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Periocular Nonmelanoma Skin Cancers: Outcome in 86 Cases Treated With High Dose Rate Electronic Brachytherapy
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Volume 99 Number 2S Supplement 2017 head and neck cancers. To identify when CT verification scans influenced physician decision-making to re-plan and test for variables that may be associated with a re-plan. Materials/Methods: Retrospective review of 50 consecutive pts treated with IMPT undergoing weekly CT verification scans for primary or recurrent head and neck cancers between June 2015 and November 2016. Kaplan-Meier estimates were used for the cumulative probability of a replan by week. Univariate Cox modeling was used to evaluate absolute change in weekly weight as a time-dependent covariate. Tumor and treatment categorical variables were evaluated with various inference methods to test potential predictive variables for a re-plan. Results: Of the 50 pts evaluated, 18 (36%) pts had CT verification scans which prompted a re-plan. All re-plans were initiated from CT verification scans week 5 (fractions (fxs) 1-25). Cumulative probability of a re-plan by week 1 (fxs 1-5): 10.0% (95% confidence interval (CI): 1.3-17.9), week 2 (fxs 6-10): 20.0% (95% CI: 8.1-30.4), week 3 (fxs 11-15): 28.0% (95% CI: 14.4-39.4), week 4 (fxs 16-20): 32.0% (95% CI: 17.8-43.8), and week 5 (fxs 21-25): 36.0% (95% CI: 21.2-48.0). The most common reasons for a re-plan were decreased target coverage (7 pts, 39%), increased dose to organs at risk (4 pts, 22%), or both (4 pts, 22%). Weight as a timedependent covariate was not associated with re-planning either as an absolute change in weight (hazard ratio (HR) 1.20, 95% CI: 0.89-1.61, pZ0.236) or as a percent change in weight (HR 1.15, 95% CI: 0.93-1.42, pZ0.193) from baseline weight at simulation. Multiple variables were inconclusive in identifying associations with a re-plan including, but not limited to: primary and/or nodal gross tumor volumes for definitive cases, T-stage, N-stage, elective neck volumes, and post-op vs. definitive cases. Pts treated with 4 fields trended towards being re-planned more often with 11 (55%) of 20 cases re-planned compared to 6 (25%) of 24 with 3 fields and 1 (17%) of 6 with 2 fields (pZ0.073). There were 16 (46%) of 35 pts with primary tumors re-planned compared to 2 (13%) of 15 pts with recurrent tumors (pZ0.052). Conclusion: Weekly CT verification scans should be utilized for pts undergoing spot-scanning IMPT for head and neck cancers, particularly when daily non-volumetric image guidance is used (e.g. orthogonal kV x-rays). Our data indicates that the first 5 weekly CT verification scans were clinically impactful particularly for pts with primary tumors. Author Disclosure: J.D. Evans: None. D. Mundy: None. A. Anand: None. W.S. Harmsen: None. N.C. Deiter: None. K.R. Jethwa: None. S.C. Lester: None. H.L. Schultz: None. Y. Garces: None. D.J. Ma: None. M.A. Neben-Wittich: None. C. Beltran: Research Grant; Varian Medical. S.H. Patel: None. R.L. Foote: Employee; Mayo Clinic. Consultant; Up to Date. responsible for clinical practice, research and education; Mayo Clinic. Responsible for the written board examination questions for head, neck and skin cancer.; ABR.
2799 Nimotuzumab in the Combination With Neoadjuvant Chemotherapy Followed By Concurrent Chemoradiation Therapy for Locoregionally Advanced Nasopharyngeal Carcinoma Patients in Endemic Area: A Retrospective Study W. Fangzheng and C. Jiang; Zhejiang Cancer Hospital, Hangzhou, China Purpose/Objective(s): The role of nimotuzumab in the combined treatment of locoregionally advanced nasopharyngeal carcinoma (LA NPC) patients remains unknown. Therefore, a retrospective study was conducted to assess the efficacy and safety of nimotuzumab plus neoadjuvant chemotherapy (NAC) followed by concurrent chemoradiotherapy (CCRT) for China patients with LA NPC. Materials/Methods: The clinical data of 210 newly diagnosed non-metastatic NPC patients, who were initially treated with nimotuzumab plus NAC followed by CCRT, were collected and retrospectively reviewed from May 2008 to April 2014. They were aged 13 to 72 years (median 46 years). The distribution of disease was stage III in 117 (55.7%), stage IVa in 75 (35.7%), and stage IVb in 18 (8.6%). Among these patients, 95 cases received cispatin-based adjuvant
chemotherapy (AC). Survival outcomes and treatment-related toxicities were analyzed using IBM SPSS 19.0 software. Results: The median follow-up duration was 48 months. Locoregional relapse and distant metastases occurred in 16 (16/210, 7.6%) and 18 (18/ 210, 8.6%) of the patients, respectively. The 5-year local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distant metastases-free survival, progression-free survival and overall survival rates were 95.6%, 94.4%, 91.7%, 84.0% and 88.7%, respectively. Univariate analysis revealed that CCRT regimens and clinical stage were correlated with OS, while adjuvant chemotherapy (AC), N stage, clinical stage and tumor response at the end of treatment were related with PFS. Multivariate analysis indicated that CCRT regimens, T stage, N stage, clinical stage and tumor response were important prognostications. 24 (11.4%) patients occurred grade 3/4 leukocytopenia and 6 (2.9%) patents developed mild liver function damage during the period of NAC, while 13 (6.2%) patients experienced grade 3/4 acute mucositis and 12 (5.7) patients occurred grade 3/4 leukocytopenia during the period of CCRT. Conclusion: The efficacy of nimotuzumab plus NAC followed by CCRT in LA NPC patients was encouraging and the toxicities were tolerable. Author Disclosure: W. Fangzheng: None. C. Jiang: None.
2800 Periocular Nonmelanoma Skin Cancers: Outcome in 86 Cases Treated With High Dose Rate Electronic Brachytherapy N.E. Flores,1 F. Muratovic,2 D. Liu,1 and T.A. Mian3; 1Arizona Dermatology, Phoenix, AZ, 2Ironwood CRC, Glendale, AZ, United States, 3 Medical Radiation Physics Inc., Scottsdale, AZ, United States Purpose/Objective(s): Eighty-six cases of peri-ocular non-melanoma skin cancer (NMSC) were treated with an accelerated radiation therapy schedule utilizing High Dose Electronic Brachytherapy. Patient selection was limited to age > 40 years, tumor size < 40mm in diameter and < 5 mm thick. Treatment sites included the upper or lower eyelids, medial or lateral canthus, or supra-orbital ridge in patients considered poor surgical candidates or who declined surgery. Demographics Pathology: 82.6% basal, 17.4% squamous Size by treatment field: 76.7% 10mm, 19.8% 20mm and 3.2% 35mm. Location: 48.8% lower lid, 25.6% medial canthus, 23.3% upper lid, 2.3% lateral canthus Age: 73.5 years median (40.8-99.6 years). Materials/Methods: Radiation therapy was administered per recommendations by ASTRO and AAPM and performed with a 50kV x-ray device. All treatments were delivered within a single dermatology practice over a four year period. A total of 4000 cGy in 500 cGy fractions was given twice weekly. Prescribed treatment depth was 0mm for non-bulky disease. Bulky disease was debrided and/or treatment depth modified during treatment as necessary. Treatment interruptions were rare, usually due to infection or contact dermatitis and limited to less than two weeks. Results: 99% of patients maintained a complete response at 2 years (0.23.7 years) median follow-up with one edge-of-field progression and no infield recurrences. Side Effects:Transient low-grade conjunctivitis when using gold eye shields, minimal loss of eyelashes for treatment involving the ciliary rim. No long-term vision changes, dry eye, corneal injury, retinitis, dacrocystitis, orbital bone injury or impairment of eyelid motion. Patient Satisfaction/Cosmesis:Self-scored functional and cosmetic outcomes ranged from very good to excellent in 100% of patients. Conclusion: Radiation therapy utilizing High Dose Rate Electronic Brachytherapy offers a unique patient option for selected NMSC arising in the peri-ocular space. When compared to multi-stage surgery, electronic brachytherapy results in improved patient comfort without the need for extended post-operative care or reconstruction. When compared to conventional radiation therapy, the high response rates, small field sizes, reduced treatment time and lower radiation dose to adjacent critical tissues makes electronic brachytherapy a useful addition to electron therapy or superficial x-ray (orthovoltage) techniques. Author Disclosure: N.E. Flores: None. F. Muratovic: None. D. Liu: None. T.A. Mian: Honoraria; American College of Radiology. ; AAPM.
Volume 99 Number 2S Supplement 2017 head and neck cancers. To identify when CT verification scans influenced physician decision-making to re-plan and test for variables that may be associated with a re-plan. Materials/Methods: Retrospective review of 50 consecutive pts treated with IMPT undergoing weekly CT verification scans for primary or recurrent head and neck cancers between June 2015 and November 2016. Kaplan-Meier estimates were used for the cumulative probability of a replan by week. Univariate Cox modeling was used to evaluate absolute change in weekly weight as a time-dependent covariate. Tumor and treatment categorical variables were evaluated with various inference methods to test potential predictive variables for a re-plan. Results: Of the 50 pts evaluated, 18 (36%) pts had CT verification scans which prompted a re-plan. All re-plans were initiated from CT verification scans week 5 (fractions (fxs) 1-25). Cumulative probability of a re-plan by week 1 (fxs 1-5): 10.0% (95% confidence interval (CI): 1.3-17.9), week 2 (fxs 6-10): 20.0% (95% CI: 8.1-30.4), week 3 (fxs 11-15): 28.0% (95% CI: 14.4-39.4), week 4 (fxs 16-20): 32.0% (95% CI: 17.8-43.8), and week 5 (fxs 21-25): 36.0% (95% CI: 21.2-48.0). The most common reasons for a re-plan were decreased target coverage (7 pts, 39%), increased dose to organs at risk (4 pts, 22%), or both (4 pts, 22%). Weight as a timedependent covariate was not associated with re-planning either as an absolute change in weight (hazard ratio (HR) 1.20, 95% CI: 0.89-1.61, pZ0.236) or as a percent change in weight (HR 1.15, 95% CI: 0.93-1.42, pZ0.193) from baseline weight at simulation. Multiple variables were inconclusive in identifying associations with a re-plan including, but not limited to: primary and/or nodal gross tumor volumes for definitive cases, T-stage, N-stage, elective neck volumes, and post-op vs. definitive cases. Pts treated with 4 fields trended towards being re-planned more often with 11 (55%) of 20 cases re-planned compared to 6 (25%) of 24 with 3 fields and 1 (17%) of 6 with 2 fields (pZ0.073). There were 16 (46%) of 35 pts with primary tumors re-planned compared to 2 (13%) of 15 pts with recurrent tumors (pZ0.052). Conclusion: Weekly CT verification scans should be utilized for pts undergoing spot-scanning IMPT for head and neck cancers, particularly when daily non-volumetric image guidance is used (e.g. orthogonal kV x-rays). Our data indicates that the first 5 weekly CT verification scans were clinically impactful particularly for pts with primary tumors. Author Disclosure: J.D. Evans: None. D. Mundy: None. A. Anand: None. W.S. Harmsen: None. N.C. Deiter: None. K.R. Jethwa: None. S.C. Lester: None. H.L. Schultz: None. Y. Garces: None. D.J. Ma: None. M.A. Neben-Wittich: None. C. Beltran: Research Grant; Varian Medical. S.H. Patel: None. R.L. Foote: Employee; Mayo Clinic. Consultant; Up to Date. responsible for clinical practice, research and education; Mayo Clinic. Responsible for the written board examination questions for head, neck and skin cancer.; ABR.
2799 Nimotuzumab in the Combination With Neoadjuvant Chemotherapy Followed By Concurrent Chemoradiation Therapy for Locoregionally Advanced Nasopharyngeal Carcinoma Patients in Endemic Area: A Retrospective Study W. Fangzheng and C. Jiang; Zhejiang Cancer Hospital, Hangzhou, China Purpose/Objective(s): The role of nimotuzumab in the combined treatment of locoregionally advanced nasopharyngeal carcinoma (LA NPC) patients remains unknown. Therefore, a retrospective study was conducted to assess the efficacy and safety of nimotuzumab plus neoadjuvant chemotherapy (NAC) followed by concurrent chemoradiotherapy (CCRT) for China patients with LA NPC. Materials/Methods: The clinical data of 210 newly diagnosed non-metastatic NPC patients, who were initially treated with nimotuzumab plus NAC followed by CCRT, were collected and retrospectively reviewed from May 2008 to April 2014. They were aged 13 to 72 years (median 46 years). The distribution of disease was stage III in 117 (55.7%), stage IVa in 75 (35.7%), and stage IVb in 18 (8.6%). Among these patients, 95 cases received cispatin-based adjuvant
chemotherapy (AC). Survival outcomes and treatment-related toxicities were analyzed using IBM SPSS 19.0 software. Results: The median follow-up duration was 48 months. Locoregional relapse and distant metastases occurred in 16 (16/210, 7.6%) and 18 (18/ 210, 8.6%) of the patients, respectively. The 5-year local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distant metastases-free survival, progression-free survival and overall survival rates were 95.6%, 94.4%, 91.7%, 84.0% and 88.7%, respectively. Univariate analysis revealed that CCRT regimens and clinical stage were correlated with OS, while adjuvant chemotherapy (AC), N stage, clinical stage and tumor response at the end of treatment were related with PFS. Multivariate analysis indicated that CCRT regimens, T stage, N stage, clinical stage and tumor response were important prognostications. 24 (11.4%) patients occurred grade 3/4 leukocytopenia and 6 (2.9%) patents developed mild liver function damage during the period of NAC, while 13 (6.2%) patients experienced grade 3/4 acute mucositis and 12 (5.7) patients occurred grade 3/4 leukocytopenia during the period of CCRT. Conclusion: The efficacy of nimotuzumab plus NAC followed by CCRT in LA NPC patients was encouraging and the toxicities were tolerable. Author Disclosure: W. Fangzheng: None. C. Jiang: None.
2800 Periocular Nonmelanoma Skin Cancers: Outcome in 86 Cases Treated With High Dose Rate Electronic Brachytherapy N.E. Flores,1 F. Muratovic,2 D. Liu,1 and T.A. Mian3; 1Arizona Dermatology, Phoenix, AZ, 2Ironwood CRC, Glendale, AZ, United States, 3 Medical Radiation Physics Inc., Scottsdale, AZ, United States Purpose/Objective(s): Eighty-six cases of peri-ocular non-melanoma skin cancer (NMSC) were treated with an accelerated radiation therapy schedule utilizing High Dose Electronic Brachytherapy. Patient selection was limited to age > 40 years, tumor size < 40mm in diameter and < 5 mm thick. Treatment sites included the upper or lower eyelids, medial or lateral canthus, or supra-orbital ridge in patients considered poor surgical candidates or who declined surgery. Demographics Pathology: 82.6% basal, 17.4% squamous Size by treatment field: 76.7% 10mm, 19.8% 20mm and 3.2% 35mm. Location: 48.8% lower lid, 25.6% medial canthus, 23.3% upper lid, 2.3% lateral canthus Age: 73.5 years median (40.8-99.6 years). Materials/Methods: Radiation therapy was administered per recommendations by ASTRO and AAPM and performed with a 50kV x-ray device. All treatments were delivered within a single dermatology practice over a four year period. A total of 4000 cGy in 500 cGy fractions was given twice weekly. Prescribed treatment depth was 0mm for non-bulky disease. Bulky disease was debrided and/or treatment depth modified during treatment as necessary. Treatment interruptions were rare, usually due to infection or contact dermatitis and limited to less than two weeks. Results: 99% of patients maintained a complete response at 2 years (0.23.7 years) median follow-up with one edge-of-field progression and no infield recurrences. Side Effects:Transient low-grade conjunctivitis when using gold eye shields, minimal loss of eyelashes for treatment involving the ciliary rim. No long-term vision changes, dry eye, corneal injury, retinitis, dacrocystitis, orbital bone injury or impairment of eyelid motion. Patient Satisfaction/Cosmesis:Self-scored functional and cosmetic outcomes ranged from very good to excellent in 100% of patients. Conclusion: Radiation therapy utilizing High Dose Rate Electronic Brachytherapy offers a unique patient option for selected NMSC arising in the peri-ocular space. When compared to multi-stage surgery, electronic brachytherapy results in improved patient comfort without the need for extended post-operative care or reconstruction. When compared to conventional radiation therapy, the high response rates, small field sizes, reduced treatment time and lower radiation dose to adjacent critical tissues makes electronic brachytherapy a useful addition to electron therapy or superficial x-ray (orthovoltage) techniques. Author Disclosure: N.E. Flores: None. F. Muratovic: None. D. Liu: None. T.A. Mian: Honoraria; American College of Radiology. ; AAPM.