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Lack of Survival Benefit in Patients with Anaplastic Astrocytoma Treated with Temozolomide during Radiotherapy
Proceedings of the 53rd Annual ASTRO Meeting
S269
Conclusions: Patients treated in this study showed less skin toxicity after 50 Gy EBRT compared to similar patient cohorts. Smoking before and/or during EBRT, absence of allergies, and breast size, T3/4 stage disease and antihormonal therapy were found to have significant influence on skin toxicity at the end of EBRT. Author Disclosure: U. Kraus-Tiefenbacher: None. G. Welzel: None. A. Sfinitzky: None. A. Simeonova: None. K. Siebenlist: None. F. Wenz: None.
2118
Dosimetric Parameters and Clinical Characteristics of Early Stage Breast Cancer Patients Treated with the SAVI Breast Brachytherapy Device
M. E. Pinn-Bingham, J. Zhang, S. Dietrich, W. Braggins, V. Sehgal, M. Al-Ghazi, J. Wong, J. Kuo, N. Ramsinghani University of California Irvine Medical Center, Orange, CA Purpose/Objective(s): The purpose of this retrospective study is to present our clinical experience and dosimetric parameters with Accelerated Partial Breast Irradiation (APBI) using the Strut-Adjusted Volume Implant (SAVI) applicator. Materials/Methods: Between June 2009 and January 2011, a total of 18 patients with 19 SAVIÔ devices (one patient had bilateral implants) completed treatment at the University of California, Irvine (Orange, CA). Six patients had Stage 0, six Stage I, six Stage IIA, and one Stage IIIA disease. All patients were treated per guidelines specified in the NSABP B-39/RTOG 0413 protocol. Two patients were treated with the size 6-1 mini, seven with size 6-1, eleven with size 8-1, and one with size 10-1. Each treatment plan was evaluated for conformance of the dose to the PTV using the following dosimetric parameters: balloon/cavity volume, PTV volume, V90, V100, V150, V200 and skin dose. Results: The median age was 55 years (range, 43-84 years). Most patients were postmenopausal (89%). Median tumor size was 1.15 cm (range, 0.01-3 cm). Tumors were positive for estrogen receptors in 68.4% of patients, progesterone receptor positive in 57.9% of patients, and Her2neu negative in 100% of reported patients. Ductal carcinoma in situ was present in 6 cancers (31.6%) and infiltrating ductal carcinoma in the remaining 68.4%. For all cases, the median cavity volume was 34.4 cc (min: 12.8 cc, max: 56.1 cc). The median PTV volume was 74.3 cc (min: 53.0 cc, max: 120.1 cc). For all cases, the median V90 was 98.9% (min: 96.0%, max: 100%). The median V100 was 93.8% (min: 87.9%, max: 98.8%). The median of V150 was 33.2 cc (min: 22.4 cc, max: 46.7 cc). The median of V200 was 16.5 cc (min: 11.1 cc, max: 23.9 cc). The median skin dose was 86.5% (min: 53.2%, max: 137.1%). Conclusions: Our results indicate that the SAVI breast brachytherapy device allows great flexibility in sculpting the dose around the tumor volume while limiting the skin dose. We have achieved excellent dosimetry comparable to that reported in the literature. Future directions will include comparing dosimetric parameters to long-term clinical outcomes. Author Disclosure: M.E. Pinn-Bingham: None. J. Zhang: None. S. Dietrich: None. W. Braggins: None. V. Sehgal: None. M. Al-Ghazi: None. J. Wong: None. J. Kuo: None. N. Ramsinghani: None.
2119
Lack of Survival Benefit in Patients with Anaplastic Astrocytoma Treated with Temozolomide during Radiotherapy
C. A. Barker, M. Chang, K. Beal, T. A. Chan Memorial Sloan-Kettering Cancer Center, New York, NY Purpose/Objective(s): Anaplastic astrocytomas (AA) represent 7% of gliomas. Treatment typically entails maximum safe resection, followed by radiotherapy (RT). Temozolomide (TMZ) chemotherapy (CT) is effective for recurrent AA, and when delivered during and after RT for newly diagnosed glioblastoma. However, the benefit of concurrent TMZ with RT for newly diagnosed AA is uncertain. Prospective studies addressing this question are years from completion therefore we retrospectively assessed the survival benefit of adding TMZ to RT for patients with AA. Materials/Methods: With IRB approval, records of patients $18 years old with primary AA histologically confirmed at MSKCC and treated with RT from 1987-2007 were reviewed, excluding patients on prospective trials to avoid duplicative reporting. Clinical variables including age at diagnosis, Karnofsky performance status (KPS), mental status, and duration of symptoms were recorded to assign patients to a RTOG RPA class. Use of TMZ during RT and use of any CTwas recorded. Survival from date of diagnosis to date of death or last follow-up was recorded. Cox regression and log rank tests were performed to assess the benefit of TMZ during RT. Results: Median follow-up of the 126 patients studied was 28 months. Thirty-three (26%) patients were alive at last follow-up, and had been followed for a median of 72 months. Median age, KPS and duration of symptoms were 43 years, 90% and 8 weeks. Mental status was abnormal in 25 (19%) patients. Twenty-one (17%) patients received TMZ during RT, and 108 (86%) patients received CT after RT. Cox regression revealed an association of RTOG RPA class (p\0.001, HR = 1.5, 95% CI 1.4-1.6), but not concurrent RT+TMZ use (p = 0.3, HR = 1.3, 95% CI 0.7-1.9) with longer survival. Log rank tests revealed no difference in the survival of patients treated with RT (median survival 32 months) or concurrent RT+TMZ (median survival 26 months, p = 0.5). Distribution of patients and median survival by RTOG RPA class and treatment group (RT or RT+TMZ) is presented in Table 1. Conclusions: In this small retrospective study with inherent limitations, concurrent TMZ during RT was not associated with longer survival in AA. Ongoing studies will further elucidate the benefit of TMZ during and after RT in a randomized fashion (NCT00626990, CATNON). Table 1: Median Survival (in months) of AA Patients by RTOG RPA Class and Treatment Group RTOG RPA Class RT (n =) RT+TMZ (n =)
1
2
3
4
5
6
57 (58) 35 (10)
24 (8) 29 (2)
17 (5) 21 (3)
14 (27) 9 (5)
17 (3) 11 (1)
14 (4) n/a (0)
Author Disclosure: C.A. Barker: None. M. Chang: None. K. Beal: None. T.A. Chan: None.
S269
Conclusions: Patients treated in this study showed less skin toxicity after 50 Gy EBRT compared to similar patient cohorts. Smoking before and/or during EBRT, absence of allergies, and breast size, T3/4 stage disease and antihormonal therapy were found to have significant influence on skin toxicity at the end of EBRT. Author Disclosure: U. Kraus-Tiefenbacher: None. G. Welzel: None. A. Sfinitzky: None. A. Simeonova: None. K. Siebenlist: None. F. Wenz: None.
2118
Dosimetric Parameters and Clinical Characteristics of Early Stage Breast Cancer Patients Treated with the SAVI Breast Brachytherapy Device
M. E. Pinn-Bingham, J. Zhang, S. Dietrich, W. Braggins, V. Sehgal, M. Al-Ghazi, J. Wong, J. Kuo, N. Ramsinghani University of California Irvine Medical Center, Orange, CA Purpose/Objective(s): The purpose of this retrospective study is to present our clinical experience and dosimetric parameters with Accelerated Partial Breast Irradiation (APBI) using the Strut-Adjusted Volume Implant (SAVI) applicator. Materials/Methods: Between June 2009 and January 2011, a total of 18 patients with 19 SAVIÔ devices (one patient had bilateral implants) completed treatment at the University of California, Irvine (Orange, CA). Six patients had Stage 0, six Stage I, six Stage IIA, and one Stage IIIA disease. All patients were treated per guidelines specified in the NSABP B-39/RTOG 0413 protocol. Two patients were treated with the size 6-1 mini, seven with size 6-1, eleven with size 8-1, and one with size 10-1. Each treatment plan was evaluated for conformance of the dose to the PTV using the following dosimetric parameters: balloon/cavity volume, PTV volume, V90, V100, V150, V200 and skin dose. Results: The median age was 55 years (range, 43-84 years). Most patients were postmenopausal (89%). Median tumor size was 1.15 cm (range, 0.01-3 cm). Tumors were positive for estrogen receptors in 68.4% of patients, progesterone receptor positive in 57.9% of patients, and Her2neu negative in 100% of reported patients. Ductal carcinoma in situ was present in 6 cancers (31.6%) and infiltrating ductal carcinoma in the remaining 68.4%. For all cases, the median cavity volume was 34.4 cc (min: 12.8 cc, max: 56.1 cc). The median PTV volume was 74.3 cc (min: 53.0 cc, max: 120.1 cc). For all cases, the median V90 was 98.9% (min: 96.0%, max: 100%). The median V100 was 93.8% (min: 87.9%, max: 98.8%). The median of V150 was 33.2 cc (min: 22.4 cc, max: 46.7 cc). The median of V200 was 16.5 cc (min: 11.1 cc, max: 23.9 cc). The median skin dose was 86.5% (min: 53.2%, max: 137.1%). Conclusions: Our results indicate that the SAVI breast brachytherapy device allows great flexibility in sculpting the dose around the tumor volume while limiting the skin dose. We have achieved excellent dosimetry comparable to that reported in the literature. Future directions will include comparing dosimetric parameters to long-term clinical outcomes. Author Disclosure: M.E. Pinn-Bingham: None. J. Zhang: None. S. Dietrich: None. W. Braggins: None. V. Sehgal: None. M. Al-Ghazi: None. J. Wong: None. J. Kuo: None. N. Ramsinghani: None.
2119
Lack of Survival Benefit in Patients with Anaplastic Astrocytoma Treated with Temozolomide during Radiotherapy
C. A. Barker, M. Chang, K. Beal, T. A. Chan Memorial Sloan-Kettering Cancer Center, New York, NY Purpose/Objective(s): Anaplastic astrocytomas (AA) represent 7% of gliomas. Treatment typically entails maximum safe resection, followed by radiotherapy (RT). Temozolomide (TMZ) chemotherapy (CT) is effective for recurrent AA, and when delivered during and after RT for newly diagnosed glioblastoma. However, the benefit of concurrent TMZ with RT for newly diagnosed AA is uncertain. Prospective studies addressing this question are years from completion therefore we retrospectively assessed the survival benefit of adding TMZ to RT for patients with AA. Materials/Methods: With IRB approval, records of patients $18 years old with primary AA histologically confirmed at MSKCC and treated with RT from 1987-2007 were reviewed, excluding patients on prospective trials to avoid duplicative reporting. Clinical variables including age at diagnosis, Karnofsky performance status (KPS), mental status, and duration of symptoms were recorded to assign patients to a RTOG RPA class. Use of TMZ during RT and use of any CTwas recorded. Survival from date of diagnosis to date of death or last follow-up was recorded. Cox regression and log rank tests were performed to assess the benefit of TMZ during RT. Results: Median follow-up of the 126 patients studied was 28 months. Thirty-three (26%) patients were alive at last follow-up, and had been followed for a median of 72 months. Median age, KPS and duration of symptoms were 43 years, 90% and 8 weeks. Mental status was abnormal in 25 (19%) patients. Twenty-one (17%) patients received TMZ during RT, and 108 (86%) patients received CT after RT. Cox regression revealed an association of RTOG RPA class (p\0.001, HR = 1.5, 95% CI 1.4-1.6), but not concurrent RT+TMZ use (p = 0.3, HR = 1.3, 95% CI 0.7-1.9) with longer survival. Log rank tests revealed no difference in the survival of patients treated with RT (median survival 32 months) or concurrent RT+TMZ (median survival 26 months, p = 0.5). Distribution of patients and median survival by RTOG RPA class and treatment group (RT or RT+TMZ) is presented in Table 1. Conclusions: In this small retrospective study with inherent limitations, concurrent TMZ during RT was not associated with longer survival in AA. Ongoing studies will further elucidate the benefit of TMZ during and after RT in a randomized fashion (NCT00626990, CATNON). Table 1: Median Survival (in months) of AA Patients by RTOG RPA Class and Treatment Group RTOG RPA Class RT (n =) RT+TMZ (n =)
1
2
3
4
5
6
57 (58) 35 (10)
24 (8) 29 (2)
17 (5) 21 (3)
14 (27) 9 (5)
17 (3) 11 (1)
14 (4) n/a (0)
Author Disclosure: C.A. Barker: None. M. Chang: None. K. Beal: None. T.A. Chan: None.