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Intensity Modulated Proton Therapy For Retreatment of Thoracic Malignancy: A Single Institution Experience
E520
International Journal of Radiation Oncology Biology Physics
Conclusion: The observed 1-year LC rate for intact and resected metastases was comparable to that seen in other institutional experiences. Of the resection cavities that failed, almost all were in-field recurrences despite excellent target dose coverage. Resection cavities treated with a dose of 25 Gy had a higher failure rate compared to those treated with 30 Gy. These data suggest that 25 Gy in 5-fractions may not be sufficient for long-term control of resected brain metastases and higher doses should be considered. Author Disclosure: D.M. Francis: None. H.B. Musunuru: None. P. Yadav: None. A. Bayliss: None. H.C. Ko: None. A. Burr: None. M.F. Bassetti: Stock; Seattle genetics. S.P. Howard: None. A.M. Baschnagel: None.
Purpose/Objective(s): This retrospective study describes a single institution’s technique and early experience with Intensity Modulated Proton Therapy (IMPT) for re-irradiation of recurrent malignancies in the chest over the past 3 years. The primary endpoint was loco-regional failure. Secondary endpoints included acute toxicities and overall survival. Materials/Methods: We identified 15 patients in this category. Group 1 (N Z 5 patients with extra-thoracic disease) was treated with palliative intent (doses from 45-55 Gy). Group 2 (N Z 10 patients with no extra-thoracic disease) was treated with curative intent (doses from 60-70 Gy). Patients, immobilized with a Vac-Q-Fix cushion, were set up in the supine position with their arms over their head. All patients underwent 4-D CT simulation for treatment planning. For tumor motion < 1 cm, the ITV technique was done. For motion > 1 cm, motion was managed with the Deep Inspiration Breath Hold SDX system. CT with contrast and PET were used. Weekly adaptive CT simulation was done. 1-3 beams using IMPT with SFO technique was used. All cases were reviewed and approved by our physicist and physician treatment planning conference weekly. Results: With median follow-up of 18 months, most patients had grade 1-2 lung and skin toxicities. There were no grade 3 or greater acute or late toxicities. 2 patients in Group 1 and 7 patients in Group 2 patients are still alive, of which, 5 of 7 have local control. Conclusion: From our early experience, IMPT is a feasible and safe modality for re-treatment of recurrent cancer in the thorax after previous radiation. Further validation with more patients and longer follow-up is needed. Author Disclosure: F. Giap: None. R. Lepage: None. L. Dong: Speaker’s Bureau; Varian Medical Systems. Advisory Board; Varian Medical Systems. Patent/License Fees/Copyright; Varian Medical System. H.B. Giap: Independent Contractor; Advanced Particle Therapy, LLC, Signet HealthCare of Asia. Stock; California Proton Therapy Center. Particle Therapy Co-Operative Group.
3234 Kypho-IORT: A New Treatment Paradigm for Pathological Fractures A. Latefi,1 D.J. Mark,2 R. Meshrekey,2 E.E. Klein,3 F. Diaz Molina,2 Y. Chen,2 and M. Ghaly3; 1Department of Neurological Surgery, Hofstra Northwell School of Medicine, Manhasset, NY, 2Department of Radiation Medicine, Hofstra Northwell School of Medicine, Lake Success, NY, 3 Department of Radiation Medicine, Northwell Health, Lake Success, NY Purpose/Objective(s): The objective of this prospective study was to assess the safety and efficacy of Kypho-IORT for painful vertebral body (VB) fractures in cancer patients. Materials/Methods: Patients with symptomatic osteolytic vertebral body metastasis underwent Kypho-IORT: kyphoplasty procedures and intraoperative radiotherapy with the ZEISS INTRABEAM System followed by cement augmentation. Tumors were limited to vertebral body (sector 1) using the International Spine Radiosurgery Consortium (ISRC) anatomic classification system, SINS scores of 7-12, and Bilsky grade of 0. Intraoperative CT delineation of gross tumor volume, needle applicator tip, and OAR was done with deformable image registration, integrating pre-operative CT and MRI images. 10 Gy was prescribed to a distance from the source tip to the distal boundary, based on the mean radius plus SD. The prescription was limited by a maximum dose limit to the spinal cord of 12 Gy. Quality of Life Measurements were done using the QOL [EORTC QLQ-C30 (version 3)], the Brief Pain Inventory (BPI), Numerical Rating Pain Scale (NRPS), ambulation, and narcotic use pre- and post-procedure at 1-week, 3-month, 6-month, 9-month, 1-year, and 2-year intervals. The involved spine will be imaged at 3-month intervals up to one year and at 2 years post-procedure. Results: 7 vertebral levels were treated. All patients were discharged home within 12 hours of the Kypho-IORT procedure. There was a statistically significant reduction in patient reported NPRS scores from preoperative baseline within 2 weeks (6.571.4 preoperative versus 3.572.57 postoperatively; pZ0.0189). After 3 months, one patient with metastatic rectal cancer suffered local progression. Patients also experienced better quality of life with respect to bone metastasis-specific issues. The QLQ-C30 is able to discriminate among patients with varying responses. Conclusion: Kypho-IORT is a safe treatment option for potentially unstable spinal metastases. Patient reported pain scores significantly improve within two weeks with improved quality of life. Long-term follow up is necessary to further evaluate efficacy. Author Disclosure: A. Latefi: None. D.J. Mark: None. R. Meshrekey: None. E.E. Klein: ; IJORBP. F. Diaz Molina: None. Y. Chen: None. M. Ghaly: None.
3235 Intensity Modulated Proton Therapy For Retreatment of Thoracic Malignancy: A Single Institution Experience F. Giap,1 R. Lepage,2 L. Dong,2 and H.B. Giap2; 1University of Texas Southwestern, Dallas, TX, 2Scripps Proton Therapy Center, San Diego, CA
3236 A Phase 2 Study of Palliative Radiation Therapy Combined With Zoledronic Acid Hydrate for Bone Metastases from Renal Cell Carcinoma: A Japanese Radiation Oncology Study Group Trial H. Harada,1 N. Shikama,2 H. Wada,3 M. Nozaki,4 N. Uchida,5 K. Hayakawa,6 K. Yamada,7 and H. Nagakura8; 1Division of Radiation Oncology, Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan, 2 Department of Radiation Oncology, Saitama Medical University International Medical Center, Hidaka-City, Japan, 3Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan, 4Dokkyo Medical University, Koshigaya, Japan, 5Tottori Prefectural Central Hospital, Tottori, Japan, 6Kitasato University, Kanagawa, Japan, 7Seirei Mikatahara General Hospital, Hamamatsu, Japan, 8KKR sapporo medical cancer, sapporo, Japan Purpose/Objective(s): Palliative radiotherapy (RT) is the standard of care for bone metastases. However, local recurrence or skeletal related events (SREs) from radioresistant histology types, such as renal cell carcinoma (RCC), in previously irradiated bone are still frequent and problematic. Historical data show that more than half of irradiated bone develop SREs within 1 year. Zoledronic acid hydrate is reported to have significantly reduced the risk of SREs in patients with RCC. However, whether zoledronic acid hydrate with palliative RT significantly reduces SREs over palliative RT alone has not been determined. The primary objective of this study was to determine whether zoledronic acid hydrate and palliative dose RT could prevent local SREs. Materials/Methods: This study was a multi-institutional, single arm, confirmatory phase II trial. Eligible patients with bone metastases from primary RCC were treated with zoledronic acid hydrate of 4 mg repeated every three or four weeks, with concurrent palliative RT of 30 Gy in 3 Gy per daily fraction. Patients with complicated bone metastases (impending pathological fracture or spinal cord compression) that required surgery
International Journal of Radiation Oncology Biology Physics
Conclusion: The observed 1-year LC rate for intact and resected metastases was comparable to that seen in other institutional experiences. Of the resection cavities that failed, almost all were in-field recurrences despite excellent target dose coverage. Resection cavities treated with a dose of 25 Gy had a higher failure rate compared to those treated with 30 Gy. These data suggest that 25 Gy in 5-fractions may not be sufficient for long-term control of resected brain metastases and higher doses should be considered. Author Disclosure: D.M. Francis: None. H.B. Musunuru: None. P. Yadav: None. A. Bayliss: None. H.C. Ko: None. A. Burr: None. M.F. Bassetti: Stock; Seattle genetics. S.P. Howard: None. A.M. Baschnagel: None.
Purpose/Objective(s): This retrospective study describes a single institution’s technique and early experience with Intensity Modulated Proton Therapy (IMPT) for re-irradiation of recurrent malignancies in the chest over the past 3 years. The primary endpoint was loco-regional failure. Secondary endpoints included acute toxicities and overall survival. Materials/Methods: We identified 15 patients in this category. Group 1 (N Z 5 patients with extra-thoracic disease) was treated with palliative intent (doses from 45-55 Gy). Group 2 (N Z 10 patients with no extra-thoracic disease) was treated with curative intent (doses from 60-70 Gy). Patients, immobilized with a Vac-Q-Fix cushion, were set up in the supine position with their arms over their head. All patients underwent 4-D CT simulation for treatment planning. For tumor motion < 1 cm, the ITV technique was done. For motion > 1 cm, motion was managed with the Deep Inspiration Breath Hold SDX system. CT with contrast and PET were used. Weekly adaptive CT simulation was done. 1-3 beams using IMPT with SFO technique was used. All cases were reviewed and approved by our physicist and physician treatment planning conference weekly. Results: With median follow-up of 18 months, most patients had grade 1-2 lung and skin toxicities. There were no grade 3 or greater acute or late toxicities. 2 patients in Group 1 and 7 patients in Group 2 patients are still alive, of which, 5 of 7 have local control. Conclusion: From our early experience, IMPT is a feasible and safe modality for re-treatment of recurrent cancer in the thorax after previous radiation. Further validation with more patients and longer follow-up is needed. Author Disclosure: F. Giap: None. R. Lepage: None. L. Dong: Speaker’s Bureau; Varian Medical Systems. Advisory Board; Varian Medical Systems. Patent/License Fees/Copyright; Varian Medical System. H.B. Giap: Independent Contractor; Advanced Particle Therapy, LLC, Signet HealthCare of Asia. Stock; California Proton Therapy Center. Particle Therapy Co-Operative Group.
3234 Kypho-IORT: A New Treatment Paradigm for Pathological Fractures A. Latefi,1 D.J. Mark,2 R. Meshrekey,2 E.E. Klein,3 F. Diaz Molina,2 Y. Chen,2 and M. Ghaly3; 1Department of Neurological Surgery, Hofstra Northwell School of Medicine, Manhasset, NY, 2Department of Radiation Medicine, Hofstra Northwell School of Medicine, Lake Success, NY, 3 Department of Radiation Medicine, Northwell Health, Lake Success, NY Purpose/Objective(s): The objective of this prospective study was to assess the safety and efficacy of Kypho-IORT for painful vertebral body (VB) fractures in cancer patients. Materials/Methods: Patients with symptomatic osteolytic vertebral body metastasis underwent Kypho-IORT: kyphoplasty procedures and intraoperative radiotherapy with the ZEISS INTRABEAM System followed by cement augmentation. Tumors were limited to vertebral body (sector 1) using the International Spine Radiosurgery Consortium (ISRC) anatomic classification system, SINS scores of 7-12, and Bilsky grade of 0. Intraoperative CT delineation of gross tumor volume, needle applicator tip, and OAR was done with deformable image registration, integrating pre-operative CT and MRI images. 10 Gy was prescribed to a distance from the source tip to the distal boundary, based on the mean radius plus SD. The prescription was limited by a maximum dose limit to the spinal cord of 12 Gy. Quality of Life Measurements were done using the QOL [EORTC QLQ-C30 (version 3)], the Brief Pain Inventory (BPI), Numerical Rating Pain Scale (NRPS), ambulation, and narcotic use pre- and post-procedure at 1-week, 3-month, 6-month, 9-month, 1-year, and 2-year intervals. The involved spine will be imaged at 3-month intervals up to one year and at 2 years post-procedure. Results: 7 vertebral levels were treated. All patients were discharged home within 12 hours of the Kypho-IORT procedure. There was a statistically significant reduction in patient reported NPRS scores from preoperative baseline within 2 weeks (6.571.4 preoperative versus 3.572.57 postoperatively; pZ0.0189). After 3 months, one patient with metastatic rectal cancer suffered local progression. Patients also experienced better quality of life with respect to bone metastasis-specific issues. The QLQ-C30 is able to discriminate among patients with varying responses. Conclusion: Kypho-IORT is a safe treatment option for potentially unstable spinal metastases. Patient reported pain scores significantly improve within two weeks with improved quality of life. Long-term follow up is necessary to further evaluate efficacy. Author Disclosure: A. Latefi: None. D.J. Mark: None. R. Meshrekey: None. E.E. Klein: ; IJORBP. F. Diaz Molina: None. Y. Chen: None. M. Ghaly: None.
3235 Intensity Modulated Proton Therapy For Retreatment of Thoracic Malignancy: A Single Institution Experience F. Giap,1 R. Lepage,2 L. Dong,2 and H.B. Giap2; 1University of Texas Southwestern, Dallas, TX, 2Scripps Proton Therapy Center, San Diego, CA
3236 A Phase 2 Study of Palliative Radiation Therapy Combined With Zoledronic Acid Hydrate for Bone Metastases from Renal Cell Carcinoma: A Japanese Radiation Oncology Study Group Trial H. Harada,1 N. Shikama,2 H. Wada,3 M. Nozaki,4 N. Uchida,5 K. Hayakawa,6 K. Yamada,7 and H. Nagakura8; 1Division of Radiation Oncology, Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan, 2 Department of Radiation Oncology, Saitama Medical University International Medical Center, Hidaka-City, Japan, 3Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan, 4Dokkyo Medical University, Koshigaya, Japan, 5Tottori Prefectural Central Hospital, Tottori, Japan, 6Kitasato University, Kanagawa, Japan, 7Seirei Mikatahara General Hospital, Hamamatsu, Japan, 8KKR sapporo medical cancer, sapporo, Japan Purpose/Objective(s): Palliative radiotherapy (RT) is the standard of care for bone metastases. However, local recurrence or skeletal related events (SREs) from radioresistant histology types, such as renal cell carcinoma (RCC), in previously irradiated bone are still frequent and problematic. Historical data show that more than half of irradiated bone develop SREs within 1 year. Zoledronic acid hydrate is reported to have significantly reduced the risk of SREs in patients with RCC. However, whether zoledronic acid hydrate with palliative RT significantly reduces SREs over palliative RT alone has not been determined. The primary objective of this study was to determine whether zoledronic acid hydrate and palliative dose RT could prevent local SREs. Materials/Methods: This study was a multi-institutional, single arm, confirmatory phase II trial. Eligible patients with bone metastases from primary RCC were treated with zoledronic acid hydrate of 4 mg repeated every three or four weeks, with concurrent palliative RT of 30 Gy in 3 Gy per daily fraction. Patients with complicated bone metastases (impending pathological fracture or spinal cord compression) that required surgery