- Email: [email protected]
Phase II Trial Of Neoadjuvant Chemoradiation With Concomitant Boost Followed By A Coycle Of Xelox In Locally Advanced Rectal Cancer
I. J. Radiation Oncology d Biology d Physics
S364
Volume 81, Number 2, Supplement, 2011
had intrahepatic CCA (29%), and 4 had perihilar CCA (14%). Twenty-four patients received adjuvant radiation therapy (86%), while 4 patients were treated with definitive intent (14%). Of the resected tumors, 10 patients had negative surgical margins (36%), 8 patients had close margins (\1mm margin) (29%), and 4 patients had grossly positive margins (22%). 36% had positive nodes. Median follow-up was 12.7 months (range, 4.6 to 52.2 months). LC, PFS, and OS at 1 year were 90%, 56%, and 76%, respectively. Grade 3-4 toxicity occurred in only 2 patients (7%). Three patients (11%) required treatment breaks, 3 patients (11%) had ED visits, and 4 patients (14%) required hospitalization. One patient died of a post-operative arterio-enteric fistula (4%) during the first week of radiation. There were no cases of radiation induced-liver disease. Analysis of dosimetric data for normal tissue structures revealed no significant correlations with toxicity or adverse events. Conclusions: Chemoradiation with IMRT is well tolerated with minimal acute treatment-related toxicities in the treatment of biliary tract cancer. Due to the small number of adverse events, we were unable to determine dosimetric correlation of toxicity with DVH parameters. Author Disclosure: L.Z. Braunstein: None. A.X. Zhu: None. J.Y. Wo: None. M. Ancukiewicz: None. B.N. Napolitano: None. J.A. Wolfgang: None. H.J. Mamon: None. L.S. Blaszkowsky: None. D.P. Ryan: None. T.S. Hong: None.
2320
Hepatocellular Carcinoma Target Volume Design and Dosimetric Features For RapidArc Plan: 4D-CT versus 3D-CT Associated With ABC
G. Gong, Y. Yin, J. Chen, T. Liu, J. Lu Shandong Cancer Hospital, Jinan, China Purpose/Objective(s): To investigate the dosimetric features of RapidArc plans for hepatocellular carcinoma (HCC) radiotherapy using different target volumes which determined by four dimension computed tomography (4D-CT) and 3D-CT associated with active breathing coordinator (ABC). Materials/Methods: 10 patients with HCC were selected to undergo 4D-CT and 3D-CT scans associated with ABC at end inspiration hold (EIH), end expiration hold (EEH), and free breathing (FB). The GTVs were contoured on 4D-CT and 3D-CT images respectively, and the internal gross target volume (ITV1, ITV2) were acquired respectively. The individual margins were obtained from GTVFB to ITV1 and ITV2 respectively, ITV3 and ITV4 were obtained from GTVFB using the individual margins respectively. PTV-1 was acquired from GTV FB using conventional margins; and PTV-2 using individual margins and PTV-3 was acquired from GTVEIH. For the PTV-1 and PTV-3, RapidArc plan with three 135 o arcs (ARC1, ARC4) were designed; for PTV-1 and PTV-2 with 360 o arc (ARC2, ARC3). The volume of GTVs, ITVs, PTVs, the individual margins and the dosimetric features of four RapidArc plans were compared. Results: The volume differences between ITV1 and ITV2, ITV3 and ITV4 were not significant (p . 0.05). The three axial margins differences from GTV FB to ITV1 and ITV2 were not significant (p . 0.05). The volume of PTV-1 was larger than PTV-2, PTV-3 (p\0.05). The differences of dose distribution for target volume in four plans were not significant (p . 0.05). The differences of OARs irradiation dose of ARC1 and ARC2 were not significant (p . 0.05). The dose of normal liver was ARC1 . ARC3 . ARC4 (p \ 0.05). Conclusions: Associated with ABC or using individual target volume determined by 3D-CT associated with ABC or 4D-CT in RapidArc plan for HCC radiotherapy can achieve perfect target dose coverage and spare more OARs. Author Disclosure: G. Gong: None. Y. Yin: None. J. Chen: None. T. Liu: None. J. Lu: None.
2321
Phase II Trial Of Neoadjuvant Chemoradiation With Concomitant Boost Followed By A Coycle Of Xelox In Locally Advanced Rectal Cancer
J. Zhu, Z. Zhang, W. Gu, Y. Xu, W. Shen, G. Cai, W. Sun, S. Cai Fudan University Cancer Hospital, Shanghai, China Purpose/Objective(s): IMRT with concomitant boost has showed efficacy in head and neck cancer but not proved in rectal cancer. Patients with pCR may have potential with lower recurrence and better overall survival. The prospective phase II trial was to evaluate the feasibility, toxicity, and response rate of preoperative concurrent chemoradiation with escalating dose by concomitant IMRT boost in locally advanced rectal cancer. Concurrent capecitabine plus oxaliplatin and one cycle of XELOX followed by CRT were used for the purpose of reduction of distance metastasis. Materials/Methods: Patients with T3-4 and/or N+ rectal cancer were treated at the Shanghai Cancer Hospital Fudan University, Shanghai from Sept 2008 to Nov 2010. All Patients received IMRT delivering 50 Gy (2 Gy/fraction) to the whole pelvis in concomitant with 55 Gy (2.2 Gy/fraction) to the primary tumor. Concurrent chemotherapy included oxaliplatin (50mg/m2 d1 weekly) and capecitabine (625mg/m2 bid, d1-5 weekly). One cycle of Xelox (oxaliplatin 130mg/m2 d1 + capecitabine 1000 mg/m2 bid d114) was given 2 weeks after the completion of concurrent chemoradiation, followed by radical surgery 8 weeks thereafter. Tumor response was evaluated by tumor regression grade (TRG) system and toxicity was evaluated by NCI-CTC 3.0 criteria. Results: A total of 51 patients were accrued to this study. The median age was 57 (range, 37-71). Eighty-six percent patients had T3 disease and 77% had N+ disease. The median distance from the anal verge was 4.5 cm (range, 3-11cm). All patients completed chemoradiation per protocol. Seventeen patients underwent sphincter-sparing procedures. TRG was Grade 4 in 14 patients, Grade 3 in 25, Grade 2 in 8, and Grade 1 in 4 patients. The good response rate (TRG 3+4) was 76.5% (39/51) and the pCR rate was 27.4% (14/51). The grade 3 toxicities of hematologic, gastro-intestinal, and skin were 3.9%,17.6%, and 25.5%, respectively. No Grade 4 toxicity has been observed. Surgical complications (infection within 3 weeks of surgery) were observed in 5 patients; all were cured with intervention treatment. Conclusions: IMRT with concomitant boost is feasible in rectal cancer. Preoperative chemoradiation combined with capecitabine and oxaliplatin, followed by a cycle of Xelox is well tolerated and results in an encouraging pCR rate for patients with locally advanced rectal cancer. Longer follow up and large clinical trial will be further studied. Author Disclosure: J. Zhu: None. Z. Zhang: None. W. Gu: None. Y. Xu: None. W. Shen: None. G. Cai: None. W. Sun: None. S. Cai: None.
S364
Volume 81, Number 2, Supplement, 2011
had intrahepatic CCA (29%), and 4 had perihilar CCA (14%). Twenty-four patients received adjuvant radiation therapy (86%), while 4 patients were treated with definitive intent (14%). Of the resected tumors, 10 patients had negative surgical margins (36%), 8 patients had close margins (\1mm margin) (29%), and 4 patients had grossly positive margins (22%). 36% had positive nodes. Median follow-up was 12.7 months (range, 4.6 to 52.2 months). LC, PFS, and OS at 1 year were 90%, 56%, and 76%, respectively. Grade 3-4 toxicity occurred in only 2 patients (7%). Three patients (11%) required treatment breaks, 3 patients (11%) had ED visits, and 4 patients (14%) required hospitalization. One patient died of a post-operative arterio-enteric fistula (4%) during the first week of radiation. There were no cases of radiation induced-liver disease. Analysis of dosimetric data for normal tissue structures revealed no significant correlations with toxicity or adverse events. Conclusions: Chemoradiation with IMRT is well tolerated with minimal acute treatment-related toxicities in the treatment of biliary tract cancer. Due to the small number of adverse events, we were unable to determine dosimetric correlation of toxicity with DVH parameters. Author Disclosure: L.Z. Braunstein: None. A.X. Zhu: None. J.Y. Wo: None. M. Ancukiewicz: None. B.N. Napolitano: None. J.A. Wolfgang: None. H.J. Mamon: None. L.S. Blaszkowsky: None. D.P. Ryan: None. T.S. Hong: None.
2320
Hepatocellular Carcinoma Target Volume Design and Dosimetric Features For RapidArc Plan: 4D-CT versus 3D-CT Associated With ABC
G. Gong, Y. Yin, J. Chen, T. Liu, J. Lu Shandong Cancer Hospital, Jinan, China Purpose/Objective(s): To investigate the dosimetric features of RapidArc plans for hepatocellular carcinoma (HCC) radiotherapy using different target volumes which determined by four dimension computed tomography (4D-CT) and 3D-CT associated with active breathing coordinator (ABC). Materials/Methods: 10 patients with HCC were selected to undergo 4D-CT and 3D-CT scans associated with ABC at end inspiration hold (EIH), end expiration hold (EEH), and free breathing (FB). The GTVs were contoured on 4D-CT and 3D-CT images respectively, and the internal gross target volume (ITV1, ITV2) were acquired respectively. The individual margins were obtained from GTVFB to ITV1 and ITV2 respectively, ITV3 and ITV4 were obtained from GTVFB using the individual margins respectively. PTV-1 was acquired from GTV FB using conventional margins; and PTV-2 using individual margins and PTV-3 was acquired from GTVEIH. For the PTV-1 and PTV-3, RapidArc plan with three 135 o arcs (ARC1, ARC4) were designed; for PTV-1 and PTV-2 with 360 o arc (ARC2, ARC3). The volume of GTVs, ITVs, PTVs, the individual margins and the dosimetric features of four RapidArc plans were compared. Results: The volume differences between ITV1 and ITV2, ITV3 and ITV4 were not significant (p . 0.05). The three axial margins differences from GTV FB to ITV1 and ITV2 were not significant (p . 0.05). The volume of PTV-1 was larger than PTV-2, PTV-3 (p\0.05). The differences of dose distribution for target volume in four plans were not significant (p . 0.05). The differences of OARs irradiation dose of ARC1 and ARC2 were not significant (p . 0.05). The dose of normal liver was ARC1 . ARC3 . ARC4 (p \ 0.05). Conclusions: Associated with ABC or using individual target volume determined by 3D-CT associated with ABC or 4D-CT in RapidArc plan for HCC radiotherapy can achieve perfect target dose coverage and spare more OARs. Author Disclosure: G. Gong: None. Y. Yin: None. J. Chen: None. T. Liu: None. J. Lu: None.
2321
Phase II Trial Of Neoadjuvant Chemoradiation With Concomitant Boost Followed By A Coycle Of Xelox In Locally Advanced Rectal Cancer
J. Zhu, Z. Zhang, W. Gu, Y. Xu, W. Shen, G. Cai, W. Sun, S. Cai Fudan University Cancer Hospital, Shanghai, China Purpose/Objective(s): IMRT with concomitant boost has showed efficacy in head and neck cancer but not proved in rectal cancer. Patients with pCR may have potential with lower recurrence and better overall survival. The prospective phase II trial was to evaluate the feasibility, toxicity, and response rate of preoperative concurrent chemoradiation with escalating dose by concomitant IMRT boost in locally advanced rectal cancer. Concurrent capecitabine plus oxaliplatin and one cycle of XELOX followed by CRT were used for the purpose of reduction of distance metastasis. Materials/Methods: Patients with T3-4 and/or N+ rectal cancer were treated at the Shanghai Cancer Hospital Fudan University, Shanghai from Sept 2008 to Nov 2010. All Patients received IMRT delivering 50 Gy (2 Gy/fraction) to the whole pelvis in concomitant with 55 Gy (2.2 Gy/fraction) to the primary tumor. Concurrent chemotherapy included oxaliplatin (50mg/m2 d1 weekly) and capecitabine (625mg/m2 bid, d1-5 weekly). One cycle of Xelox (oxaliplatin 130mg/m2 d1 + capecitabine 1000 mg/m2 bid d114) was given 2 weeks after the completion of concurrent chemoradiation, followed by radical surgery 8 weeks thereafter. Tumor response was evaluated by tumor regression grade (TRG) system and toxicity was evaluated by NCI-CTC 3.0 criteria. Results: A total of 51 patients were accrued to this study. The median age was 57 (range, 37-71). Eighty-six percent patients had T3 disease and 77% had N+ disease. The median distance from the anal verge was 4.5 cm (range, 3-11cm). All patients completed chemoradiation per protocol. Seventeen patients underwent sphincter-sparing procedures. TRG was Grade 4 in 14 patients, Grade 3 in 25, Grade 2 in 8, and Grade 1 in 4 patients. The good response rate (TRG 3+4) was 76.5% (39/51) and the pCR rate was 27.4% (14/51). The grade 3 toxicities of hematologic, gastro-intestinal, and skin were 3.9%,17.6%, and 25.5%, respectively. No Grade 4 toxicity has been observed. Surgical complications (infection within 3 weeks of surgery) were observed in 5 patients; all were cured with intervention treatment. Conclusions: IMRT with concomitant boost is feasible in rectal cancer. Preoperative chemoradiation combined with capecitabine and oxaliplatin, followed by a cycle of Xelox is well tolerated and results in an encouraging pCR rate for patients with locally advanced rectal cancer. Longer follow up and large clinical trial will be further studied. Author Disclosure: J. Zhu: None. Z. Zhang: None. W. Gu: None. Y. Xu: None. W. Shen: None. G. Cai: None. W. Sun: None. S. Cai: None.