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Intensity Modulated Radiotherapy for Gastric Cancers: Toxicity and Clinical Outcome
I. J. Radiation Oncology d Biology d Physics
S264
Volume 72, Number 1, Supplement, 2008
Materials/Methods: Between March 2003 and February 2007, 24 inoperable patients were treated by SRT (32-51 Gy in 3 or 4 fractions). Four patients declined other alternative treatment and 20 patients failed previous treatment including transcatheter arterial chemoembolization or radiofrequency ablation. Sixteen patients had solitary mass and 8 patients had multiple masses in the liver. The diameter of treated tumor was 2.6-15.8 cm (median 5.2 cm). The follow-up duration from SRT was 4-46 months (median 15 months). Results: The 1-year and 2-year overall survival rates were 54.2% and 35.0%, respectively (median 15 months). The 1-year and 2year local progression free control rate was 62.5% and 46.9%, respectively (median 14 months). The group treated by over 70 Gy (NTD2Gy) showed better survival than that treated by \70 Gy (p = 0.037). Planning target volume and serum alpha-fetoprotein level before SBRT were also statistically significant prognostic factor for survival (p = 0.008 and 0.023, respectively). Severe acute radiation toxicity was not observed during follow-up period. A patient could receive lobectomy after SRT by virtue of decrease of tumor size and expansion of normal liver volume and he survives 35 months after SRT. Conclusions: The result of SRT is comparable to previous reports in localized unresectable HCC without severe complication. We have shown that the SRT is an effective and safe treatment modality. It should be considered to be a potentially valuable treatment option. Author Disclosure: Y. Seo, None; M. Kim, None; S. Yoo, None; C. Cho, None; K. Yang, None; H. Yoo, None; C. Choi, None; Y. Ji, None; D. Lee, None; C. Han, None.
2211
Intensity Modulated Radiotherapy for Gastric Cancers: Toxicity and Clinical Outcome
Y. Minn, J. Ford, G. A. Fisher, J. Norton, A. C. Koong, D. T. Chang Stanford University Cancer Center, Stanford, CA Purpose/Objective(s): To report the outcomes and toxicity of intensity-modulated radiotherapy (IMRT) for adenocarcinoma of the stomach. Materials/Methods: Nineteen patients with Stage IB-IV gastric cancers were treated with postoperative IMRT from August 2002 - August 2007 at Stanford University. Median dose was 45 Gy (range, 43.2-54 Gy). Respiratory gating was utilized in 68% of patients. All patients received concurrent chemotherapy with capecitabine (n = 13), 5-FU (n = 4), or carboplatin/ capecitabine (n = 2). Eighteen patients received 1-3 cycles of chemotherapy prior to start of RT, and 17 patients received 1-2 cycles post-RT. The IMRT plans were generated to minimize dose received to the liver, kidneys, and spinal cord. Median mean dose to the kidney receiving higher radiation was 14.0 Gy (range, 7.0-19.7 Gy), and median mean dose to the kidney receiving less radiation was 11.2 Gy (range, 3.7-14.7 Gy). Median V20 for the higher dose kidney and lower dose kidney was 17.6% (range, 13.8-35.8%) and 9.6% (range, 0.9-23.2%), respectively. Median mean dose for both kidneys was 12.7 Gy (range, 5.4-15.5 Gy) and median V20 for both kidneys was 14.7% (range, 8.5-27.5%). Median mean liver dose was 16.1 Gy (10.1-23.8 Gy). Results: Median age at diagnosis was 54.2 years (range, 43-76.4 years). Median follow-up time from diagnosis is 19.4 mo (range, 7-43.6 mo). Eighteen patients had adenocarcinoma and 1 had undifferentiated carcinoma. Seven patients had signet ring features. At last follow-up, 5 patients have died, 3 patients are alive with progressive disease, and 11 patients are alive with no evidence of disease. Median overall survival (OS) and progression-free survival (PFS) have not been reached. The 2-year OS and PFS from surgery was 88% and 78%, respectively. Two patients had a local recurrence at the anastomosis site. Seven patients had distant metastases. Overall, the radiation treatment was well tolerated. No feeding tube placement was required due to treatment toxicity, although 7 patients had feeding tubes placed at the time of surgery. No patient required treatment breaks due to toxicity, but 1 patient refused treatment for several days due to personal reasons. Mean weight loss was 5.9 lbs (range, 0-15lbs). A total of 14/18 (78%) of patients experienced Grade 2 or less acute GI toxicity. 4/18 (22%) had Grade 3 acute GI toxicity. Grade 3 late toxicity was experienced by 4 patients: small bowel obstruction (n = 2), strictures requiring surgery (n = 1), lysis of adhesions requiring surgery (n = 1). Grade 2 late toxicity was experienced by 2 patients (gastritis n = 1, ulcer n = 1). No late renal toxicity has been observed (median pre-RT and recent post-RT serum creatinine level were both 0.9 mg/dL). Conclusions: An IMRT for gastric cancers is a well-tolerated treatment technique that provides excellent local control, with less dose to normal organs. No evidence of late renal dysfunction has been observed. Author Disclosure: Y. Minn, None; J. Ford, None; G.A. Fisher, None; J. Norton, None; A.C. Koong, None; D.T. Chang, None.
2212
A Comparative Study on Radiology and Pathology Target Volume in Primary Liver Cancer
F. Shi, J. Yu, X. Shi, L. Kong, G. Wei, M. Li, W. Li Shandong Tumor Hospital, China Background: The incidence of primary liver cancer (PLC) in China is high. Three dimensional conformal radiation therapy (3DCRT) and intensity-modulated radiation therapy (IMRT) are currently being explored as a new radiation technique for the treatment of localized primary liver cancer and hepatic metastases. Using this technique, tumor control probability and patient’s survival rate have been improved, while the radiation-induced liver disease reduced. Therefore, it is important to know how much margin is needed to ensure accurate radiation dose delivery. However, there is no report about the accurate margin in the radiation therapy of PLC. Purpose/Objective(s): In this study, according to the contrast of gross tumor volume (GTV) of primary liver cancer (PLC) between radiology and pathology, we tried to define the correlation of GTV between radiology and pathology, and define the degree of local microscopic extension (ME) of PLC, so to define the margin of CTV precisely. At the process of target volume definition of 3D-CRT and IMRT, the GTV of radiology could direct the definition of CTV precisely. To provide accordance how much margin would be enough from GTV to CTV of 3D-CRT and IMRT. Materials/Methods: From February 2006 to December 2006, 28 PLC patients after surgical resection were studied. All patients had a CT scan of the liver before surgery and had routine pathology examination after surgery. We measured the tumor sizes at X
S264
Volume 72, Number 1, Supplement, 2008
Materials/Methods: Between March 2003 and February 2007, 24 inoperable patients were treated by SRT (32-51 Gy in 3 or 4 fractions). Four patients declined other alternative treatment and 20 patients failed previous treatment including transcatheter arterial chemoembolization or radiofrequency ablation. Sixteen patients had solitary mass and 8 patients had multiple masses in the liver. The diameter of treated tumor was 2.6-15.8 cm (median 5.2 cm). The follow-up duration from SRT was 4-46 months (median 15 months). Results: The 1-year and 2-year overall survival rates were 54.2% and 35.0%, respectively (median 15 months). The 1-year and 2year local progression free control rate was 62.5% and 46.9%, respectively (median 14 months). The group treated by over 70 Gy (NTD2Gy) showed better survival than that treated by \70 Gy (p = 0.037). Planning target volume and serum alpha-fetoprotein level before SBRT were also statistically significant prognostic factor for survival (p = 0.008 and 0.023, respectively). Severe acute radiation toxicity was not observed during follow-up period. A patient could receive lobectomy after SRT by virtue of decrease of tumor size and expansion of normal liver volume and he survives 35 months after SRT. Conclusions: The result of SRT is comparable to previous reports in localized unresectable HCC without severe complication. We have shown that the SRT is an effective and safe treatment modality. It should be considered to be a potentially valuable treatment option. Author Disclosure: Y. Seo, None; M. Kim, None; S. Yoo, None; C. Cho, None; K. Yang, None; H. Yoo, None; C. Choi, None; Y. Ji, None; D. Lee, None; C. Han, None.
2211
Intensity Modulated Radiotherapy for Gastric Cancers: Toxicity and Clinical Outcome
Y. Minn, J. Ford, G. A. Fisher, J. Norton, A. C. Koong, D. T. Chang Stanford University Cancer Center, Stanford, CA Purpose/Objective(s): To report the outcomes and toxicity of intensity-modulated radiotherapy (IMRT) for adenocarcinoma of the stomach. Materials/Methods: Nineteen patients with Stage IB-IV gastric cancers were treated with postoperative IMRT from August 2002 - August 2007 at Stanford University. Median dose was 45 Gy (range, 43.2-54 Gy). Respiratory gating was utilized in 68% of patients. All patients received concurrent chemotherapy with capecitabine (n = 13), 5-FU (n = 4), or carboplatin/ capecitabine (n = 2). Eighteen patients received 1-3 cycles of chemotherapy prior to start of RT, and 17 patients received 1-2 cycles post-RT. The IMRT plans were generated to minimize dose received to the liver, kidneys, and spinal cord. Median mean dose to the kidney receiving higher radiation was 14.0 Gy (range, 7.0-19.7 Gy), and median mean dose to the kidney receiving less radiation was 11.2 Gy (range, 3.7-14.7 Gy). Median V20 for the higher dose kidney and lower dose kidney was 17.6% (range, 13.8-35.8%) and 9.6% (range, 0.9-23.2%), respectively. Median mean dose for both kidneys was 12.7 Gy (range, 5.4-15.5 Gy) and median V20 for both kidneys was 14.7% (range, 8.5-27.5%). Median mean liver dose was 16.1 Gy (10.1-23.8 Gy). Results: Median age at diagnosis was 54.2 years (range, 43-76.4 years). Median follow-up time from diagnosis is 19.4 mo (range, 7-43.6 mo). Eighteen patients had adenocarcinoma and 1 had undifferentiated carcinoma. Seven patients had signet ring features. At last follow-up, 5 patients have died, 3 patients are alive with progressive disease, and 11 patients are alive with no evidence of disease. Median overall survival (OS) and progression-free survival (PFS) have not been reached. The 2-year OS and PFS from surgery was 88% and 78%, respectively. Two patients had a local recurrence at the anastomosis site. Seven patients had distant metastases. Overall, the radiation treatment was well tolerated. No feeding tube placement was required due to treatment toxicity, although 7 patients had feeding tubes placed at the time of surgery. No patient required treatment breaks due to toxicity, but 1 patient refused treatment for several days due to personal reasons. Mean weight loss was 5.9 lbs (range, 0-15lbs). A total of 14/18 (78%) of patients experienced Grade 2 or less acute GI toxicity. 4/18 (22%) had Grade 3 acute GI toxicity. Grade 3 late toxicity was experienced by 4 patients: small bowel obstruction (n = 2), strictures requiring surgery (n = 1), lysis of adhesions requiring surgery (n = 1). Grade 2 late toxicity was experienced by 2 patients (gastritis n = 1, ulcer n = 1). No late renal toxicity has been observed (median pre-RT and recent post-RT serum creatinine level were both 0.9 mg/dL). Conclusions: An IMRT for gastric cancers is a well-tolerated treatment technique that provides excellent local control, with less dose to normal organs. No evidence of late renal dysfunction has been observed. Author Disclosure: Y. Minn, None; J. Ford, None; G.A. Fisher, None; J. Norton, None; A.C. Koong, None; D.T. Chang, None.
2212
A Comparative Study on Radiology and Pathology Target Volume in Primary Liver Cancer
F. Shi, J. Yu, X. Shi, L. Kong, G. Wei, M. Li, W. Li Shandong Tumor Hospital, China Background: The incidence of primary liver cancer (PLC) in China is high. Three dimensional conformal radiation therapy (3DCRT) and intensity-modulated radiation therapy (IMRT) are currently being explored as a new radiation technique for the treatment of localized primary liver cancer and hepatic metastases. Using this technique, tumor control probability and patient’s survival rate have been improved, while the radiation-induced liver disease reduced. Therefore, it is important to know how much margin is needed to ensure accurate radiation dose delivery. However, there is no report about the accurate margin in the radiation therapy of PLC. Purpose/Objective(s): In this study, according to the contrast of gross tumor volume (GTV) of primary liver cancer (PLC) between radiology and pathology, we tried to define the correlation of GTV between radiology and pathology, and define the degree of local microscopic extension (ME) of PLC, so to define the margin of CTV precisely. At the process of target volume definition of 3D-CRT and IMRT, the GTV of radiology could direct the definition of CTV precisely. To provide accordance how much margin would be enough from GTV to CTV of 3D-CRT and IMRT. Materials/Methods: From February 2006 to December 2006, 28 PLC patients after surgical resection were studied. All patients had a CT scan of the liver before surgery and had routine pathology examination after surgery. We measured the tumor sizes at X