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IMRT With Image-Guided Brachytherapy in Non-metastatic Locally Advanced Cervical Cancer
E310
International Journal of Radiation Oncology Biology Physics
(7%), pre- and post-operative RT (15%), RT alone (4%), surgery->RT>surgery (4%) and chemotherapy only (7%). Of the 15 patients receiving RT, the median dose to the primary was 55 Gy (26-70 Gy). Five patients had regional nodes included in the treatment field (3 pelvic, 2 inguinal). After a median of 44 months follow up, the 5-yr OS is 69%, CSS is 77%, LC is 73% and PFS is 56%. Receipt of RT was not significantly associated with OS, CSS, PFS, LC, or MFS. Of the 10 patients who recurred, 5 developed distant recurrences, 2 local recurrences, and 3 regional nodal recurrences. Of the 15 patients receiving RT, 40% (6/15) recurred, 67% of which were distant only recurrences. Of the 10 patients that received primary site RT with exclusion of inguinal or pelvic LNs, no patients failed in a regional lymph node. Conclusion: In a large single institution series of primary vulvovaginal sarcoma, leiomyosarcoma was the most common histology. The cancer-specific survival was 77%. Of patients treated with primary site only radiation therapy, there were no nodal recurrences, suggesting treatment of the primary alone may be sufficient, although larger numbers are needed to further assess. Author Disclosure: A.L. Russo: None. R. Miao: None. H. Wang: None. J.T. Mullen: None. A.B. Haynes: None. M. Del Carmen: None. T.F. DeLaney: None. Y.E. Chen: None.
Leader Title of the project: Novel Tar. C.B. Simone: ; Annals of Palliative Medicine, Proton Collaborative Group (PCG). V. Verma: None.
2738 Patterns of Care for Stage IA Cervical Cancer: A Study of the Utilization of Curative-Intent Radiation Therapy versus Hysterectomy-Type Surgery J. Ryckman,1 C. Lin,1 C.B. Simone II,2 and V. Verma1; 1Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 2 University of Maryland Medical Center, Baltimore, MD Purpose/Objective(s): The standard of care for clinical IA cervical cancer is surgery versus radiotherapy. Herein, we investigated practice patterns associated with administration of 1) radiation therapy (RT) alone, 2) definitive hysterectomy (HYS) alone, and 3) the addition of RT to HYS. Regarding the treatment of clinical IA cervical cancer, we predict that socioeconomic disparities influence patterns of care. Materials/Methods: The National Cancer Data Base (NCDB) was queried for clinical IA primary cervical cancer cases (2004-2013) receiving curative-intent RT and/or HYS. Patients with unknown RT status were excluded, as were benign histologies and receipt of fertility sparing surgery. Patient, tumor, and treatment parameters were extracted. KaplanMeier analysis was used to evaluate overall survival (OS) between patients receiving 1) RT alone, 2) HYS alone and 3) the addition of RT to HYS. Cox proportional hazards modeling determined variables associated with receipt of RT, HYS and OS. Results: In total, 3816 patients were analyzed (nZ3514 [92.1%] HYS alone, nZ100 [2.6%] RT alone, nZ202 [5.3%] HYS + RT). On multivariate analysis of HYS alone versus RT alone, RT was more likely to be given to patients that were older (p<0.001) and with Medicare (pZ0.011) or uninsured/unknown status (pZ0.003). Treatment by HYS alone approached significance with the two highest income quartiles (pZ0.013, pZ0.054). On multivariate analysis of patients receiving RT in addition to HYS, adjuvant RT was added most commonly for positive margins (pZ<0.001) and increasing age (pZ<0.001). The five year overall survival was higher with HYS alone than with RT alone (96% vs 69%, pZ<0.0001). The addition of RT to HYS did not improve overall survival. Conclusion: Socioeconomic factors were associated with receipt of RT alone versus HYS alone for clinical stage IA cervical cancer. Although these data must be further validated with better-defined patient selection, these factors need to be addressed in order to ensure the highest quality cancer care to all patients. Author Disclosure: J. Ryckman: None. C. Lin: Research Grant; DHHS/ NIH/NCI, Eppley Cancer center at UNMC, Quest Pharma Tech, Inc.. To purchase a research drug; Eppley Cancer center at UNMC. Focus is on translational studies that address basic and clinical issues of importance to improving outcome of patients with pancreatic cancer. Role: Project
2739 IMRT With Image-Guided Brachytherapy in Nonmetastatic Locally Advanced Cervical Cancer A. Saidi, I. Fortin, M.C. Beauchemin, and M. Barkati; Centre Hospitalier de l’Universite de Montreal, Montreal, QC, Canada Purpose/Objective(s): Intensity modulated radiotherapy (IMRT) and image-guided adaptive brachytherapy (IGABT) have been only recently introduced in the treatment of locally advanced cervical cancer (LACC). We retrospectively assessed the overall clinical outcomes, patterns of failure, and toxicity in LACC patients from a single institution in a modern treatment era. Materials/Methods: A cohort of 138 patients with cervical squamous cell carcinoma or adenocarcinoma was treated with IMRT to a dose of 45 Gy and a boost of 5.4 to 14.4 Gy for involved lymph nodes, with concomitant chemotherapy, and IGABT. D2cc of the rectum, bladder and bowel were converted into the equivalent dose in 2 Gy fractions (EQD2) using a linear quadratic model (a/bZ3 Gy). PET-scan was done for all patients at diagnosis and in the majority of patients (NZ127) to assess treatment response. We reported late toxicity using RTOG/EORTC scoring system. Kaplan-Meier analyses for overall survival (OS), disease-free survival (DFS), pelvic control (PC) and local control (LC) were performed. Results: Of 138 patients identified and treated between March 2011 and November 2015, 50 had stage IB, 62 had stage II, 21 had stage III and 5 had stage IVA. The median age was 51 years (range, 28-93). Histology was squamous cell carcinoma in 118 patients (85.5%). All patients had a staging PET-scan and 97% had an MRI at diagnosis. MRI tumor volume was >30 cm3 in 47% of cases. Nodal involvement was reported in 82 patients (59.4%). The median follow-up was 28 months. Endocavitary high-dose rate (HDR) IGABT was used for all patients. The median prescribed dose to the tumor was 84.3 Gy. The median D2cc to the bladder, rectum and bowel was 82.2 Gy, 67.6 Gy and 78.9 Gy, respectively. Complete PET response was observed in 113 out of 127 patients (89%). Three-year OS and DFS were 85.3% and 78.9%, respectively. Local control and pelvic control rates at 3 years were 94.8% and 91.9%, respectively. Twenty-seven patients (19.6%) were diagnosed with recurrent disease. Of these, 20 had evidence of distant recurrence and 3 had isolated local relapse. Four patients had only regional nodal recurrence, 3 of which were para-aortic recurrences that were not included in the original treatment field. Median time to relapse was 8 months (range, 2.5-45). Grade 3 late toxicities for bladder, vagina and bowel were observed in 4%, 3% and 2% of patients, respectively. Conclusion: Contemporary treatment of LACC with chemoradiation using IMRT and IGABT yields to higher rates of OS and DFS compared to previously published series. These good outcomes can be attributed to thorough clinical staging using PET-scan and MRI, the use of IMRT as well as the use of IGABT which allow dose escalation to involved lymph nodes and to the primary tumor without major impact on toxicity. As the majority of recurrences are distant, future trials should focus on optimizing systemic therapy. Author Disclosure: A. Saidi: None. I. Fortin: Research Grant; CARO fellowship grant. M. Beauchemin: None. M. Barkati: None.
2740 A Score Combining SUVpeak of the Primary Tumor Computed on Pretreatment FDG-PET Scans and Neutrophilia Predicts Outcome in Locally Advanced Cervical Cancer A. Schernberg,1 S. Reuze,2 C. Robert,3 R. SUN,1 E. Limkin,1 I. Buvat,4 F. Orlhac,4 L. Dercle,5 A. Escande,6 C. Haie-Meder,1 E. Deutsch,7 and C. Chargari8; 1Radiation Oncology department, Gustave Roussy
International Journal of Radiation Oncology Biology Physics
(7%), pre- and post-operative RT (15%), RT alone (4%), surgery->RT>surgery (4%) and chemotherapy only (7%). Of the 15 patients receiving RT, the median dose to the primary was 55 Gy (26-70 Gy). Five patients had regional nodes included in the treatment field (3 pelvic, 2 inguinal). After a median of 44 months follow up, the 5-yr OS is 69%, CSS is 77%, LC is 73% and PFS is 56%. Receipt of RT was not significantly associated with OS, CSS, PFS, LC, or MFS. Of the 10 patients who recurred, 5 developed distant recurrences, 2 local recurrences, and 3 regional nodal recurrences. Of the 15 patients receiving RT, 40% (6/15) recurred, 67% of which were distant only recurrences. Of the 10 patients that received primary site RT with exclusion of inguinal or pelvic LNs, no patients failed in a regional lymph node. Conclusion: In a large single institution series of primary vulvovaginal sarcoma, leiomyosarcoma was the most common histology. The cancer-specific survival was 77%. Of patients treated with primary site only radiation therapy, there were no nodal recurrences, suggesting treatment of the primary alone may be sufficient, although larger numbers are needed to further assess. Author Disclosure: A.L. Russo: None. R. Miao: None. H. Wang: None. J.T. Mullen: None. A.B. Haynes: None. M. Del Carmen: None. T.F. DeLaney: None. Y.E. Chen: None.
Leader Title of the project: Novel Tar. C.B. Simone: ; Annals of Palliative Medicine, Proton Collaborative Group (PCG). V. Verma: None.
2738 Patterns of Care for Stage IA Cervical Cancer: A Study of the Utilization of Curative-Intent Radiation Therapy versus Hysterectomy-Type Surgery J. Ryckman,1 C. Lin,1 C.B. Simone II,2 and V. Verma1; 1Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 2 University of Maryland Medical Center, Baltimore, MD Purpose/Objective(s): The standard of care for clinical IA cervical cancer is surgery versus radiotherapy. Herein, we investigated practice patterns associated with administration of 1) radiation therapy (RT) alone, 2) definitive hysterectomy (HYS) alone, and 3) the addition of RT to HYS. Regarding the treatment of clinical IA cervical cancer, we predict that socioeconomic disparities influence patterns of care. Materials/Methods: The National Cancer Data Base (NCDB) was queried for clinical IA primary cervical cancer cases (2004-2013) receiving curative-intent RT and/or HYS. Patients with unknown RT status were excluded, as were benign histologies and receipt of fertility sparing surgery. Patient, tumor, and treatment parameters were extracted. KaplanMeier analysis was used to evaluate overall survival (OS) between patients receiving 1) RT alone, 2) HYS alone and 3) the addition of RT to HYS. Cox proportional hazards modeling determined variables associated with receipt of RT, HYS and OS. Results: In total, 3816 patients were analyzed (nZ3514 [92.1%] HYS alone, nZ100 [2.6%] RT alone, nZ202 [5.3%] HYS + RT). On multivariate analysis of HYS alone versus RT alone, RT was more likely to be given to patients that were older (p<0.001) and with Medicare (pZ0.011) or uninsured/unknown status (pZ0.003). Treatment by HYS alone approached significance with the two highest income quartiles (pZ0.013, pZ0.054). On multivariate analysis of patients receiving RT in addition to HYS, adjuvant RT was added most commonly for positive margins (pZ<0.001) and increasing age (pZ<0.001). The five year overall survival was higher with HYS alone than with RT alone (96% vs 69%, pZ<0.0001). The addition of RT to HYS did not improve overall survival. Conclusion: Socioeconomic factors were associated with receipt of RT alone versus HYS alone for clinical stage IA cervical cancer. Although these data must be further validated with better-defined patient selection, these factors need to be addressed in order to ensure the highest quality cancer care to all patients. Author Disclosure: J. Ryckman: None. C. Lin: Research Grant; DHHS/ NIH/NCI, Eppley Cancer center at UNMC, Quest Pharma Tech, Inc.. To purchase a research drug; Eppley Cancer center at UNMC. Focus is on translational studies that address basic and clinical issues of importance to improving outcome of patients with pancreatic cancer. Role: Project
2739 IMRT With Image-Guided Brachytherapy in Nonmetastatic Locally Advanced Cervical Cancer A. Saidi, I. Fortin, M.C. Beauchemin, and M. Barkati; Centre Hospitalier de l’Universite de Montreal, Montreal, QC, Canada Purpose/Objective(s): Intensity modulated radiotherapy (IMRT) and image-guided adaptive brachytherapy (IGABT) have been only recently introduced in the treatment of locally advanced cervical cancer (LACC). We retrospectively assessed the overall clinical outcomes, patterns of failure, and toxicity in LACC patients from a single institution in a modern treatment era. Materials/Methods: A cohort of 138 patients with cervical squamous cell carcinoma or adenocarcinoma was treated with IMRT to a dose of 45 Gy and a boost of 5.4 to 14.4 Gy for involved lymph nodes, with concomitant chemotherapy, and IGABT. D2cc of the rectum, bladder and bowel were converted into the equivalent dose in 2 Gy fractions (EQD2) using a linear quadratic model (a/bZ3 Gy). PET-scan was done for all patients at diagnosis and in the majority of patients (NZ127) to assess treatment response. We reported late toxicity using RTOG/EORTC scoring system. Kaplan-Meier analyses for overall survival (OS), disease-free survival (DFS), pelvic control (PC) and local control (LC) were performed. Results: Of 138 patients identified and treated between March 2011 and November 2015, 50 had stage IB, 62 had stage II, 21 had stage III and 5 had stage IVA. The median age was 51 years (range, 28-93). Histology was squamous cell carcinoma in 118 patients (85.5%). All patients had a staging PET-scan and 97% had an MRI at diagnosis. MRI tumor volume was >30 cm3 in 47% of cases. Nodal involvement was reported in 82 patients (59.4%). The median follow-up was 28 months. Endocavitary high-dose rate (HDR) IGABT was used for all patients. The median prescribed dose to the tumor was 84.3 Gy. The median D2cc to the bladder, rectum and bowel was 82.2 Gy, 67.6 Gy and 78.9 Gy, respectively. Complete PET response was observed in 113 out of 127 patients (89%). Three-year OS and DFS were 85.3% and 78.9%, respectively. Local control and pelvic control rates at 3 years were 94.8% and 91.9%, respectively. Twenty-seven patients (19.6%) were diagnosed with recurrent disease. Of these, 20 had evidence of distant recurrence and 3 had isolated local relapse. Four patients had only regional nodal recurrence, 3 of which were para-aortic recurrences that were not included in the original treatment field. Median time to relapse was 8 months (range, 2.5-45). Grade 3 late toxicities for bladder, vagina and bowel were observed in 4%, 3% and 2% of patients, respectively. Conclusion: Contemporary treatment of LACC with chemoradiation using IMRT and IGABT yields to higher rates of OS and DFS compared to previously published series. These good outcomes can be attributed to thorough clinical staging using PET-scan and MRI, the use of IMRT as well as the use of IGABT which allow dose escalation to involved lymph nodes and to the primary tumor without major impact on toxicity. As the majority of recurrences are distant, future trials should focus on optimizing systemic therapy. Author Disclosure: A. Saidi: None. I. Fortin: Research Grant; CARO fellowship grant. M. Beauchemin: None. M. Barkati: None.
2740 A Score Combining SUVpeak of the Primary Tumor Computed on Pretreatment FDG-PET Scans and Neutrophilia Predicts Outcome in Locally Advanced Cervical Cancer A. Schernberg,1 S. Reuze,2 C. Robert,3 R. SUN,1 E. Limkin,1 I. Buvat,4 F. Orlhac,4 L. Dercle,5 A. Escande,6 C. Haie-Meder,1 E. Deutsch,7 and C. Chargari8; 1Radiation Oncology department, Gustave Roussy