- Email: [email protected]
Positron Emission Tomography For Locally Advanced Cervical Cancer: A Survey Assessing Canadian Practice Patterns And Access
Proceedings of the 53rd Annual ASTRO Meeting
2527
Positron Emission Tomography For Locally Advanced Cervical Cancer: A Survey Assessing Canadian Practice Patterns And Access
R. N. Banerjee1, G. Dundas2, C. Doll1 1
Tom Baker Cancer Centre / University of Calgary, Calgary, AB, Canada, 2Cross Cancer Institute / University of Alberta, Edmonton, AB, Canada Purpose/Objective(s): Positron emission tomography (PET) imaging has emerged as a valuable tool in the management of locally advanced cervical cancer (LACC), both in assessment of lymph node status and determination of response to chemoradiotherapy (CRT). The aim of this study was to survey Canadian radiation oncologists (ROs) to determine access to PET imaging for LACC patients and assess current practice patterns. Materials/Methods: Radiation oncology centers across Canada were contacted to identify ROs who treat patients with LACC. The focus of the survey was patients treated with radical CRT with curative intent. A 23-item questionnaire was sent via an anonymous online tool. Questions asked referred to access to PET imaging, opinions regarding indications for PET imaging, and practice patterns for the use of PET in this patient population. Questionnaire responses were tabulated and analyzed. Results: Response rate was 63% (33/52). Most respondents (79%) have access to PET for LACC patients, usually restricted to study protocols. 50% of respondents consider access to PET timely. Frequency of routine ordering of PET pre- and post-treatment (to assess response), is 46% and 15%, respectively. With better access, 91% would routinely order PET pre-treatment, and 61% would order it for post-treatment assessment. 85% consider PET standard of care for initial staging and nearly half (45%) believe it should be standard of care to assess treatment response. Over 70% do not order PET as often as they feel it is clinically indicated due to access limitations. 74% agree that better access to PET would lead to improved care for LACC patients in Canada. Conclusions: Support is strong among Canadian ROs for the routine use of PET imaging in the initial work up of patients with LACC. Access to PET scans limits routine use for these patients in clinically indicated situations. There is strong support for developing guidelines for PET use in this patient population. Author Disclosure: R.N. Banerjee: None. G. Dundas: None. C. Doll: None.
2528
Patterns of Recurrence After Definitive Radiation Therapy for Locoregionally-Confined Cervical Cancer
J. M. Boyle, E. Donnelly, J. Lurain, J. Schink, D. Singh, M. Gentile, B. Weitner, J. Strauss, A. Rademaker, W. Small Northwestern University Robert H. Lurie Comprehensive Cancer Center, Chicago, IL Purpose/Objective(s): The objective of this study was to determine the patterns of recurrence in patients treated with definitive radiotherapy (RT) or chemoradiotherapy (CRT) for cervical cancer. Materials/Methods: We identified 236 patients with locoregionally-confined, stage IB1 through IVA, intact cervical cancer treated between 1979 and 2008 at Northwestern Memorial Hospital. Clinical data on all patients including age, stage, histology, lymph node status, radiation records, chemotherapy regimen, recurrence patterns, and survival were collected. All patients underwent definitive RT (44%) or CRT (56%) with combined external beam radiation, the majority (62%) with extended field, defined as any field with a superior border higher than L4. All patients also received low-dose rate brachytherapy. For patients who experienced a regional nodal recurrence without evidence of a central recurrence, the relationship between the recurrence and radiation field was determined. For this analysis, pelvic and para-aortic lymph nodes were defined as regional nodes. Results: After a median follow-up of 24 months [0 - 757 months] a total of 66 patients (28%) experienced disease recurrence, with a recurrence-free survival of 59% at 5 years. Twenty patients experienced isolated regional recurrence as the site of first failure without evidence of a central recurrence; of these, six (30%) were outside of the radiation field (four para-aortic and two high common). By contrast, only one patient who received extended field RT recurred in the para-aortic chain and none recurred in the common iliac lymph nodes. Conclusions: In this single institution retrospective review, omission of extended-field RT was associated with a higher risk of isolated regional failure in the high common iliac and para-aortic lymph node chains. Author Disclosure: J.M. Boyle: None. E. Donnelly: None. J. Lurain: None. J. Schink: None. D. Singh: None. M. Gentile: None. B. Weitner: None. J. Strauss: None. A. Rademaker: None. W. Small: None.
2529
Changes of Bone Mineral Densities, Serum Female Hormones and Markers of Bone Resorption after Pelvic Radiation Therapy in Patients With Uterine Cervical Carcinoma
J. Saitoh, Y. Suzuki, T. Ohno, S. Noda, M. Wakatsuki, N. Okonogi, Y. Ohkubo, H. Ushijima, T. Oike, T. Nakano Gunma University Graduate School of Medicine, Maebashi, Japan Purpose/Objective(s): The aims of this study were to prospectively investigate the changes of bone mineral densities (BMD), serum female hormones (estradiol) and markers of bone resorption (NTx and TRACP-5b) after pelvic radiation therapy in patients with uterine cervical carcinoma. Materials/Methods: Between June 2009 and June 2010, 30 patients with uterine cervical carcinoma were treated with external beam radiation therapy and high-dose-rate intracavitary brachytherapy. The patients’ ages ranged from 34 - 83 years, with a median of 65 years. The external beam irradiation was delivered with 10-MV photons to the whole pelvis with a fractional dose of 2 Gy in 5 fractions per week. A center shield was inserted when the whole pelvic irradiation dose reached 20 or 30 Gy, and then center-shielded external beam radiation therapy was continued to a total dose of 50 Gy in principle. BMD, estradiol, NTx and TRACP-5b were measured before treatment, at three month and at a year after treatment. Results: Examinations of 1-year follow-up have been carried out in 15 patients. BMD of lumbar vertebra within irradiation field (L5) decreased in 12 patients (80%), and increased in 3 patients at a year after therapy. Increase of BMD in the 3 patients was due to bone fracture. Except for these 3 patients, mean values of BMD of L5 were 0.858 g/cm2 at pretreatment, and 0.711 g/cm2 at a year after treatment, and significant decrease was observed (P\0.01). Mean values of BMD of un-irradiated lumbar vertebra (L2 - 4) were 0.860 g/cm2 at pretreatment, and 0.865 g/cm2 at a year after treatment. The measured values of estradiol a year
S463
2527
Positron Emission Tomography For Locally Advanced Cervical Cancer: A Survey Assessing Canadian Practice Patterns And Access
R. N. Banerjee1, G. Dundas2, C. Doll1 1
Tom Baker Cancer Centre / University of Calgary, Calgary, AB, Canada, 2Cross Cancer Institute / University of Alberta, Edmonton, AB, Canada Purpose/Objective(s): Positron emission tomography (PET) imaging has emerged as a valuable tool in the management of locally advanced cervical cancer (LACC), both in assessment of lymph node status and determination of response to chemoradiotherapy (CRT). The aim of this study was to survey Canadian radiation oncologists (ROs) to determine access to PET imaging for LACC patients and assess current practice patterns. Materials/Methods: Radiation oncology centers across Canada were contacted to identify ROs who treat patients with LACC. The focus of the survey was patients treated with radical CRT with curative intent. A 23-item questionnaire was sent via an anonymous online tool. Questions asked referred to access to PET imaging, opinions regarding indications for PET imaging, and practice patterns for the use of PET in this patient population. Questionnaire responses were tabulated and analyzed. Results: Response rate was 63% (33/52). Most respondents (79%) have access to PET for LACC patients, usually restricted to study protocols. 50% of respondents consider access to PET timely. Frequency of routine ordering of PET pre- and post-treatment (to assess response), is 46% and 15%, respectively. With better access, 91% would routinely order PET pre-treatment, and 61% would order it for post-treatment assessment. 85% consider PET standard of care for initial staging and nearly half (45%) believe it should be standard of care to assess treatment response. Over 70% do not order PET as often as they feel it is clinically indicated due to access limitations. 74% agree that better access to PET would lead to improved care for LACC patients in Canada. Conclusions: Support is strong among Canadian ROs for the routine use of PET imaging in the initial work up of patients with LACC. Access to PET scans limits routine use for these patients in clinically indicated situations. There is strong support for developing guidelines for PET use in this patient population. Author Disclosure: R.N. Banerjee: None. G. Dundas: None. C. Doll: None.
2528
Patterns of Recurrence After Definitive Radiation Therapy for Locoregionally-Confined Cervical Cancer
J. M. Boyle, E. Donnelly, J. Lurain, J. Schink, D. Singh, M. Gentile, B. Weitner, J. Strauss, A. Rademaker, W. Small Northwestern University Robert H. Lurie Comprehensive Cancer Center, Chicago, IL Purpose/Objective(s): The objective of this study was to determine the patterns of recurrence in patients treated with definitive radiotherapy (RT) or chemoradiotherapy (CRT) for cervical cancer. Materials/Methods: We identified 236 patients with locoregionally-confined, stage IB1 through IVA, intact cervical cancer treated between 1979 and 2008 at Northwestern Memorial Hospital. Clinical data on all patients including age, stage, histology, lymph node status, radiation records, chemotherapy regimen, recurrence patterns, and survival were collected. All patients underwent definitive RT (44%) or CRT (56%) with combined external beam radiation, the majority (62%) with extended field, defined as any field with a superior border higher than L4. All patients also received low-dose rate brachytherapy. For patients who experienced a regional nodal recurrence without evidence of a central recurrence, the relationship between the recurrence and radiation field was determined. For this analysis, pelvic and para-aortic lymph nodes were defined as regional nodes. Results: After a median follow-up of 24 months [0 - 757 months] a total of 66 patients (28%) experienced disease recurrence, with a recurrence-free survival of 59% at 5 years. Twenty patients experienced isolated regional recurrence as the site of first failure without evidence of a central recurrence; of these, six (30%) were outside of the radiation field (four para-aortic and two high common). By contrast, only one patient who received extended field RT recurred in the para-aortic chain and none recurred in the common iliac lymph nodes. Conclusions: In this single institution retrospective review, omission of extended-field RT was associated with a higher risk of isolated regional failure in the high common iliac and para-aortic lymph node chains. Author Disclosure: J.M. Boyle: None. E. Donnelly: None. J. Lurain: None. J. Schink: None. D. Singh: None. M. Gentile: None. B. Weitner: None. J. Strauss: None. A. Rademaker: None. W. Small: None.
2529
Changes of Bone Mineral Densities, Serum Female Hormones and Markers of Bone Resorption after Pelvic Radiation Therapy in Patients With Uterine Cervical Carcinoma
J. Saitoh, Y. Suzuki, T. Ohno, S. Noda, M. Wakatsuki, N. Okonogi, Y. Ohkubo, H. Ushijima, T. Oike, T. Nakano Gunma University Graduate School of Medicine, Maebashi, Japan Purpose/Objective(s): The aims of this study were to prospectively investigate the changes of bone mineral densities (BMD), serum female hormones (estradiol) and markers of bone resorption (NTx and TRACP-5b) after pelvic radiation therapy in patients with uterine cervical carcinoma. Materials/Methods: Between June 2009 and June 2010, 30 patients with uterine cervical carcinoma were treated with external beam radiation therapy and high-dose-rate intracavitary brachytherapy. The patients’ ages ranged from 34 - 83 years, with a median of 65 years. The external beam irradiation was delivered with 10-MV photons to the whole pelvis with a fractional dose of 2 Gy in 5 fractions per week. A center shield was inserted when the whole pelvic irradiation dose reached 20 or 30 Gy, and then center-shielded external beam radiation therapy was continued to a total dose of 50 Gy in principle. BMD, estradiol, NTx and TRACP-5b were measured before treatment, at three month and at a year after treatment. Results: Examinations of 1-year follow-up have been carried out in 15 patients. BMD of lumbar vertebra within irradiation field (L5) decreased in 12 patients (80%), and increased in 3 patients at a year after therapy. Increase of BMD in the 3 patients was due to bone fracture. Except for these 3 patients, mean values of BMD of L5 were 0.858 g/cm2 at pretreatment, and 0.711 g/cm2 at a year after treatment, and significant decrease was observed (P\0.01). Mean values of BMD of un-irradiated lumbar vertebra (L2 - 4) were 0.860 g/cm2 at pretreatment, and 0.865 g/cm2 at a year after treatment. The measured values of estradiol a year
S463