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PO-250 CONCURRENT CHEMORADIOTHERAPY WITH HDR INTRACAVITARY BRACHYTHERAPY FOR CERVICAL CANCER: A PHASE II STUDY
World Congress of Brachytherapy 2012 Materials and Methods: From January 2009 196 pts. with endometrial cancer were treated with BBRT plus ERT in postoperative setting as out patients. The treatment schedule was 18 Gy in 3 fractions as boost before ERT to pts. of our Center (group A), to pts. by others Centers BBRT (group B) was performed after ERT (conformal 3D radiotherapy in both cases) the dose was prescribed to 5 mm from the surface of the applicator 3 cm the active length of the source. The implant optimisation was performed recognizing the bladder dose and the rectal dose as average of almost 3 points for each critical organ with a semi-3D technique aided by simulator, the optimal target-dose volume was determined with radiopaque marker into the rectum and Foley catheter balloon in the bladder. We measured the lenght and the diameter of each vaginal cilinder so we calculated the volume of treated vagina. By these data we enrolled a third observational group (C) consisting of only 10 pts. from our center with volume of treated vagina measured before and after ERT and finally underwent to BBRT. Results: In the group A we enrolled 116 pts. the others 70 in group B. The median lenght, diameter and volume of both groups resulted the same, while the recorded ranges of each parameter were different expecially for measured volume ( 7.5-30 cm³ for A versus 5-30 cm³ for B ).In the B group we also recorded pain during the introduction of vaginal cilinder and acute toxicity G1-G2 of bladder and rectum, requiring supportive care by ERT; so the vaginal introduction of complete cilinder was more difficult than group A. In group C the median reduction of the measured volume of vagina resulted 25% (1035%).In the group A the vaginal lenght at the first follow up after the treatment completation was the nearest to the lenght during the simulation. In the B group the BBRT was performed 2-3 weeks after the completation of ERT. Conclusions: The use of HDR Brachitherapy to boost gynaecological cancers is widely accepted. Vaginal stenosis by Radiotherapy is an acute toxicity that starts at the beginning of treatment and increases using small vagynal cilinder, so to obtain a perfect timing for boost after ERT we need more collaboration with the neighbouring centers. Boost before ERT increases pts. compliance to treatment and probably reduces geographic missing. PO-250 CONCURRENT CHEMORADIOTHERAPY WITH HDR INTRACAVITARY BRACHYTHERAPY FOR CERVICAL CANCER: A PHASE II STUDY T. Toita1, R. Kitagawa2, T. Hamano3, K. Umayahara4, Y. Hirashima5, Y. Aoki6, M. Oguchi7, M. Mikami8, K. Takizawa4 1 University of Ryukyus, Radiology, Okinawa, Japan 2 NTT Medical Center Tokyo, Obstetrics and Gynecology, Tokyo, Japan 3 Kitasato University, Biostatistics, Tokyo, Japan 4 Cancer Institute Hospital, Gynecology, Tokyo, Japan 5 Shizuoka Cancer Center Hospital, Gynecology, Shizuoka, Japan 6 University of Ryukyus, Obstetrics and Gynecology, Okinawa, Japan 7 Cancer Institute Hospital, Radiation Oncology, Tokyo, Japan 8 Tokai University School of Medicine, Obstetrics and Gynecology, Kanagawa, Japan Purpose/Objective: A multicenter phase II trial was conducted to assess the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) with high-dose-rate intracavitary brachytherapy (HDR-ICBT) using a low cumulative dose schedule in patients with locally advanced uterine cervical cancer. Materials and Methods: The Japanese Gynecologic Oncology Group (JGOG) study JGOG1066 enrolled patients with FIGO stage III-IVA cervical cancer who had no para-aortic lymphadenopathy (> 10mm) as assessed by CT. Patients received definitive radiotherapy consisting of whole-pelvis external beam radiotherapy (EBRT), pelvic EBRT with midline block, and HDR-ICBT. The cumulative linear quadratic equivalent dose (EQD2) was 62-65 Gy prescribed at point A. Threedimensional planning using CT/MRI was not applied. Cisplatin (40 mg/m2 weekly) was administered concurrently with radiotherapy for 5 courses. All patients received individual case review of radiotherapy quality assurance. Results: Of the 72 patients registered from 25 institutions between March 2008 and January 2009, 71 patients were eligible. Median age of the patients was 57 years. FIGO stages were IIIA in 3 patinets, IIIB in 64 patients, and IVA in 4 patients. Median tumor diameter, as assessed by MRI, was 55 mm. With a median follow-up of 28 months, 21 patients had pelvic failure (primary=14, node=6, other=1), and 17
S 101 patients developed distant metastases (para-aortic=11, lung=2, other=4). The 2-year pelvic disease progression-free rate (PDF) was 73% (95% CI, 61% to 82%). The 2-year progression-free survival rate and overall survival rate were 66% (95% CI, 54% to 76%), and 90% (95% CI, 80% to 95%), respectively. The 2-year cumulative late complication rates by grades were 24% for all grades, 9% for grade 1, 12% for grade 2, 3% for grade 3, and 0 for grades 4/5. Conclusions: Despite a limited follow-up period, the JGOG1066 study demonstrated that CCRT using HDR-ICBT with a low cumulative RT dose schedule achieved comparable pelvic disease control to that achieved with global dose schedules (EQD2=85Gy), with a lower incidence of late toxicity for patients with locally advanced uterine cervical cancer. PO-251 IMPACT OF BLADDER DISTENSION ON ORGANS AT RISK IN 3D INTRACAVITARY BRACHYTHERAPY FOR GYNECOLOGICAL CANCER H. Bajwa1, K. Rehman1, I. Niazi2, M. Ali2, I. Haider1, S. Usman1, A. Masood1 1 Shaukat khanum Memorial Cancer Hospital, Radiotherapy, Lahore, Pakistan 2 Shaukat khanum Memorial Cancer Hospital, Radiology, Lahore, Pakistan Purpose/Objective: To determine the effects of bladder distension on organs at risk (OAR) in intracavitary brachytherapy (ICBT) for gynecological cancer with 3D Image Based Planning Materials and Methods: Thirty-two patients with gynecological cancer were treated with high-dose radiation (HDR) brachytherapy, out of which twenty-eight were diagnosed with cervical cancer and treated with 700 cGy/fraction for 4 fractions and the remaining four were diagnosed with endometrium cancer and treated with 600 cGy/fraction for 2 fractions. Pelvic CT scans were obtained from patients with indwelling catheters in place defined as empty bladder) and from patients who received 200 cc injections of sterile water in their bladders (defined as full bladder) for three-dimensional (3D) analysis. Regions of Interest (ROI) were drawn by a radiologist for four organs at risk (OAR): bladder, rectum, sigmoid colon and small bowel. All planning parameters including dwell positions and dwell times were kept constant for both plans. Dose Volume Histograms (DVHs) were used to compare the maximum dose and the mean dose of the OAR when the patient had empty bladder (Emax and Emean respectively) with the maximum dose and mean dose when the patient had full bladder (Fmax and Fmean respectively). Results: The Emean of bladder was 277cGy and the Fmean was 208cGy (P = 0.000) and Emax of bladder was 1710 cGy and Fmax was 2298cGy (P = 0.000). The Emean of rectum was 196cGy and the Fmean was 198cGy (P = 0.000) and Emax of rectum was 986cGy and Fmax was 951cGy (P = 0.058). The Emean of sigmoid colon was 135cGy and the Fmean was 107cGy (P = 0.000) and Emax of sigmoid colon was 1792cGy and Fmax was 899cGy (P = 0.000). The Emean of small bowel was 104cGy and the Fmean was 67cGy (P = 0.000) and Emax of small bowel was 1469cGy and Fmax was 609cGy (P = 0.000). Conclusions: This study shows that treating patients with full bladder results in reduced organ-exposure in the case of sigmoid colon and small bowel. Although the maximum bladder dose was higher, the mean dose was less, reducing thereby the risk of complications. The rectal dose, however, was not affected by the bladder state. PO-252 ADJUVANT CARBOPLATIN/PACLITAXEL AND INTRAVAGINAL RADIATION FOR STAGE I-II SEROUS ENDOMETRIAL CANCER A. Kiess1, S. Damast2, V. Makker3, M.A. Kollmeier1, G.J. Gardner4, N.R. Abu-Rustum4, R.R. Barakat4, K.M. Alektiar1 1 Memorial Sloan-Kettering Cancer Center, Dept of Radiation Oncology, New York NY, USA 2 Yale School of Medicine, Dept of Therapeutic Radiology, New Haven CT, USA 3 Memorial Sloan-Kettering Cancer Center, Gynecologic Medical Oncology Service, New York NY, USA
S 101 patients developed distant metastases (para-aortic=11, lung=2, other=4). The 2-year pelvic disease progression-free rate (PDF) was 73% (95% CI, 61% to 82%). The 2-year progression-free survival rate and overall survival rate were 66% (95% CI, 54% to 76%), and 90% (95% CI, 80% to 95%), respectively. The 2-year cumulative late complication rates by grades were 24% for all grades, 9% for grade 1, 12% for grade 2, 3% for grade 3, and 0 for grades 4/5. Conclusions: Despite a limited follow-up period, the JGOG1066 study demonstrated that CCRT using HDR-ICBT with a low cumulative RT dose schedule achieved comparable pelvic disease control to that achieved with global dose schedules (EQD2=85Gy), with a lower incidence of late toxicity for patients with locally advanced uterine cervical cancer. PO-251 IMPACT OF BLADDER DISTENSION ON ORGANS AT RISK IN 3D INTRACAVITARY BRACHYTHERAPY FOR GYNECOLOGICAL CANCER H. Bajwa1, K. Rehman1, I. Niazi2, M. Ali2, I. Haider1, S. Usman1, A. Masood1 1 Shaukat khanum Memorial Cancer Hospital, Radiotherapy, Lahore, Pakistan 2 Shaukat khanum Memorial Cancer Hospital, Radiology, Lahore, Pakistan Purpose/Objective: To determine the effects of bladder distension on organs at risk (OAR) in intracavitary brachytherapy (ICBT) for gynecological cancer with 3D Image Based Planning Materials and Methods: Thirty-two patients with gynecological cancer were treated with high-dose radiation (HDR) brachytherapy, out of which twenty-eight were diagnosed with cervical cancer and treated with 700 cGy/fraction for 4 fractions and the remaining four were diagnosed with endometrium cancer and treated with 600 cGy/fraction for 2 fractions. Pelvic CT scans were obtained from patients with indwelling catheters in place defined as empty bladder) and from patients who received 200 cc injections of sterile water in their bladders (defined as full bladder) for three-dimensional (3D) analysis. Regions of Interest (ROI) were drawn by a radiologist for four organs at risk (OAR): bladder, rectum, sigmoid colon and small bowel. All planning parameters including dwell positions and dwell times were kept constant for both plans. Dose Volume Histograms (DVHs) were used to compare the maximum dose and the mean dose of the OAR when the patient had empty bladder (Emax and Emean respectively) with the maximum dose and mean dose when the patient had full bladder (Fmax and Fmean respectively). Results: The Emean of bladder was 277cGy and the Fmean was 208cGy (P = 0.000) and Emax of bladder was 1710 cGy and Fmax was 2298cGy (P = 0.000). The Emean of rectum was 196cGy and the Fmean was 198cGy (P = 0.000) and Emax of rectum was 986cGy and Fmax was 951cGy (P = 0.058). The Emean of sigmoid colon was 135cGy and the Fmean was 107cGy (P = 0.000) and Emax of sigmoid colon was 1792cGy and Fmax was 899cGy (P = 0.000). The Emean of small bowel was 104cGy and the Fmean was 67cGy (P = 0.000) and Emax of small bowel was 1469cGy and Fmax was 609cGy (P = 0.000). Conclusions: This study shows that treating patients with full bladder results in reduced organ-exposure in the case of sigmoid colon and small bowel. Although the maximum bladder dose was higher, the mean dose was less, reducing thereby the risk of complications. The rectal dose, however, was not affected by the bladder state. PO-252 ADJUVANT CARBOPLATIN/PACLITAXEL AND INTRAVAGINAL RADIATION FOR STAGE I-II SEROUS ENDOMETRIAL CANCER A. Kiess1, S. Damast2, V. Makker3, M.A. Kollmeier1, G.J. Gardner4, N.R. Abu-Rustum4, R.R. Barakat4, K.M. Alektiar1 1 Memorial Sloan-Kettering Cancer Center, Dept of Radiation Oncology, New York NY, USA 2 Yale School of Medicine, Dept of Therapeutic Radiology, New Haven CT, USA 3 Memorial Sloan-Kettering Cancer Center, Gynecologic Medical Oncology Service, New York NY, USA