- Email: [email protected]
Outcomes in Patients With Recurrent Desmoid Tumor Managed With Surgery Alone, Combined Surgery and Radiation Therapy, or Radiation Therapy Alone
E704
International Journal of Radiation Oncology Biology Physics
4/11 (36%) pMM cases, moderate to strong FOLH1 expression was identified within the lesions. FOLH1 expression correlated with dysplasia and depth of pMM invasion. 9/14 (64%) mMM cases stained positive for FOLH1. The conditioned medium from 4/6 MM cell lines induced in vitro FOLH1 expression in HUVEC, independently of BRAF mutation status; endothelial FOLH1 effectively internalized J591. Conclusion: FOLH1 is significantly increased in pMM and mMM. By immunohistochemistry, FOLH1 is more abundantly expressed in mMM neovessels as compared to pMM. MM induces endothelial FOLH1 expression and facilitated J591 internalization. Our findings support testing the efficacy of J591-derived targeted therapy for MM. Author Disclosure: M.K. Ramirez-Fort: None. B. Meier: None. J.R. Vissicchio: None. J. Moy: None. H. Liu: None. E. Contassot: None. B.D. Robinson: None. V. Navarro: None. S. Kim: None. W. Leconet: None. D. Nguyen: None. E.C. Nwokedi: None. C.S. Lange: None. S.T. Tagawa: None. N.H. Bander: None. L.E. French: None.
(PZ0.116). Boost radiation was not associated with better survival. After ICS, RT improved OS (PZ0.044). A trend of PPFS and PFS increase was observed but the difference was not statistically significant (PZ0.073 and PZ0.076). Analysis according to RT modalities for patients with ICS was not performed because of the very limited number of patients. Conclusion: In this large series for DSCRT, adjuvant RT as part of multimodal treatment seems to confer oncological benefits for patients treated for abdominal DSRCT after cytoreductive surgery and perioperative chemotherapy. Author Disclosure: V. Atallah: None. C. Honore´: None. D. Orbach: None. S. Helfre: None. A. Ducassou: None. L. Thomas: None. M. Levitchi: None. A. Mervoyer: None. S. Naji: None. C. Dupin: None. N. Leduc: None. B. Pauline: None. G. Kantor: None. M. Sunyach: None. P. Sargos: None.
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Impact of Radiation Therapy Modalities as Part of Multimodal Treatment in Abdominal Desmoplastic Small Round Cell Tumor: A Retrospective Analysis of 107 Patients V. Atallah,1,2 C. Honore´,3 D. Orbach,4 S. Helfre,5 A. Ducassou,6 L. Thomas,2 M.B. Levitchi,7 A. Mervoyer,8 S. Naji,9 C. Dupin,10 N. Leduc,2 B.L. Pauline,11 G. Kantor,12 M.P. Sunyach,13 and P. Sargos12; 1 Universitary Hospital, Pointe-a-Pitre, Guadeloupe, 2Institut Bergonie´, Bordeaux, France, 3Gustave Roussy Institute, Villejuif, France, 4Curie Institute, PARIS, France, 5Curie Institute, Paris, France, 6Universitary Cancer Institute, Toulouse, France, 7Institut de Cance´rologie de Lorraine, Nancy, France, 8Department of Radiation Oncology, ICO, Nantes Saint Herblain, France, 9Institut Paoli-Calmettes, Marseille, France, 10HautLeveque Hospital, CHU Bordeaux, Pessac, France, 11University Hospital, Bordeaux, France, 12Institut Bergonie, Bordeaux, France, 13Leon Berard Center, Lyon, France
Outcomes in Patients With Recurrent Desmoid Tumor Managed With Surgery Alone, Combined Surgery and Radiation Therapy, or Radiation Therapy Alone M.S. Gentile,1 A. Jacobson,1 H. Wang,2 S. Goldberg,3 E. Choy,4 J.T. Mullen,5 F.J. Hornicek,3 Y.L.E. Chen,1 and T.F. DeLaney1; 1 Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, 2Massachusetts General Hospital, Boston, MA, United States, 3 Massachusetts General Hospital, Boston, MA, 4Division of Hematology/ Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, 5Department of Surgery, Massachusetts General Hospital, Boston, MA
Purpose/Objective(s): Desmoplastic small round cell tumor (DSRCT) is a rare peritoneal tumor affecting predominantly children and young adult white males with a high rate of local failure after surgery. We performed a multicentric retrospective study to identify the prognostic impact of adjuvant abdominal radiation therapy. Materials/Methods: All patients treated for primary abdominal DSRCT in 8 French centers from 1991 to 2014 were included. Patients were retrospectively staged into 3 groups: group A treated with adjuvant radiation therapy (RT) after cytoreductive surgery, group B without RT after cytoreductive surgery, and group C by exclusive chemotherapy. Peritoneal progression-free survival (PPFS), progression-free survival (PFS), and overall survival (OS) were evaluated. We also performed a direct comparison between groups A and B to evaluate RT after cytoreductive surgery. RT was also evaluated according to completeness of surgery: complete cytoreductive surgery (CCS) or incomplete cytoreductive surgery (ICS). We also compared results according to RT modalities: whole abdominopelvic RT (WAP-RT) or focalized RT (F-RT), WAP-RT dose or boost modalities. Results: Thirty-seven (35.9%), 36 (34.9%), and 30 (28.0%) patients were included in groups A, B and C, respectively. Three-year OS was 61.2% (41.0-76.0), 37.6% (22.0-53.1), and 17.3% (6.3-32.8) for groups A, B and C, respectively. OS, PPFS, and PFS differed significantly between the 3 groups (P<0.001; P<0.001; and P<0.001, respectively). OS and PPFS were higher in group A (RT group) compared to group B (no RT group) (PZ0.045 and PZ0.006, respectively). Three-year PPFS was 23.8% (10.3-40.4) for group A and 12.51% (4.0-26.2) for group B. After CCS, RT improved PPFS (PZ0.024) but differences in OS and PFS were not significant (PZ0.40 and PZ0.30, respectively). Median PFS for patients undergoing WAP-RT was 22.4 (14.4-42.3) months and 8.6 (8.6-29.1) months for patients undergoing F-RT (PZ0.0376) after CCS (PZ0.031). On the 26 patients treated by WAP-RT, PPFS differed significantly for patients treated by a dose 30 Gy (PZ0.031). A trend of OS increase was observed (47.0 vs 28.0 months) but was not statistically significant
Purpose/Objective(s): Desmoid tumor is a benign tumor that can be locally aggressive and is managed with a variety of treatments including surgery, radiation therapy (RT), and systemic agents in the recurrent setting. The purpose of this study was to determine the disease-free survival (DFS) in patients with recurrent desmoid tumor treated with one of these modalities. Materials/Methods: The medical records of 43 patients with recurrent desmoid tumor treated at our institution from 1980 through 2012 were reviewed to collect patient, tumor, and treatment-related characteristics. Kaplan Meier method was used to analyze survival outcomes. Results: The median age of the patient at first recurrence was 36.4 years (range, 9-79). There were 17 (39.5%) male patients. Breakdown of tumor location was 25 (58.1%) in the extremity, 5 (11.6%) in the spine/sacrum/ bony pelvis, 4 (9.3%) in the trunk, and 2 (4.7%) in the head and neck, with 1 (2.3%) in the thorax and 1 (2.3%) in the retroperitoneum. The median size of tumor at time of initial surgery was 8 cm (range, 3.1 e 21) and 12 (28%) of patients had close or positive margins. Margin status was not available for 17 (39.5%) patients. Median time to recurrence was 14 months (range, 1.9-96.1). Median follow-up was 9 years (range, 1.3-35). At the time of first recurrence, 17 (39.5%) patients were treated with surgery alone, 18 (41.9%) patients were treated with surgery and RT, and 5 (11.6%) patients were treated with RT alone. Other patients were treated with observation, systemic therapy alone, or a combination of surgery and/ or RT with systemic therapy. One patient in the RT alone group was also treated with systemic therapy. Three (7%) of patients were treated with systemic therapy. Of those patients treated with RT, the median dose was 55.5 Gy (range, 48.4-64.6). Eleven (25.6%) were treated with conventional RT, 5 (11.6%) patients were treated with protons, 2 (4.7%) were treated with IMRT, and 1 (2.3%) was treated with IORT. RT modality was not specified for 3 (7.0%) patients. Five-year DFS was 34.3% (95% CI: 13.556.5) and 63.5% (95% CI: 35.3-82) for patients treated with surgery alone or a combination of surgery and RT, respectively. In addition, there were no recurrences in the 5 patients treated with RT alone (PZ0.009). Conclusion: DFS is best in patients treated with RT alone or a combination of surgery and RT at the time of first recurrence. Inclusion of RT as treatment modality may be considered for patients with recurrent desmoid tumor when technically feasible and the risk of morbidity is small.
Volume 96 Number 2S Supplement 2016 Author Disclosure: M.S. Gentile: None. A. Jacobson: None. H. Wang: None. S. Goldberg: None. E. Choy: None. J.T. Mullen: None. F.J. Hornicek: None. Y.E. Chen: None. T.F. DeLaney: None.
3729 Evaluating the Impact of Sentinel Node Biopsy in Merkel Cell Carcinoma J.A. Marascio,1 N.A. Madden,1 D. Zaenger,1 B.M. Rabatic,1 D. McDermott,2 A.K. Misiura,3 S. Shaaban,1 E.M. Marchan,1 K. Huang,1 A. Amoush,1 A. Al-Basheer,1 A. Green,1 B.G. Dasher,1 J. Howington,1 J.G. Stewart,1 W. Martin,1 M. Pishgou,1 C.L. Ferguson,1 F.M. Kong,4 and W.F. Mourad1; 1Augusta University, Augusta, GA, 2Hershey Medical Center, Hershey, PA, 3Hahnemann University Hospital, Philadelphia, PA, 4 Department of Radiation Oncology, Augusta University, Augusta, GA Purpose/Objective(s): Merkel cell carcinoma (MCC) is a rare neuroendocrine malignancy of the skin with a predilection for aggressive behavior. Previous studies evaluating sentinel lymph node biopsy (SLNB) in MCC have shown positivity rates typically ranging from 22% to 48% in clinically N0 patients. The benefit of SLNB has also been well established in other similarly aggressive tumors, such as melanoma. As a result, sentinel lymph node biopsy (SLNB) is currently recommended for all clinically N0 patients, though its impact remains unclear. The aim of this review was to evaluate for a survival benefit in clinically N0 patients undergoing SLNB. Materials/Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients diagnosed with MCC from 2003 through 2012 with skin as the primary site. Patients up to age 75 years were included, provided they underwent a cancer-directed surgery. Patients with positive lymph nodes or distant disease were excluded. Cause-specific survival was then compared in patients who underwent SLNB as opposed to no pathologic nodal evaluation. Results: A total of 603 patients were identified who met the above criteria. Patients undergoing SLNB had a median age of 65 years with a range of 38-75, 59% were male, and 95% were white. With regard to tumor size: 57% were 2 cm, 13% were 2-5 cm, and 30% were >5 cm. In all, 52% of patients received radiation. Patients with no pathologic nodal evaluation had a median age of 68 years with a range of 37-75, 60% were male, and 94% were white. With regard to tumor size, 34% were 2 cm, 19% were 2-5 cm, and 47% were >5 cm. A total of 48% of patients received radiation. Patients undergoing SLNB had an improved 5-year CSS of 91.3% (95% CI 86.4-94.5%) compared to the nonpathologic nodal evaluation group, with a 5-year CSS of 72.5% (95% CI 65.4-78.4%). When analyzing tumors 2cm, the improved outcome was maintained for SLNB patients vs nonpathologic the nodal evaluation group with a 5-year CSS of 94.70% (95% CI 88.4-97.6) compared to 79.3% (95% CI 66.6-87.6%). Conclusion: A CSS advantage was found for patients undergoing SLNB. This advantage remained significant when stratifying for tumors <2 cm. The reason for this advantage is not fully clear but could be in part from decreased false negatives for nodal staging, therapeutic effect of the SLNB, or a result of more complete care. While prospective data are needed to confirm these findings, the rare nature of these tumors renders this a clinical challenge. Regardless, our current findings support the standard of care of SLNB in clinically N0 patients. Author Disclosure: J.A. Marascio: None. N.A. Madden: None. D. Zaenger: None. B.M. Rabatic: None. D. McDermott: None. A.K. Misiura: None. S. Shaaban: None. E.M. Marchan: None. K. Huang: None. A. Amoush: None. A. Al-Basheer: None. A. Green: None. B.G. Dasher: None. J. Howington: None. J.G. Stewart: None. W. Martin: None. M. Pishgou: None. C.L. Ferguson: None. F. Kong: Honoraria; Varian Medical Systems, Zhejiang Cancer Hospital. W.F. Mourad: None.
3730 Oncologic Outcome of Bimodality Approach for Cutaneous Adnexal Carcinoma J.A. Marascio,1 N.A. Madden,1 B.M. Rabatic,1 D. Zaenger,1 D. McDermott,2 A.K. Misiura,3 S. Shaaban,1 E.M. Marchan,1 K. Huang,1 A. Amoush,1 A. Al-Basheer,1 A. Green,1 B.G. Dasher,1 J. Howington,1
Poster Viewing E705 J.G. Stewart,1 W. Martin,1 M. Pishgou,1 C.L. Ferguson,1 F.M. Kong,4 and W.F. Mourad1; 1Augusta University, Augusta, GA, 2Hershey Medical Center, Hershey, PA, 3Hahnemann University Hospital, Philadelphia, PA, 4 Department of Radiation Oncology, Augusta University, Augusta, GA Purpose/Objective(s): Cutaneous adnexal carcinomas (CAC) are rare neoplasms arising from hair follicles and sebaceous, apocrine, and eccrine glands. While in general prognosis is good, these tumors are thought to be locally aggressive. Due to the rare nature of these tumors, treatment paradigms have been adapted from skin cancer data. Tumors are generally treated with surgery, with some high-risk patients receiving adjuvant radiation. However, the role of radiation remains undefined and practice varies by institution. Here we aim to identify cohorts of patients that may be at higher risk and analyze outcomes. Materials/Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients with CAC with skin as the primary site. Patients diagnosed between 1998 and 2010 were included. Patients with known metastatic disease were excluded. Five-year causespecific survival (CSS) was then calculated for multiple variables, including tumor size, nodal status, subsite, age, sex, race, and grade. Grade was divided into low grade (I and II) and high grade (III and IV). Frequency of radiation use was evaluated with regard to risk factors. Results: A total of 3551 patients who met the above criteria were identified. The median age was 68 years, and 54.4% were male. Ethnicity was as follows: white 81.2%, black 6.1%, other 5.1%, and unknown 7.5%. Median follow-up was not reached. Grade, nodal status, and age were found to have statistically significant (11.4%, 23.0%, 4.6%, P<0.05) impacts on 5-year CSS. Patients with low- and high-grade disease were found to have 5-year CSS of 97.3% and 85.9%. Those who were node negative vs positive at presentation were noted to have 5-year CSS of 97.1% vs 74.1%. Last, patients stratified by age (70 years as cutoff) had 5-year CSS of 97.6% (<70) and 93.0% (70). In all, 7% of well-differentiated tumors and 18% of poorly differentiated tumors received radiation. Node-negative and node-positive patients received radiation in 5% and 58% of cases. Conclusion: While overall prognosis is good, we identified variables that were associated with a statistically inferior 5-year CSS. Nodal involvement and high tumor grade were most predictive, as noted in Table 1. Patients with these risk factors may derive benefit from comprehensive postoperative radiation as these tumors tend to be locoregionally aggressive. Despite its potential therapeutic value, our study shows radiation has been underutilized in these high-risk groups. While prospective data is the best way to confirm or refute our findings, it is always a major clinical challenge to conduct such a study in this rare set of tumors. Nevertheless, we need more data on other potential risk factors such as perineural invasion, extracapsular extension, and lymphovascular invasion. Author Disclosure: J.A. Marascio: None. N.A. Madden: None. B.M. Rabatic: None. D. Zaenger: None. D. McDermott: None. A.K. Misiura: None. S. Shaaban: None. E.M. Marchan: None. K. Huang: None. A. Amoush: None. A. Al-Basheer: None. A. Green: None. B.G. Dasher: None. J. Howington: None. J.G. Stewart: None. W. Martin: None. M. Pishgou: None. C.L. Ferguson: None. F. Kong: Honoraria; Varian Medical Systems, Zhejiang Cancer Hospital. W.F. Mourad: None.
3731 Correlation of Molecular Imaging and Biomarkers Expression in the Prediction of Metastatic Capacity of Soft Tissue Sarcomas N. Ybarra,1 M. Vallieres,2 K. Jeyaseelan,1 C.R. Freeman,3 S. Jung,4 R. Turcotte,3 J. Seuntjens,2 and I. El Naqa5; 1RI-MUHC Glen site, Montreal, QC, Canada, 2McGill University Health Centre, Canada, Montreal, QC, Canada, 3McGill University Health Centre, Montreal, QC, Canada, 4McGill University Health Centre, Glen site, Montreal, QC, Canada, 5University of Michigan, Ann Arbor, MI Purpose/Objective(s): Soft tissue sarcomas (STS) are an uncommon type of tumors representing only 1% of adult cancers. STS are very heterogeneous in terms of gene expression, even among tumors of the same diagnosis. The prognosis for patients with adult STS depends on several factors, including the patient’s age and the size, histologic grade, and stage
International Journal of Radiation Oncology Biology Physics
4/11 (36%) pMM cases, moderate to strong FOLH1 expression was identified within the lesions. FOLH1 expression correlated with dysplasia and depth of pMM invasion. 9/14 (64%) mMM cases stained positive for FOLH1. The conditioned medium from 4/6 MM cell lines induced in vitro FOLH1 expression in HUVEC, independently of BRAF mutation status; endothelial FOLH1 effectively internalized J591. Conclusion: FOLH1 is significantly increased in pMM and mMM. By immunohistochemistry, FOLH1 is more abundantly expressed in mMM neovessels as compared to pMM. MM induces endothelial FOLH1 expression and facilitated J591 internalization. Our findings support testing the efficacy of J591-derived targeted therapy for MM. Author Disclosure: M.K. Ramirez-Fort: None. B. Meier: None. J.R. Vissicchio: None. J. Moy: None. H. Liu: None. E. Contassot: None. B.D. Robinson: None. V. Navarro: None. S. Kim: None. W. Leconet: None. D. Nguyen: None. E.C. Nwokedi: None. C.S. Lange: None. S.T. Tagawa: None. N.H. Bander: None. L.E. French: None.
(PZ0.116). Boost radiation was not associated with better survival. After ICS, RT improved OS (PZ0.044). A trend of PPFS and PFS increase was observed but the difference was not statistically significant (PZ0.073 and PZ0.076). Analysis according to RT modalities for patients with ICS was not performed because of the very limited number of patients. Conclusion: In this large series for DSCRT, adjuvant RT as part of multimodal treatment seems to confer oncological benefits for patients treated for abdominal DSRCT after cytoreductive surgery and perioperative chemotherapy. Author Disclosure: V. Atallah: None. C. Honore´: None. D. Orbach: None. S. Helfre: None. A. Ducassou: None. L. Thomas: None. M. Levitchi: None. A. Mervoyer: None. S. Naji: None. C. Dupin: None. N. Leduc: None. B. Pauline: None. G. Kantor: None. M. Sunyach: None. P. Sargos: None.
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Impact of Radiation Therapy Modalities as Part of Multimodal Treatment in Abdominal Desmoplastic Small Round Cell Tumor: A Retrospective Analysis of 107 Patients V. Atallah,1,2 C. Honore´,3 D. Orbach,4 S. Helfre,5 A. Ducassou,6 L. Thomas,2 M.B. Levitchi,7 A. Mervoyer,8 S. Naji,9 C. Dupin,10 N. Leduc,2 B.L. Pauline,11 G. Kantor,12 M.P. Sunyach,13 and P. Sargos12; 1 Universitary Hospital, Pointe-a-Pitre, Guadeloupe, 2Institut Bergonie´, Bordeaux, France, 3Gustave Roussy Institute, Villejuif, France, 4Curie Institute, PARIS, France, 5Curie Institute, Paris, France, 6Universitary Cancer Institute, Toulouse, France, 7Institut de Cance´rologie de Lorraine, Nancy, France, 8Department of Radiation Oncology, ICO, Nantes Saint Herblain, France, 9Institut Paoli-Calmettes, Marseille, France, 10HautLeveque Hospital, CHU Bordeaux, Pessac, France, 11University Hospital, Bordeaux, France, 12Institut Bergonie, Bordeaux, France, 13Leon Berard Center, Lyon, France
Outcomes in Patients With Recurrent Desmoid Tumor Managed With Surgery Alone, Combined Surgery and Radiation Therapy, or Radiation Therapy Alone M.S. Gentile,1 A. Jacobson,1 H. Wang,2 S. Goldberg,3 E. Choy,4 J.T. Mullen,5 F.J. Hornicek,3 Y.L.E. Chen,1 and T.F. DeLaney1; 1 Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, 2Massachusetts General Hospital, Boston, MA, United States, 3 Massachusetts General Hospital, Boston, MA, 4Division of Hematology/ Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, 5Department of Surgery, Massachusetts General Hospital, Boston, MA
Purpose/Objective(s): Desmoplastic small round cell tumor (DSRCT) is a rare peritoneal tumor affecting predominantly children and young adult white males with a high rate of local failure after surgery. We performed a multicentric retrospective study to identify the prognostic impact of adjuvant abdominal radiation therapy. Materials/Methods: All patients treated for primary abdominal DSRCT in 8 French centers from 1991 to 2014 were included. Patients were retrospectively staged into 3 groups: group A treated with adjuvant radiation therapy (RT) after cytoreductive surgery, group B without RT after cytoreductive surgery, and group C by exclusive chemotherapy. Peritoneal progression-free survival (PPFS), progression-free survival (PFS), and overall survival (OS) were evaluated. We also performed a direct comparison between groups A and B to evaluate RT after cytoreductive surgery. RT was also evaluated according to completeness of surgery: complete cytoreductive surgery (CCS) or incomplete cytoreductive surgery (ICS). We also compared results according to RT modalities: whole abdominopelvic RT (WAP-RT) or focalized RT (F-RT), WAP-RT dose or boost modalities. Results: Thirty-seven (35.9%), 36 (34.9%), and 30 (28.0%) patients were included in groups A, B and C, respectively. Three-year OS was 61.2% (41.0-76.0), 37.6% (22.0-53.1), and 17.3% (6.3-32.8) for groups A, B and C, respectively. OS, PPFS, and PFS differed significantly between the 3 groups (P<0.001; P<0.001; and P<0.001, respectively). OS and PPFS were higher in group A (RT group) compared to group B (no RT group) (PZ0.045 and PZ0.006, respectively). Three-year PPFS was 23.8% (10.3-40.4) for group A and 12.51% (4.0-26.2) for group B. After CCS, RT improved PPFS (PZ0.024) but differences in OS and PFS were not significant (PZ0.40 and PZ0.30, respectively). Median PFS for patients undergoing WAP-RT was 22.4 (14.4-42.3) months and 8.6 (8.6-29.1) months for patients undergoing F-RT (PZ0.0376) after CCS (PZ0.031). On the 26 patients treated by WAP-RT, PPFS differed significantly for patients treated by a dose 30 Gy (PZ0.031). A trend of OS increase was observed (47.0 vs 28.0 months) but was not statistically significant
Purpose/Objective(s): Desmoid tumor is a benign tumor that can be locally aggressive and is managed with a variety of treatments including surgery, radiation therapy (RT), and systemic agents in the recurrent setting. The purpose of this study was to determine the disease-free survival (DFS) in patients with recurrent desmoid tumor treated with one of these modalities. Materials/Methods: The medical records of 43 patients with recurrent desmoid tumor treated at our institution from 1980 through 2012 were reviewed to collect patient, tumor, and treatment-related characteristics. Kaplan Meier method was used to analyze survival outcomes. Results: The median age of the patient at first recurrence was 36.4 years (range, 9-79). There were 17 (39.5%) male patients. Breakdown of tumor location was 25 (58.1%) in the extremity, 5 (11.6%) in the spine/sacrum/ bony pelvis, 4 (9.3%) in the trunk, and 2 (4.7%) in the head and neck, with 1 (2.3%) in the thorax and 1 (2.3%) in the retroperitoneum. The median size of tumor at time of initial surgery was 8 cm (range, 3.1 e 21) and 12 (28%) of patients had close or positive margins. Margin status was not available for 17 (39.5%) patients. Median time to recurrence was 14 months (range, 1.9-96.1). Median follow-up was 9 years (range, 1.3-35). At the time of first recurrence, 17 (39.5%) patients were treated with surgery alone, 18 (41.9%) patients were treated with surgery and RT, and 5 (11.6%) patients were treated with RT alone. Other patients were treated with observation, systemic therapy alone, or a combination of surgery and/ or RT with systemic therapy. One patient in the RT alone group was also treated with systemic therapy. Three (7%) of patients were treated with systemic therapy. Of those patients treated with RT, the median dose was 55.5 Gy (range, 48.4-64.6). Eleven (25.6%) were treated with conventional RT, 5 (11.6%) patients were treated with protons, 2 (4.7%) were treated with IMRT, and 1 (2.3%) was treated with IORT. RT modality was not specified for 3 (7.0%) patients. Five-year DFS was 34.3% (95% CI: 13.556.5) and 63.5% (95% CI: 35.3-82) for patients treated with surgery alone or a combination of surgery and RT, respectively. In addition, there were no recurrences in the 5 patients treated with RT alone (PZ0.009). Conclusion: DFS is best in patients treated with RT alone or a combination of surgery and RT at the time of first recurrence. Inclusion of RT as treatment modality may be considered for patients with recurrent desmoid tumor when technically feasible and the risk of morbidity is small.
Volume 96 Number 2S Supplement 2016 Author Disclosure: M.S. Gentile: None. A. Jacobson: None. H. Wang: None. S. Goldberg: None. E. Choy: None. J.T. Mullen: None. F.J. Hornicek: None. Y.E. Chen: None. T.F. DeLaney: None.
3729 Evaluating the Impact of Sentinel Node Biopsy in Merkel Cell Carcinoma J.A. Marascio,1 N.A. Madden,1 D. Zaenger,1 B.M. Rabatic,1 D. McDermott,2 A.K. Misiura,3 S. Shaaban,1 E.M. Marchan,1 K. Huang,1 A. Amoush,1 A. Al-Basheer,1 A. Green,1 B.G. Dasher,1 J. Howington,1 J.G. Stewart,1 W. Martin,1 M. Pishgou,1 C.L. Ferguson,1 F.M. Kong,4 and W.F. Mourad1; 1Augusta University, Augusta, GA, 2Hershey Medical Center, Hershey, PA, 3Hahnemann University Hospital, Philadelphia, PA, 4 Department of Radiation Oncology, Augusta University, Augusta, GA Purpose/Objective(s): Merkel cell carcinoma (MCC) is a rare neuroendocrine malignancy of the skin with a predilection for aggressive behavior. Previous studies evaluating sentinel lymph node biopsy (SLNB) in MCC have shown positivity rates typically ranging from 22% to 48% in clinically N0 patients. The benefit of SLNB has also been well established in other similarly aggressive tumors, such as melanoma. As a result, sentinel lymph node biopsy (SLNB) is currently recommended for all clinically N0 patients, though its impact remains unclear. The aim of this review was to evaluate for a survival benefit in clinically N0 patients undergoing SLNB. Materials/Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients diagnosed with MCC from 2003 through 2012 with skin as the primary site. Patients up to age 75 years were included, provided they underwent a cancer-directed surgery. Patients with positive lymph nodes or distant disease were excluded. Cause-specific survival was then compared in patients who underwent SLNB as opposed to no pathologic nodal evaluation. Results: A total of 603 patients were identified who met the above criteria. Patients undergoing SLNB had a median age of 65 years with a range of 38-75, 59% were male, and 95% were white. With regard to tumor size: 57% were 2 cm, 13% were 2-5 cm, and 30% were >5 cm. In all, 52% of patients received radiation. Patients with no pathologic nodal evaluation had a median age of 68 years with a range of 37-75, 60% were male, and 94% were white. With regard to tumor size, 34% were 2 cm, 19% were 2-5 cm, and 47% were >5 cm. A total of 48% of patients received radiation. Patients undergoing SLNB had an improved 5-year CSS of 91.3% (95% CI 86.4-94.5%) compared to the nonpathologic nodal evaluation group, with a 5-year CSS of 72.5% (95% CI 65.4-78.4%). When analyzing tumors 2cm, the improved outcome was maintained for SLNB patients vs nonpathologic the nodal evaluation group with a 5-year CSS of 94.70% (95% CI 88.4-97.6) compared to 79.3% (95% CI 66.6-87.6%). Conclusion: A CSS advantage was found for patients undergoing SLNB. This advantage remained significant when stratifying for tumors <2 cm. The reason for this advantage is not fully clear but could be in part from decreased false negatives for nodal staging, therapeutic effect of the SLNB, or a result of more complete care. While prospective data are needed to confirm these findings, the rare nature of these tumors renders this a clinical challenge. Regardless, our current findings support the standard of care of SLNB in clinically N0 patients. Author Disclosure: J.A. Marascio: None. N.A. Madden: None. D. Zaenger: None. B.M. Rabatic: None. D. McDermott: None. A.K. Misiura: None. S. Shaaban: None. E.M. Marchan: None. K. Huang: None. A. Amoush: None. A. Al-Basheer: None. A. Green: None. B.G. Dasher: None. J. Howington: None. J.G. Stewart: None. W. Martin: None. M. Pishgou: None. C.L. Ferguson: None. F. Kong: Honoraria; Varian Medical Systems, Zhejiang Cancer Hospital. W.F. Mourad: None.
3730 Oncologic Outcome of Bimodality Approach for Cutaneous Adnexal Carcinoma J.A. Marascio,1 N.A. Madden,1 B.M. Rabatic,1 D. Zaenger,1 D. McDermott,2 A.K. Misiura,3 S. Shaaban,1 E.M. Marchan,1 K. Huang,1 A. Amoush,1 A. Al-Basheer,1 A. Green,1 B.G. Dasher,1 J. Howington,1
Poster Viewing E705 J.G. Stewart,1 W. Martin,1 M. Pishgou,1 C.L. Ferguson,1 F.M. Kong,4 and W.F. Mourad1; 1Augusta University, Augusta, GA, 2Hershey Medical Center, Hershey, PA, 3Hahnemann University Hospital, Philadelphia, PA, 4 Department of Radiation Oncology, Augusta University, Augusta, GA Purpose/Objective(s): Cutaneous adnexal carcinomas (CAC) are rare neoplasms arising from hair follicles and sebaceous, apocrine, and eccrine glands. While in general prognosis is good, these tumors are thought to be locally aggressive. Due to the rare nature of these tumors, treatment paradigms have been adapted from skin cancer data. Tumors are generally treated with surgery, with some high-risk patients receiving adjuvant radiation. However, the role of radiation remains undefined and practice varies by institution. Here we aim to identify cohorts of patients that may be at higher risk and analyze outcomes. Materials/Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients with CAC with skin as the primary site. Patients diagnosed between 1998 and 2010 were included. Patients with known metastatic disease were excluded. Five-year causespecific survival (CSS) was then calculated for multiple variables, including tumor size, nodal status, subsite, age, sex, race, and grade. Grade was divided into low grade (I and II) and high grade (III and IV). Frequency of radiation use was evaluated with regard to risk factors. Results: A total of 3551 patients who met the above criteria were identified. The median age was 68 years, and 54.4% were male. Ethnicity was as follows: white 81.2%, black 6.1%, other 5.1%, and unknown 7.5%. Median follow-up was not reached. Grade, nodal status, and age were found to have statistically significant (11.4%, 23.0%, 4.6%, P<0.05) impacts on 5-year CSS. Patients with low- and high-grade disease were found to have 5-year CSS of 97.3% and 85.9%. Those who were node negative vs positive at presentation were noted to have 5-year CSS of 97.1% vs 74.1%. Last, patients stratified by age (70 years as cutoff) had 5-year CSS of 97.6% (<70) and 93.0% (70). In all, 7% of well-differentiated tumors and 18% of poorly differentiated tumors received radiation. Node-negative and node-positive patients received radiation in 5% and 58% of cases. Conclusion: While overall prognosis is good, we identified variables that were associated with a statistically inferior 5-year CSS. Nodal involvement and high tumor grade were most predictive, as noted in Table 1. Patients with these risk factors may derive benefit from comprehensive postoperative radiation as these tumors tend to be locoregionally aggressive. Despite its potential therapeutic value, our study shows radiation has been underutilized in these high-risk groups. While prospective data is the best way to confirm or refute our findings, it is always a major clinical challenge to conduct such a study in this rare set of tumors. Nevertheless, we need more data on other potential risk factors such as perineural invasion, extracapsular extension, and lymphovascular invasion. Author Disclosure: J.A. Marascio: None. N.A. Madden: None. B.M. Rabatic: None. D. Zaenger: None. D. McDermott: None. A.K. Misiura: None. S. Shaaban: None. E.M. Marchan: None. K. Huang: None. A. Amoush: None. A. Al-Basheer: None. A. Green: None. B.G. Dasher: None. J. Howington: None. J.G. Stewart: None. W. Martin: None. M. Pishgou: None. C.L. Ferguson: None. F. Kong: Honoraria; Varian Medical Systems, Zhejiang Cancer Hospital. W.F. Mourad: None.
3731 Correlation of Molecular Imaging and Biomarkers Expression in the Prediction of Metastatic Capacity of Soft Tissue Sarcomas N. Ybarra,1 M. Vallieres,2 K. Jeyaseelan,1 C.R. Freeman,3 S. Jung,4 R. Turcotte,3 J. Seuntjens,2 and I. El Naqa5; 1RI-MUHC Glen site, Montreal, QC, Canada, 2McGill University Health Centre, Canada, Montreal, QC, Canada, 3McGill University Health Centre, Montreal, QC, Canada, 4McGill University Health Centre, Glen site, Montreal, QC, Canada, 5University of Michigan, Ann Arbor, MI Purpose/Objective(s): Soft tissue sarcomas (STS) are an uncommon type of tumors representing only 1% of adult cancers. STS are very heterogeneous in terms of gene expression, even among tumors of the same diagnosis. The prognosis for patients with adult STS depends on several factors, including the patient’s age and the size, histologic grade, and stage