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Pleural and Pericardial Effusion after Radiotherapy or Concurrent Chemo-radiotherapy (CCR) for Esophageal Cancer - Single Institutional Retrospective Study
Proceedings of the 50th Annual ASTRO Meeting Conclusions: While the response rate in this poor prognostic group of patients is encouraging and meets the statistical criteria for further study, the median survival of 6 months to date suggest only modest improvement. Toxicity is manageable, but not insignificant. A fourth institution will activate this study in 3/08. The study will be closed to accrual 7/08, or at a maximum of 41 patients. Complete analysis and updated results will be presented along with future considerations for incorporation of a targeted agent as part of this treatment strategy. Author Disclosure: W.F. Regine, None; N.N. Hanna, None; R. Wong, None; P. Major, None; M.C. Garofalo, None; H.R. Alexander, None; N. Pandya, None; N.L. Kennedy, None; M. Mohiuddin, None.
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Correlation of Quantitatively Derived Post-therapy FDG-PET Metabolic Volumes with Pathologic Findings in Patients Undergoing Tri-modality Therapy for Esophageal Cancer
E. P. Kielhorn, S. Nagda, S. H. Lee, J. Tydell, J. Halama, K. Rychlick, S. Yong, M. Shoup, B. Emami Loyola University Medical Center, Maywood, IL Purpose/Objective(s): To determine whether quantitative metabolic volumes and associated parameters derived from posttherapy FDG-PET scans correlate with pathologic or clinical outcome in patients with carcinoma of the esophagus/gastroesophageal (E/ GEJ) junction undergoing neoadjuvant chemoradiotherapy (CRT). Materials/Methods: Twenty-five patients with histologically-confirmed locally-advanced E/GEJ cancer were retrospectively studied. All patients underwent FDG-PET imaging prior to and after neoadjuvant CRT. Using a semi-automated 3D thresholdbased region-growing program (Hermes Medical Solutions; Stockholm, Sweden) metabolic uptake in the region of the primary tumor was quantitatively evaluated using two different SUV threshold methods: minimum SUV $2.5 (SUV 2.5) and mean liver SUV + 2 SD (L+2SD). Parameters studied included volume, dimensions (length, AP, lateral), and mean/maximum SUV within the volume of interest on pre and posttherapy images. Absolute and percent changes within these variables were also calculated. These parameters were then correlated with pathologic findings, overall survival, and disease-free survival. Results: There was a significant reduction (p\0.02) in volume (73.7 cc vs. 21.6 cc), AP dimension (38.9 mm vs. 18.9 mm), lateral dimension (39.4 vs. 18.9), mean SUV (4.1 vs. 2.6), and maximum SUV (10.0 vs. 4.1) in the post-CRT PET studies compared to the pre-CRT studies using SUV 2.5 threshold. Similar reductions were also observed using L+2SD threshold (data not shown). The post-CRT PET volume (SUV 2.5) correlated with gross tumor size, pathologic tumor size, and tumor (T) downstaging (p \ 0.05). Additionally, T downstaging correlated with percent change in mean SUV, lateral dimension, and AP dimension (SUV 2.5) (p \ 0.05). The mean post-CRT volume (SUV 2.5) of those with T downstaging was 14.3 cc vs. 37.1 cc for those who did not have T downstaging (p = 0.034). Post-CRT PET volume (L+2SD) correlated with pathologic N stage and N downstaging (p \ 0.01). Improved overall survival and disease-free survival was observed in those with T downstaging (p = 0.075 and p = 0.008, respectively) and those with pathologic tumor size \0.6 cm (p = 0.017 and p = 0.010, respectively). Conclusions: Post-therapy FDG-PET-based metabolic volumes and associated parameters correlate with pathologic findings after surgery in patients undergoing neoadjuvant CRT for esophageal carcinoma. In addition to posttherapy mean and maximum SUV, volumetric assessment may be important in evaluating the response to treatment. Author Disclosure: E.P. Kielhorn, None; S. Nagda, None; S.H. Lee, None; J. Tydell, None; J. Halama, None; K. Rychlick, None; S. Yong, None; M. Shoup, None; B. Emami, None.
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Pleural and Pericardial Effusion after Radiotherapy or Concurrent Chemo-radiotherapy (CCR) for Esophageal Cancer - Single Institutional Retrospective Study
J. Fukada, N. Shigematsu, Y. Kitagawa, T. Ohashi, S. Kutsuki, E. Kunieda, Y. Shiraishi, A. Kubo, T. Kawase Keio University, School of Medicine, Tokyo, Japan Purpose/Objective(s): Pleural effusion and pericardial effusion after radiotherapy or chemo-radiotherapy has been reported recently. The aim of this study is to evaluate the incidence of these adverse events and the clinical characteristics retrospectively. Materials/Methods: Between 2001 and 2005, 136 patients of thoracic and/or abdominal esophageal cancer received definitive radiotherapy or chemoradiotherapy. Seventeen patients died of disease within 6 months and 17 patients were lost to follow-up. A total of 102 patients can be evaluated more than 6 months after treatment. There were 11 women and 91 men and the median age was 66 years old (range, 48-88 years). Radiotherapy was performed by 6MV X-ray, 2 Gy per day, five times a week. Twentyfive patients performed radiation alone. Concurrent daily low-dose 5-FU and CDDP were administered in 72 patients and 5 patients received other types of chemotherapy resume. Radiotherapy was delivered to the primary lesion and subclinical regional lymph node region. After 46 Gy, radiation field was limited to the involved lesion avoiding spinal cord with a maximum total dose of 60 Gy. Evaluation was done by follow-up chest CT scan. Statistical analyses were calculated according to Kaplan-Mayer method, and applied the generalized Wilcoxon test. Results: The median follow-up was 29 (range, 6 to 66) months. Among 77 CCR and 25 radiation alone patients, pleural effusion was observed 34 (44%) and 8 (32%), pericardial effusion was observed 37 (49%), and 6 (24%) and both sites effusions were observed 24 (31%) and 3 (12%), respectively. The adverse event by pleural and pericardial effusions classified Grade 3 or more (NCICTCAE3.0) were observed in 2 and 5 patients, respectively. Mediastinal field width (more than 8 cm) (p = 0.00001) and age (more than 70 years) (p = 0.009) were the significant factors of pleural effusion. Radiation for lower thoracic and abdominal esophageal lesion (p = 0.004, p = 0.048) and combined chemotherapy (p = 0.046) were the significant factors of pericardial effusion. Patients with both combined chemotherapy and elder age had developed pleural effusion in 60% and pericardial effusion in 50% within 3 years. And none of both effusions were observed for the patients without these two factors within 5 years. Conclusions: Pleural and pericardial effusions are relatively common late adverse events. Larger field size cases, elder cases and combined chemotherapy cases need careful follow-up. Author Disclosure: J. Fukada, None; N. Shigematsu, None; Y. Kitagawa, None; T. Ohashi, None; S. Kutsuki, None; E. Kunieda, None; Y. Shiraishi, None; A. Kubo, None; T. Kawase, None.
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Correlation of Quantitatively Derived Post-therapy FDG-PET Metabolic Volumes with Pathologic Findings in Patients Undergoing Tri-modality Therapy for Esophageal Cancer
E. P. Kielhorn, S. Nagda, S. H. Lee, J. Tydell, J. Halama, K. Rychlick, S. Yong, M. Shoup, B. Emami Loyola University Medical Center, Maywood, IL Purpose/Objective(s): To determine whether quantitative metabolic volumes and associated parameters derived from posttherapy FDG-PET scans correlate with pathologic or clinical outcome in patients with carcinoma of the esophagus/gastroesophageal (E/ GEJ) junction undergoing neoadjuvant chemoradiotherapy (CRT). Materials/Methods: Twenty-five patients with histologically-confirmed locally-advanced E/GEJ cancer were retrospectively studied. All patients underwent FDG-PET imaging prior to and after neoadjuvant CRT. Using a semi-automated 3D thresholdbased region-growing program (Hermes Medical Solutions; Stockholm, Sweden) metabolic uptake in the region of the primary tumor was quantitatively evaluated using two different SUV threshold methods: minimum SUV $2.5 (SUV 2.5) and mean liver SUV + 2 SD (L+2SD). Parameters studied included volume, dimensions (length, AP, lateral), and mean/maximum SUV within the volume of interest on pre and posttherapy images. Absolute and percent changes within these variables were also calculated. These parameters were then correlated with pathologic findings, overall survival, and disease-free survival. Results: There was a significant reduction (p\0.02) in volume (73.7 cc vs. 21.6 cc), AP dimension (38.9 mm vs. 18.9 mm), lateral dimension (39.4 vs. 18.9), mean SUV (4.1 vs. 2.6), and maximum SUV (10.0 vs. 4.1) in the post-CRT PET studies compared to the pre-CRT studies using SUV 2.5 threshold. Similar reductions were also observed using L+2SD threshold (data not shown). The post-CRT PET volume (SUV 2.5) correlated with gross tumor size, pathologic tumor size, and tumor (T) downstaging (p \ 0.05). Additionally, T downstaging correlated with percent change in mean SUV, lateral dimension, and AP dimension (SUV 2.5) (p \ 0.05). The mean post-CRT volume (SUV 2.5) of those with T downstaging was 14.3 cc vs. 37.1 cc for those who did not have T downstaging (p = 0.034). Post-CRT PET volume (L+2SD) correlated with pathologic N stage and N downstaging (p \ 0.01). Improved overall survival and disease-free survival was observed in those with T downstaging (p = 0.075 and p = 0.008, respectively) and those with pathologic tumor size \0.6 cm (p = 0.017 and p = 0.010, respectively). Conclusions: Post-therapy FDG-PET-based metabolic volumes and associated parameters correlate with pathologic findings after surgery in patients undergoing neoadjuvant CRT for esophageal carcinoma. In addition to posttherapy mean and maximum SUV, volumetric assessment may be important in evaluating the response to treatment. Author Disclosure: E.P. Kielhorn, None; S. Nagda, None; S.H. Lee, None; J. Tydell, None; J. Halama, None; K. Rychlick, None; S. Yong, None; M. Shoup, None; B. Emami, None.
2200
Pleural and Pericardial Effusion after Radiotherapy or Concurrent Chemo-radiotherapy (CCR) for Esophageal Cancer - Single Institutional Retrospective Study
J. Fukada, N. Shigematsu, Y. Kitagawa, T. Ohashi, S. Kutsuki, E. Kunieda, Y. Shiraishi, A. Kubo, T. Kawase Keio University, School of Medicine, Tokyo, Japan Purpose/Objective(s): Pleural effusion and pericardial effusion after radiotherapy or chemo-radiotherapy has been reported recently. The aim of this study is to evaluate the incidence of these adverse events and the clinical characteristics retrospectively. Materials/Methods: Between 2001 and 2005, 136 patients of thoracic and/or abdominal esophageal cancer received definitive radiotherapy or chemoradiotherapy. Seventeen patients died of disease within 6 months and 17 patients were lost to follow-up. A total of 102 patients can be evaluated more than 6 months after treatment. There were 11 women and 91 men and the median age was 66 years old (range, 48-88 years). Radiotherapy was performed by 6MV X-ray, 2 Gy per day, five times a week. Twentyfive patients performed radiation alone. Concurrent daily low-dose 5-FU and CDDP were administered in 72 patients and 5 patients received other types of chemotherapy resume. Radiotherapy was delivered to the primary lesion and subclinical regional lymph node region. After 46 Gy, radiation field was limited to the involved lesion avoiding spinal cord with a maximum total dose of 60 Gy. Evaluation was done by follow-up chest CT scan. Statistical analyses were calculated according to Kaplan-Mayer method, and applied the generalized Wilcoxon test. Results: The median follow-up was 29 (range, 6 to 66) months. Among 77 CCR and 25 radiation alone patients, pleural effusion was observed 34 (44%) and 8 (32%), pericardial effusion was observed 37 (49%), and 6 (24%) and both sites effusions were observed 24 (31%) and 3 (12%), respectively. The adverse event by pleural and pericardial effusions classified Grade 3 or more (NCICTCAE3.0) were observed in 2 and 5 patients, respectively. Mediastinal field width (more than 8 cm) (p = 0.00001) and age (more than 70 years) (p = 0.009) were the significant factors of pleural effusion. Radiation for lower thoracic and abdominal esophageal lesion (p = 0.004, p = 0.048) and combined chemotherapy (p = 0.046) were the significant factors of pericardial effusion. Patients with both combined chemotherapy and elder age had developed pleural effusion in 60% and pericardial effusion in 50% within 3 years. And none of both effusions were observed for the patients without these two factors within 5 years. Conclusions: Pleural and pericardial effusions are relatively common late adverse events. Larger field size cases, elder cases and combined chemotherapy cases need careful follow-up. Author Disclosure: J. Fukada, None; N. Shigematsu, None; Y. Kitagawa, None; T. Ohashi, None; S. Kutsuki, None; E. Kunieda, None; Y. Shiraishi, None; A. Kubo, None; T. Kawase, None.
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