Clear Cell

Clear Cell

I. J. Radiation Oncology d Biology d Physics S358 Volume 75, Number 3, Supplement, 2009 Results: The IMRT and non-IMRT groups had similar stage dis...

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I. J. Radiation Oncology d Biology d Physics

S358

Volume 75, Number 3, Supplement, 2009

Results: The IMRT and non-IMRT groups had similar stage distribution, histology, and rates of lymph node involvement. For all patients, any persistent or new disease seen on the post-therapy FDG-PET correlated with overall recurrence risk (p \ 0.0001) and cause-specific survival (p\0.0001). The post-treatment FDG-PET findings were not significantly different between the IMRT and non-IMRT patients (p = 0.9774). The mean follow-up for all patients alive at the time of last follow-up was 52 months (72 months non-IMRT, 22 months IMRT). At the time of last follow-up, 178 patients had developed a recurrence, 39 in the IMRT group and 139 in the non-IMRT group. The difference in recurrence-free survival between the two groups did not reach statistical significance (p = 0.0738), although the IMRT group showed better overall cause-specific survival (p\0.0001). Sixty-two patients (8 IMRT and 54 non-IMRT) developed Grade 3 or greater bowel or bladder complications, and the risk was significantly less for patients treated with IMRT (p = 0.0017). Conclusions: Cervical cancer patients treated with FDG-PET-guided IMRT have similar recurrence rates and significantly less treatment-related toxicity compared to patients treated with conventional, non-IMRT radiotherapy. Author Disclosure: E.A. Kidd, None; B.A. Siegel, None; F. Dehdashti, None; J.S. Rader, None; S. Mutic, None; D.G. Mutch, None; M.A. Powell, None; P.W. Grigsby, None.

2393

Long-term Outcome of Adjuvant High-dose Whole Abdominopelvic Irradiation for Patients with Stage I/II Endometrial Cancer with High-risk Pathologic Features Including Serous Papillary/Clear Cell

M. Wallace, D. Krauss, A. Martinez, S. Weiner, C. Mitchell, P. Y. Chen, E. Cook, D. Brabbins William Beaumont Hospital, Royal Oak, MI Purpose/Objective(s): Endometrial cancer patients with serous papillary/clear cell (SP/CC) histology and those with high-grade, deeply invasive endometrioid lesions have a poor prognosis and survival. To improve outcomes, a trial of whole abdominal irradiation with a para-aortic, diaphragmatic, pelvic, and vaginal boost (WAPI) was initiated in 1986. This analysis evaluates long-term results of adjuvant WAPI in patients at increased risk for abdominopelvic recurrence and specifically, those individuals with Stage I–II disease and SP/CC histology. Materials/Methods: In a prospective, nonrandomized trial, 59 patients with Stage I–II endometrial cancer were identified who were felt to be at increased risk for intra-abdominal and pelvic recurrence between January 1986 and August 2007 with a minimum of 1-year follow-up. All patients were surgically staged and treated. Forty-three patients (73%) were 1989 FIGO Stage I and 16 (27%) were Stage II. Forty-six (78%) had serous papillary or clear cell histology. All 13 adenocarcinoma patients had either high-grade lesions and/or deep myometrial invasion. Results: Mean follow-up for the entire group was 6.5 years (range, 1.0–18.0). Median age for the entire group was 62 years (range, 42–87). Ten-year overall survival (OS), disease-free survival (DFS), and cause-specific survival (CSS) were 61%, 79%, and 83%, respectively. No statistical differences were noted between histologic subtypes. Only increasing age was noted significant for OS (p = 0.002) and lymphovascular invasion was noted significant for CSS in univariate analysis, (p = 0.043). The 17% (n = 10) recurred with the first site of failure being lung (50%), inguinal lymph nodes (20%), abdomen/pelvis (10%), vagina (10%), and other (20%). Recurrence rates were 80% in patients with SP/CC and 20% in those with adenocarcinoma (p = 0.865). The majority of patients experienced acute Grade 1–2 GI or hematologic toxicity. Fourteen percent (n = 8) experienced chronic Grade 3 GI symptoms, and 2% (n = 1) experienced chronic Grade 3 renal toxicities. Conclusions: Adjuvant high-dose WAPI is effective treatment for this subset of Stage I–II endometrial carcinoma patients. The treatment resulted in excellent survival rates (10-year CSS = 83% for SP/CC) with a low incidence of long-term complications. Therefore, the results support our recommendation of WAPI as the treatment of choice for these patients with SP/CC histology and high-grade endometrioid lesions with deep myometrial invasion. Author Disclosure: M. Wallace, None; D. Krauss, None; A. Martinez, None; S. Weiner, None; C. Mitchell, None; P.Y. Chen, None; E. Cook, None; D. Brabbins, None.

2394

Intensity Modulated Radiation Therapy (IMRT), High Dose Rate Brachytherapy (HDR) and Weekly Cisplatinum (CDDP) for Treatment of Locally Advanced Cervical Cancer (LACC)

N. Thawani, R. Kabarriti, W. Gao, J. Vainshtein, R. Yaparpalvi, K. J. Mehta, W. J. Skinner, M. Einstein, S. Kalnicki, S. Mutyala Albert Einstein College of Medicine Montefiore Center, Bronx, NY Purpose/Objective(s): Chemoradiotherapy has significantly improved LACC cure rates, not without substantial acute and late toxicities. The IMRT, through inverse planning with dose constraints to organs at risk, provides dose sculpting to target with potential decrease in toxicity. This study reports outcomes of patients with LACC treated with chemoradiotherapy delivered with IMRT weekly CDDP. Materials/Methods: This retrospective review was approved by the local IRB. 76 consecutive LACC patients treated from 10/05 to 3/09 with the combination regimen of weekly CDDP (40 mg/sq m/week) and whole pelvic IMRT to 45 Gy in 25 fractions followed by HDR Brachytherapy (27.5–30 Gy in 5 fractions) were identified for this study. Fifty-six patients who completed the fully prescribed regimen were included for this analysis. The clinical target volume included the cervix, uterus, pelvic nodes, presacral nodes, and para-aortic nodes (if considered at risk). Additional parametrial boost was given with 9–14.4 Gy in 1.8 Gy per fraction for persistent parametrial disease. The IMRT plans were generated with dose constraints to the bladder, small bowel, and femoral heads. Patients were assessed for acute and chronic toxicity, local control, and overall survival; acute and late toxicities were analyzed according to RTOG criteria. Kaplan-Meier (KM) curves were generated to assess local control (LC), disease free survival (DFS), and overall survival (OS). Results: The histologies were squamous cell 53 and adenocarcinoma 3. Stage distribution was IB1-2, IB2-2, IIA-2, IIB-30, IIIA-2, IIIB-16, and IVA-2. The median follow-up was 10.4 months (mean 12.9, range, 1–38 months). Acute Grade 3–4 GI and GU toxicity was seen in 5% (3/56) and 7% (4/56), respectively. No Grade 3 or 4 skin toxicity or weight loss was seen. A total of 60.7% of the patients (34/56) had Grade 3–4 hematologic toxicity. Chronic Grade 3–4 GI and GU toxicity was seen in 7% (4/56) and 0% (0/ 56), respectively. Local control rate was 96% at 1 year. The KM estimated OS and DFS at 1 year were 96% and 89%, respectively.