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One Versus 3 Fraction Pancreatic SBRT for Pancreatic Adenocarcinoma: Single Institution Retrospective Review
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Volume 99 Number 2S Supplement 2017
1051 One Versus 3 Fraction Pancreatic SBRT for Pancreatic Adenocarcinoma: Single Institution Retrospective Review P. Sutera,1 M. Bernard,2 K. Quan,3 B.S. Gill,2 and D.E. Heron2; 1 University of Pittsburgh School of Medicine, Pittsburgh, PA, 2Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, 3Division of Radiation Oncology, Walker Family Cancer Centre, St. Catharine’s, ON, Canada Purpose/Objective(s): Early reports of Stereotactic Body Radiation Therapy (SBRT) for pancreatic carcinoma used a single fraction regimen, but subsequent clinical experience switched to multi-fraction regimens. We therefore conducted a single institution review of patients treated with single or multi-fraction SBRT to determine if there were differences in outcome based on fractionation. Materials/Methods: We conducted a retrospective review of patients treated between 2004 and 2014. Overall survival (OS), local control (LC), regional control (RC), and late toxicity were our primary endpoints. Statistical analysis was performed using IBM SPSS Statistics Version 23. P-values less than 0.05 were deemed significant for both univariate (UVA) and multivariate analysis (MVA). Results: We identified 289 patients with 291 lesions who had pathologically confirmed pancreatic adenocarcinoma. Median age was 69 (33-90) years. Median gross tumor volume (GTV) was 12.3 cm3 (range 8.6-21.3) and planning tumor volume (PTV) 17.9 cm3 (range 12e27). Single fraction was used in 90 (30.9%) and multifraction in 201 (69.1%) lesions. At a median follow-up of 17.3 months (IQR 10.1-29.3 months), the median survival for the entire cohort 17.8 months with a 2-year OS of 35.3%. While univariate analysis showed multi-fraction schemes to have a higher 2-year OS 30.5% vs. 37.5% (P Z 0.019), it did not hold significance on multivariate analysis. Multi-fractionation schemes were found to have a higher 2-year LC (69.7% vs 56.8%) on MVA [HR Z 0.53, 95% CI (0.330.85), P Z 0.009]. Fractionation scheme on univariate analysis did not affect regional control (P Z 0.541) or distant metastasis (P Z 0.226). At 2 years, late grade 2+ toxicity was 7.8% and late grade 3+ toxicity was 3.5%. Post-SBRT CA19-9 was found on MVA to be a prognostic factor for OS [HR Z 1.01, 95% CI (1.01-1.01), P Z 0.009], RC [HR Z 1.01, 95% CI (1.01-1.01), P Z 0.02] and DM [HR Z 1.01, 95% CI (1.01-1.01), P Z 0.001]. Conclusion: This single institution retrospective review shows multifraction regimens SBRT had a higher LC than single fractionation regimens. While multi-fraction regimens had a higher OS on univariate, this did not hold true on MVA. We showed low rates of late grade 2+ and grade 3+ toxicity with SBRT. Post-SBRT CA19-9 was found to be significant factor for OS, RC, and DM. This single institution report is the largest retrospective series showing multi-fraction regimens SBRT is associated with a higher LC than single fractionation regimens. Author Disclosure: P. Sutera: None. M. Bernard: None. K. Quan: None. B.S. Gill: None. D.E. Heron: Partnership; Cancer Treatment Services International. In this role, I am a Board Member for UPMC Cancer Center; UPMC Cancer Center. Vice Chairman of Clinical Affairs for the Department of Radiation Oncology; University of Pittsburgh School of Medicine.
1052 Long-Term Results of Stereotactic Body Radiation Therapy for Patients With Small Hepatocellular Carcinoma Ineligible for Resection or Ablation Therapies K. Kubo,1 T. Kimura,2 H. Aikata,3 S. Takahashi,4 Y. Takeuchi,2 I. Takahashi,2 I. Nishibuchi,2 Y. Murakami,2 K. Chayama,3 and Y. Nagata2; 1 Department of Radiation Oncology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan, 2Department of Radiation Oncology, Hiroshima University, Hiroshima, Japan, 3Department of Medicine and Molecular Science, Hiroshima University, Hiroshima, Japan, 4Department of Radiation Oncology, Kagawa University Hospital, Kagawa, Japan
Purpose/Objective(s): To evaluate the long-term outcome of stereotactic body radiotherapy (SBRT) in patients with small hepatocellular carcinoma (HCC) who are ineligible for resection or ablation therapies. Materials/Methods: We previously published the efficacy and safety of SBRT in 65 patients with 74 HCC who were ineligible for resection or ablation therapies. The following inclusion criteria for curative SBRT were used: (i) age over 20 years; (ii) an Eastern Cooperative Oncology Group Performance Status of 0e2; (iii) ChildeTurcotteePugh (CTP) class A or B; (iv) less than three HCC nodules, each up to 50 mm in diameter without portal venous thrombosis or extrahepatic metastases; (v) inoperability because of poor general condition or surgery refusal; and (vi) unsuitability for radiofrequency ablation because of tumor location (on the liver surface, particularly high risk of pneumothorax, or near the porta hepatis), tumor invisibility on ultrasonography, or bleeding tendencies (platelet count, 50,000/mL; prothrombin activity, 50%). Patients were treated with the prescribed dose of 48 Gy in four fractions at the isocenter. CTP scoring was used to classify 56 and 9 patients into classes A and B, respectively. Local progression was defined as irradiated tumor growth on a dynamic computed tomography follow-up. Tumor responses were assessed according to the modified Response Evaluation Criteria in Solid Tumors. Treatment-related toxicities were evaluated according to the Common Terminology Criteria for Adverse Events version 4.0. We also updated the survival and tumor control outcomes for these same patients, with 2 years’ additional follow-up. Results: In previous study, the median follow-up period was 26 months (range, 3e60), and 29 months in survivors (range, 16e60). The 2-year overall survival and local control rates were 76.0% (95% confidence interval [CI], 65.4e86.7%) and 100% (95% CI, 100%), respectively. In this study, the median follow-up period at the time of evaluation was 41 months (range, 3e73), and 58 months in survivors (range, 24e73). The 3-year and 5-year overall survival rates were 56.3% (95% CI, 44.1e68.5%) and 40.9% (95% CI, 28.0e53.8%), respectively. The 3-year and 5-year local control rates were both 100% (95% CI, 100%). Grade 3 or higher toxicities were observed in 15 (23.1%) patients. During the 2 years of additional follow-up period, the proportion of patients who had grade 3 or higher toxicities did not increase. The incidence of grade 3 or higher toxicities was higher in CTP class B than in class A (P Z 0.0127). Conclusion: SBRT was effective and relatively safe for patients with small HCC who were ineligible for resection or ablation therapies even during longer follow-up times. Author Disclosure: K. Kubo: None. T. Kimura: None. H. Aikata: None. S. Takahashi: None. Y. Takeuchi: None. I. Takahashi: None. I. Nishibuchi: None. Y. Murakami: None. K. Chayama: None. Y. Nagata: None.
1053 Proton Beam Therapy for Locally Recurrent Hepatocellular Carcinoma After Radiofrequency Ablation or Transcatheter Arterial Chemoembolization S. Hashimoto,1,2 H. Ogino,3 H. Iwata,1 Y. Hattori,1,2 K. Nakajima,1,3 M. Nakanishi,2 F. Baba,4 S. Sasaki,5 Y. Kuwabara,6 K. Senoo,7 Y. Shibamoto,2 and J.E. Mizoe1; 1Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan, 2Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan, 3Department of Radiation Oncology, Nagoya Proton Therapy Center- Nagoya City West Medical Center, Nagoya, Japan, 4Department of Radiotherapy, Nagoya City West Medical Center, Nagoya, Japan, 5Department of Diagnostic Radiology, Nagoya West Medical Center, Nagoya, Japan, 6Department of Gastroenterogic Surgery, Nagoya West Medical Center, Nagoya, Japan, 7 Department of Gastroenterology, Nagoya City West Medical Center, Nagoya, Japan Purpose/Objective(s): Although radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) are common treatments for hepatocellular carcinoma (HCC), HCC often recurs locally after RFA
Volume 99 Number 2S Supplement 2017
1051 One Versus 3 Fraction Pancreatic SBRT for Pancreatic Adenocarcinoma: Single Institution Retrospective Review P. Sutera,1 M. Bernard,2 K. Quan,3 B.S. Gill,2 and D.E. Heron2; 1 University of Pittsburgh School of Medicine, Pittsburgh, PA, 2Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, 3Division of Radiation Oncology, Walker Family Cancer Centre, St. Catharine’s, ON, Canada Purpose/Objective(s): Early reports of Stereotactic Body Radiation Therapy (SBRT) for pancreatic carcinoma used a single fraction regimen, but subsequent clinical experience switched to multi-fraction regimens. We therefore conducted a single institution review of patients treated with single or multi-fraction SBRT to determine if there were differences in outcome based on fractionation. Materials/Methods: We conducted a retrospective review of patients treated between 2004 and 2014. Overall survival (OS), local control (LC), regional control (RC), and late toxicity were our primary endpoints. Statistical analysis was performed using IBM SPSS Statistics Version 23. P-values less than 0.05 were deemed significant for both univariate (UVA) and multivariate analysis (MVA). Results: We identified 289 patients with 291 lesions who had pathologically confirmed pancreatic adenocarcinoma. Median age was 69 (33-90) years. Median gross tumor volume (GTV) was 12.3 cm3 (range 8.6-21.3) and planning tumor volume (PTV) 17.9 cm3 (range 12e27). Single fraction was used in 90 (30.9%) and multifraction in 201 (69.1%) lesions. At a median follow-up of 17.3 months (IQR 10.1-29.3 months), the median survival for the entire cohort 17.8 months with a 2-year OS of 35.3%. While univariate analysis showed multi-fraction schemes to have a higher 2-year OS 30.5% vs. 37.5% (P Z 0.019), it did not hold significance on multivariate analysis. Multi-fractionation schemes were found to have a higher 2-year LC (69.7% vs 56.8%) on MVA [HR Z 0.53, 95% CI (0.330.85), P Z 0.009]. Fractionation scheme on univariate analysis did not affect regional control (P Z 0.541) or distant metastasis (P Z 0.226). At 2 years, late grade 2+ toxicity was 7.8% and late grade 3+ toxicity was 3.5%. Post-SBRT CA19-9 was found on MVA to be a prognostic factor for OS [HR Z 1.01, 95% CI (1.01-1.01), P Z 0.009], RC [HR Z 1.01, 95% CI (1.01-1.01), P Z 0.02] and DM [HR Z 1.01, 95% CI (1.01-1.01), P Z 0.001]. Conclusion: This single institution retrospective review shows multifraction regimens SBRT had a higher LC than single fractionation regimens. While multi-fraction regimens had a higher OS on univariate, this did not hold true on MVA. We showed low rates of late grade 2+ and grade 3+ toxicity with SBRT. Post-SBRT CA19-9 was found to be significant factor for OS, RC, and DM. This single institution report is the largest retrospective series showing multi-fraction regimens SBRT is associated with a higher LC than single fractionation regimens. Author Disclosure: P. Sutera: None. M. Bernard: None. K. Quan: None. B.S. Gill: None. D.E. Heron: Partnership; Cancer Treatment Services International. In this role, I am a Board Member for UPMC Cancer Center; UPMC Cancer Center. Vice Chairman of Clinical Affairs for the Department of Radiation Oncology; University of Pittsburgh School of Medicine.
1052 Long-Term Results of Stereotactic Body Radiation Therapy for Patients With Small Hepatocellular Carcinoma Ineligible for Resection or Ablation Therapies K. Kubo,1 T. Kimura,2 H. Aikata,3 S. Takahashi,4 Y. Takeuchi,2 I. Takahashi,2 I. Nishibuchi,2 Y. Murakami,2 K. Chayama,3 and Y. Nagata2; 1 Department of Radiation Oncology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan, 2Department of Radiation Oncology, Hiroshima University, Hiroshima, Japan, 3Department of Medicine and Molecular Science, Hiroshima University, Hiroshima, Japan, 4Department of Radiation Oncology, Kagawa University Hospital, Kagawa, Japan
Purpose/Objective(s): To evaluate the long-term outcome of stereotactic body radiotherapy (SBRT) in patients with small hepatocellular carcinoma (HCC) who are ineligible for resection or ablation therapies. Materials/Methods: We previously published the efficacy and safety of SBRT in 65 patients with 74 HCC who were ineligible for resection or ablation therapies. The following inclusion criteria for curative SBRT were used: (i) age over 20 years; (ii) an Eastern Cooperative Oncology Group Performance Status of 0e2; (iii) ChildeTurcotteePugh (CTP) class A or B; (iv) less than three HCC nodules, each up to 50 mm in diameter without portal venous thrombosis or extrahepatic metastases; (v) inoperability because of poor general condition or surgery refusal; and (vi) unsuitability for radiofrequency ablation because of tumor location (on the liver surface, particularly high risk of pneumothorax, or near the porta hepatis), tumor invisibility on ultrasonography, or bleeding tendencies (platelet count, 50,000/mL; prothrombin activity, 50%). Patients were treated with the prescribed dose of 48 Gy in four fractions at the isocenter. CTP scoring was used to classify 56 and 9 patients into classes A and B, respectively. Local progression was defined as irradiated tumor growth on a dynamic computed tomography follow-up. Tumor responses were assessed according to the modified Response Evaluation Criteria in Solid Tumors. Treatment-related toxicities were evaluated according to the Common Terminology Criteria for Adverse Events version 4.0. We also updated the survival and tumor control outcomes for these same patients, with 2 years’ additional follow-up. Results: In previous study, the median follow-up period was 26 months (range, 3e60), and 29 months in survivors (range, 16e60). The 2-year overall survival and local control rates were 76.0% (95% confidence interval [CI], 65.4e86.7%) and 100% (95% CI, 100%), respectively. In this study, the median follow-up period at the time of evaluation was 41 months (range, 3e73), and 58 months in survivors (range, 24e73). The 3-year and 5-year overall survival rates were 56.3% (95% CI, 44.1e68.5%) and 40.9% (95% CI, 28.0e53.8%), respectively. The 3-year and 5-year local control rates were both 100% (95% CI, 100%). Grade 3 or higher toxicities were observed in 15 (23.1%) patients. During the 2 years of additional follow-up period, the proportion of patients who had grade 3 or higher toxicities did not increase. The incidence of grade 3 or higher toxicities was higher in CTP class B than in class A (P Z 0.0127). Conclusion: SBRT was effective and relatively safe for patients with small HCC who were ineligible for resection or ablation therapies even during longer follow-up times. Author Disclosure: K. Kubo: None. T. Kimura: None. H. Aikata: None. S. Takahashi: None. Y. Takeuchi: None. I. Takahashi: None. I. Nishibuchi: None. Y. Murakami: None. K. Chayama: None. Y. Nagata: None.
1053 Proton Beam Therapy for Locally Recurrent Hepatocellular Carcinoma After Radiofrequency Ablation or Transcatheter Arterial Chemoembolization S. Hashimoto,1,2 H. Ogino,3 H. Iwata,1 Y. Hattori,1,2 K. Nakajima,1,3 M. Nakanishi,2 F. Baba,4 S. Sasaki,5 Y. Kuwabara,6 K. Senoo,7 Y. Shibamoto,2 and J.E. Mizoe1; 1Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan, 2Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan, 3Department of Radiation Oncology, Nagoya Proton Therapy Center- Nagoya City West Medical Center, Nagoya, Japan, 4Department of Radiotherapy, Nagoya City West Medical Center, Nagoya, Japan, 5Department of Diagnostic Radiology, Nagoya West Medical Center, Nagoya, Japan, 6Department of Gastroenterogic Surgery, Nagoya West Medical Center, Nagoya, Japan, 7 Department of Gastroenterology, Nagoya City West Medical Center, Nagoya, Japan Purpose/Objective(s): Although radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) are common treatments for hepatocellular carcinoma (HCC), HCC often recurs locally after RFA