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Outcomes for Accelerated Partial Breast Irradiation with a Strut-Based Brachytherapy Applicator: 320 Patients with at least 24-Month Followup
Abstracts / Brachytherapy 12 (2013) S11eS77 correlating with time periods!1yr; 1 yr (1-2yrs); 3 yr (2-4yrs); 5yr (4-6yrs) using the Harvard scale with photographic documentation. Results: The median and mean followup periods were 72 and 71 months. Excellent/Good cosmetic outcomes at ! 1, 1-2, 3, and 5yrs were 99%, 99%, 97%, and 96%. Age over 60 yrs, reexcision, V200 O 10cc, V150 O 25 cc, and infections requiring antibiotics were associated with a nonsignificant decrement in cosmesis, while the number of catheters, chemotherapy, and diabetes did not influence results. Conclusions: Cosmetic outcomes have been remarkably stable over time, indicating few late effects of irradiation despite the fraction size of 340 cGy delivered with interstitial brachytherapy APBI. Low skin surface dose, high dose homogeneity, and low V200, despite large volumes treated, likely contributed to excellent cosmesis.
OR12 Presentation Time: 9:45 AM Outcomes for Accelerated Partial Breast Irradiation with a Strut-Based Brachytherapy Applicator: 320 Patients with at least 24-Month Followup Robert R. Kuske, MD1, Ben H. Han, MD2, Robert L. Hong, MD3, Lydia Komarnicky, MD4, Maureen Lyden, MS5, Sudha Mahalingam, MD6, Constantine A. Mantz, MD7, Stephen Nigh, MD8, Kerri Perry, MD9, JonDavid Pollock, MD10, Jon Strasser, MD11, Catheryn Yashar, MD12. 1 Arizona Breast Cancer Specialists, Phoenix, AZ; 2South Florida Radiation Oncology, Boynton Beach, FL; 3Virginia Hospital, Arlington, VA; 4Drexel University, Philadelphia, PA; 5BioStat International, Inc., Tampa, FL; 6Radiation Medicine, The Christ Hospital Research Center, Cincinnati, OH; 721st Century Oncology, Scottsdale, AZ; 8Radiation Oncology, Northwest Comm. Hosp., Arlington Heights, IL; 9Kerri Perry MD, Denton, TX; 10Schiffler Cancer Center, Wheeling, WV; 11Christiana Care Health Sysytem, Newark, NJ; 12Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA. Purpose: The SAVI Collaborative Research Group (SCRG), a multiinstitutional group, was formed to study the long-term outcomes of women treated with APBI using strut-based applicators. As of October 2, 2012, we present followup data on women enrolled in this retrospective study, whose treatments were completed at least 24 months before their latest followup. Materials and Methods: All patients treated at least 24 months prior to the abstract submission, for whom followup data were recorded, were grouped for statistical analysis. Patients, accrued at 11 institutions, were treated with accelerated partial breast irradiation using the strut-based brachytherapy device with conventional dose and fractionation (3.4 Gy x 10 fractions twice daily). Treatment planning goals for the planning target volume (PTV) were: V90O90%; V150!50 cc & V200!20 cc. Patients were followed regularly and outcomes graded based on the CTCAE v3.0 (common terminology criteria for adverse events, version 3.0). Results: All patients (n5320; 230 invasive, 90 DCIS) successfully completed treatment and had no serious adverse events during treatment. Median followup was 35 months (range; 23-59 months). Of the 320 subjects (median age 63 yr, range 40-88 yr), 87% were post-menopausal with a median tumor size of 12 mm (range 0-55 mm). Most patients were estrogen receptor positive (ERþ 88%) and received hormone therapy (69%). Treatment planning parameters (median values) for the PTV were V90597.4%, V150528.0 cc, and V200514.2 cc. Toxicity at any time post-treatment (Grade $2) was low: hyperpigmentation 5 0.3%, telangiectasia 5 2.2%, seroma 5 2.5%, fat necrosis 5 0.9%, and breast asymmetry from radiation therapy 5 3.8%. Examination of associations between treatment variables and toxicities demonstrated that seroma formation was weakly associated with V90 (yes vs no; 93.9% vs 96.3%; p50.020) but not V150 or V200 (pO0.51). Telangiectasia development was weakly associated with skin spacing (5.4 mm vs 11.9 mm, p50.057) but not skin dose (p50.55). For all patients in the database with followup (n5989), local control was excellent with true recurrences (TR)/marginal miss (MM) of 0.61% and ipsilateral/elsewhere recurrences of 0.91%. Conclusions: Relatively few toxicities were observed and resulted in a few statistically significant associations. For some (i.e., seroma and coverage) the associations were statistically significant due large numbers of
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observations, but are likely clinically irrelevant (seroma associated with V90 but no other PTV dose parameter). Recurrences remain low to date. For these 320 patients with more than 2 years of total followup (median 35 months), strut-based brachytherapy appears to be a well-tolerated, effective treatment with minimal acute and few adverse late toxicities.
MISCELLANEOUS ORAL Thursday, April 18, 2013 2:00 PMe3:00 PM OR13 Presentation Time: 2:00 PM High-Dose-Rate Interstitial Brachytherapy Alone for Early Stage Penile Carcinoma Daya N. Sharma, MD, Nikhil Joshi, MD, Kunhi P. Haresh, MD, Subhash Gupta, MD, Pramod K. Julka, MD, Goura K. Rath, MD. Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India. Purpose: Interstitial brachytherapy (IBT) is a preferred treatment option over partial penectomy in selected patients with T1-T2 stage penile carcinoma because of its ability to preserve the organ. The existing literature on IBT is largely based on the experience with low-dose-rate (LDR) and there is extremely limited experience with high-dose-rate (HDR) IBT in penile carcinoma. We studied the role of HDR IBT alone in patients with T1-T2 stage penile carcinoma. Materials and Methods: From April 2010 to July 2012, we treated 8 patients with histopathologically proved early stage penile carcinoma without regional node metastases. Median age was 42 years. Size of the primary lesion ranged from 1.5 cm to 3.7 cm. No patient had inguinal or pelvic lymph node metastases. Under spinal anesthesia, a 2-plane or 3plane interstitial free hand implant was done using a total of 4-9 plastic catheters. The prescribed dose of HDR IBT was 45 Gy in 15 fractions over 8 days using twice a day fraction schedule (with a minimum of 6 hours interval between two fractions). Catheters were removed immediately after the completion of treatment. Patients were regularly followed up monthly for 6 months and then every three months till 2 years. Results: Followup period ranged from 2-28 months (median 20 months). No patient had recurrence at primary site or inguino-pelvic region. Two of 8 patients had grade-II mucositis which healed over 8-10 weeks. No patient had urethral stenosis. All patients who completed one year of followup had satisfactory sexual life. Conclusions: Though small sample size, our results have demonstrated excellent results with HDR IBT in patients with early stage penile carcinoma.
OR14 Presentation Time: 2:09 PM Neoadjuvant High Dose Endorectal Brachytherapy for Rectal Adenocarcinoma; Preliminary Outcome Study Amy Hacker-Prietz, PA-C, Joseph M. Herman, MD, Susan Gearhart, MD, Nilo Azad, MD, Elzabeth Wick, MD, Luis A. Diaz, MD, Jonathan Efron, MD, Eun Ji Shin, MD, Rachit Kumar, MD, Aaron Wild, Susannah Ellsworth, MD. Radiation Oncology & Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, MD. Purpose: Neoadjuvant chemoradiation therapy (NCRT) is the standard of care for TxN1-2, T3-4N0, rectal adenocarcinoma. Previous studies have shown improved local control and reduced toxicity with NCRT compared to adjuvant therapy. NCRT consists of approximately 5-6weeks of external beam radiation with concurrent 5-Fluorouracil. Intensity modulated radiation therapy has been studied in attempt to further limit dosing and toxicity to surrounding normal tissue, but length of treatment does not differ. This may allow dose escalation and improved local control (LC). The addition of more aggressive chemotherapy to NCRT has increased acute toxicity rates, yet failed to improve LC rates. Therefore a novel approach using high dose endorectal brachytherapy (HDR-EBT) given in 4 fractions (6.5Gy/day) on a pilot study was investigated. Preliminary results of the first nine patients on protocol were reviewed. Materials and Methods: Cases of the first 9 patients enrolled on HDREBT pilot study, who underwent surgical resection, were reviewed. All
OR12 Presentation Time: 9:45 AM Outcomes for Accelerated Partial Breast Irradiation with a Strut-Based Brachytherapy Applicator: 320 Patients with at least 24-Month Followup Robert R. Kuske, MD1, Ben H. Han, MD2, Robert L. Hong, MD3, Lydia Komarnicky, MD4, Maureen Lyden, MS5, Sudha Mahalingam, MD6, Constantine A. Mantz, MD7, Stephen Nigh, MD8, Kerri Perry, MD9, JonDavid Pollock, MD10, Jon Strasser, MD11, Catheryn Yashar, MD12. 1 Arizona Breast Cancer Specialists, Phoenix, AZ; 2South Florida Radiation Oncology, Boynton Beach, FL; 3Virginia Hospital, Arlington, VA; 4Drexel University, Philadelphia, PA; 5BioStat International, Inc., Tampa, FL; 6Radiation Medicine, The Christ Hospital Research Center, Cincinnati, OH; 721st Century Oncology, Scottsdale, AZ; 8Radiation Oncology, Northwest Comm. Hosp., Arlington Heights, IL; 9Kerri Perry MD, Denton, TX; 10Schiffler Cancer Center, Wheeling, WV; 11Christiana Care Health Sysytem, Newark, NJ; 12Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA. Purpose: The SAVI Collaborative Research Group (SCRG), a multiinstitutional group, was formed to study the long-term outcomes of women treated with APBI using strut-based applicators. As of October 2, 2012, we present followup data on women enrolled in this retrospective study, whose treatments were completed at least 24 months before their latest followup. Materials and Methods: All patients treated at least 24 months prior to the abstract submission, for whom followup data were recorded, were grouped for statistical analysis. Patients, accrued at 11 institutions, were treated with accelerated partial breast irradiation using the strut-based brachytherapy device with conventional dose and fractionation (3.4 Gy x 10 fractions twice daily). Treatment planning goals for the planning target volume (PTV) were: V90O90%; V150!50 cc & V200!20 cc. Patients were followed regularly and outcomes graded based on the CTCAE v3.0 (common terminology criteria for adverse events, version 3.0). Results: All patients (n5320; 230 invasive, 90 DCIS) successfully completed treatment and had no serious adverse events during treatment. Median followup was 35 months (range; 23-59 months). Of the 320 subjects (median age 63 yr, range 40-88 yr), 87% were post-menopausal with a median tumor size of 12 mm (range 0-55 mm). Most patients were estrogen receptor positive (ERþ 88%) and received hormone therapy (69%). Treatment planning parameters (median values) for the PTV were V90597.4%, V150528.0 cc, and V200514.2 cc. Toxicity at any time post-treatment (Grade $2) was low: hyperpigmentation 5 0.3%, telangiectasia 5 2.2%, seroma 5 2.5%, fat necrosis 5 0.9%, and breast asymmetry from radiation therapy 5 3.8%. Examination of associations between treatment variables and toxicities demonstrated that seroma formation was weakly associated with V90 (yes vs no; 93.9% vs 96.3%; p50.020) but not V150 or V200 (pO0.51). Telangiectasia development was weakly associated with skin spacing (5.4 mm vs 11.9 mm, p50.057) but not skin dose (p50.55). For all patients in the database with followup (n5989), local control was excellent with true recurrences (TR)/marginal miss (MM) of 0.61% and ipsilateral/elsewhere recurrences of 0.91%. Conclusions: Relatively few toxicities were observed and resulted in a few statistically significant associations. For some (i.e., seroma and coverage) the associations were statistically significant due large numbers of
S17
observations, but are likely clinically irrelevant (seroma associated with V90 but no other PTV dose parameter). Recurrences remain low to date. For these 320 patients with more than 2 years of total followup (median 35 months), strut-based brachytherapy appears to be a well-tolerated, effective treatment with minimal acute and few adverse late toxicities.
MISCELLANEOUS ORAL Thursday, April 18, 2013 2:00 PMe3:00 PM OR13 Presentation Time: 2:00 PM High-Dose-Rate Interstitial Brachytherapy Alone for Early Stage Penile Carcinoma Daya N. Sharma, MD, Nikhil Joshi, MD, Kunhi P. Haresh, MD, Subhash Gupta, MD, Pramod K. Julka, MD, Goura K. Rath, MD. Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India. Purpose: Interstitial brachytherapy (IBT) is a preferred treatment option over partial penectomy in selected patients with T1-T2 stage penile carcinoma because of its ability to preserve the organ. The existing literature on IBT is largely based on the experience with low-dose-rate (LDR) and there is extremely limited experience with high-dose-rate (HDR) IBT in penile carcinoma. We studied the role of HDR IBT alone in patients with T1-T2 stage penile carcinoma. Materials and Methods: From April 2010 to July 2012, we treated 8 patients with histopathologically proved early stage penile carcinoma without regional node metastases. Median age was 42 years. Size of the primary lesion ranged from 1.5 cm to 3.7 cm. No patient had inguinal or pelvic lymph node metastases. Under spinal anesthesia, a 2-plane or 3plane interstitial free hand implant was done using a total of 4-9 plastic catheters. The prescribed dose of HDR IBT was 45 Gy in 15 fractions over 8 days using twice a day fraction schedule (with a minimum of 6 hours interval between two fractions). Catheters were removed immediately after the completion of treatment. Patients were regularly followed up monthly for 6 months and then every three months till 2 years. Results: Followup period ranged from 2-28 months (median 20 months). No patient had recurrence at primary site or inguino-pelvic region. Two of 8 patients had grade-II mucositis which healed over 8-10 weeks. No patient had urethral stenosis. All patients who completed one year of followup had satisfactory sexual life. Conclusions: Though small sample size, our results have demonstrated excellent results with HDR IBT in patients with early stage penile carcinoma.
OR14 Presentation Time: 2:09 PM Neoadjuvant High Dose Endorectal Brachytherapy for Rectal Adenocarcinoma; Preliminary Outcome Study Amy Hacker-Prietz, PA-C, Joseph M. Herman, MD, Susan Gearhart, MD, Nilo Azad, MD, Elzabeth Wick, MD, Luis A. Diaz, MD, Jonathan Efron, MD, Eun Ji Shin, MD, Rachit Kumar, MD, Aaron Wild, Susannah Ellsworth, MD. Radiation Oncology & Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, MD. Purpose: Neoadjuvant chemoradiation therapy (NCRT) is the standard of care for TxN1-2, T3-4N0, rectal adenocarcinoma. Previous studies have shown improved local control and reduced toxicity with NCRT compared to adjuvant therapy. NCRT consists of approximately 5-6weeks of external beam radiation with concurrent 5-Fluorouracil. Intensity modulated radiation therapy has been studied in attempt to further limit dosing and toxicity to surrounding normal tissue, but length of treatment does not differ. This may allow dose escalation and improved local control (LC). The addition of more aggressive chemotherapy to NCRT has increased acute toxicity rates, yet failed to improve LC rates. Therefore a novel approach using high dose endorectal brachytherapy (HDR-EBT) given in 4 fractions (6.5Gy/day) on a pilot study was investigated. Preliminary results of the first nine patients on protocol were reviewed. Materials and Methods: Cases of the first 9 patients enrolled on HDREBT pilot study, who underwent surgical resection, were reviewed. All