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PO-404 VOXELIZED DOSE-RESPONSE STUDY IN HIGH DOSE RATE (HDR) 192IR BRACHYTHERAPY FOR RECTAL CANCER
World Congress of Brachytherapy 2012 with recurrent nasopharyngeal SCC, both treated by chemoradiotherapy (70 Gy+ cis q21). Median follow up was 8 months. 4 out of 5 patients are still alive with no evidence of disease. 1 of them (nasopharyngeal SCC) is dead for massive bleeding 2 months after the procedure. In 1 case (recurrence of an adenoid cystic carcinoma of the coana) we had a transient deficit of the VI cranial nerve, totally solved after 2 weeks of steroids. Conclusions: Combination of the endoscopic approach for removal of recurrence and perioperative brachytherapy seems to be an effective option for treating local recurrences. The morbidity of the endoscopic approach is minimal, perioperative radiation can start the day after. The endoscopic approach allows an optimal catheter positioning with an extraordinary exposure and anatomic detail; on the other hand the combination with brachytherapy may lead to enlarge the indications for an endoscopic approach in the salvage of sinonasal recurrences. PO-404 VOXELIZED DOSE-RESPONSE STUDY IN HIGH DOSE RATE (HDR) 192IR BRACHYTHERAPY FOR RECTAL CANCER R.F. Hobbs1, Y. Le1, E.P. Armour1, J. Efron2, N. Azad3, L. Diaz3, H. Qiu3, G. Sgouros4, S.L. Gearhart2, J.M. Herman1 1 Johns Hopkins University, Radiation Oncology, Baltimore MD, USA 2 Johns Hopkins University, Surgery, Baltimore MD, USA 3 Johns Hopkins University, Oncology, Baltimore MD, USA 4 Johns Hopkins University, Radiology, Baltimore MD, USA Purpose/Objective: Dose-response studies in radiation therapy are typically using single response values for tumors across ensembles of tumors. Using the HDR treatment plan dose grid and voxelized preand post-therapy FDG-PET images, we show correlations between voxelized dose and FDG uptake response in individual tumors. Materials and Methods: Five patients were treated for localized rectal cancer using 192Ir high dose rate (HDR) brachytherapy in conjunction with surgery. FDG-PET images were acquired before HDR therapy and 6-8 weeks after treatment (prior to surgery). Treatment planning was done on a commercial workstation and the dose grid was calculated. The two PETs and the treatment dose grid were registered to each other. The difference in PET SUV values before and after HDR was plotted versus absorbed radiation dose for each voxel (left figure). The voxels were then separated into bins for every 400 cGy of absorbed dose and the bin average values plotted similarly (right figure) Results: Four of the five patients showed a significant positive correlation (R2 = 0.18, 0.70, 0.81, 0.82 and 0.89, respectively) between PET uptake difference in the targeted region and the absorbed dose for the binned voxels (see figure).
S 161 4 5
University of Maryland, Interventional Radiology, Baltimore MD, USA University of Maryland, Medical Oncology, Baltimore MD, USA
Purpose/Objective: Hepatic brachytherapy with selective internal radiation therapy (SIRT) using Y90 resin microspheres (SIR-Spheres) has been extensively described in the treatment of metastatic colorectal cancer (mCRC). However, its application as a treatment modality in other tumor types has been documented primarily through small case series and data regarding optimal timing of treatment and patient selection are still emerging. We reviewed our large singleinstitutional experience with this modality in patients with adequate staging and multidisciplinary oncologic management. Materials and Methods: Records of all patients undergoing SIRT after determination of appropriate eligibility by our multidisciplinary hepatobiliary tumor board between 3/2002- 4/2011 were reviewed on an IRB approved protocol. Appropriate laboratory and imaging workup was performed to determine liver function, tumor burden and extent of extrahepatic disease. Hepatic angiography and macroaggregated albumin perfusion scans were performed to assess liver anatomy and lung shunting. Meticulous coil embolization of collateral vessels-atrisk was performed. Patients were typically treated with initial infusion to the hepatic lobe with more extensive disease followed by treatment to the contralateral lobe 3-4 weeks later using an individualized dose of Y90. Follow-up imaging was performed 3 months later and systemic therapy was as per the treating medical oncologist. Uni- and multi-variable statistical analyses were performed to determine variables associated with OS. Results: 112 patients with complete data were evaluated with the following tumor types: Colorectal cancer (N=64, 57%), hepatocellular (N=9), esophageal (N=7), neuroendocrine (N=6), breast (N=5) and other (N=21). Mean patient age was 59 (12.6), 58 (11.0) for CRC cancer patients. Median OS for the entire cohort was 29 months from initial diagnosis and 8 months from date of 1st Y90 treatment. LogRank analysis demonstrated rate of death in patients with ≥5 lesions was twice that in patients with <5 lesions (p =0.04, HR=1.99, CI: 1.028, 4.181) at both 3 and 6 months post SIRT. Patients with <5 liver lesions were able to complete more cycles of chemotherapy than their counterparts with ≥5 lesions. No significant differences were found among age, race, performance status, and tumor histology. In patients with mCRC liver tumor burden of less than 25% was associated with a longer median survival (28 vs 20 months), and a higher 5yr OS of 18% vs 11% (p= .044). In patients undergoing RF ablation prior to SIRT, median survival was increased from 22 to 32 months, and 5yr OS improved from 0% to 27% (p=.005). Conclusions: These data suggest that early intervention with SIRT in lower volume disease in conjunction with other modalities prolongs survival and allows, more importantly, for more extensive systemic management through delivery of more chemotherapy cycles. PO-406 NON MELANOMA SKIN CANCER TREATED WITH SUPERFICIAL BRACHYTHERAPY (BQT) OF HIGH DOSE RATE (HDR) WITH LEIPZIG OR MOULD M. Villavicencio-Queijeiro1, B.H.Y. Bautista Hernandez Yicel1, M.M.J. Montoya Monterrubio Juan1, L.C.P. Lujan Castilla Pomponio1, F.M.S. Fuentes Mariles Sonia1, R.V.D. Ruesga Vazquez Daniel1 1 Hospital General de Mexico (Goverment), Département de RadioOncologie, DF, Mexico
Conclusions: By considering larger ensembles of voxels, such as organ average absorbed dose or the dose bins considered here, valuable information may be obtained. The dose-response correlations as measured by FDG-PET difference potentially underlines the importance of FDG-PET as a measure of response, as well as the value of voxelized information. PO-405 EARLY INTERVENTION WITH SELECTIVE INTERNAL RADIATION THERAPY (SIRT) IMPROVES SURVIVAL AND LOCAL/SYSTEMIC OPTIONS N. Sharma1, E.M. Nichols1, S. Grabowski1, P. Amin1, M. Garofalo1, A. Hanlon2, N. Hanna3, R. Patel4, M. Horiba5, F. Moeslein4 1 University of Maryland, Radiation Oncology, Baltimore MD, USA 2 University of Pennsylvania, Biostatistics, Baltimore MD, USA 3 University of Maryland, Surgical Oncology, Baltimore MD, USA
Purpose/Objective: Introduction: Non melanoma skin cancer is one of five causes of dead in men and women like the result of the epidemiological change in the world Objective: To compare the local control in CPNM with superficial brachytherapy (BQT) of high dose rate (HDR) with Leipzig or mould. Materials and Methods: Retrospective research in 98 patients with CPNM in head and neck area, treated only with BQT, superficial HDR, in the BQT Department of the Radiotherapy Service in Hospital General de Mexico from April 1st 2005 to December 31st 2011. Patients were divided into 5 non-homogeneus groups (nose, eye, face, hand and ear). In the table 1 are the results of the different localizations and the type of applicator. In all the cases the prescribed dose was 5064cGy in 12 fractions, 3 times a week (Monday, Wednesday and Friday) for 4 weeks. In the applicator's choice the type of surface was essential. In homogeneus
S 161 4 5
University of Maryland, Interventional Radiology, Baltimore MD, USA University of Maryland, Medical Oncology, Baltimore MD, USA
Purpose/Objective: Hepatic brachytherapy with selective internal radiation therapy (SIRT) using Y90 resin microspheres (SIR-Spheres) has been extensively described in the treatment of metastatic colorectal cancer (mCRC). However, its application as a treatment modality in other tumor types has been documented primarily through small case series and data regarding optimal timing of treatment and patient selection are still emerging. We reviewed our large singleinstitutional experience with this modality in patients with adequate staging and multidisciplinary oncologic management. Materials and Methods: Records of all patients undergoing SIRT after determination of appropriate eligibility by our multidisciplinary hepatobiliary tumor board between 3/2002- 4/2011 were reviewed on an IRB approved protocol. Appropriate laboratory and imaging workup was performed to determine liver function, tumor burden and extent of extrahepatic disease. Hepatic angiography and macroaggregated albumin perfusion scans were performed to assess liver anatomy and lung shunting. Meticulous coil embolization of collateral vessels-atrisk was performed. Patients were typically treated with initial infusion to the hepatic lobe with more extensive disease followed by treatment to the contralateral lobe 3-4 weeks later using an individualized dose of Y90. Follow-up imaging was performed 3 months later and systemic therapy was as per the treating medical oncologist. Uni- and multi-variable statistical analyses were performed to determine variables associated with OS. Results: 112 patients with complete data were evaluated with the following tumor types: Colorectal cancer (N=64, 57%), hepatocellular (N=9), esophageal (N=7), neuroendocrine (N=6), breast (N=5) and other (N=21). Mean patient age was 59 (12.6), 58 (11.0) for CRC cancer patients. Median OS for the entire cohort was 29 months from initial diagnosis and 8 months from date of 1st Y90 treatment. LogRank analysis demonstrated rate of death in patients with ≥5 lesions was twice that in patients with <5 lesions (p =0.04, HR=1.99, CI: 1.028, 4.181) at both 3 and 6 months post SIRT. Patients with <5 liver lesions were able to complete more cycles of chemotherapy than their counterparts with ≥5 lesions. No significant differences were found among age, race, performance status, and tumor histology. In patients with mCRC liver tumor burden of less than 25% was associated with a longer median survival (28 vs 20 months), and a higher 5yr OS of 18% vs 11% (p= .044). In patients undergoing RF ablation prior to SIRT, median survival was increased from 22 to 32 months, and 5yr OS improved from 0% to 27% (p=.005). Conclusions: These data suggest that early intervention with SIRT in lower volume disease in conjunction with other modalities prolongs survival and allows, more importantly, for more extensive systemic management through delivery of more chemotherapy cycles. PO-406 NON MELANOMA SKIN CANCER TREATED WITH SUPERFICIAL BRACHYTHERAPY (BQT) OF HIGH DOSE RATE (HDR) WITH LEIPZIG OR MOULD M. Villavicencio-Queijeiro1, B.H.Y. Bautista Hernandez Yicel1, M.M.J. Montoya Monterrubio Juan1, L.C.P. Lujan Castilla Pomponio1, F.M.S. Fuentes Mariles Sonia1, R.V.D. Ruesga Vazquez Daniel1 1 Hospital General de Mexico (Goverment), Département de RadioOncologie, DF, Mexico
Conclusions: By considering larger ensembles of voxels, such as organ average absorbed dose or the dose bins considered here, valuable information may be obtained. The dose-response correlations as measured by FDG-PET difference potentially underlines the importance of FDG-PET as a measure of response, as well as the value of voxelized information. PO-405 EARLY INTERVENTION WITH SELECTIVE INTERNAL RADIATION THERAPY (SIRT) IMPROVES SURVIVAL AND LOCAL/SYSTEMIC OPTIONS N. Sharma1, E.M. Nichols1, S. Grabowski1, P. Amin1, M. Garofalo1, A. Hanlon2, N. Hanna3, R. Patel4, M. Horiba5, F. Moeslein4 1 University of Maryland, Radiation Oncology, Baltimore MD, USA 2 University of Pennsylvania, Biostatistics, Baltimore MD, USA 3 University of Maryland, Surgical Oncology, Baltimore MD, USA
Purpose/Objective: Introduction: Non melanoma skin cancer is one of five causes of dead in men and women like the result of the epidemiological change in the world Objective: To compare the local control in CPNM with superficial brachytherapy (BQT) of high dose rate (HDR) with Leipzig or mould. Materials and Methods: Retrospective research in 98 patients with CPNM in head and neck area, treated only with BQT, superficial HDR, in the BQT Department of the Radiotherapy Service in Hospital General de Mexico from April 1st 2005 to December 31st 2011. Patients were divided into 5 non-homogeneus groups (nose, eye, face, hand and ear). In the table 1 are the results of the different localizations and the type of applicator. In all the cases the prescribed dose was 5064cGy in 12 fractions, 3 times a week (Monday, Wednesday and Friday) for 4 weeks. In the applicator's choice the type of surface was essential. In homogeneus