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Postoperative Stereotactic Radiosurgery for Resected Brain Metastases: A Comparison of Outcomes for Large Resection Cavities.
E120
International Journal of Radiation Oncology Biology Physics
actual delivered dose of spinal cord was higher than the planned dose. So, dose limitation should be more strict to assure spinal cord safety. Author Disclosure: B. Zhao: None. M. Zhang: None. J. Yin: None. Y. Pan: None. C. Mi: None. X. Gao: None.
2287
2286 Hypofractionated Stereotactic Radiation Therapy for Leptomeningeal Metastases: A Single-Arm Phase 2 Trial R. Zhao,1 J. Xiao,2 N. Bi,3 Y. Zhang,4 Q. Liu,4 Y. Ma,5 D. Liu,6 S. Yang,6 and Y. Li7; 1Cancer Hospital & Institute, Chinese Academy of Medical Sciences, Beijing, China, 2Cancer Hospital, Chinese Academy of Medical Sciences(CAMS), Beijing, China, 3Cancer Hospital and Institute, National Cancer Center, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China, 4Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China, 5Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China, 6Cancer Hospital, Chinese Acedemy of Medical Sciences(CAMS), Beijing, China, 7National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China Purpose/Objective(s): A single-arm phase II study was conducted to investigate the efficacy and safety of hypofractionated stereotactic radiotherapy (FSRT) for leptomeningeal metastases (LMs). Materials/Methods: Patients (pts) with LMs, with or without brain metastases (BMs) were enrolled. According to whether received prior whole brain radiotherapy (WBRT) or not, pts were treated with FSRT+WBRT or FSRT alone, using tomotherapy (TOMO) , intensity modulated radiotherapy (IMRT) or X-ray knife. WBRT was given by 40Gy/2Gy/20f, while the meninges and BMs were increased to 60Gy/3Gy/20f. Temozolomide (TMZ) was applied selectively with a concurrent dose of 75mg/m2/d and adjuvant dose of 150mg/m2/d*5d, q28d for 6 cycles. Pts received intrathecal chemotherapy (MTX+AraC+Dex) based on cerebrospinal fluid (CSF) cytology, which was reexamined to assess whether tumor cell became negative postchemotherapy. Efficacy and toxicities were evaluated with Recist criteria and CTCAE 4.0. Local control and survival were assessed with Kaplan-Meier analyses. The primary end point was local control rate (LCR) and secondary end points included intracranial progression free survival (IPFS), progression free survival (PFS), overall survival (OS) and toxicities. Results: From August 2013 to October 2016, 28 pts (male: femaleZ10:18) were enrolled, and median age was 53 (range: 34-72) years old. The major primary disease was non small cell lung cancer (71.4%). Median KPS score was 80 (50-90). 20 cases (71.4%) had multiple BMs (3), and 13 cases (46.4%) had large BMs (>6cc). 22 cases (78.6%) were treated for the first time, while others had prior radiotherapy (3 WBRT, 2 SRT, and 1 WBRT+SRT). 19 cases (67.9%) have received prior targeted therapy. The number of pts received WBRT+FSRT, FSRT and WBRT alone were 19, 7 and 2, respectively. 22 cases (75.9%) were treated by TOMO. Median GTV and whole brain dose was 60 Gy(14-60Gy) and 40 Gy(25-50 Gy). 15 cases (51.7%) had concurrent TMZ, and 4 had adjuvant TMZ. 8 pts received intrathecal chemotherapy, and 2 pts’ CSF cytology became negative post-chemotherapy. Median follow-up time was 11.7 months (95%CI: 10.8-12.5m). CR ,PR and SD was 53.6%, 14.3% and 32.1% respectivly. Median survival time (MST) was 13.0 months (95%CI: 3.4-22.7). The 1-year LC, IPFS, PFS and OS was 62.6%, 43.6%, 19.0% and 48.3%, respectively. NoGrade 3 toxicities was observed. 4 pts died of intracranial progress ( survival time was 5.9m , 7.0m , 8.5m , and 9.2m respectively ). Other death reason included systemic failure (6 pts), primary tumor progression (1pt) and medical disease (1pt). Conclusion: WBRT plus FSRT was an efficient and safe treatment for LMs. Intrathecal chemotherapy can be performed considering CSF cytology. Further studies with larger sample size were warrented. Author Disclosure: R. Zhao: None. J. Xiao: None. N. Bi: None. Y. Zhang: None. Q. Liu: None. Y. Ma: None. D. Liu: None. S. Yang: None. Y. Li: None.
Postoperative Stereotactic Radiosurgery for Resected Brain Metastases: A Comparison of Outcomes for Large Resection Cavities. J. Zhong,1 M.J. Ferris,1 J. Switchenko,2 R.H. Press,3 Z.S. Buchwald,1 J.J. Olson,4 B.R. Eaton,1 W.J. Curran Jr,1 H.K.G. Shu,1 I.R. Crocker,3 and K. Patel1; 1Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, 2Department of Biostatistics & Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, GA, 3Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, 4Winship Cancer Institute of Emory University, Atlanta, GA Purpose/Objective(s): Although historical trials have established the role of surgical resection followed by whole brain irradiation (WBRT), WBRT has recently been shown to cause significant neurocognitive decline. Many practitioners have employed post-operative stereotactic radiosurgery (SRS) to tumor resection cavities to increase local control without significant neurocognitive sequelae. However, there have been no significant series detailing outcomes of large brain metastases treated with resection and post-operative SRS. Here, we compare outcomes in patients with large brain metastases > 4 cm to those with smaller metastases 4 cm treated with surgical resection followed by SRS to the resection cavity. Materials/Methods: Consecutive patients with brain metastases treated at our institution with surgical resection and post-operative SRS were retrospectively reviewed. Patients were stratified into 4 cm and > 4 cm cohorts based on pre-operative maximal tumor dimension. Cumulative incidence of local failure, radiation necrosis, and death were analyzed for the two cohorts. Results: A total of 117 consecutive cases were identified. Of these patients, 90 (77%) had pre-operative tumors were 4 cm, and 27 (23%) were > 4 cm in greatest dimension. The only significant baseline difference between the two groups was a higher proportion of patients with gross total resection of their tumors in the 4 cm compared to the > 4 cm cohort, 76% vs. 48%, (p<0.01). The 1-year rates of local failure, radiation necrosis, and overall survival for the 4 cm and > 4 cm cohorts were 12.3% and 16.0%, 26.9% and 28.4%, and 80.6% and 67.6%, respectively (all p>0.05). The rates of local failure and radiation necrosis were not statistically different on multivariable analysis based on tumor size. Conclusion: Brain metastases > 4 cm in largest dimension managed by resection and radiosurgery to the tumor cavity have promising local control rates without a significant increase in radiation necrosis on our retrospective review. Author Disclosure: J. Zhong: None. M.J. Ferris: None. J. Switchenko: None. R.H. Press: None. Z.S. Buchwald: None. J.J. Olson: None. B.R. Eaton: None. W.J. Curran: ; ASCO. H. Shu: None. I.R. Crocker: None. K. Patel: None.
2288 Leadership Education in Radiation Oncology Residency Training J. Adleman,1 M. Niglas,1 and B.A. Millar1,2; 1Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada, 2Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada Purpose/Objective(s): To identify the leadership training needs of radiation oncology residents in our program and to develop a leadership curriculum to address any identified training gaps. Materials/Methods: An online questionnaire was administered anonymously to current residents and recent graduates of our radiation oncology training program. Qualitative and quantitative data was collected on the following domains: advanced courses and degrees held by participants, previous leadership training, current leadership training in the residency program, current and previous leadership responsibilities, and perceived gaps in residency leadership training. A 4-point Likert scale (0 Z not important, 4 Z very important) was used to identify training needs and gaps in the current training program. These areas were then targeted for development of new leadership curricular content.
International Journal of Radiation Oncology Biology Physics
actual delivered dose of spinal cord was higher than the planned dose. So, dose limitation should be more strict to assure spinal cord safety. Author Disclosure: B. Zhao: None. M. Zhang: None. J. Yin: None. Y. Pan: None. C. Mi: None. X. Gao: None.
2287
2286 Hypofractionated Stereotactic Radiation Therapy for Leptomeningeal Metastases: A Single-Arm Phase 2 Trial R. Zhao,1 J. Xiao,2 N. Bi,3 Y. Zhang,4 Q. Liu,4 Y. Ma,5 D. Liu,6 S. Yang,6 and Y. Li7; 1Cancer Hospital & Institute, Chinese Academy of Medical Sciences, Beijing, China, 2Cancer Hospital, Chinese Academy of Medical Sciences(CAMS), Beijing, China, 3Cancer Hospital and Institute, National Cancer Center, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China, 4Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China, 5Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China, 6Cancer Hospital, Chinese Acedemy of Medical Sciences(CAMS), Beijing, China, 7National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China Purpose/Objective(s): A single-arm phase II study was conducted to investigate the efficacy and safety of hypofractionated stereotactic radiotherapy (FSRT) for leptomeningeal metastases (LMs). Materials/Methods: Patients (pts) with LMs, with or without brain metastases (BMs) were enrolled. According to whether received prior whole brain radiotherapy (WBRT) or not, pts were treated with FSRT+WBRT or FSRT alone, using tomotherapy (TOMO) , intensity modulated radiotherapy (IMRT) or X-ray knife. WBRT was given by 40Gy/2Gy/20f, while the meninges and BMs were increased to 60Gy/3Gy/20f. Temozolomide (TMZ) was applied selectively with a concurrent dose of 75mg/m2/d and adjuvant dose of 150mg/m2/d*5d, q28d for 6 cycles. Pts received intrathecal chemotherapy (MTX+AraC+Dex) based on cerebrospinal fluid (CSF) cytology, which was reexamined to assess whether tumor cell became negative postchemotherapy. Efficacy and toxicities were evaluated with Recist criteria and CTCAE 4.0. Local control and survival were assessed with Kaplan-Meier analyses. The primary end point was local control rate (LCR) and secondary end points included intracranial progression free survival (IPFS), progression free survival (PFS), overall survival (OS) and toxicities. Results: From August 2013 to October 2016, 28 pts (male: femaleZ10:18) were enrolled, and median age was 53 (range: 34-72) years old. The major primary disease was non small cell lung cancer (71.4%). Median KPS score was 80 (50-90). 20 cases (71.4%) had multiple BMs (3), and 13 cases (46.4%) had large BMs (>6cc). 22 cases (78.6%) were treated for the first time, while others had prior radiotherapy (3 WBRT, 2 SRT, and 1 WBRT+SRT). 19 cases (67.9%) have received prior targeted therapy. The number of pts received WBRT+FSRT, FSRT and WBRT alone were 19, 7 and 2, respectively. 22 cases (75.9%) were treated by TOMO. Median GTV and whole brain dose was 60 Gy(14-60Gy) and 40 Gy(25-50 Gy). 15 cases (51.7%) had concurrent TMZ, and 4 had adjuvant TMZ. 8 pts received intrathecal chemotherapy, and 2 pts’ CSF cytology became negative post-chemotherapy. Median follow-up time was 11.7 months (95%CI: 10.8-12.5m). CR ,PR and SD was 53.6%, 14.3% and 32.1% respectivly. Median survival time (MST) was 13.0 months (95%CI: 3.4-22.7). The 1-year LC, IPFS, PFS and OS was 62.6%, 43.6%, 19.0% and 48.3%, respectively. NoGrade 3 toxicities was observed. 4 pts died of intracranial progress ( survival time was 5.9m , 7.0m , 8.5m , and 9.2m respectively ). Other death reason included systemic failure (6 pts), primary tumor progression (1pt) and medical disease (1pt). Conclusion: WBRT plus FSRT was an efficient and safe treatment for LMs. Intrathecal chemotherapy can be performed considering CSF cytology. Further studies with larger sample size were warrented. Author Disclosure: R. Zhao: None. J. Xiao: None. N. Bi: None. Y. Zhang: None. Q. Liu: None. Y. Ma: None. D. Liu: None. S. Yang: None. Y. Li: None.
Postoperative Stereotactic Radiosurgery for Resected Brain Metastases: A Comparison of Outcomes for Large Resection Cavities. J. Zhong,1 M.J. Ferris,1 J. Switchenko,2 R.H. Press,3 Z.S. Buchwald,1 J.J. Olson,4 B.R. Eaton,1 W.J. Curran Jr,1 H.K.G. Shu,1 I.R. Crocker,3 and K. Patel1; 1Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, 2Department of Biostatistics & Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, GA, 3Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, 4Winship Cancer Institute of Emory University, Atlanta, GA Purpose/Objective(s): Although historical trials have established the role of surgical resection followed by whole brain irradiation (WBRT), WBRT has recently been shown to cause significant neurocognitive decline. Many practitioners have employed post-operative stereotactic radiosurgery (SRS) to tumor resection cavities to increase local control without significant neurocognitive sequelae. However, there have been no significant series detailing outcomes of large brain metastases treated with resection and post-operative SRS. Here, we compare outcomes in patients with large brain metastases > 4 cm to those with smaller metastases 4 cm treated with surgical resection followed by SRS to the resection cavity. Materials/Methods: Consecutive patients with brain metastases treated at our institution with surgical resection and post-operative SRS were retrospectively reviewed. Patients were stratified into 4 cm and > 4 cm cohorts based on pre-operative maximal tumor dimension. Cumulative incidence of local failure, radiation necrosis, and death were analyzed for the two cohorts. Results: A total of 117 consecutive cases were identified. Of these patients, 90 (77%) had pre-operative tumors were 4 cm, and 27 (23%) were > 4 cm in greatest dimension. The only significant baseline difference between the two groups was a higher proportion of patients with gross total resection of their tumors in the 4 cm compared to the > 4 cm cohort, 76% vs. 48%, (p<0.01). The 1-year rates of local failure, radiation necrosis, and overall survival for the 4 cm and > 4 cm cohorts were 12.3% and 16.0%, 26.9% and 28.4%, and 80.6% and 67.6%, respectively (all p>0.05). The rates of local failure and radiation necrosis were not statistically different on multivariable analysis based on tumor size. Conclusion: Brain metastases > 4 cm in largest dimension managed by resection and radiosurgery to the tumor cavity have promising local control rates without a significant increase in radiation necrosis on our retrospective review. Author Disclosure: J. Zhong: None. M.J. Ferris: None. J. Switchenko: None. R.H. Press: None. Z.S. Buchwald: None. J.J. Olson: None. B.R. Eaton: None. W.J. Curran: ; ASCO. H. Shu: None. I.R. Crocker: None. K. Patel: None.
2288 Leadership Education in Radiation Oncology Residency Training J. Adleman,1 M. Niglas,1 and B.A. Millar1,2; 1Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada, 2Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada Purpose/Objective(s): To identify the leadership training needs of radiation oncology residents in our program and to develop a leadership curriculum to address any identified training gaps. Materials/Methods: An online questionnaire was administered anonymously to current residents and recent graduates of our radiation oncology training program. Qualitative and quantitative data was collected on the following domains: advanced courses and degrees held by participants, previous leadership training, current leadership training in the residency program, current and previous leadership responsibilities, and perceived gaps in residency leadership training. A 4-point Likert scale (0 Z not important, 4 Z very important) was used to identify training needs and gaps in the current training program. These areas were then targeted for development of new leadership curricular content.