- Email: [email protected]
Outcomes Reported by Cancer Survivors after Radiation Therapy
I. J. Radiation Oncology d Biology d Physics
S566
Volume 81, Number 2, Supplement, 2011
Materials/Methods: Between 1998 and 2001, 1310 patients with localized prostate cancer were treated with EBRT (n = 897) or BRT (n = 413). We compared the incidence rates of SM in our patients with the general population extracted from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) dataset combined with the 2000 census data. Results: The 10-year likelihoods for SM development in the EBRT and BRT groups were 25% and 15%, respectively (p = 0.02). The 10-year likelihoods for in-field (IF) SM development in these groups were 4.9% and 1.6%, respectively (p = 0.24). Multivariate analysis of predictors for development of all SM showed that EBRT vs BRT was the only significant variable identified (p = 0.05), with a trend for older patients to develop a SM. The increased incidence of SM for EBRT patients was explained by a higher incidence of skin cancers outside of the radiation field observed for this cohort compared with BRT patients (10.6% and 3.3%, respectively, p = 0.004). For the EBRT group, 5- and 10-year mortality rates were 1.96% and 5.1% due to out-of field (OOF) cancers; for IF-SM the corresponding mortality rates were 0.1% and 0.7%. Among the BRT group, the 5- and 10-year mortality rates related to OOF-SM were 0.8% and 2.7%. When compared with cancer incidence rates in the general population, our observed SM rates after prostate irradiation were not significantly different. Conclusions: Using modern sophisticated treatment techniques, we report low rates of IF bladder and rectal second-cancer risks after prostate cancer radiotherapy. Further, the likelihood of mortality secondary to a SM was uncommon. Higher rates of SM observed in the EBRT cohort compared with BRT was related to a small but significantly increased number of skin cancers noted in the EBRT patients compared with the general population. Author Disclosure: D.M. Housman: None. M.J. Zelefsky: None. X. Pei: None. Z. Alicikus: None. J.M. Magsanoc: None. Y. Yamada: None. M. Kollmeier: None. B. Cox: None. Z. Zhang: None.
2742
Creation of RTOG-Compliant Locally Advanced Breast, Postoperative Pancreas, and High Risk Prostate Cancer Atlases Assisted by Slice- and Volume-Based CT Deformable Registration
A. V. Louie1, V. Velker1, J. Hwee1, R. Dinniwell2, G. Rodrigues1 1
University of Western Ontario, London, ON, Canada, 2University of Toronto, Toronto, ON, Canada
Purpose/Objective(s): Contouring of target and normal tissue structures can be a time consuming exercise associated with significant levels of inter- and intra-physician variability. The purpose of this investigation was to create and evaluate multiple RTOG compliant atlas libraries ability to reduce overall contouring time, inter-physician variability, and to provide the radiation oncology community a standardized platform for teaching and research. Materials/Methods: Anonymized CT datasets of 50 high risk breast post-lumpectomy (BR), 50 high risk prostate (PRO), and 9 post-operative pancreas (POP) cases were created as part of the LocStar (London Ontario Consistently Segmented Tri-purpose Atlas Resource) library project. For each case, RTOG compliant organs at risk and clinical target volumes (CTV) were manually contoured using a slice-by-slice deformable contouring registration tool (Contour CoPilot, MIMVista, Cleveland OH). A bootstrap methodology was then utilized to sequentially create volume deformable registered atlas-based contours for subsequent patients in each atlas. Statistical analyses included descriptive time statistics, Dice Similarity Coefficients, two-group Student’s test, and/or ANOVA. Results: The average time to manually contour a case were: PRO - 19 min 6 s; POP - 26 min 57 s and BR - 50 min 41 s. Mean times for MIMVista atlas based autocontouring were 1 min 25 s (BR), 2 min 14 s (PRO), and 1 min 11 s (POP). Mean DICE scores for PRO were: prostate 0.71, seminal vesicles 0.30, CTV nodes 0.71, bladder 0.83, rectum 0.48, penile bulb 0.39, and femoral heads 0.91. For POP, mean DICE scores were: aorta 0.49, celiac axis 0.08, CTV 0.49, kidneys 0.68, liver 0.75, pancreas 0.08, portal vein 0.01, superior mesenteric artery 0.04, spinal cord 0.77, spleen 0.62, and stomach 0.37. For BR, mean DICE were: chest wall 0.88, seroma 0.07, supraclavicular lymph nodes (SCV) 0.71, axillary lymph nodes 0.73, lungs 0.97, and heart 0.90. Statistically significant improvements in DICE with increased case number were observed for SCV (p = 0.003) and lung contours (p = 0.02), but not in any of the remaining targets (all p.0.1). Conclusions: Creation of RTOG-compliant atlases is feasible and can be assisted by slice-based and volume-based deformable registration contouring algorithms. While some targets can likely be auto-contoured; highly variable and individualized targets such as breast seromas, nodal target volumes, and targets for localization of contouring such as the portal vein, superior mesenteric artery, aorta, and celiac axis should be contoured manually using slice-deformable assistive technologies. Author Disclosure: A.V. Louie: None. V. Velker: None. J. Hwee: None. R. Dinniwell: None. G. Rodrigues: None.
2743
Outcomes Reported by Cancer Survivors after Radiation Therapy
C. E. Hill-Kayser, C. Vachani, M. K. Hampshire, G. A. Di Lullo, J. M. Metz University of Pennsylvania, Philadelphia, PA Purpose/Objective(s): Cancer survivors may be at significant risk for late effects after radiotherapy therapy. The impact of toxicity after cancer treatment on survivors is not well described. This Internet based study evaluates patient perceptions of toxicity after radiation therapy. Materials/Methods: Patient-reported data was gathered via a convenience sample frame from cancer survivors voluntarily utilizing a publically available, free, Internet-based tool for creation of survivorship care plans. Available at www.livestrongcareplan.com and through the OncoLink website, the tool allows survivors to enter data regarding diagnosis, demographics, and treatments, and provides customized guidelines for future care. During use of the tool, survivors are queried regarding late effects associated with specific treatments, and asked to answer ‘‘yes,’’ ‘‘no,’’ or ‘‘I don’t know.’’ They are also asked to score GI and GU toxicity using modified versions of validated scales. All data have been maintained with institutional review board approval.
Proceedings of the 53rd Annual ASTRO Meeting
S567
Results: Of 3223 cancer survivors answering queries regarding late effects, 1785 (55%) had undergone radiotherapy (78% women, 88% Caucasian). Their most common diagnoses were breast (53%), lymphoma/leukemia (10%), GI (8%), and GU (8%) cancers. Median time from diagnosis was 2.3 years. Of the whole cohort, the most common late effects reported were concern regarding cognitive changes (58%), sexual changes (55%), changes in texture/color of skin (50%), and chronic pain/ numbness/tingling (39%). Late effects by disease site are outlined in Table 1. Conclusions: Cancer survivors choosing to use this tool after radiation therapy describe significant late toxicity. Cognitive and sexual changes appear more prominent than expected within this population. These findings have significant implications for patient counseling, as well as management of patients after radiation therapy.
Most commonly reported late effects by cancer survivors after radiation according to diagnosis Diagnosis # Users Patient Reported Outcomes Breast Cancer 944 (53%) Cognitive changes (62%) Skin changes (53%) Chronic pain/ numbness/ tingling (53%) Leukemia/ 181 (10%) Cognitive changes (50%) Sexual changes (49%) Skin changes (46%) lymphoma Gastrointestinal 160 (9%) Cognitive changes (50%) Sexual changes (44%) Chronic diarrhea (32%) Genitourinary 145 (8%) Sexual changes (56%) Urinary incontinence (20%) Skin changes (18%) Head and Neck 90 (5%) Decreased saliva (83%) Difficulty speaking/ Skin changes (70%) swallowing (80%) Gynecologic 88 (5%) Sexual changes (78%) Cognitive changes (49%) Skin changes (40%) Lung 51 (3%) Skin changes (44%) Chronic pain/ numbness/ Hearing loss (34%) tingling (43%)
Loss of flexibility (34%) Hypothyroid (40%) Skin changes (23%) Osteoporosis (12%) Loss of neck flexibility (57%) Weight gain (33%) Hypothyroid (29%)
Author Disclosure: C.E. Hill-Kayser: None. C. Vachani: None. M.K. Hampshire: None. G.A. Di Lullo: None. J.M. Metz: None.
2744
National Survey of Health Care Providers’ Views on the Risk of Inadvertent Exposure of Pregnant Patients to Ionizing Radiation in Canadian Radiotherapy Departments
J. D. Caon1, R. Olson2, S. Tyldesley1, A. Bergman3, M. Bobinski4, M. Fong5, V. Ma6, R. Vellani5, K. Goddard1 1 BC Cancer Agency, Department of Radiation Oncology, Vancouver, BC, Canada, 2BC Cancer Agency, Department of Radiation Oncology, Prince George, BC, Canada, 3BC Cancer Agency, Department of Medical Physics, Vancouver, BC, Canada, 4University of British Columbia, Faculty of Law, Vancouver, BC, Canada, 5BC Cancer Agency, Department of Radiation Therapy, Vancouver, BC, Canada, 6University of British Columbia, Vancouver, BC, Canada
Purpose/Objective(s): Women of child-bearing age are at risk of developing a malignancy that requires treatment with radiation therapy (RT). Radiation exposure to pregnant patients is associated with a risk of fetal malformation or death. A preliminary survey in a Canadian province suggested that safety mechanisms to prevent inadvertent RT to pregnant patients were not clearly established, and therefore a national survey was undertaken. Materials/Methods: An online survey was created and distributed to all radiation oncologists (RO), radiation oncology residents (ROR), radiation therapists (RTT), and medical physicists (MP) who were members of their respective national agencies (n = 2146). Results: 317 respondents (14.8%) completed the questionnaire, with the highest response rate from ROs (34.2%). The majority were RTTs (55.2%), followed by ROs (31.4%), MPs (9.5%), and RORs (3.8%). All Canadian provinces, with the exception of Nova Scotia, were represented. Only 58.2% of ROs/RORs remembered to discuss the risk of RT in pregnancy most of the time. The majority (69.7%) of respondents did not believe or know if RTTs discussed the risks of radiation in pregnancy. In addition, the majority (65.2%) either thought no warning signs existed in their department, or were unsure of their existence. Only 8.3% of respondents believed their centre had patient information handouts. Few (9.0%) respondents encountered a situation where a pregnant patient was inadvertently treated with RT, and 13.2% encountered a situation where a pregnant patient was almost inadvertently treated with RT; there was no significant difference by province (p = 0.79 and p = 0.18, respectively). Each occupation thought that discussion by ROs, education by RTTs, and routine pregnancy testing were the most effective methods to prevent inadvertent radiation exposure. Conclusions: No consistent mechanisms appear to be in place across Canadian cancer centers to prevent inadvertent ionizing radiation exposure to pregnant patients. Furthermore, 19% of respondents encountered situations in which a pregnant patient was, or was almost, inadvertently irradiated. This suggests that national guidelines together with detailed institutional policies and procedures need to be developed. Author Disclosure: J.D. Caon: None. R. Olson: None. S. Tyldesley: None. A. Bergman: None. M. Bobinski: None. M. Fong: None. V. Ma: None. R. Vellani: None. K. Goddard: None.
2745
Referral Patterns of Patients for Palliative Radiation Therapy in British Columbia: A Comparison Between Northern and Urban Family Physicians
S. Lengoc, J. Soo, J. French, C. McGahan, S. Tyldesley, R. Olson British Columbia Cancer Agency, Vancouver, BC, Canada Purpose/Objective(s): Previous studies have shown that Palliative Radiation Therapy (PRT) is often underutilized especially in rural and remote settings despite evidence that it is effective in managing symptoms from advanced or metastatic cancer.
S566
Volume 81, Number 2, Supplement, 2011
Materials/Methods: Between 1998 and 2001, 1310 patients with localized prostate cancer were treated with EBRT (n = 897) or BRT (n = 413). We compared the incidence rates of SM in our patients with the general population extracted from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) dataset combined with the 2000 census data. Results: The 10-year likelihoods for SM development in the EBRT and BRT groups were 25% and 15%, respectively (p = 0.02). The 10-year likelihoods for in-field (IF) SM development in these groups were 4.9% and 1.6%, respectively (p = 0.24). Multivariate analysis of predictors for development of all SM showed that EBRT vs BRT was the only significant variable identified (p = 0.05), with a trend for older patients to develop a SM. The increased incidence of SM for EBRT patients was explained by a higher incidence of skin cancers outside of the radiation field observed for this cohort compared with BRT patients (10.6% and 3.3%, respectively, p = 0.004). For the EBRT group, 5- and 10-year mortality rates were 1.96% and 5.1% due to out-of field (OOF) cancers; for IF-SM the corresponding mortality rates were 0.1% and 0.7%. Among the BRT group, the 5- and 10-year mortality rates related to OOF-SM were 0.8% and 2.7%. When compared with cancer incidence rates in the general population, our observed SM rates after prostate irradiation were not significantly different. Conclusions: Using modern sophisticated treatment techniques, we report low rates of IF bladder and rectal second-cancer risks after prostate cancer radiotherapy. Further, the likelihood of mortality secondary to a SM was uncommon. Higher rates of SM observed in the EBRT cohort compared with BRT was related to a small but significantly increased number of skin cancers noted in the EBRT patients compared with the general population. Author Disclosure: D.M. Housman: None. M.J. Zelefsky: None. X. Pei: None. Z. Alicikus: None. J.M. Magsanoc: None. Y. Yamada: None. M. Kollmeier: None. B. Cox: None. Z. Zhang: None.
2742
Creation of RTOG-Compliant Locally Advanced Breast, Postoperative Pancreas, and High Risk Prostate Cancer Atlases Assisted by Slice- and Volume-Based CT Deformable Registration
A. V. Louie1, V. Velker1, J. Hwee1, R. Dinniwell2, G. Rodrigues1 1
University of Western Ontario, London, ON, Canada, 2University of Toronto, Toronto, ON, Canada
Purpose/Objective(s): Contouring of target and normal tissue structures can be a time consuming exercise associated with significant levels of inter- and intra-physician variability. The purpose of this investigation was to create and evaluate multiple RTOG compliant atlas libraries ability to reduce overall contouring time, inter-physician variability, and to provide the radiation oncology community a standardized platform for teaching and research. Materials/Methods: Anonymized CT datasets of 50 high risk breast post-lumpectomy (BR), 50 high risk prostate (PRO), and 9 post-operative pancreas (POP) cases were created as part of the LocStar (London Ontario Consistently Segmented Tri-purpose Atlas Resource) library project. For each case, RTOG compliant organs at risk and clinical target volumes (CTV) were manually contoured using a slice-by-slice deformable contouring registration tool (Contour CoPilot, MIMVista, Cleveland OH). A bootstrap methodology was then utilized to sequentially create volume deformable registered atlas-based contours for subsequent patients in each atlas. Statistical analyses included descriptive time statistics, Dice Similarity Coefficients, two-group Student’s test, and/or ANOVA. Results: The average time to manually contour a case were: PRO - 19 min 6 s; POP - 26 min 57 s and BR - 50 min 41 s. Mean times for MIMVista atlas based autocontouring were 1 min 25 s (BR), 2 min 14 s (PRO), and 1 min 11 s (POP). Mean DICE scores for PRO were: prostate 0.71, seminal vesicles 0.30, CTV nodes 0.71, bladder 0.83, rectum 0.48, penile bulb 0.39, and femoral heads 0.91. For POP, mean DICE scores were: aorta 0.49, celiac axis 0.08, CTV 0.49, kidneys 0.68, liver 0.75, pancreas 0.08, portal vein 0.01, superior mesenteric artery 0.04, spinal cord 0.77, spleen 0.62, and stomach 0.37. For BR, mean DICE were: chest wall 0.88, seroma 0.07, supraclavicular lymph nodes (SCV) 0.71, axillary lymph nodes 0.73, lungs 0.97, and heart 0.90. Statistically significant improvements in DICE with increased case number were observed for SCV (p = 0.003) and lung contours (p = 0.02), but not in any of the remaining targets (all p.0.1). Conclusions: Creation of RTOG-compliant atlases is feasible and can be assisted by slice-based and volume-based deformable registration contouring algorithms. While some targets can likely be auto-contoured; highly variable and individualized targets such as breast seromas, nodal target volumes, and targets for localization of contouring such as the portal vein, superior mesenteric artery, aorta, and celiac axis should be contoured manually using slice-deformable assistive technologies. Author Disclosure: A.V. Louie: None. V. Velker: None. J. Hwee: None. R. Dinniwell: None. G. Rodrigues: None.
2743
Outcomes Reported by Cancer Survivors after Radiation Therapy
C. E. Hill-Kayser, C. Vachani, M. K. Hampshire, G. A. Di Lullo, J. M. Metz University of Pennsylvania, Philadelphia, PA Purpose/Objective(s): Cancer survivors may be at significant risk for late effects after radiotherapy therapy. The impact of toxicity after cancer treatment on survivors is not well described. This Internet based study evaluates patient perceptions of toxicity after radiation therapy. Materials/Methods: Patient-reported data was gathered via a convenience sample frame from cancer survivors voluntarily utilizing a publically available, free, Internet-based tool for creation of survivorship care plans. Available at www.livestrongcareplan.com and through the OncoLink website, the tool allows survivors to enter data regarding diagnosis, demographics, and treatments, and provides customized guidelines for future care. During use of the tool, survivors are queried regarding late effects associated with specific treatments, and asked to answer ‘‘yes,’’ ‘‘no,’’ or ‘‘I don’t know.’’ They are also asked to score GI and GU toxicity using modified versions of validated scales. All data have been maintained with institutional review board approval.
Proceedings of the 53rd Annual ASTRO Meeting
S567
Results: Of 3223 cancer survivors answering queries regarding late effects, 1785 (55%) had undergone radiotherapy (78% women, 88% Caucasian). Their most common diagnoses were breast (53%), lymphoma/leukemia (10%), GI (8%), and GU (8%) cancers. Median time from diagnosis was 2.3 years. Of the whole cohort, the most common late effects reported were concern regarding cognitive changes (58%), sexual changes (55%), changes in texture/color of skin (50%), and chronic pain/ numbness/tingling (39%). Late effects by disease site are outlined in Table 1. Conclusions: Cancer survivors choosing to use this tool after radiation therapy describe significant late toxicity. Cognitive and sexual changes appear more prominent than expected within this population. These findings have significant implications for patient counseling, as well as management of patients after radiation therapy.
Most commonly reported late effects by cancer survivors after radiation according to diagnosis Diagnosis # Users Patient Reported Outcomes Breast Cancer 944 (53%) Cognitive changes (62%) Skin changes (53%) Chronic pain/ numbness/ tingling (53%) Leukemia/ 181 (10%) Cognitive changes (50%) Sexual changes (49%) Skin changes (46%) lymphoma Gastrointestinal 160 (9%) Cognitive changes (50%) Sexual changes (44%) Chronic diarrhea (32%) Genitourinary 145 (8%) Sexual changes (56%) Urinary incontinence (20%) Skin changes (18%) Head and Neck 90 (5%) Decreased saliva (83%) Difficulty speaking/ Skin changes (70%) swallowing (80%) Gynecologic 88 (5%) Sexual changes (78%) Cognitive changes (49%) Skin changes (40%) Lung 51 (3%) Skin changes (44%) Chronic pain/ numbness/ Hearing loss (34%) tingling (43%)
Loss of flexibility (34%) Hypothyroid (40%) Skin changes (23%) Osteoporosis (12%) Loss of neck flexibility (57%) Weight gain (33%) Hypothyroid (29%)
Author Disclosure: C.E. Hill-Kayser: None. C. Vachani: None. M.K. Hampshire: None. G.A. Di Lullo: None. J.M. Metz: None.
2744
National Survey of Health Care Providers’ Views on the Risk of Inadvertent Exposure of Pregnant Patients to Ionizing Radiation in Canadian Radiotherapy Departments
J. D. Caon1, R. Olson2, S. Tyldesley1, A. Bergman3, M. Bobinski4, M. Fong5, V. Ma6, R. Vellani5, K. Goddard1 1 BC Cancer Agency, Department of Radiation Oncology, Vancouver, BC, Canada, 2BC Cancer Agency, Department of Radiation Oncology, Prince George, BC, Canada, 3BC Cancer Agency, Department of Medical Physics, Vancouver, BC, Canada, 4University of British Columbia, Faculty of Law, Vancouver, BC, Canada, 5BC Cancer Agency, Department of Radiation Therapy, Vancouver, BC, Canada, 6University of British Columbia, Vancouver, BC, Canada
Purpose/Objective(s): Women of child-bearing age are at risk of developing a malignancy that requires treatment with radiation therapy (RT). Radiation exposure to pregnant patients is associated with a risk of fetal malformation or death. A preliminary survey in a Canadian province suggested that safety mechanisms to prevent inadvertent RT to pregnant patients were not clearly established, and therefore a national survey was undertaken. Materials/Methods: An online survey was created and distributed to all radiation oncologists (RO), radiation oncology residents (ROR), radiation therapists (RTT), and medical physicists (MP) who were members of their respective national agencies (n = 2146). Results: 317 respondents (14.8%) completed the questionnaire, with the highest response rate from ROs (34.2%). The majority were RTTs (55.2%), followed by ROs (31.4%), MPs (9.5%), and RORs (3.8%). All Canadian provinces, with the exception of Nova Scotia, were represented. Only 58.2% of ROs/RORs remembered to discuss the risk of RT in pregnancy most of the time. The majority (69.7%) of respondents did not believe or know if RTTs discussed the risks of radiation in pregnancy. In addition, the majority (65.2%) either thought no warning signs existed in their department, or were unsure of their existence. Only 8.3% of respondents believed their centre had patient information handouts. Few (9.0%) respondents encountered a situation where a pregnant patient was inadvertently treated with RT, and 13.2% encountered a situation where a pregnant patient was almost inadvertently treated with RT; there was no significant difference by province (p = 0.79 and p = 0.18, respectively). Each occupation thought that discussion by ROs, education by RTTs, and routine pregnancy testing were the most effective methods to prevent inadvertent radiation exposure. Conclusions: No consistent mechanisms appear to be in place across Canadian cancer centers to prevent inadvertent ionizing radiation exposure to pregnant patients. Furthermore, 19% of respondents encountered situations in which a pregnant patient was, or was almost, inadvertently irradiated. This suggests that national guidelines together with detailed institutional policies and procedures need to be developed. Author Disclosure: J.D. Caon: None. R. Olson: None. S. Tyldesley: None. A. Bergman: None. M. Bobinski: None. M. Fong: None. V. Ma: None. R. Vellani: None. K. Goddard: None.
2745
Referral Patterns of Patients for Palliative Radiation Therapy in British Columbia: A Comparison Between Northern and Urban Family Physicians
S. Lengoc, J. Soo, J. French, C. McGahan, S. Tyldesley, R. Olson British Columbia Cancer Agency, Vancouver, BC, Canada Purpose/Objective(s): Previous studies have shown that Palliative Radiation Therapy (PRT) is often underutilized especially in rural and remote settings despite evidence that it is effective in managing symptoms from advanced or metastatic cancer.