- Email: [email protected]
Identification of Prognostic Index for Brain Metastases in Japanese Patients
E110 3
Department of Radiation Oncology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland Purpose/Objective(s): Patients with atypical and malignant meningiomas are at high-risk for local recurrence despite gross total resection. Postoperative radiation therapy significantly improves tumor control. Proton radiation therapy (PT), and especially the pencil beam scanning (PBS) technique, is well-suited to deliver high-dose radiation to these tumors while limiting the dose delivered to organs at risks. We report long term outcomes following PBS PT, at a single institution, for these tumors. Materials/Methods: Between July 1997 and May 2015, 35 patients (mean age 48.4 years, range 4 e 73) with histologically proven WHO Grade II-III meningiomas (atypical: n Z 33 [94%], malignant n Z 2 [6%]) were treated with PBS PT. All patients underwent at least 1 surgical resection (Simpson grade I [3%], grade II [14%], grade III [6%], and grade IV [77%]) prior to PBS PT. Twenty four patients (69%) were treated at initial diagnosis, while 11 (31%) were treated for recurrent disease. Sixteen (46%) patients had lesions involving the skull base. Median PBS PT dose was 62 Gy(RBE) (range, 54-68). Gross tumor volume and planning target volume ranged from 10.76 to 441.34 cc (median, 51.66) and 22.51 to 1141.99 cc (median, 192.8), respectively. Mean follow-up was 54.1 months (range 10.27 e 186.93). Late toxicity was graded with the Common Terminology Criteria for Adverse Events, Version 4.0. Results: Overall, 9 (26%) treatment failures were observed. Five-year local control (LC) and overall survival rates were 67.9% and 80.6%, respectively. Local failures were primarily in the treatment field: 6 (67%) infield, 1 (11%) marginal, 2 (22%) infield and marginal failures, respectively. Four (44%) failures were captured solely by radiographic follow-up without any clinical symptoms. The outcome of patients treated for recurrent disease was less favorable: the 5-year LC was 76.8% versus 42.0% for patients treated at diagnosis and recurrence, respectively (P Z 0.058). On univariate analysis, no other factor influenced LC or OS significantly in this small cohort. Late grade 3 toxicity was rare and encountered in only 3 (9%) patients. Two of these patients required steroid therapy due to brain necrosis/edema. One patient underwent cataract surgery after intraorbital PBS PT. No grade 4 or 5 toxicities were observed. Five-year grade 3 toxicity-free survival was 93.9%. Conclusion: PBS PT is an effective and safe treatment for patients with non-benign meningiomas. Despite large initial/residual disease, PBS PT affords high local control rates with limited toxicity. Upfront therapy likely yields improved outcomes compared with delay to recurrence. Frequent radiological follow-up for asymptomatic patients remains important. Author Disclosure: F.R. Murray: None. J.W. Snider: None. A. Bolsi: None. A.J. Lomax: None. M. Walser: None. R.A. Schneider: None. D.C. Weber: None.
2269 Experimental Study of PLDR on the Treatment and Radiation Injury of Orthotopic Implantation Model of Human Glioma in Embryonic Zebrafish P. Zhang,1 M. Yuan,2 and J. Lang3; 1Sichuan Cancer Hospital, Chengdu, China, 2Sichuan Cancer Hospital, Chengdu, China, 3Radiation Oncology Department, Sichuan Cancer Hospital and Institution, Chengdu, China Purpose/Objective(s): To establish an orthotopic implantation model of human U87R glioma cell lines in embryonic zebrafish, investigate the result of local tumor control, survival time, and normal tissue toxicity of pulsed low-dose rate radiation therapy (PLDR) and analysis the result of the bloodebrain barrier of PLDR. Materials/Methods: Forty-eight hpf embryonic Tg (flk:GFP) transgenic Zebrafish were implanted with U87R cell lines in brain. After 24h, successfully established orthotopic implantation models were divided into the
International Journal of Radiation Oncology Biology Physics following 3 groups: control (n Z 25), conventional radiation therapy (RT; n Z 25), and PLDR (n Z 25). The whole body irradiation was delivered using a 6 MV X-ray linear accelerator and the dose rate was 300MU/min. RT group received 2 Gy daily dose and PLDR group received 2 Gy daily dose which treated by 100.2 Gy pulses with 3-minute intervals to achieve an effective low dose rate of 6.7 cGy min1 for 4 consecutive days. Digital micrographs were taken with a confocal laser scanning microscope, analyzed by Axiovision rel.4.8 software. Data was assayed by ANOVA. A level of P<0.05 was regarded as statistically significant. Results: An orthotopic implantation model of human U87R glioma cell lines in embryonic zebrafish was established successfully. For the local tumor control, PLDR and RT significantly inhibited the growth of U87R orthotopic implantation compared with the control group (P<0.05). The PLDR group also have significantly results than RT group (P<0.05). Median Survival time was 6 days, 7 days, and 9 days for the control group, RT and PLDR group (P<0.05) respectively. Rate of the tail shape change which representative normal tissue radiation injury of zebrafish was 24% and 16% for the RT and PLDR group (P<0.05). The effect to bloodebrain barrier was not found in RT and PLDR group. Conclusion: Our study established orthotopic implantation model of human U87R glioma cell lines in embryonic zebrafish successfully. For the treatment the experiment showed that PLDR could control U87MG tumors better than conventional RT and PLDR induced much less normal tissue toxicity than RT. Thus, PLDR would be a good modality for glioblastoma treatment. Author Disclosure: P. Zhang: None. M. Yuan: None. J. Lang: None.
2270 Identification of Prognostic Index for Brain Metastases in Japanese Patients A. Niiya, K. Murakami, R. Kobayashi, M. Kato, N. Okabe, M. Obinata, Y. Ozawa, M. Morota, H. Shinjo, and Y. Kagami; Department of Radiation Oncology, Showa University Hospital, Shinagawa, Tokyo, Japan Purpose/Objective(s): In Japan, several prognostic indices for brain metastases patients, including Graded Prognostic Assessment (GPA), Basic Score for Brain Metastases (BSBM), modified Basic Score for Brain Metastases (modified BSBM), original Radiation Therapy Oncology Group-Recursive Partitioning Analysis (original RTOG-RPA), modified Recursive Partitioning Analysis (modified RPA) and Score Index for Radiosurgery in brain metastases (SIR) have been proposed. We examined which prognostic index was correlated with the prognosis of Japanese patients with brain metastases in our hospital. Materials/Methods: We analyzed the outcome of 175 patients between March 2011 and December 2015. Prognostic factors included age, sex, KPS, control of primary tumor, extra-cranial metastases, primary tumor and 5 significant brain factors (Maximum Tumor Diameter, Tumor number, Total Tumor Volume, MRI findings on localized MD and neurological symptoms). We summed the previously noted prognostic factors and GPA, BSBM, modified BSBM, original RTOG-RPA, modified RPA, and SIR were calculated. Multivariate analysis was utilized to identify any correlation between prognostic factors, prognostic scores, and survival. Results: Patients included 112 with cancer of the lung, 41 of the breast, 9 of the digestive system and 13 with other cancers. The median age of the patient cohort at diagnosis of brain metastases was 67 years (range: 24e87 years). Ninety-seven patients were male and 78 were female. One hundred sixty-nine patients were treated with whole brain irradiation (WBRT) and 6 were treated with stereotactic radiosurgery (SRS). The median score of KPS was 60 (range: 10-100). Overall median survival was 9.9 months. Utilizing Multivariate analysis, KPS and neurological symptoms were significantly correlated with survival. In other words, brain factors such as maximum tumor diameter, tumor number, total tumor volume, and localized MD had no significant difference. Multivariate analysis demonstrated
Volume 96 Number 2S Supplement 2016
Poster Viewing E111 94 new mets from 0-6 months (early). At 6-12 months (late), 19 out of 29 patients alive developed 78 new mets. In total, 172 new brain mets were identified, 16 of which were symptomatic (9.3%). These 16 mets, identified in 8 patients, demonstrated neurological symptoms related to the location of the new tumor (Table 1). Conclusion: Our study showed that following initial radiation treatment, most new brain mets are asymptomatic (90.7%) when identified on routine MRI. This suggests that distant tumor control might play a less significant role in the initial radiation choice, since these new brain mets can be treated before becoming symptomatic. Further, this could support delaying or avoiding WBRT in favor of upfront SRS, in order to reduce toxicity and promote better quality of life. A prospective trial is currently in progress.
that original RTOG-RPA and BSBM had correlation with prognosis. Median survival for Original RTOG-RPA classes 1, 2, and 3 was 10.4 months, 11 months, and 8.7 months respectively (P Z 0.0094). Median survival for BSBM classes 0, 1, 2, and 3 was 7.8 months, 10.4 months, 16.7 months and 7.6 months respectively (P Z 0.0322). Other prognostic indices didn’t relate to survival. Conclusion: Original RTOG-RPA and BSBM correlated well with prognosis of the Japanese patients with brain metastases in our hospital. Author Disclosure: A. Niiya: None. K. Murakami: None. R. Kobayashi: None. M. Kato: None. N. Okabe: None. M. Obinata: None. Y. Ozawa: None. M. Morota: None. H. Shinjo: None. Y. Kagami: None.
2271
Abstract 2271; Table 1. Symptomatology of the 16 new symptomatic brain mets in patients (n [ 8). Seven types of symptoms were experienced and in some cases patients had multiple symptoms. Severity of symptoms ranged from mild to severe.
Retrospective Analysis to Determine the Frequency of Symptomatic New Brain Metastases During Routine Magnetic Resonance Imaging Surveillance Following Stereotactic Radiosurgery or Whole-Brain Radiation Therapy D.R. Eichorn,1 M.U. Ali,1 A. Lesenskyj,1 A. Potts,1 V. Trivedi,1 R. Patchell,2 T.H. Chen,2 S. Williamson,2 C.R. Maxwell,1 and A. Mintz2; 1 Capital Health Medical Center - Regional, Trenton, NJ, 2Capital Health Medical Center - Hopewell, Pennington, NJ Purpose/Objective(s): Initial use of stereotactic radiosurgery (SRS) for treatment of brain metastases (mets) has been questioned due to higher failure rate of distant control compared to whole-brain radiation therapy (WBRT). WBRT has been shown to be associated with increased toxicity and cognitive decline, yet overall survival (OS) rates are similar. Whether high rates of distant control failure with SRS should be a chief consideration in choice of radiation technique, depends on whether the new mets are symptomatic when identified through routine MRI screening. This review aims to determine the proportion of new brain mets that are symptomatic following initial radiation treatment, as a way to provide valuable insight for making an initial treatment decision. We hypothesize that the majority of new brain mets are asymptomatic. Materials/Methods: From 2012-2015, 115 consecutive charts of patients treated with SRS, WBRT or both were reviewed for development of new mets during the first year after treatment. Serial MRIs occurred every 3 months. Chart reviewers and statisticians were blinded to the hypothesis. Data collected at each interval included MRI review, neurological and general symptoms, and treatment modalities. Results: Median patient age was 64.6 years, with 43% being male and 57% female. Frequent primary tumors were lung (49.5%), breast (15.1%), colon (6.1%), melanoma (6.1%), and renal (6.1%). Mean OS was 9.8 months. Following initial treatment, 30 out of 46 patients alive developed
Symptom
Number of patients with symptom
Aphasia Ataxia Cognitive decline Focal weakness Headache Numbness and tingling Vision changes
1 1 1 4 2 1 2
Author Disclosure: D.R. Eichorn: None. M.U. Ali: None. A. Lesenskyj: None. A. Potts: None. V. Trivedi: None. R. Patchell: None. T.H. Chen: None. S. Williamson: None. C.R. Maxwell: None. A. Mintz: None.
2272 Analysis of Treatment Utilization in Patients With Low-Grade Gliomas Using Data From the National Cancer Data Base (NCDB) T. Gunter1 and O. Algan2; 1College of Medicine University of Oklahoma Health Sciences Center, Oklahoma City, OK, 2University of Oklahoma Health Sciences Center, Oklahoma City, OK Purpose/Objective(s): To evaluate clinicopathologic factors associated with treatment utilization for patients with low grade gliomas (LGG). Materials/Methods: The NCDB is a comprehensive national database that captures approximately 70% of newly diagnosed cancer patients in the US. Data for patients meeting the criteria for LGG (WHO Grade II) were extracted from the NCDB from 2004-2013. Patients with available data
Abstract 2272; Table 1.
Differentiation Tumor diameter Age Histology Underwent surgery # of adverse prognostic features
Insurance status
Well-differentiated Moderately-differentiated <6 cm 6 cm <40 years 40 years Non-astrocytoma Astrocytoma Yes No 0 1 2 3 Insured Uninsured
Surgery
Radiation Therapy
Chemotherapy
Combination
NS NS NS NS 81.3% 68.8% 64.7% 82.9%
30.1% 39.9% 34.3% 45.3% 30.6% 43.4% 31.8% 44.3% 32.6% 52.1% 24.7% 33.2% 49.2% 48.7% NS NS
28.3% 34.1% 29.0% 39.9% 29.2% 35.6% 34.9% 30.1% 23.1% 41.5% 27.0%* 31.4%* 32.9%* 36.5%* NS NS
14.2% 18.8% 15.3% 24.1% 14.2% 20.6% 15.8% 19.8% 15.0% 25.6% 10.8% 16.0% 22.4% 24.3% 18.3%y 14.1%y
87.5% 82.1% 67.0% 55.7% NS NS
Combination: chemotherapy and radiation therapy NS: nonsignificant difference *: P [ 0.037 y: P [ 0.049.
Department of Radiation Oncology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland Purpose/Objective(s): Patients with atypical and malignant meningiomas are at high-risk for local recurrence despite gross total resection. Postoperative radiation therapy significantly improves tumor control. Proton radiation therapy (PT), and especially the pencil beam scanning (PBS) technique, is well-suited to deliver high-dose radiation to these tumors while limiting the dose delivered to organs at risks. We report long term outcomes following PBS PT, at a single institution, for these tumors. Materials/Methods: Between July 1997 and May 2015, 35 patients (mean age 48.4 years, range 4 e 73) with histologically proven WHO Grade II-III meningiomas (atypical: n Z 33 [94%], malignant n Z 2 [6%]) were treated with PBS PT. All patients underwent at least 1 surgical resection (Simpson grade I [3%], grade II [14%], grade III [6%], and grade IV [77%]) prior to PBS PT. Twenty four patients (69%) were treated at initial diagnosis, while 11 (31%) were treated for recurrent disease. Sixteen (46%) patients had lesions involving the skull base. Median PBS PT dose was 62 Gy(RBE) (range, 54-68). Gross tumor volume and planning target volume ranged from 10.76 to 441.34 cc (median, 51.66) and 22.51 to 1141.99 cc (median, 192.8), respectively. Mean follow-up was 54.1 months (range 10.27 e 186.93). Late toxicity was graded with the Common Terminology Criteria for Adverse Events, Version 4.0. Results: Overall, 9 (26%) treatment failures were observed. Five-year local control (LC) and overall survival rates were 67.9% and 80.6%, respectively. Local failures were primarily in the treatment field: 6 (67%) infield, 1 (11%) marginal, 2 (22%) infield and marginal failures, respectively. Four (44%) failures were captured solely by radiographic follow-up without any clinical symptoms. The outcome of patients treated for recurrent disease was less favorable: the 5-year LC was 76.8% versus 42.0% for patients treated at diagnosis and recurrence, respectively (P Z 0.058). On univariate analysis, no other factor influenced LC or OS significantly in this small cohort. Late grade 3 toxicity was rare and encountered in only 3 (9%) patients. Two of these patients required steroid therapy due to brain necrosis/edema. One patient underwent cataract surgery after intraorbital PBS PT. No grade 4 or 5 toxicities were observed. Five-year grade 3 toxicity-free survival was 93.9%. Conclusion: PBS PT is an effective and safe treatment for patients with non-benign meningiomas. Despite large initial/residual disease, PBS PT affords high local control rates with limited toxicity. Upfront therapy likely yields improved outcomes compared with delay to recurrence. Frequent radiological follow-up for asymptomatic patients remains important. Author Disclosure: F.R. Murray: None. J.W. Snider: None. A. Bolsi: None. A.J. Lomax: None. M. Walser: None. R.A. Schneider: None. D.C. Weber: None.
2269 Experimental Study of PLDR on the Treatment and Radiation Injury of Orthotopic Implantation Model of Human Glioma in Embryonic Zebrafish P. Zhang,1 M. Yuan,2 and J. Lang3; 1Sichuan Cancer Hospital, Chengdu, China, 2Sichuan Cancer Hospital, Chengdu, China, 3Radiation Oncology Department, Sichuan Cancer Hospital and Institution, Chengdu, China Purpose/Objective(s): To establish an orthotopic implantation model of human U87R glioma cell lines in embryonic zebrafish, investigate the result of local tumor control, survival time, and normal tissue toxicity of pulsed low-dose rate radiation therapy (PLDR) and analysis the result of the bloodebrain barrier of PLDR. Materials/Methods: Forty-eight hpf embryonic Tg (flk:GFP) transgenic Zebrafish were implanted with U87R cell lines in brain. After 24h, successfully established orthotopic implantation models were divided into the
International Journal of Radiation Oncology Biology Physics following 3 groups: control (n Z 25), conventional radiation therapy (RT; n Z 25), and PLDR (n Z 25). The whole body irradiation was delivered using a 6 MV X-ray linear accelerator and the dose rate was 300MU/min. RT group received 2 Gy daily dose and PLDR group received 2 Gy daily dose which treated by 100.2 Gy pulses with 3-minute intervals to achieve an effective low dose rate of 6.7 cGy min1 for 4 consecutive days. Digital micrographs were taken with a confocal laser scanning microscope, analyzed by Axiovision rel.4.8 software. Data was assayed by ANOVA. A level of P<0.05 was regarded as statistically significant. Results: An orthotopic implantation model of human U87R glioma cell lines in embryonic zebrafish was established successfully. For the local tumor control, PLDR and RT significantly inhibited the growth of U87R orthotopic implantation compared with the control group (P<0.05). The PLDR group also have significantly results than RT group (P<0.05). Median Survival time was 6 days, 7 days, and 9 days for the control group, RT and PLDR group (P<0.05) respectively. Rate of the tail shape change which representative normal tissue radiation injury of zebrafish was 24% and 16% for the RT and PLDR group (P<0.05). The effect to bloodebrain barrier was not found in RT and PLDR group. Conclusion: Our study established orthotopic implantation model of human U87R glioma cell lines in embryonic zebrafish successfully. For the treatment the experiment showed that PLDR could control U87MG tumors better than conventional RT and PLDR induced much less normal tissue toxicity than RT. Thus, PLDR would be a good modality for glioblastoma treatment. Author Disclosure: P. Zhang: None. M. Yuan: None. J. Lang: None.
2270 Identification of Prognostic Index for Brain Metastases in Japanese Patients A. Niiya, K. Murakami, R. Kobayashi, M. Kato, N. Okabe, M. Obinata, Y. Ozawa, M. Morota, H. Shinjo, and Y. Kagami; Department of Radiation Oncology, Showa University Hospital, Shinagawa, Tokyo, Japan Purpose/Objective(s): In Japan, several prognostic indices for brain metastases patients, including Graded Prognostic Assessment (GPA), Basic Score for Brain Metastases (BSBM), modified Basic Score for Brain Metastases (modified BSBM), original Radiation Therapy Oncology Group-Recursive Partitioning Analysis (original RTOG-RPA), modified Recursive Partitioning Analysis (modified RPA) and Score Index for Radiosurgery in brain metastases (SIR) have been proposed. We examined which prognostic index was correlated with the prognosis of Japanese patients with brain metastases in our hospital. Materials/Methods: We analyzed the outcome of 175 patients between March 2011 and December 2015. Prognostic factors included age, sex, KPS, control of primary tumor, extra-cranial metastases, primary tumor and 5 significant brain factors (Maximum Tumor Diameter, Tumor number, Total Tumor Volume, MRI findings on localized MD and neurological symptoms). We summed the previously noted prognostic factors and GPA, BSBM, modified BSBM, original RTOG-RPA, modified RPA, and SIR were calculated. Multivariate analysis was utilized to identify any correlation between prognostic factors, prognostic scores, and survival. Results: Patients included 112 with cancer of the lung, 41 of the breast, 9 of the digestive system and 13 with other cancers. The median age of the patient cohort at diagnosis of brain metastases was 67 years (range: 24e87 years). Ninety-seven patients were male and 78 were female. One hundred sixty-nine patients were treated with whole brain irradiation (WBRT) and 6 were treated with stereotactic radiosurgery (SRS). The median score of KPS was 60 (range: 10-100). Overall median survival was 9.9 months. Utilizing Multivariate analysis, KPS and neurological symptoms were significantly correlated with survival. In other words, brain factors such as maximum tumor diameter, tumor number, total tumor volume, and localized MD had no significant difference. Multivariate analysis demonstrated
Volume 96 Number 2S Supplement 2016
Poster Viewing E111 94 new mets from 0-6 months (early). At 6-12 months (late), 19 out of 29 patients alive developed 78 new mets. In total, 172 new brain mets were identified, 16 of which were symptomatic (9.3%). These 16 mets, identified in 8 patients, demonstrated neurological symptoms related to the location of the new tumor (Table 1). Conclusion: Our study showed that following initial radiation treatment, most new brain mets are asymptomatic (90.7%) when identified on routine MRI. This suggests that distant tumor control might play a less significant role in the initial radiation choice, since these new brain mets can be treated before becoming symptomatic. Further, this could support delaying or avoiding WBRT in favor of upfront SRS, in order to reduce toxicity and promote better quality of life. A prospective trial is currently in progress.
that original RTOG-RPA and BSBM had correlation with prognosis. Median survival for Original RTOG-RPA classes 1, 2, and 3 was 10.4 months, 11 months, and 8.7 months respectively (P Z 0.0094). Median survival for BSBM classes 0, 1, 2, and 3 was 7.8 months, 10.4 months, 16.7 months and 7.6 months respectively (P Z 0.0322). Other prognostic indices didn’t relate to survival. Conclusion: Original RTOG-RPA and BSBM correlated well with prognosis of the Japanese patients with brain metastases in our hospital. Author Disclosure: A. Niiya: None. K. Murakami: None. R. Kobayashi: None. M. Kato: None. N. Okabe: None. M. Obinata: None. Y. Ozawa: None. M. Morota: None. H. Shinjo: None. Y. Kagami: None.
2271
Abstract 2271; Table 1. Symptomatology of the 16 new symptomatic brain mets in patients (n [ 8). Seven types of symptoms were experienced and in some cases patients had multiple symptoms. Severity of symptoms ranged from mild to severe.
Retrospective Analysis to Determine the Frequency of Symptomatic New Brain Metastases During Routine Magnetic Resonance Imaging Surveillance Following Stereotactic Radiosurgery or Whole-Brain Radiation Therapy D.R. Eichorn,1 M.U. Ali,1 A. Lesenskyj,1 A. Potts,1 V. Trivedi,1 R. Patchell,2 T.H. Chen,2 S. Williamson,2 C.R. Maxwell,1 and A. Mintz2; 1 Capital Health Medical Center - Regional, Trenton, NJ, 2Capital Health Medical Center - Hopewell, Pennington, NJ Purpose/Objective(s): Initial use of stereotactic radiosurgery (SRS) for treatment of brain metastases (mets) has been questioned due to higher failure rate of distant control compared to whole-brain radiation therapy (WBRT). WBRT has been shown to be associated with increased toxicity and cognitive decline, yet overall survival (OS) rates are similar. Whether high rates of distant control failure with SRS should be a chief consideration in choice of radiation technique, depends on whether the new mets are symptomatic when identified through routine MRI screening. This review aims to determine the proportion of new brain mets that are symptomatic following initial radiation treatment, as a way to provide valuable insight for making an initial treatment decision. We hypothesize that the majority of new brain mets are asymptomatic. Materials/Methods: From 2012-2015, 115 consecutive charts of patients treated with SRS, WBRT or both were reviewed for development of new mets during the first year after treatment. Serial MRIs occurred every 3 months. Chart reviewers and statisticians were blinded to the hypothesis. Data collected at each interval included MRI review, neurological and general symptoms, and treatment modalities. Results: Median patient age was 64.6 years, with 43% being male and 57% female. Frequent primary tumors were lung (49.5%), breast (15.1%), colon (6.1%), melanoma (6.1%), and renal (6.1%). Mean OS was 9.8 months. Following initial treatment, 30 out of 46 patients alive developed
Symptom
Number of patients with symptom
Aphasia Ataxia Cognitive decline Focal weakness Headache Numbness and tingling Vision changes
1 1 1 4 2 1 2
Author Disclosure: D.R. Eichorn: None. M.U. Ali: None. A. Lesenskyj: None. A. Potts: None. V. Trivedi: None. R. Patchell: None. T.H. Chen: None. S. Williamson: None. C.R. Maxwell: None. A. Mintz: None.
2272 Analysis of Treatment Utilization in Patients With Low-Grade Gliomas Using Data From the National Cancer Data Base (NCDB) T. Gunter1 and O. Algan2; 1College of Medicine University of Oklahoma Health Sciences Center, Oklahoma City, OK, 2University of Oklahoma Health Sciences Center, Oklahoma City, OK Purpose/Objective(s): To evaluate clinicopathologic factors associated with treatment utilization for patients with low grade gliomas (LGG). Materials/Methods: The NCDB is a comprehensive national database that captures approximately 70% of newly diagnosed cancer patients in the US. Data for patients meeting the criteria for LGG (WHO Grade II) were extracted from the NCDB from 2004-2013. Patients with available data
Abstract 2272; Table 1.
Differentiation Tumor diameter Age Histology Underwent surgery # of adverse prognostic features
Insurance status
Well-differentiated Moderately-differentiated <6 cm 6 cm <40 years 40 years Non-astrocytoma Astrocytoma Yes No 0 1 2 3 Insured Uninsured
Surgery
Radiation Therapy
Chemotherapy
Combination
NS NS NS NS 81.3% 68.8% 64.7% 82.9%
30.1% 39.9% 34.3% 45.3% 30.6% 43.4% 31.8% 44.3% 32.6% 52.1% 24.7% 33.2% 49.2% 48.7% NS NS
28.3% 34.1% 29.0% 39.9% 29.2% 35.6% 34.9% 30.1% 23.1% 41.5% 27.0%* 31.4%* 32.9%* 36.5%* NS NS
14.2% 18.8% 15.3% 24.1% 14.2% 20.6% 15.8% 19.8% 15.0% 25.6% 10.8% 16.0% 22.4% 24.3% 18.3%y 14.1%y
87.5% 82.1% 67.0% 55.7% NS NS
Combination: chemotherapy and radiation therapy NS: nonsignificant difference *: P [ 0.037 y: P [ 0.049.