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Population-Based Analysis of Stereotactic Body Radiation Therapy for Oligometastatic Lymph Node Disease
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Volume 96 Number 2S Supplement 2016 response, while pain remained stable in 8.3%, and progressed in 8.3%. A neurological response was achieved in 60% of patients, with 20% remaining stable and 20% progressing. Local control based on radiological imaging was achieved in 78.6% of cases, while progression was noted in 21.4%. Recurrence within the PTV occurred in 1 treated vertebral body (2.1%) while marginal recurrence occurred in 3 vertebral bodies (6.3%) with a median time to recurrence of 4.5 months. A total of 5 vertebral compression fractures (9.6%) were a potential complication of SRS, no other toxicities were noted. Conclusion: Our data shows SRS to be an effective treatment modality for hepatocellular spinal metastasis providing fair pain, neurological, and local control with minimal associated toxicities and a low rate of recurrence. Author Disclosure: D. Boyce-Fappiano: None. E. Elibe: None. I.Y. Lee: Consultant; Medtronic. Speaker Honorarium with travel expenses; Varian Medical Systems. J. Rock: None. M.U. Siddiqui: HFHS rad-onc department receives research funding from entity; Varian Medical Systems, Philips Medical. Leads QA efforts in HFHS rad-onc clinic; Henry Ford Health System. F. Siddiqui: HFHS rad-onc department receives research funding from entity; Varian Medical Systems, Philips Medical. Assist in leading rad-onc department; Henry Ford Health System.
3273 Population-Based Analysis of Stereotactic Body Radiation Therapy for Oligometastatic Lymph Node Disease R. Yeung,1 J. Hamm,1 M.C. Liu,1 and D. Schellenberg2; 1British Columbia Cancer Agency, Vancouver, BC, Canada, 2British Columbia Cancer Agency, Surrey, BC, Canada Purpose/Objective(s): In the setting of limited metastatic burden of disease, stereotactic body radiation therapy (SBRT) has been shown to achieve high local control rates. It has been hypothesized that SBRT may translate to better quality of life by delaying the need for systemic chemotherapy and possibly increased survival. There is limited published literature on the efficacy of SBRT in limited nodal metastases. The primary objective is to report the clinical outcome of SBRT in a series of patients with either solitary or oligometastases from various tumors to lymph nodes. Materials/Methods: A retrospective study of patients treated on a provincial protocol with SBRT to metastatic lymph nodes (March 2010 and June 2015) was conducted. Primary endpoint was local control (LC) and chemotherapy free survival following SBRT. Secondary endpoints included toxicities, progression free survival (PFS), and overall survival (OS). Results: Eighteen patients underwent SBRT to a metastatic lymph node with a mean age of 61.8 years (range: 20-84 years) and a median follow-up of 22 months. There were 4 (22%) liver, seven (39%) colorectal, four (22%) pancreatic, one (6%) esophageal, 1 (6%) gallbladder and 1 (6%) lung primary. Eleven (61%) patients had lymph node metastases as part of their initial presentation of metastatic disease. Seven patients (39%) had systemic therapy prior to SBRT, with the majority of patients (71%) receiving 2 lines of chemotherapy. Eight patients had solitary metastatic disease at the time of SBRT, with all patients having 4 or fewer total sites of metastases. Average size of the lymph node metastases was 2.3cm (range: 0.8-6.2cm). RT doses were 31 to 60 Gy in 4 to 10 fractions, with 44% of patients receiving 35 Gy in 5 fractions. At 1 year, LC was 93% and chemotherapy-free survival from the time of SBRT was 58%. PFS at 1 and 2 years were 42% and 18% respectively. One and 2 year OS were 92% and 84%. There were no grade 3 or higher toxicities reported. On univariate analysis, absence of prior chemotherapy and non-colorectal primary approached significance for improved local control (both PZ0.052) while solitary metastases was associated with improved PFS (PZ0.029) and trended to improved chemotherapy-free survival (PZ0.066). Conclusion: In this single institution study, SBRT to oligometastatic lymph nodes provides high local control and a moderate chemotherapy-free interval with acceptable toxicities. Progression of disease remains prominent in these patients. Larger cohort studies are required to better identify a
subset of patients with oligometastatic nodal disease who benefit the most from SBRT. Author Disclosure: R. Yeung: None. J. Hamm: None. M. Liu: None. D. Schellenberg: Research Grant; Varian. Honoraria; Varian.
3274 Single-Fraction Stereotactic Radiosurgery for Renal Cell Carcinoma Spine Metastasis D. Boyce-Fappiano, E. Elibe, I.Y. Lee, J. Rock, M.S.U. Siddiqui, and F. Siddiqui; Henry Ford Health System, Detroit, MI Purpose/Objective(s): Renal cell carcinoma (RCC) is a radio-resistant tumor histology that often metastasizes to the spine causing severe pain, vertebral compression fractures, and neurological deficits due to cord compression. Due to the radio-resistant nature of RCC it is believed that SRS offers an advantage over traditional fractionated radiation therapy. We reviewed our institutional experience to determine the efficacy and safety of SRS for RCC spinal metastases. Materials/Methods: Electronic medical records of clinical exams, and computed tomography/magnetic resonance imaging were evaluated with IRB approval. Post treatment pain control, neurological improvement, and radiographic tumor control were the primary endpoints of this analysis. Results: A total of 40 patients (83 vertebral bodies) underwent SRS between 06/2001 and 12/2015 for pathologically confirmed renal cell carcinoma spinal metastasis. The patient population consisted of 72.5% males and 27.5% females with a median age of 58.2 years. 72.5%, 20%, and 7.5% of patients are white, African American, and of other ethnicities respectively. 25 (62.5%) patients are deceased with a median survival time of 3.5 months. Tumor locations included: 3.4% cervical, 52.5% thoracic, 40.7% lumbar, and 3.4% sacral. Median dose of SRS was 18 Gy (range 10 e 18 Gy). Median target volume was 68 cc (range 17 e 208 cc). 85% of patients presented with back pain, while 45% of patients had a recognizable neurological deficit. 23.1% of patients had surgical resection of their spinal tumor prior to SRS, while 25.6% of patients received fractionated RT prior to SRS. Follow-up for treatment response was available in 24 (60%) patients (40 vertebral bodies) with a median follow-up time of 5.2 months. Local failure (within the PTV) occurred in 5 treated vertebral bodies (14.7%). 45.5% of cases achieved a notable pain response, while pain remained stable in 22.7%, and progressed in 31.8%. A neurological response was achieved in 37.5% of patients, with 25% remaining stable and 37.5% progressing. Local control based on radiological imaging was achieved in 76.3% of cases, while progression was noted in 23.7%. Recurrence occurred in 3 treated vertebral bodies (8.8%) with a median time to recurrence of 14.6 months. A total of 4 vertebral compression fractures (10%) were a potential complication of SRS, no other toxicities were noted. Conclusion: Our data shows SRS to be an effective treatment modality for RCC spinal metastasis providing fair pain, neurological, and local control with minimal associated toxicities and a low rate of recurrence. Author Disclosure: D. Boyce-Fappiano: None. E. Elibe: None. I.Y. Lee: Consultant; Medtronic. Speaker Honorarium with travel expenses; Varian Medical Systems. J. Rock: None. M.U. Siddiqui: HFHS rad-onc department receives research funding from entity; Varian Medical Systems, Philips Medical. Leads QA efforts in HFHS rad-onc clinic; Henry Ford Health System. F. Siddiqui: HFHS rad-onc department receives research funding from entity; Varian Medical Systems, Philips Medical. Assist in leading rad-onc department; Henry Ford Health System.
3275 Economic Impact of Palliative Radiation Therapy of Bone Metastases With a Single Fraction Dose: A One-Institution Experience E. Jorda, C. Domingo, M.D.M. Alcala´, A. Ciafre, D. Dualde Beltran, and E. Ferrer Albiach; Hospital Clinico Universitario, Valencia, Spain Purpose/Objective(s): Approximately a quarter of patients treated in a radiation oncology department are palliative patients. Bone metastases are
Volume 96 Number 2S Supplement 2016 response, while pain remained stable in 8.3%, and progressed in 8.3%. A neurological response was achieved in 60% of patients, with 20% remaining stable and 20% progressing. Local control based on radiological imaging was achieved in 78.6% of cases, while progression was noted in 21.4%. Recurrence within the PTV occurred in 1 treated vertebral body (2.1%) while marginal recurrence occurred in 3 vertebral bodies (6.3%) with a median time to recurrence of 4.5 months. A total of 5 vertebral compression fractures (9.6%) were a potential complication of SRS, no other toxicities were noted. Conclusion: Our data shows SRS to be an effective treatment modality for hepatocellular spinal metastasis providing fair pain, neurological, and local control with minimal associated toxicities and a low rate of recurrence. Author Disclosure: D. Boyce-Fappiano: None. E. Elibe: None. I.Y. Lee: Consultant; Medtronic. Speaker Honorarium with travel expenses; Varian Medical Systems. J. Rock: None. M.U. Siddiqui: HFHS rad-onc department receives research funding from entity; Varian Medical Systems, Philips Medical. Leads QA efforts in HFHS rad-onc clinic; Henry Ford Health System. F. Siddiqui: HFHS rad-onc department receives research funding from entity; Varian Medical Systems, Philips Medical. Assist in leading rad-onc department; Henry Ford Health System.
3273 Population-Based Analysis of Stereotactic Body Radiation Therapy for Oligometastatic Lymph Node Disease R. Yeung,1 J. Hamm,1 M.C. Liu,1 and D. Schellenberg2; 1British Columbia Cancer Agency, Vancouver, BC, Canada, 2British Columbia Cancer Agency, Surrey, BC, Canada Purpose/Objective(s): In the setting of limited metastatic burden of disease, stereotactic body radiation therapy (SBRT) has been shown to achieve high local control rates. It has been hypothesized that SBRT may translate to better quality of life by delaying the need for systemic chemotherapy and possibly increased survival. There is limited published literature on the efficacy of SBRT in limited nodal metastases. The primary objective is to report the clinical outcome of SBRT in a series of patients with either solitary or oligometastases from various tumors to lymph nodes. Materials/Methods: A retrospective study of patients treated on a provincial protocol with SBRT to metastatic lymph nodes (March 2010 and June 2015) was conducted. Primary endpoint was local control (LC) and chemotherapy free survival following SBRT. Secondary endpoints included toxicities, progression free survival (PFS), and overall survival (OS). Results: Eighteen patients underwent SBRT to a metastatic lymph node with a mean age of 61.8 years (range: 20-84 years) and a median follow-up of 22 months. There were 4 (22%) liver, seven (39%) colorectal, four (22%) pancreatic, one (6%) esophageal, 1 (6%) gallbladder and 1 (6%) lung primary. Eleven (61%) patients had lymph node metastases as part of their initial presentation of metastatic disease. Seven patients (39%) had systemic therapy prior to SBRT, with the majority of patients (71%) receiving 2 lines of chemotherapy. Eight patients had solitary metastatic disease at the time of SBRT, with all patients having 4 or fewer total sites of metastases. Average size of the lymph node metastases was 2.3cm (range: 0.8-6.2cm). RT doses were 31 to 60 Gy in 4 to 10 fractions, with 44% of patients receiving 35 Gy in 5 fractions. At 1 year, LC was 93% and chemotherapy-free survival from the time of SBRT was 58%. PFS at 1 and 2 years were 42% and 18% respectively. One and 2 year OS were 92% and 84%. There were no grade 3 or higher toxicities reported. On univariate analysis, absence of prior chemotherapy and non-colorectal primary approached significance for improved local control (both PZ0.052) while solitary metastases was associated with improved PFS (PZ0.029) and trended to improved chemotherapy-free survival (PZ0.066). Conclusion: In this single institution study, SBRT to oligometastatic lymph nodes provides high local control and a moderate chemotherapy-free interval with acceptable toxicities. Progression of disease remains prominent in these patients. Larger cohort studies are required to better identify a
subset of patients with oligometastatic nodal disease who benefit the most from SBRT. Author Disclosure: R. Yeung: None. J. Hamm: None. M. Liu: None. D. Schellenberg: Research Grant; Varian. Honoraria; Varian.
3274 Single-Fraction Stereotactic Radiosurgery for Renal Cell Carcinoma Spine Metastasis D. Boyce-Fappiano, E. Elibe, I.Y. Lee, J. Rock, M.S.U. Siddiqui, and F. Siddiqui; Henry Ford Health System, Detroit, MI Purpose/Objective(s): Renal cell carcinoma (RCC) is a radio-resistant tumor histology that often metastasizes to the spine causing severe pain, vertebral compression fractures, and neurological deficits due to cord compression. Due to the radio-resistant nature of RCC it is believed that SRS offers an advantage over traditional fractionated radiation therapy. We reviewed our institutional experience to determine the efficacy and safety of SRS for RCC spinal metastases. Materials/Methods: Electronic medical records of clinical exams, and computed tomography/magnetic resonance imaging were evaluated with IRB approval. Post treatment pain control, neurological improvement, and radiographic tumor control were the primary endpoints of this analysis. Results: A total of 40 patients (83 vertebral bodies) underwent SRS between 06/2001 and 12/2015 for pathologically confirmed renal cell carcinoma spinal metastasis. The patient population consisted of 72.5% males and 27.5% females with a median age of 58.2 years. 72.5%, 20%, and 7.5% of patients are white, African American, and of other ethnicities respectively. 25 (62.5%) patients are deceased with a median survival time of 3.5 months. Tumor locations included: 3.4% cervical, 52.5% thoracic, 40.7% lumbar, and 3.4% sacral. Median dose of SRS was 18 Gy (range 10 e 18 Gy). Median target volume was 68 cc (range 17 e 208 cc). 85% of patients presented with back pain, while 45% of patients had a recognizable neurological deficit. 23.1% of patients had surgical resection of their spinal tumor prior to SRS, while 25.6% of patients received fractionated RT prior to SRS. Follow-up for treatment response was available in 24 (60%) patients (40 vertebral bodies) with a median follow-up time of 5.2 months. Local failure (within the PTV) occurred in 5 treated vertebral bodies (14.7%). 45.5% of cases achieved a notable pain response, while pain remained stable in 22.7%, and progressed in 31.8%. A neurological response was achieved in 37.5% of patients, with 25% remaining stable and 37.5% progressing. Local control based on radiological imaging was achieved in 76.3% of cases, while progression was noted in 23.7%. Recurrence occurred in 3 treated vertebral bodies (8.8%) with a median time to recurrence of 14.6 months. A total of 4 vertebral compression fractures (10%) were a potential complication of SRS, no other toxicities were noted. Conclusion: Our data shows SRS to be an effective treatment modality for RCC spinal metastasis providing fair pain, neurological, and local control with minimal associated toxicities and a low rate of recurrence. Author Disclosure: D. Boyce-Fappiano: None. E. Elibe: None. I.Y. Lee: Consultant; Medtronic. Speaker Honorarium with travel expenses; Varian Medical Systems. J. Rock: None. M.U. Siddiqui: HFHS rad-onc department receives research funding from entity; Varian Medical Systems, Philips Medical. Leads QA efforts in HFHS rad-onc clinic; Henry Ford Health System. F. Siddiqui: HFHS rad-onc department receives research funding from entity; Varian Medical Systems, Philips Medical. Assist in leading rad-onc department; Henry Ford Health System.
3275 Economic Impact of Palliative Radiation Therapy of Bone Metastases With a Single Fraction Dose: A One-Institution Experience E. Jorda, C. Domingo, M.D.M. Alcala´, A. Ciafre, D. Dualde Beltran, and E. Ferrer Albiach; Hospital Clinico Universitario, Valencia, Spain Purpose/Objective(s): Approximately a quarter of patients treated in a radiation oncology department are palliative patients. Bone metastases are