- Email: [email protected]
Larynx-sparing Techniques using Intensity Modulated Radiation Therapy for Head and Neck Cancer Treatment
I. J. Radiation Oncology d Biology d Physics
S482
Volume 78, Number 3, Supplement, 2010
difference in volume of -13.6% (-21.9 to -3.4). The median (range) difference in volume encompassed by the .24Gy isodose (Par24) was -2.7cm3 (-6.3 to 3.5), translating to a median proportional change in volume of -12.7% (-31.9 to 17.2). Absolute volume and recalculated dose data for the recontoured organs on CBCT were similar to the original planning CT contours and dose and the comparison is not presented here. Median (range) mean CLPG dose on week one was 29Gy (22.8 to 49.2) and 26.9Gy (22.7 to 49.4) on week 6 corresponding to a median absolute variation of -0.1Gy (-4.6 to 2.0) (or -0.4% (-15.9 to 8.2)). The estimated NTCP values on weeks one and six were 17% (10 to 67) and 15% (9 to 67), respectively, corresponding to a median variation of -0.2% (-6 to 3) or a proportional change of -2% (-38 to 22). Conclusions: Contralateral parotid gland shrinkage can be observed during a course of therapeutic irradiation and can be quantified using CBCT. The data suggests that the pattern of shrinkage may tend to occur centrifocally within the parotid gland, as both the entire gland and the medial portion (Par24) reduced in size although the range of values for the Par24 was large. The reduction in parotid size does not appear to affect mean dose or estimated NTCP significantly when IG-IMRT is delivered with daily CBCT online matching. Author Disclosure: M. Lei, None; C. Clark, None; E. Adams, None; K. Freeman, None; C. Jamieson, None; M. Dabbs, None; T. Jordan, None; S. Whitaker, None; A. Nisbet, None; T. Guerrero Urbano, None.
2624
Dosimetric and Radiobiological Comparison of Patients with Head and Neck Tumors Treated by Helical Tomotherapy, RapidArc, and Classical IMRT
D. Leignel1, D. Fernandez1, J. Maisonobe1, S. Zefkili2, S. Dupont1, V. Bodez3, D. Ledu1, B. Dessard Diana1, C. Durdux1, P. Giraud1 1 Hopital Europeen Georges Pompidou, Paris, France, 2Institut Curie, Paris, France, 3Institut Sainte Catherine, Avignon, France
Purpose/Objective(s): To evaluate the dosimetric results of three different IMRT techniques on a homogeneous group of patients with head and neck (H&N) tumors. Materials/Methods: From February 2007 and March 2008, 10 patients with oropharynx (7 patients), oral cavity (2 patients), and nasopharynx (1 patient) tumors were treated with HT (Tomotherapy, USA). Same patients were planned for a double modulated dynamic arc therapy using RapidArc (RA) and a sliding window IMRT (swIMRT) (Varian Medical System, USA). A dose of 66 Gy was prescribed to the PTV66 (GTV and enlarged nodes), 56 Gy to the PTV56 (high risk cervical nodes), and 50 Gy to PTV50 (low risk cervical nodes) by simultaneous integrated boost scheme. All relevant DVH parameters, physical indices: Coverage Index (CI, acceptable if . 0.95), Homogeneity Index (HI, acceptable if # 1.1), and radiobiological data (EUD, NTCP), concerning PTVs and Organs at Risk (OAR) were used to compare the 3 IMRT modalities (Artiview, Aquilab, France). Results: The coverage of PTV66 (CI: HT = 0.96±0.04, RA = 0.97±0.1, swIMRT = 0.97±0.02, p = NS) and PTV56 (CI: HT = 0.95±0.03, RA = 0.95±0.02, swIMRT = 0.95±0.02, p = NS) was acceptable with the 3 techniques whereas the coverage of PTV50 was not adequate with RA (CI: RA = 0.94±0.03, HT = 0.97±0.02, swIMRT = 0.95±0.02; p\0.05). HT was the best technique in terms of homogeneity for all PTVs whereas RA significantly decreases the maximum dose (hot spots) in the largest PTV (PTV50 and PTV56) compared to swIMRT (HI: PTV66: HT = 1.06±0.01, RA = 1.10±0.03, swIMRT = 1.11±0.02, p\0.05; PTV56: HT = 1.11±0.02, RA = 1.12±0.02, swIMRT = 1.17±0.03, p\0.05 ; PTV50: HT = 1.10±0.02, RA = 1.13±0.02, swIMRT = 1.22±0.03, p\0.05). There was no difference in mean dose in the ipsi and controlateral parotids (ipsilateral: HT = 24.6 Gy±2.5, RA = 25.3 Gy±3.9, swIMRT = 25.3 Gy±5.0, p = NS; controlateral: HT = 20.3 Gy±3.1, RA = 19.8 Gy±3.0, swIMRT = 22 Gy±3.5, p = NS), but HT is statistically superior to the two other techniques in terms of NTCP (ipsilateral: HT = 21.9 %±7.8, RA = 32.8 %±16.9, swIMRT = 39.2 %±16.3, p = NS; controlateral: HT = 12.4 %±5.8, RA = 20.0 %±13.4, swIMRT = 30.9 %±12.5, p\0.05) and of EUD (ipsilateral: HT = 20.6Gy±3.0, RA = 27.4 Gy±6.0, swIMRT = 27 Gy±6.7, p\0.05; controlateral: HT = 15.1 Gy±5.1, RA = 19.6 Gy±7.9, swIMRT = 22.4Gy±7.8, p = NS). Conclusions: In terms of H&N tumor coverage and homogeneity HT appears to be the best technique while it allows a good protection of normal tissues. RA seems to be a good alternative as it assures a better controlateral parotid preservation than classical IMRT. Author Disclosure: D. Leignel, None; D. Fernandez, None; J. Maisonobe, None; S. Zefkili, None; S. Dupont, None; V. Bodez, None; D. Ledu, None; B. Dessard Diana, None; C. Durdux, None; P. Giraud, None.
2625
Larynx-sparing Techniques using Intensity Modulated Radiation Therapy for Head and Neck Cancer Treatment
H. Lin, V. Bar Ad, L. Appenzoller, Z. Tochner, S. Both University of Pennsylvania, Philadelphia, PA Purpose/Objective(s): Intensity modulated radiation therapy (IMRT) allows for an accurate delivery of prescribed doses to multiple target volumes while sparing organs at risk (OARs). The purpose of the current study was to explore if the laryngeal dose can be reduced by using a whole-field IMRT technique (WF-IMRT) when compared with a junctioned IMRT (J-IMRT). Materials/Methods: WF-IMRT planning was performed by using a concomitant boost technique based on the institutional protocol with a total dose of 57.6 Gy delivered to the planning treatment volume (PTV) 57.6, 64 Gy to the PTV64, and 70.4 Gy to the PTV70.4, with a total of 32 fractions. The PTV57.6 included the clinically negative regions of the neck considered for elective radiation therapy. The PTV64 was defined as the volume including the gross tumor and positive cervical lymph nodes and the surrounding areas of potential microscopic spread. PTV70.4 was defined as the gross extent of tumor, including the primary tumor and the involved cervical lymph. The larynx was defined as superiorly covering the arythnoid cartilages and inferiorly including the thyroid cartilage. The J-IMRT technique consisted of an IMRT plan for the superior neck, matched with conventional half-beam blocked anterior-posterior opposing neck fields at the level of the thyroid notch. A central block was used for the anterior lower neck field to restrict the dose at larynx level and a cord block was used for the posterior field to protect the spinal cord. Fixed jaw technique was used for superior IMRT and there was no gap with inferior fields. Eclipse 8.8 TPS was used for all plans. For each patient, a plan with 7-9 coplanar IMRT beams of 6MV was optimized to achieve best coverage to the target volumes, the minimum dose to larynx and other OARs. The coverage to the PTV and the dose to the larynx were compared between the two techniques.
Proceedings of the 52nd Annual ASTRO Meeting Results: Five consecutive patients with non-laryngeal head and neck cancer were analyzed. Both the primary site and regional lymphatics were included in a WF-IMRT and was compared to a J-IMRT technique. In four cases the neck disease extended inferiorly to the level of the larynx. Using the WF-IMRT the PTV coverage remained excellent while 95% of the PTV57.6 dose coverage was 99.2 ± 0.4% and the minimum, maximum, median and mean laryngeal dose of 16.17± 0.82 Gy, 32.28 ± 4.77 Gy, 18.25 ± 1.05 Gy, and 18.73 ± 1.09 Gy, respectively. Using the J-IMRT technique, the 95% dose coverage for PTV57.6 was 98.04% ± 1.30% and the minimal, maximum, median and mean laryngeal dose of 10.58 ± 1.10 Gy, 51.17 ±7.97 Gy, 15.77 ± 1.74 Gy and 18.19 ±2.17 Gy, respectively. Conclusions: Using WF-IMRT technique allowed optimal coverage of the target volumes and reducing the dose to the larynx while avoided the dosimetric uncertainty at the match line level present with J-IMRT technique. Author Disclosure: H. Lin, None; V. Bar Ad, None; L. Appenzoller, None; Z. Tochner, None; S. Both, None.
2626
Radiation Therapy in the Treatment of Angiosarcoma of the Head and Neck
J. Romanyshyn, S. Wolden, N. Caria, J. Setton, S. G. Patel, J. P. Shah, A. R. Shaha, D. G. Pfister, N. Y. Lee Memorial Sloan-Kettering Cancer Center, New York, NY Purpose/Objective(s): Cutaneous angiosarcoma is an aggressive vascular tumor constituting less than 0.1% of head and neck malignancies. The aim of this retrospective analysis is to analyze the treatment outcomes of patients who received radiotherapy (RT) for angiosarcoma of the head and neck. Materials/Methods: Between 5/91 and 1/09, 20 patients with histologically proven angiosarcoma of the head and neck without a history of prior radiotherapy were treated by RT with curative intent at our institution. The median age was 74 (52-91) years. Twelve patients had unresectable disease and were treated definitively, typically to 6000-7000 cGy. The remaining 8 underwent surgical resection followed by post-op RT, typically to 6000 cGy. Eleven patients received chemotherapy, 8 prior to RT (6 definitive, 2 post-op) and 3 concurrently (2 definitive, 1 post-op), of which the most common agent was paclitaxel. Eleven tumors were .5 cm in diameter (1 post-op, 10 definitive) at presentation, and 75 % originated in the scalp. Overall survival (OS), local relapsefree survival (LRFS), and distant metastasis-free survival (DMFS) were calculated from the date of diagnosis using the KaplanMeier method. Toxicities were graded using the Common Toxicity Criteria v3.0. Results: The median follow-up was 20.7 months (2.4-184) with 6 patients alive at last follow-up. For all patients, the median OS was 31.8 months (1-y OS, 90 %; 2-y OS, 66 %). The median OS was 24.2 months for patients treated definitively and 136 months for those treated post-operatively (p = 0.029). LR occurred in 8 patients after a median of 41.5 months (1-y LRFS, 89 %; 2-y LRFS, 67 %). Three patients developed cervical lymph node metastases after treatment, all of which followed LR. DM occurred in 8 patients at a median of 135 months (1-y DMFS, 82 %; 2-y DMFS, 56 %). Lung was the most common site of DM (n = 7) followed by liver (n = 2). There were no significant differences between definitive and post-op RT in LRFS (p = 0.11) or DMFS (p = 0.27). In the 16 patients with available toxicity data, acute dermatitis was grade 2 in 7 (44 %) and grade 3 in 7 (44%). One patient developed necrosis of his skin graft and underlying calvarium 5 months after receiving 6000 cGy post-operatively. Age .70 years, primary scalp location, tumor size .5 cm, and the addition of chemotherapy were examined by univariate analysis. None of these factors had a significant impact on survival, although the small sample size limits the power of these analyses. Conclusions: In our institutional experience with angiosarcoma of the head and neck, treatment outcomes were similar to those reported in the literature. RT achieved reasonable local control at two years, which did not differ between definitive and post-op modalities. Post-operative RT was associated with improved OS compared to definitive RT, likely due to pre-treatment patient and tumor characteristics. Author Disclosure: J. Romanyshyn, None; S. Wolden, None; N. Caria, None; J. Setton, None; S.G. Patel, None; J.P. Shah, None; A.R. Shaha, None; D.G. Pfister, None; N.Y. Lee, None.
2627
Incorporating Gross Anatomy Education into Radiation Oncology Residency
A. R. Cabrera1, W. R. Lee1, R. Madden1, E. J. Hoppenworth1, L. B. Marks2, J. P. Chino1 1
Duke University Medical Center, Durham, NC, 2University of North Carolina School of Medicine, Chapel Hill, NC
Purpose/Objective(s): Radiation oncologists require a thorough understanding of anatomy. We developed an educational program for residents integrating cadaver dissection into the instruction of oncologic anatomy, imaging, and treatment planning, and herein assess learning efficacy and resident satisfaction. Materials/Methods: Monthly modules based on anatomic site were implemented during the 2008 and 2009 academic years at Duke University. All 14 radiation oncology residents participated. Modules consisted of a 1-hour clinically oriented lecture followed by a 1-hour gross anatomy session. Clinical lectures were case based and focused on radiographic anatomy, image segmentation, and field design. Gross anatomy sessions centered on cadavers prepared by anatomists, with small groups rotating through stations where anatomists led cadaver exploration. Adjacent monitors featured radiologic imaging to facilitate synthesis of gross anatomy with imaging anatomy. Participants completed pretests and immediate posttests with ‘‘boards style’’ multiple choice and contouring questions. Review questions testing content from previous sessions evaluated long-term knowledge retention. Paired analyses were performed by Wilcoxon signed-rank and McNemar tests. Satisfaction on a 10-point scale was assessed via survey. Results: Eighteen modules were held over the 2-year period. One hundred seven tests were collected with 46 evaluable pretest and posttest pairs. Immediate learning: Median overall score improved from 63% on pretests to 87% on posttests (p\0.001). Improvements were seen in both multiple choice scores (median 64% vs. 85%; p\0.001) and contouring scores (median 62% vs. 81%; p\ 0.001). These gains occurred among first year residents (median overall score 59% vs. 87%, p \ 0.001) and among more senior residents (median overall score 65% vs. 88%, p \ 0.001). Knowledge retention: 74 review questions were completed 1-12 months after each intervention and compared to matched questions on pretests and posttests. Median percentage correct on pretest, posttest, and review questions were 58%, 86%, and 84%, respectively (pretest vs. review, p = 0.02; posttest vs. review, p = 0.58). Course satisfaction: Participants gave the course a median rating of 9 (IQR 8-9), with 1 being ‘‘less effective than most educational interventions’’ and 10 being ‘‘more effective than most educational interventions.’’
S483
S482
Volume 78, Number 3, Supplement, 2010
difference in volume of -13.6% (-21.9 to -3.4). The median (range) difference in volume encompassed by the .24Gy isodose (Par24) was -2.7cm3 (-6.3 to 3.5), translating to a median proportional change in volume of -12.7% (-31.9 to 17.2). Absolute volume and recalculated dose data for the recontoured organs on CBCT were similar to the original planning CT contours and dose and the comparison is not presented here. Median (range) mean CLPG dose on week one was 29Gy (22.8 to 49.2) and 26.9Gy (22.7 to 49.4) on week 6 corresponding to a median absolute variation of -0.1Gy (-4.6 to 2.0) (or -0.4% (-15.9 to 8.2)). The estimated NTCP values on weeks one and six were 17% (10 to 67) and 15% (9 to 67), respectively, corresponding to a median variation of -0.2% (-6 to 3) or a proportional change of -2% (-38 to 22). Conclusions: Contralateral parotid gland shrinkage can be observed during a course of therapeutic irradiation and can be quantified using CBCT. The data suggests that the pattern of shrinkage may tend to occur centrifocally within the parotid gland, as both the entire gland and the medial portion (Par24) reduced in size although the range of values for the Par24 was large. The reduction in parotid size does not appear to affect mean dose or estimated NTCP significantly when IG-IMRT is delivered with daily CBCT online matching. Author Disclosure: M. Lei, None; C. Clark, None; E. Adams, None; K. Freeman, None; C. Jamieson, None; M. Dabbs, None; T. Jordan, None; S. Whitaker, None; A. Nisbet, None; T. Guerrero Urbano, None.
2624
Dosimetric and Radiobiological Comparison of Patients with Head and Neck Tumors Treated by Helical Tomotherapy, RapidArc, and Classical IMRT
D. Leignel1, D. Fernandez1, J. Maisonobe1, S. Zefkili2, S. Dupont1, V. Bodez3, D. Ledu1, B. Dessard Diana1, C. Durdux1, P. Giraud1 1 Hopital Europeen Georges Pompidou, Paris, France, 2Institut Curie, Paris, France, 3Institut Sainte Catherine, Avignon, France
Purpose/Objective(s): To evaluate the dosimetric results of three different IMRT techniques on a homogeneous group of patients with head and neck (H&N) tumors. Materials/Methods: From February 2007 and March 2008, 10 patients with oropharynx (7 patients), oral cavity (2 patients), and nasopharynx (1 patient) tumors were treated with HT (Tomotherapy, USA). Same patients were planned for a double modulated dynamic arc therapy using RapidArc (RA) and a sliding window IMRT (swIMRT) (Varian Medical System, USA). A dose of 66 Gy was prescribed to the PTV66 (GTV and enlarged nodes), 56 Gy to the PTV56 (high risk cervical nodes), and 50 Gy to PTV50 (low risk cervical nodes) by simultaneous integrated boost scheme. All relevant DVH parameters, physical indices: Coverage Index (CI, acceptable if . 0.95), Homogeneity Index (HI, acceptable if # 1.1), and radiobiological data (EUD, NTCP), concerning PTVs and Organs at Risk (OAR) were used to compare the 3 IMRT modalities (Artiview, Aquilab, France). Results: The coverage of PTV66 (CI: HT = 0.96±0.04, RA = 0.97±0.1, swIMRT = 0.97±0.02, p = NS) and PTV56 (CI: HT = 0.95±0.03, RA = 0.95±0.02, swIMRT = 0.95±0.02, p = NS) was acceptable with the 3 techniques whereas the coverage of PTV50 was not adequate with RA (CI: RA = 0.94±0.03, HT = 0.97±0.02, swIMRT = 0.95±0.02; p\0.05). HT was the best technique in terms of homogeneity for all PTVs whereas RA significantly decreases the maximum dose (hot spots) in the largest PTV (PTV50 and PTV56) compared to swIMRT (HI: PTV66: HT = 1.06±0.01, RA = 1.10±0.03, swIMRT = 1.11±0.02, p\0.05; PTV56: HT = 1.11±0.02, RA = 1.12±0.02, swIMRT = 1.17±0.03, p\0.05 ; PTV50: HT = 1.10±0.02, RA = 1.13±0.02, swIMRT = 1.22±0.03, p\0.05). There was no difference in mean dose in the ipsi and controlateral parotids (ipsilateral: HT = 24.6 Gy±2.5, RA = 25.3 Gy±3.9, swIMRT = 25.3 Gy±5.0, p = NS; controlateral: HT = 20.3 Gy±3.1, RA = 19.8 Gy±3.0, swIMRT = 22 Gy±3.5, p = NS), but HT is statistically superior to the two other techniques in terms of NTCP (ipsilateral: HT = 21.9 %±7.8, RA = 32.8 %±16.9, swIMRT = 39.2 %±16.3, p = NS; controlateral: HT = 12.4 %±5.8, RA = 20.0 %±13.4, swIMRT = 30.9 %±12.5, p\0.05) and of EUD (ipsilateral: HT = 20.6Gy±3.0, RA = 27.4 Gy±6.0, swIMRT = 27 Gy±6.7, p\0.05; controlateral: HT = 15.1 Gy±5.1, RA = 19.6 Gy±7.9, swIMRT = 22.4Gy±7.8, p = NS). Conclusions: In terms of H&N tumor coverage and homogeneity HT appears to be the best technique while it allows a good protection of normal tissues. RA seems to be a good alternative as it assures a better controlateral parotid preservation than classical IMRT. Author Disclosure: D. Leignel, None; D. Fernandez, None; J. Maisonobe, None; S. Zefkili, None; S. Dupont, None; V. Bodez, None; D. Ledu, None; B. Dessard Diana, None; C. Durdux, None; P. Giraud, None.
2625
Larynx-sparing Techniques using Intensity Modulated Radiation Therapy for Head and Neck Cancer Treatment
H. Lin, V. Bar Ad, L. Appenzoller, Z. Tochner, S. Both University of Pennsylvania, Philadelphia, PA Purpose/Objective(s): Intensity modulated radiation therapy (IMRT) allows for an accurate delivery of prescribed doses to multiple target volumes while sparing organs at risk (OARs). The purpose of the current study was to explore if the laryngeal dose can be reduced by using a whole-field IMRT technique (WF-IMRT) when compared with a junctioned IMRT (J-IMRT). Materials/Methods: WF-IMRT planning was performed by using a concomitant boost technique based on the institutional protocol with a total dose of 57.6 Gy delivered to the planning treatment volume (PTV) 57.6, 64 Gy to the PTV64, and 70.4 Gy to the PTV70.4, with a total of 32 fractions. The PTV57.6 included the clinically negative regions of the neck considered for elective radiation therapy. The PTV64 was defined as the volume including the gross tumor and positive cervical lymph nodes and the surrounding areas of potential microscopic spread. PTV70.4 was defined as the gross extent of tumor, including the primary tumor and the involved cervical lymph. The larynx was defined as superiorly covering the arythnoid cartilages and inferiorly including the thyroid cartilage. The J-IMRT technique consisted of an IMRT plan for the superior neck, matched with conventional half-beam blocked anterior-posterior opposing neck fields at the level of the thyroid notch. A central block was used for the anterior lower neck field to restrict the dose at larynx level and a cord block was used for the posterior field to protect the spinal cord. Fixed jaw technique was used for superior IMRT and there was no gap with inferior fields. Eclipse 8.8 TPS was used for all plans. For each patient, a plan with 7-9 coplanar IMRT beams of 6MV was optimized to achieve best coverage to the target volumes, the minimum dose to larynx and other OARs. The coverage to the PTV and the dose to the larynx were compared between the two techniques.
Proceedings of the 52nd Annual ASTRO Meeting Results: Five consecutive patients with non-laryngeal head and neck cancer were analyzed. Both the primary site and regional lymphatics were included in a WF-IMRT and was compared to a J-IMRT technique. In four cases the neck disease extended inferiorly to the level of the larynx. Using the WF-IMRT the PTV coverage remained excellent while 95% of the PTV57.6 dose coverage was 99.2 ± 0.4% and the minimum, maximum, median and mean laryngeal dose of 16.17± 0.82 Gy, 32.28 ± 4.77 Gy, 18.25 ± 1.05 Gy, and 18.73 ± 1.09 Gy, respectively. Using the J-IMRT technique, the 95% dose coverage for PTV57.6 was 98.04% ± 1.30% and the minimal, maximum, median and mean laryngeal dose of 10.58 ± 1.10 Gy, 51.17 ±7.97 Gy, 15.77 ± 1.74 Gy and 18.19 ±2.17 Gy, respectively. Conclusions: Using WF-IMRT technique allowed optimal coverage of the target volumes and reducing the dose to the larynx while avoided the dosimetric uncertainty at the match line level present with J-IMRT technique. Author Disclosure: H. Lin, None; V. Bar Ad, None; L. Appenzoller, None; Z. Tochner, None; S. Both, None.
2626
Radiation Therapy in the Treatment of Angiosarcoma of the Head and Neck
J. Romanyshyn, S. Wolden, N. Caria, J. Setton, S. G. Patel, J. P. Shah, A. R. Shaha, D. G. Pfister, N. Y. Lee Memorial Sloan-Kettering Cancer Center, New York, NY Purpose/Objective(s): Cutaneous angiosarcoma is an aggressive vascular tumor constituting less than 0.1% of head and neck malignancies. The aim of this retrospective analysis is to analyze the treatment outcomes of patients who received radiotherapy (RT) for angiosarcoma of the head and neck. Materials/Methods: Between 5/91 and 1/09, 20 patients with histologically proven angiosarcoma of the head and neck without a history of prior radiotherapy were treated by RT with curative intent at our institution. The median age was 74 (52-91) years. Twelve patients had unresectable disease and were treated definitively, typically to 6000-7000 cGy. The remaining 8 underwent surgical resection followed by post-op RT, typically to 6000 cGy. Eleven patients received chemotherapy, 8 prior to RT (6 definitive, 2 post-op) and 3 concurrently (2 definitive, 1 post-op), of which the most common agent was paclitaxel. Eleven tumors were .5 cm in diameter (1 post-op, 10 definitive) at presentation, and 75 % originated in the scalp. Overall survival (OS), local relapsefree survival (LRFS), and distant metastasis-free survival (DMFS) were calculated from the date of diagnosis using the KaplanMeier method. Toxicities were graded using the Common Toxicity Criteria v3.0. Results: The median follow-up was 20.7 months (2.4-184) with 6 patients alive at last follow-up. For all patients, the median OS was 31.8 months (1-y OS, 90 %; 2-y OS, 66 %). The median OS was 24.2 months for patients treated definitively and 136 months for those treated post-operatively (p = 0.029). LR occurred in 8 patients after a median of 41.5 months (1-y LRFS, 89 %; 2-y LRFS, 67 %). Three patients developed cervical lymph node metastases after treatment, all of which followed LR. DM occurred in 8 patients at a median of 135 months (1-y DMFS, 82 %; 2-y DMFS, 56 %). Lung was the most common site of DM (n = 7) followed by liver (n = 2). There were no significant differences between definitive and post-op RT in LRFS (p = 0.11) or DMFS (p = 0.27). In the 16 patients with available toxicity data, acute dermatitis was grade 2 in 7 (44 %) and grade 3 in 7 (44%). One patient developed necrosis of his skin graft and underlying calvarium 5 months after receiving 6000 cGy post-operatively. Age .70 years, primary scalp location, tumor size .5 cm, and the addition of chemotherapy were examined by univariate analysis. None of these factors had a significant impact on survival, although the small sample size limits the power of these analyses. Conclusions: In our institutional experience with angiosarcoma of the head and neck, treatment outcomes were similar to those reported in the literature. RT achieved reasonable local control at two years, which did not differ between definitive and post-op modalities. Post-operative RT was associated with improved OS compared to definitive RT, likely due to pre-treatment patient and tumor characteristics. Author Disclosure: J. Romanyshyn, None; S. Wolden, None; N. Caria, None; J. Setton, None; S.G. Patel, None; J.P. Shah, None; A.R. Shaha, None; D.G. Pfister, None; N.Y. Lee, None.
2627
Incorporating Gross Anatomy Education into Radiation Oncology Residency
A. R. Cabrera1, W. R. Lee1, R. Madden1, E. J. Hoppenworth1, L. B. Marks2, J. P. Chino1 1
Duke University Medical Center, Durham, NC, 2University of North Carolina School of Medicine, Chapel Hill, NC
Purpose/Objective(s): Radiation oncologists require a thorough understanding of anatomy. We developed an educational program for residents integrating cadaver dissection into the instruction of oncologic anatomy, imaging, and treatment planning, and herein assess learning efficacy and resident satisfaction. Materials/Methods: Monthly modules based on anatomic site were implemented during the 2008 and 2009 academic years at Duke University. All 14 radiation oncology residents participated. Modules consisted of a 1-hour clinically oriented lecture followed by a 1-hour gross anatomy session. Clinical lectures were case based and focused on radiographic anatomy, image segmentation, and field design. Gross anatomy sessions centered on cadavers prepared by anatomists, with small groups rotating through stations where anatomists led cadaver exploration. Adjacent monitors featured radiologic imaging to facilitate synthesis of gross anatomy with imaging anatomy. Participants completed pretests and immediate posttests with ‘‘boards style’’ multiple choice and contouring questions. Review questions testing content from previous sessions evaluated long-term knowledge retention. Paired analyses were performed by Wilcoxon signed-rank and McNemar tests. Satisfaction on a 10-point scale was assessed via survey. Results: Eighteen modules were held over the 2-year period. One hundred seven tests were collected with 46 evaluable pretest and posttest pairs. Immediate learning: Median overall score improved from 63% on pretests to 87% on posttests (p\0.001). Improvements were seen in both multiple choice scores (median 64% vs. 85%; p\0.001) and contouring scores (median 62% vs. 81%; p\ 0.001). These gains occurred among first year residents (median overall score 59% vs. 87%, p \ 0.001) and among more senior residents (median overall score 65% vs. 88%, p \ 0.001). Knowledge retention: 74 review questions were completed 1-12 months after each intervention and compared to matched questions on pretests and posttests. Median percentage correct on pretest, posttest, and review questions were 58%, 86%, and 84%, respectively (pretest vs. review, p = 0.02; posttest vs. review, p = 0.58). Course satisfaction: Participants gave the course a median rating of 9 (IQR 8-9), with 1 being ‘‘less effective than most educational interventions’’ and 10 being ‘‘more effective than most educational interventions.’’
S483