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Primary extracranial primary cancers treated with body stereotactic radiosurgery (bsr)
Proceedings of the 44th Annual ASTRO Meeting
Materials/Methods: The records of 27 patients (29 elbows) treated with radiation therapy between 1993–1998 were reviewed. Twenty-one patients (23 elbows) had greater than 3 months follow-up available for review and are included in this analysis. All patients were classified using the classification system developed by Hastings and Graham prior to surgery. Pre-operative, intra-operative, and post-operative range of motion were recorded and compared. Radiation therapy dose ranged from 600-700cGy in one fraction delivered post-operatively. Results: The median follow-up was 10.2 months (range: 3.4-62.1 months). When comparing the pre-operative range of motion with the range of motion achieved intra-operatively, the median increase in range of motion achieved in the operating room was 75 degrees (range: 15-160 degrees). In comparing the post-operative range of motion with the pre-operative range of motion, the median increase in mobility was 57.5 degrees (range: 10-145 degrees). No patient experienced a post-operative wound complication. Conclusions: Radiation therapy consisting of 700 cGy in one fraction delivered post-operatively is successful in maintaining intra-operative range of motion gains in the majority of patients. This form of therapy should be considered in patients presenting with Hastings and Graham Class II or III heterotopic bone formation around the elbow joint or in patients with multiple prior surgeries who have exhibited a tendency towards subsequent heterotopic bone formation.
2165
Primary Extracranial Primary Cancers Treated with Body Stereotactic Radiosurgery (BSR) 1
I. Grosman , P.J. Silverman1, G.S. Lederman1, J. Lowry2, B. Gilson1, D. Bockowski1, F. Volpicella1 1 Department of Radiation Oncology, Staten Island University Hospital, Staten Island, NY, 2Department of Radiology, Staten Island University Hospital, Staten Island, NY
Purpose/Objective: BSR is a non-invasive fiducially-guided fixation system allowing for precision guided radiation to extracranial cancers. The rationale of high-dose hypofractionated radiosurgery for primary cancers is to escalate dose and thereby improve local control and/or obtain symptomatic palliation. Materials/Methods: 1016 primary cancers in 751 patients completed treatment between February 1997 and August 2001. Most cancers were unsuccessfully previously extensively treated by surgery, chemotherapy, and/or radiosurgery. The purpose of treatment was either palliation of symptoms or control of progressive cancer. 546 primary cancers with volumes 0.16cc to 5,240 (mean 187.1cc) were radiographically evaluated in 406 patients (pts) aged 16 to 89 years (mean 63) with dose per radiosurgery fraction of 180 to 1000 Centigray (cGy) (mean 722.9) in 2 to 8 fractions (mean 5). Follow-up ranged from 1 to 51 mos (mean 8.1). Lung cancers were the most frequent target (56%) followed by pancreas (9%) and liver (5%). Success of BSR is defined as cessation of growth, shrinkage or disappearance of cancer as measured with follow-up contrast CT scanning. Results: The overall control rate was 89% with 46% of the cancers showing cessation of growth, 40% decreasing in size, 3% disappearing, while 11% progressing. The control rate for primary lung cancers was 86%. Conclusions: This data suggests that BSR at this early juncture offers high local control rates for cancers in their primary site. These patients often had been heavily pre-treated with surgery, chemotherapy, and radiation. Despite that, treatment was well-tolerated and at this early point, promising in obtaining high levels of local control.
2166
Error Rates in Radiation Therapy: Results of a Quality Assurance Review
G. Huang1, D. Hodgson2, G. Medlam1, G. Lockwood3 1 Department of Radiation Therapy, Princess Margaret Hospital, Toronto, ON, Canada, 2Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON, Canada, 3Department of Biostatistics, Princess Margaret Hospital, Toronto, ON, Canada
Purpose/Objective: Little is known about the frequency and factors associated with errors in the delivery of radiation therapy (RT). The Princess Margaret Hospital has a process for reporting errors that occur during RT. We undertook a formal analysis of all errors reported over a 5 1/2 year period to determine the prevalence, type and severity of errors, and to identify opportunities to eliminate these events. Materials/Methods: In 1996, a process of documenting RT errors on standardized incident forms was introduced. These forms are completed by the radiation therapy technologists at the time the error occurs, and desribes the type of error, the contributing factors, and possible means of future prevention. The treating oncologist indicates the clincial significance of the error. Errors were defined as deviations from the prescribed treatment in terms of dose, shielding, field size or accessory use, but did not include minor targeting discrepencies identified by routine port films. Data were collected for all incident forms from Jan 1, 1996 through Jun 30, 2001. Data regarding all patients treated over the same period (i.e. patients at risk) were obtained from electronic RT records. An RT course was defined as all RT given to a single patient within a 3 month period. A region was defined as any RT volume with a unique dose and fractionation schedule, so that a single course could involve treatment to multiple regions. Results: Among 24,853 RT courses delivered, there were 463 errors (1.9%, 95% CI ⫽ 1.7-2.0%). The clinical significance was rated none or minor in 92% of cases, moderate in 4% (0.08% of courses) and severe in 0% (4% missing). Errors related to dose in 18%, field size in 41%, and accessory use in 41%. Tumor sites with error rates significantly above the mean were sarcoma (5.8%, 95% CI ⫽ 4.3-7.8), head and neck (4.7%, 95% CI ⫽ 3.9-5.7), and lymphoma (3.2%, 95% CI ⫽ 2.4-4.1). Sites with error rates significantly below the mean were breast (0.9%, 95% CI ⫽ 0.7-1.2%), and lung (1.1%, 95% CI ⫽ 0.8-1.5). There were 36,256 regions treated (error rate 1.3%, 95%CI ⫽ 1.2-1.4). After accounting for treatment to multiple regions, the head and neck RT error rate was not significantly different from the mean (1.7%, 95% CI ⫽ 1.4-2.0), while the error rate remained above the mean for sarcoma and lymphoma, and less than average for breast RT.
305
Materials/Methods: The records of 27 patients (29 elbows) treated with radiation therapy between 1993–1998 were reviewed. Twenty-one patients (23 elbows) had greater than 3 months follow-up available for review and are included in this analysis. All patients were classified using the classification system developed by Hastings and Graham prior to surgery. Pre-operative, intra-operative, and post-operative range of motion were recorded and compared. Radiation therapy dose ranged from 600-700cGy in one fraction delivered post-operatively. Results: The median follow-up was 10.2 months (range: 3.4-62.1 months). When comparing the pre-operative range of motion with the range of motion achieved intra-operatively, the median increase in range of motion achieved in the operating room was 75 degrees (range: 15-160 degrees). In comparing the post-operative range of motion with the pre-operative range of motion, the median increase in mobility was 57.5 degrees (range: 10-145 degrees). No patient experienced a post-operative wound complication. Conclusions: Radiation therapy consisting of 700 cGy in one fraction delivered post-operatively is successful in maintaining intra-operative range of motion gains in the majority of patients. This form of therapy should be considered in patients presenting with Hastings and Graham Class II or III heterotopic bone formation around the elbow joint or in patients with multiple prior surgeries who have exhibited a tendency towards subsequent heterotopic bone formation.
2165
Primary Extracranial Primary Cancers Treated with Body Stereotactic Radiosurgery (BSR) 1
I. Grosman , P.J. Silverman1, G.S. Lederman1, J. Lowry2, B. Gilson1, D. Bockowski1, F. Volpicella1 1 Department of Radiation Oncology, Staten Island University Hospital, Staten Island, NY, 2Department of Radiology, Staten Island University Hospital, Staten Island, NY
Purpose/Objective: BSR is a non-invasive fiducially-guided fixation system allowing for precision guided radiation to extracranial cancers. The rationale of high-dose hypofractionated radiosurgery for primary cancers is to escalate dose and thereby improve local control and/or obtain symptomatic palliation. Materials/Methods: 1016 primary cancers in 751 patients completed treatment between February 1997 and August 2001. Most cancers were unsuccessfully previously extensively treated by surgery, chemotherapy, and/or radiosurgery. The purpose of treatment was either palliation of symptoms or control of progressive cancer. 546 primary cancers with volumes 0.16cc to 5,240 (mean 187.1cc) were radiographically evaluated in 406 patients (pts) aged 16 to 89 years (mean 63) with dose per radiosurgery fraction of 180 to 1000 Centigray (cGy) (mean 722.9) in 2 to 8 fractions (mean 5). Follow-up ranged from 1 to 51 mos (mean 8.1). Lung cancers were the most frequent target (56%) followed by pancreas (9%) and liver (5%). Success of BSR is defined as cessation of growth, shrinkage or disappearance of cancer as measured with follow-up contrast CT scanning. Results: The overall control rate was 89% with 46% of the cancers showing cessation of growth, 40% decreasing in size, 3% disappearing, while 11% progressing. The control rate for primary lung cancers was 86%. Conclusions: This data suggests that BSR at this early juncture offers high local control rates for cancers in their primary site. These patients often had been heavily pre-treated with surgery, chemotherapy, and radiation. Despite that, treatment was well-tolerated and at this early point, promising in obtaining high levels of local control.
2166
Error Rates in Radiation Therapy: Results of a Quality Assurance Review
G. Huang1, D. Hodgson2, G. Medlam1, G. Lockwood3 1 Department of Radiation Therapy, Princess Margaret Hospital, Toronto, ON, Canada, 2Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON, Canada, 3Department of Biostatistics, Princess Margaret Hospital, Toronto, ON, Canada
Purpose/Objective: Little is known about the frequency and factors associated with errors in the delivery of radiation therapy (RT). The Princess Margaret Hospital has a process for reporting errors that occur during RT. We undertook a formal analysis of all errors reported over a 5 1/2 year period to determine the prevalence, type and severity of errors, and to identify opportunities to eliminate these events. Materials/Methods: In 1996, a process of documenting RT errors on standardized incident forms was introduced. These forms are completed by the radiation therapy technologists at the time the error occurs, and desribes the type of error, the contributing factors, and possible means of future prevention. The treating oncologist indicates the clincial significance of the error. Errors were defined as deviations from the prescribed treatment in terms of dose, shielding, field size or accessory use, but did not include minor targeting discrepencies identified by routine port films. Data were collected for all incident forms from Jan 1, 1996 through Jun 30, 2001. Data regarding all patients treated over the same period (i.e. patients at risk) were obtained from electronic RT records. An RT course was defined as all RT given to a single patient within a 3 month period. A region was defined as any RT volume with a unique dose and fractionation schedule, so that a single course could involve treatment to multiple regions. Results: Among 24,853 RT courses delivered, there were 463 errors (1.9%, 95% CI ⫽ 1.7-2.0%). The clinical significance was rated none or minor in 92% of cases, moderate in 4% (0.08% of courses) and severe in 0% (4% missing). Errors related to dose in 18%, field size in 41%, and accessory use in 41%. Tumor sites with error rates significantly above the mean were sarcoma (5.8%, 95% CI ⫽ 4.3-7.8), head and neck (4.7%, 95% CI ⫽ 3.9-5.7), and lymphoma (3.2%, 95% CI ⫽ 2.4-4.1). Sites with error rates significantly below the mean were breast (0.9%, 95% CI ⫽ 0.7-1.2%), and lung (1.1%, 95% CI ⫽ 0.8-1.5). There were 36,256 regions treated (error rate 1.3%, 95%CI ⫽ 1.2-1.4). After accounting for treatment to multiple regions, the head and neck RT error rate was not significantly different from the mean (1.7%, 95% CI ⫽ 1.4-2.0), while the error rate remained above the mean for sarcoma and lymphoma, and less than average for breast RT.
305