after start of radiation therapy .HBOT was given in a single place hyperbaric chamber. The chamber was pressurized with air over 10 min to a treatment pressure of 2.0 atmospheres absolute (ATA). At this pressure, 100% oxygen was delivered by oronasal mask in 60min. Depressurization was done on air over 10 min, resulting in an overall treatment duration of 60 min with a total of 80 min of hyperbaric oxygen breathing. Adverse event assessment was performed during RT using the National Cancer Institute Common Toxicity Criteria (version 4.0) (NCICTC). Subjective symptom assessment was performed by the ten-grade Numerical Rating Scale (NRS) system. A detailed pathologic examination of the esophagectomy specimen was performed for evaluation of esophagitis in 2 patients. Results: No patients exhibited NCICTC grade 3 or more esophagitis (grade 1; 8 patients and grade 2; 2 patients). Subjective symptoms such as chest pain and odynophagia were observed in 2 (20%) patients and the remaining 8 patients developed no symptoms when estimated by NRS. There was no evidence of acute and chronic inflammation, and structural and fibrotic changes, which originated in esophagitis induced by CRT in the resected 2 specimens. Conclusions: HBOT has the potential to reduce the adverse events of CRT for patients with esophageal cancer. Author Disclosure: Y. Kaila: None. N. Uchiyama: None. M. Nakajo: None.
Evaluation of Early Response to Concomitant Chemoradiation Therapy by Interim 18-FDG PET-CT Imaging in Patients With Locally Advanced Esophageal Carcinomas L. Quero,1 X. Cuenca,2 E. Hindie,1 S. Rivera,1 L. Vercellino,1 V. BaruchHennequin,1 J. Gornet,1 P. Cattan,1 M. Chirica,1 and C. Hennequin1; 1Saint Louis Hospital, Paris, France, 2Pitie Salpetriere Hospital, Paris, France Purpose/Objective(s): The best way to assess the response to chemoradiation therapy of locally advanced esophageal carcinomas is not known. We used 18FDG-PET/CT to evaluate the metabolic response during chemoradiation therapy and tried to correlate this response to survival. Materials/Methods: Patients with biopsy-proven esophageal carcinoma underwent a FDG-PET/CT with evaluation of the standardized uptake value (SUV) before any treatment (SUV1) and during chemoradiation therapy after two cycles of 5FU-cisplatine and 20 Gy (SUV2). Metabolic response was defined as 1-(SUV2/SUV1). Surgery was discussed after 40 Gy and three cycles of chemotherapy. Results of interim PET were not considered for therapeutic decision. Results: Seventy-two patients were included in this study and 59 (82%) could receive the second FDG-PET/CT examination. Median survival was 22.2 months, 1- and 2-year overall survival were 70% and 46% respectively. Nineteen patients (32%) underwent surgery. Mean SUV1 and SUV2 were 12.3+/-6.2 and 6+/-4.1, respectively (p < 0.001). There was a significant correlation between overall survival and metabolic response. Using a cut-off for metabolic response of 50%, sensitivity and specificity for survival were 0.7 and 0.58. The 2-year overall survival of good responders was 62% as compared to 27% for poor metabolic responders. A multivariate analysis was performed, including T and N stages, surgery, histology, and metabolic response: only metabolic response was significantly associated with 2-year survival (p Z 0.009). Conclusions: Early evaluation of metabolic response had a great prognostic value and could help identify good responders to chemoradiation therapy. Author Disclosure: L. Quero: None. X. Cuenca: None. E. Hindie: None. S. Rivera: None. L. Vercellino: None. V. Baruch-Hennequin: None. J. Gornet: None. P. Cattan: None. M. Chirica: None. C. Hennequin: None.
2227 CT Prognostication in Esophageal Cancer Treated With Definitive Chemoradiation Is Still Relevant C. Yip,1 A. Michaelidou,1 R.H. Thomas,2 V. Goh,3,4 and D.B. Landau1,3; 1 Department of Oncology, Guys and St Thomas NHS Foundation Trust, London, United Kingdom, 2Department of Radiology, Guy’s & St. Thomas’ Hospital, London, United Kingdom, 3Division of Imaging Sciences & Biomedical Engineering, Kings College London, London, United Kingdom, 4Department of Radiology, Guys & St Thomas NHS Foundation Trust, London, United Kingdom Purpose/Objective(s): Esophageal cancer remains a disease that has a dismal prognosis. Definitive chemoradiation (CRT) is increasingly being used in these patients but only 20-30% will achieve complete pathological response whilst most will fail locoregionally. Computed tomography (CT) remains the most commonly performed imaging modality in esophageal cancer worldwide. We performed a retrospective review of patients in our tertiary referral center treated with definitive CRT to identify CT prognostic factors, which could select patients who may benefit from trimodality treatment. Materials/Methods: Patients who received definitive CRT between 2005 and 2008 were identified from our institutional database. Patients who had staging and post-treatment contrast enhanced CT that were available for central review were included. An experienced Radiologist reviewed all scans to identify relevant prognostic CT parameters: changes in maximal wall thickness (WT) and bipendicular dimensions (BP), downstaging from T4 to non-T4 (T4) and changes in sum of nodal sizes (SN). WT, BP and SN were analyzed both as continuous and categorical variables (partial
International Journal of Radiation Oncology Biology Physics
was 9.7 months (range, 3 - 23.6) and 15.3 months (range, 2.9 - 39.7) in the no-prior WBRT and prior WBRT cohort, respectively. The most common primary site was non-small cell lung cancer and RPA class was 2. In the no prior WBRT and prior WBRT cohort, the median survival was 23.6 months and 39.7 months, the 12 month-cavity progression free survival (PFS) was 79% and 100%, the median time to progression was not reached and 17.7 months, and the 12 month-distant brain PFS was 63% and 52%, respectively (comparisons were not significantly different). Three patients (3/10) developed grade 3 radiation necrosis, and all in the prior WBRT cohort. Conclusion: We report favorable outcomes with HSCRT in patients with and without prior WBRT; however, as salvage therapy there is a moderate risk of radiation necrosis. Author Disclosure: H. Soliman: None. A. Al-Omair: None. W. Xu: None. A. Karotki: None. N. Phan: None. S. Das: None. J. Perry: None. M. Tsao: None. T. Mainprize: None. A. Sahgal: None.
2226
2225 Hyperbaric Oxygen Therapy for Reducing Adverse Events of Chemoradiation therapy for Esophageal Cancer Y. Kajiya,1 N. Uchiyama,1 and M. Nakajo2; 1Kagoshima municipal hospital, Kagoshima, Japan, 2Kagoshima University Hospital, Kagoshima, Japan Purpose/Objective(s): Acute esophagitis is a common complication of radiation therapy for esophageal cancer. The use of more effective regimens such as concurrent chemoradiation therapy (CRT) or hyperfractionation has resulted in an increased incidence (15-25%) of grade 3 or greater acute esophagitis, which may require meticulous management. Thus, it is valuable to reduce the grade of acute esophagitis and patient’s symptoms, which accompany such an intensive therapy. Hyperbaric oxygenation therapy (HBOT) improves the oxygen supply to hypoxic tumor cells and has been used as an adjuvant to enhance the therapeutic effect on malignant tumors. HBOT has also been used for treatment of late radiation tissue injury, but little is known whether HBOT can reduce the grade of iatrogenic acute esophagitis. The aim of our study was to examine whether HBOT can reduce the grade of acute esophagitis and symptoms of patients with esophageal cancer who received concurrent CRT. Materials/Methods: We reviewed 10 patients who had clinical stage I-IVB esophageal cancer and received CRT and HBOT. The prescribed total radiation dose ranged between 40 Gy and 60 Gy with concurrent chemotherapy of 1-2 courses of cisplatin and 5-fluorouracil. HBOT was performed in all patients at one session per day, 5 days per week. RT was performed within 30 minutes after completion of HBOT. The median number of total sessions was 20, and was started within 2 days after start of radiation therapy .HBOT was given in a single place hyperbaric chamber. The chamber was pressurized with air over 10 min to a treatment pressure of 2.0 atmospheres absolute (ATA). At this pressure, 100% oxygen was delivered by oronasal mask in 60min. Depressurization was done on air over 10 min, resulting in an overall treatment duration of 60 min with a total of 80 min of hyperbaric oxygen breathing. Adverse event assessment was performed during RT using the National Cancer Institute Common Toxicity Criteria (version 4.0) (NCICTC). Subjective symptom assessment was performed by the ten-grade Numerical Rating Scale (NRS) system. A detailed pathologic examination of the esophagectomy specimen was performed for evaluation of esophagitis in 2 patients. Results: No patients exhibited NCICTC grade 3 or more esophagitis (grade 1; 8 patients and grade 2; 2 patients). Subjective symptoms such as chest pain and odynophagia were observed in 2 (20%) patients and the remaining 8 patients developed no symptoms when estimated by NRS. There was no evidence of acute and chronic inflammation, and structural and fibrotic changes, which originated in esophagitis induced by CRT in the resected 2 specimens. Conclusions: HBOT has the potential to reduce the adverse events of CRT for patients with esophageal cancer. Author Disclosure: Y. Kaila: None. N. Uchiyama: None. M. Nakajo: None.
Evaluation of Early Response to Concomitant Chemoradiation Therapy by Interim 18-FDG PET-CT Imaging in Patients With Locally Advanced Esophageal Carcinomas L. Quero,1 X. Cuenca,2 E. Hindie,1 S. Rivera,1 L. Vercellino,1 V. BaruchHennequin,1 J. Gornet,1 P. Cattan,1 M. Chirica,1 and C. Hennequin1; 1Saint Louis Hospital, Paris, France, 2Pitie Salpetriere Hospital, Paris, France Purpose/Objective(s): The best way to assess the response to chemoradiation therapy of locally advanced esophageal carcinomas is not known. We used 18FDG-PET/CT to evaluate the metabolic response during chemoradiation therapy and tried to correlate this response to survival. Materials/Methods: Patients with biopsy-proven esophageal carcinoma underwent a FDG-PET/CT with evaluation of the standardized uptake value (SUV) before any treatment (SUV1) and during chemoradiation therapy after two cycles of 5FU-cisplatine and 20 Gy (SUV2). Metabolic response was defined as 1-(SUV2/SUV1). Surgery was discussed after 40 Gy and three cycles of chemotherapy. Results of interim PET were not considered for therapeutic decision. Results: Seventy-two patients were included in this study and 59 (82%) could receive the second FDG-PET/CT examination. Median survival was 22.2 months, 1- and 2-year overall survival were 70% and 46% respectively. Nineteen patients (32%) underwent surgery. Mean SUV1 and SUV2 were 12.3+/-6.2 and 6+/-4.1, respectively (p < 0.001). There was a significant correlation between overall survival and metabolic response. Using a cut-off for metabolic response of 50%, sensitivity and specificity for survival were 0.7 and 0.58. The 2-year overall survival of good responders was 62% as compared to 27% for poor metabolic responders. A multivariate analysis was performed, including T and N stages, surgery, histology, and metabolic response: only metabolic response was significantly associated with 2-year survival (p Z 0.009). Conclusions: Early evaluation of metabolic response had a great prognostic value and could help identify good responders to chemoradiation therapy. Author Disclosure: L. Quero: None. X. Cuenca: None. E. Hindie: None. S. Rivera: None. L. Vercellino: None. V. Baruch-Hennequin: None. J. Gornet: None. P. Cattan: None. M. Chirica: None. C. Hennequin: None.
2227 CT Prognostication in Esophageal Cancer Treated With Definitive Chemoradiation Is Still Relevant C. Yip,1 A. Michaelidou,1 R.H. Thomas,2 V. Goh,3,4 and D.B. Landau1,3; 1 Department of Oncology, Guys and St Thomas NHS Foundation Trust, London, United Kingdom, 2Department of Radiology, Guy’s & St. Thomas’ Hospital, London, United Kingdom, 3Division of Imaging Sciences & Biomedical Engineering, Kings College London, London, United Kingdom, 4Department of Radiology, Guys & St Thomas NHS Foundation Trust, London, United Kingdom Purpose/Objective(s): Esophageal cancer remains a disease that has a dismal prognosis. Definitive chemoradiation (CRT) is increasingly being used in these patients but only 20-30% will achieve complete pathological response whilst most will fail locoregionally. Computed tomography (CT) remains the most commonly performed imaging modality in esophageal cancer worldwide. We performed a retrospective review of patients in our tertiary referral center treated with definitive CRT to identify CT prognostic factors, which could select patients who may benefit from trimodality treatment. Materials/Methods: Patients who received definitive CRT between 2005 and 2008 were identified from our institutional database. Patients who had staging and post-treatment contrast enhanced CT that were available for central review were included. An experienced Radiologist reviewed all scans to identify relevant prognostic CT parameters: changes in maximal wall thickness (WT) and bipendicular dimensions (BP), downstaging from T4 to non-T4 (T4) and changes in sum of nodal sizes (SN). WT, BP and SN were analyzed both as continuous and categorical variables (partial