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Physician Assessment Versus the Graded Prognostic Assessment (GPA) for Brain Metastases
E126
International Journal of Radiation Oncology Biology Physics
Author Disclosure: M.L. Siker: None. S. Firat: None. D. Prah: None. C.J. Schultz: Research support and travel expenses; Elekta AB. A. Dayal: None. C. Masterson: None. J.M. Connelly: Advisor; Novacure. W.M. Mueller: None. J.A. Bovi: None.
School of Medicine, Stanford, CA, 2Stanford University Department of Radiation Oncology, Stanford, CA, 3Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA, 4Stanford University, Stanford, CA
2306 First Report of Paragangliomas Treated With Proton Therapy I. Chowdhury,1 K.T. Nead,2 R.A. Lustig,3 D. Bigelow,4 M. Ruckenstein,5 K.A. Cengel,6 A. Lin,7 and M. Alonso-Basanta3; 1The Commonwealth Medical College, Scranton, PA, 2University of Pennsylvania, Philadelphia, PA, 3University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA, 4University of Pennsylvania - Department of Otorhinolaryngology, Philadelphia, PA, 5University of Pennsylvania Department of Radiation Oncology, Philadelphia, PA, 6University of Pennsylvania, Philadelphia, PA, United States, 7Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA Purpose/Objective(s): Paragangliomas (PGL) are slow-growing, rare tumors of neuroendocrine origin treated primarily with surgery or radiation therapy (RT). Intensity-modulated radiation therapy (IMRT) has evolved as the main technique for RT. Here we report the first analysis of PGL treated with proton therapy (PT). We hypothesize similar safety and radiological outcome profiles as conventional IMRT. Materials/Methods: We retrospectively reviewed patients treated with PT or IMRT from 2008-2014. Toxicity was standardized using the Common Terminology Criteria for Adverse Events v5.0 and RTOG/EORTC Toxicity Criteria. Radiologic response was determined by board certified radiologists. Categorical variables were compared using Fisher’s exact test. Medians were compared using a nonparametric K-sample test on the equality of medians. Results: We identified 27 patients with 28 PGLs of which 18 (64%) were treated with PT and 10 (36%) were treated with IMRT. The cohort was 56% female (n Z 27) with a median age of 53 years and a median follow-up time of 30.9 months (interquartile range [IQR], 12.3-42.7). Tumors included 25 (89.3%) head and neck PGL (carotid body, glomus jugulare/tympanicum/vagale) and 3 (10.7%) extra-adrenal PGL. Patients underwent treatment to a median dose of 50.4 Gy (range 45.0-70.0) and 54.9 Gy (range 35.0-70.4) in the PT and IMRT treated groups respectively (P Z 0.112). Fractions ranged from 1.8-2.5 Gy. Median planning treatment volume (PTV) was 162.2 (IQR 94.4-247.0) and 82.4 (IQR 55.9-222.2) cubic centimeters in the PT and IMRT treated groups respectively (P Z 0.693). The most common toxicities for PT included fatigue (77.8%), radiation dermatitis (66.7%) and dysgeusia (55.6%), while IMRT patients had xerostomia (60%), radiation dermatitis (40%) dysgeusia (50%). There were 11 (64.7%) PT and 7 (70%) IMRT patients with grade 2 or higher toxicities (P Z 1.0), while 5 (29%) PT and 2 (20%) IMRT patients had grade 3 toxicities (P Z 0.68). Pre-treatment symptoms were stable, improved and worse in 9 (53%), 6 (35%) and 2 (12%) patients in the PT group respectively, while stable and worse in 6 (60%) and 4 (40%) in the IMRT group respectively. Partial radiologic response was seen in 9 (52.9%) in the PT group and 1 (10%) in the IMRT group (P Z 0.048). Conclusion: We report the first analysis for the treatment of PGL with PT. Our data suggest comparable rates of toxicity and better radiographic response with proton therapy despite larger treatment volumes and overall lower dose. Compared to IMRT, PT is a safe and effective treatment for PGL. Author Disclosure: I. Chowdhury: None. K.T. Nead: None. R.A. Lustig: None. D. Bigelow: None. M. Ruckenstein: None. K.A. Cengel: None. A. Lin: None. M. Alonso-Basanta: None.
2307 Physician Assessment Versus the Graded Prognostic Assessment (GPA) for Brain Metastases S. Aggarwal,1 N.D. Prionas,2 J.N. Carter,3 P. Pradhan,4 J.L. Bui,4 D.K. Fujimoto,1 R. von Eyben,1 A.C. Koong,1 D.T. Chang,1 C.K. Ho,1 and S.G. Soltys1; 1Department of Radiation Oncology, Stanford University
Purpose/Objective(s): Providing appropriate management options in patients with brain metastases is often challenging as treatment decisions are often based on life expectancy, which is difficult to estimate. We evaluated physicianreported estimates of overall survival for patients with brain metastases compared to their brain metastasis graded prognostic assessment (GPA). Materials/Methods: We prospectively enrolled patients with brain metastases treated with whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS) in a single institution over a 9-month period. Prior to treatment, faculty and residents in the Radiation Oncology department prospectively predicted patient survival in 3-month increments. A total of 116 physician-reported survival estimates in 196 patients were recorded. Nineteen were treated with WBRT and 177 with SRS. The disease specific GPA for the appropriate histology or general GPA was calculated and compared to the physician estimates and patients’ overall survival. The correlation of GPA and survival was evaluated using a univariate regression. Results: The median follow-up for all patients is 3.2 months. Fifty-five patients died (5 WBRT and 50 SRS) and were eligible for survival analyses. Of those that died, the median survival was 3.0 months after WBRT and 3.8 months after SRS. For WBRT and SRS patients, median GPA was 1 and 2 respectively. Faculty predicted survival outcomes do not correlate with GPA predicted survival (P Z 0.001). In terms of under-predicting, correctly predicting, and over-predicting survival, faculty results were 71%, 13%, and 4%, respectively (P < 0.0001); residents were 88%, 6%, and 6%, respectively (P < 0.0001). Conclusion: Prediction of survival in patients with brain metastases remains challenging. Furthermore, most physicians under-estimate overall survival in patients with brain metastases treated with SRS. Longer follow-up is needed to evaluate the efficacy of GPA and develop a more robust tool to guide treatment decision for patients with brain metastases. Author Disclosure: S. Aggarwal: None. N.D. Prionas: None. J.N. Carter: None. P. Pradhan: None. J.L. Bui: None. D.K. Fujimoto: None. R. von Eyben: None. A.C. Koong: None. D.T. Chang: None. C.K. Ho: None. S.G. Soltys: None.
2308 Comparison of Acute Fatigue Levels in Patients Receiving Radiation Therapy for Pituitary Macroadenoma Delivered by 3 Techniques S. O’Sullivan, C. MacEochaidh, E. McVeigh, M. Dunne, and C. Faul; St Luke’s Radiation Oncology, Rathgar, Ireland Purpose/Objective(s): To compare acute fatigue levels in patients receiving radiation therapy (RT) for pituitary macro-adenoma, delivered by three techniques: three-field three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and fractionated stereotactic radiation therapy (F-SRS). Considering more conformal techniques (IMRT or F-SRS) result in less irradiation of normal tissue at higher and intermediate iso-dose levels, we wanted to determine if this resulted in lower rates of acute fatigue compared with 3D-CRT. Materials/Methods: This is a non-randomized study of CT-based external beam RT, delivered for 56 patients at a single institution between 2000 and 2015. All had had prior surgery, and, where applicable, were resistant to medical therapy. Data from the patient chart and RT plan were retrospectively reviewed and analyzed on the following: age, hormonal replacement status, gross tumor volume (GTV), planning target volume (PTV), GTV to PTV margin, and fatigue as graded weekly during RT and at first follow up. Patient information was stored on a password protected computer, and data entered onto an excel spreadsheet. Results were analyzed using STATA, however due to the small numbers, statistical significance was not reached, and thus results are purely descriptive.
International Journal of Radiation Oncology Biology Physics
Author Disclosure: M.L. Siker: None. S. Firat: None. D. Prah: None. C.J. Schultz: Research support and travel expenses; Elekta AB. A. Dayal: None. C. Masterson: None. J.M. Connelly: Advisor; Novacure. W.M. Mueller: None. J.A. Bovi: None.
School of Medicine, Stanford, CA, 2Stanford University Department of Radiation Oncology, Stanford, CA, 3Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA, 4Stanford University, Stanford, CA
2306 First Report of Paragangliomas Treated With Proton Therapy I. Chowdhury,1 K.T. Nead,2 R.A. Lustig,3 D. Bigelow,4 M. Ruckenstein,5 K.A. Cengel,6 A. Lin,7 and M. Alonso-Basanta3; 1The Commonwealth Medical College, Scranton, PA, 2University of Pennsylvania, Philadelphia, PA, 3University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA, 4University of Pennsylvania - Department of Otorhinolaryngology, Philadelphia, PA, 5University of Pennsylvania Department of Radiation Oncology, Philadelphia, PA, 6University of Pennsylvania, Philadelphia, PA, United States, 7Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA Purpose/Objective(s): Paragangliomas (PGL) are slow-growing, rare tumors of neuroendocrine origin treated primarily with surgery or radiation therapy (RT). Intensity-modulated radiation therapy (IMRT) has evolved as the main technique for RT. Here we report the first analysis of PGL treated with proton therapy (PT). We hypothesize similar safety and radiological outcome profiles as conventional IMRT. Materials/Methods: We retrospectively reviewed patients treated with PT or IMRT from 2008-2014. Toxicity was standardized using the Common Terminology Criteria for Adverse Events v5.0 and RTOG/EORTC Toxicity Criteria. Radiologic response was determined by board certified radiologists. Categorical variables were compared using Fisher’s exact test. Medians were compared using a nonparametric K-sample test on the equality of medians. Results: We identified 27 patients with 28 PGLs of which 18 (64%) were treated with PT and 10 (36%) were treated with IMRT. The cohort was 56% female (n Z 27) with a median age of 53 years and a median follow-up time of 30.9 months (interquartile range [IQR], 12.3-42.7). Tumors included 25 (89.3%) head and neck PGL (carotid body, glomus jugulare/tympanicum/vagale) and 3 (10.7%) extra-adrenal PGL. Patients underwent treatment to a median dose of 50.4 Gy (range 45.0-70.0) and 54.9 Gy (range 35.0-70.4) in the PT and IMRT treated groups respectively (P Z 0.112). Fractions ranged from 1.8-2.5 Gy. Median planning treatment volume (PTV) was 162.2 (IQR 94.4-247.0) and 82.4 (IQR 55.9-222.2) cubic centimeters in the PT and IMRT treated groups respectively (P Z 0.693). The most common toxicities for PT included fatigue (77.8%), radiation dermatitis (66.7%) and dysgeusia (55.6%), while IMRT patients had xerostomia (60%), radiation dermatitis (40%) dysgeusia (50%). There were 11 (64.7%) PT and 7 (70%) IMRT patients with grade 2 or higher toxicities (P Z 1.0), while 5 (29%) PT and 2 (20%) IMRT patients had grade 3 toxicities (P Z 0.68). Pre-treatment symptoms were stable, improved and worse in 9 (53%), 6 (35%) and 2 (12%) patients in the PT group respectively, while stable and worse in 6 (60%) and 4 (40%) in the IMRT group respectively. Partial radiologic response was seen in 9 (52.9%) in the PT group and 1 (10%) in the IMRT group (P Z 0.048). Conclusion: We report the first analysis for the treatment of PGL with PT. Our data suggest comparable rates of toxicity and better radiographic response with proton therapy despite larger treatment volumes and overall lower dose. Compared to IMRT, PT is a safe and effective treatment for PGL. Author Disclosure: I. Chowdhury: None. K.T. Nead: None. R.A. Lustig: None. D. Bigelow: None. M. Ruckenstein: None. K.A. Cengel: None. A. Lin: None. M. Alonso-Basanta: None.
2307 Physician Assessment Versus the Graded Prognostic Assessment (GPA) for Brain Metastases S. Aggarwal,1 N.D. Prionas,2 J.N. Carter,3 P. Pradhan,4 J.L. Bui,4 D.K. Fujimoto,1 R. von Eyben,1 A.C. Koong,1 D.T. Chang,1 C.K. Ho,1 and S.G. Soltys1; 1Department of Radiation Oncology, Stanford University
Purpose/Objective(s): Providing appropriate management options in patients with brain metastases is often challenging as treatment decisions are often based on life expectancy, which is difficult to estimate. We evaluated physicianreported estimates of overall survival for patients with brain metastases compared to their brain metastasis graded prognostic assessment (GPA). Materials/Methods: We prospectively enrolled patients with brain metastases treated with whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS) in a single institution over a 9-month period. Prior to treatment, faculty and residents in the Radiation Oncology department prospectively predicted patient survival in 3-month increments. A total of 116 physician-reported survival estimates in 196 patients were recorded. Nineteen were treated with WBRT and 177 with SRS. The disease specific GPA for the appropriate histology or general GPA was calculated and compared to the physician estimates and patients’ overall survival. The correlation of GPA and survival was evaluated using a univariate regression. Results: The median follow-up for all patients is 3.2 months. Fifty-five patients died (5 WBRT and 50 SRS) and were eligible for survival analyses. Of those that died, the median survival was 3.0 months after WBRT and 3.8 months after SRS. For WBRT and SRS patients, median GPA was 1 and 2 respectively. Faculty predicted survival outcomes do not correlate with GPA predicted survival (P Z 0.001). In terms of under-predicting, correctly predicting, and over-predicting survival, faculty results were 71%, 13%, and 4%, respectively (P < 0.0001); residents were 88%, 6%, and 6%, respectively (P < 0.0001). Conclusion: Prediction of survival in patients with brain metastases remains challenging. Furthermore, most physicians under-estimate overall survival in patients with brain metastases treated with SRS. Longer follow-up is needed to evaluate the efficacy of GPA and develop a more robust tool to guide treatment decision for patients with brain metastases. Author Disclosure: S. Aggarwal: None. N.D. Prionas: None. J.N. Carter: None. P. Pradhan: None. J.L. Bui: None. D.K. Fujimoto: None. R. von Eyben: None. A.C. Koong: None. D.T. Chang: None. C.K. Ho: None. S.G. Soltys: None.
2308 Comparison of Acute Fatigue Levels in Patients Receiving Radiation Therapy for Pituitary Macroadenoma Delivered by 3 Techniques S. O’Sullivan, C. MacEochaidh, E. McVeigh, M. Dunne, and C. Faul; St Luke’s Radiation Oncology, Rathgar, Ireland Purpose/Objective(s): To compare acute fatigue levels in patients receiving radiation therapy (RT) for pituitary macro-adenoma, delivered by three techniques: three-field three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and fractionated stereotactic radiation therapy (F-SRS). Considering more conformal techniques (IMRT or F-SRS) result in less irradiation of normal tissue at higher and intermediate iso-dose levels, we wanted to determine if this resulted in lower rates of acute fatigue compared with 3D-CRT. Materials/Methods: This is a non-randomized study of CT-based external beam RT, delivered for 56 patients at a single institution between 2000 and 2015. All had had prior surgery, and, where applicable, were resistant to medical therapy. Data from the patient chart and RT plan were retrospectively reviewed and analyzed on the following: age, hormonal replacement status, gross tumor volume (GTV), planning target volume (PTV), GTV to PTV margin, and fatigue as graded weekly during RT and at first follow up. Patient information was stored on a password protected computer, and data entered onto an excel spreadsheet. Results were analyzed using STATA, however due to the small numbers, statistical significance was not reached, and thus results are purely descriptive.