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Prognostic Factors for Locally Advanced Pancreatic Cancer Treated With Chemoradiation
I. J. Radiation Oncology d Biology d Physics
S302
2181
Volume 69, Number 3, Supplement, 2007
Analysis of Dose-volume Histogram Parameters for Radiation Pneumonitis After Concurrent Chemoradiotherapy for Esophageal Cancer
H. Asakura1, T. Hashimoto1, S. Zenda1,2, H. Harada1, K. Hirakawa1,3, M. Mizumoto1, H. Yamashita4, H. Fuji4, S. Murayama4, T. Nishimura1 1 Division of Radiation Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan, 2Division of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan, 3Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan, 4Division of Proton Therapy, Shizuoka Cancer Center Hospital, Shizuoka, Japan
Purpose/Objective(s): To evaluate Dose-Volume Histogram (DVH) parameters as predictors of radiation pneumonitis (RP) in esophageal cancer patients treated with concurrent chemoradiotherapy. Materials/Methods: Records of all esophageal cancer patients treated with concurrent chemoradiotherapy at Shizuoka Cancer Center between September 2002 and December 2004 were retrospectively reviewed. Thirty-seven patients with squamous cell carcinoma, a follow-up time of .1 year from start of treatment, and concomitant chemotherapy consists of 5-fluorouracil and cisplatin were analyzed. Patients with carcinoma of cervical esophagus, 76 years of age or older, or previous treatment were excluded. Radiotherapy was delivered at 2 Gy per fraction to a total of 54–60 Gy (median, 60 Gy) with a conventional beam arrangements (i.e., AP/PA fields followed by off-cord oblique fields). Percentage of lung volume that receiving more than 5 Gy, 10 Gy, 15 Gy, 20 Gy, 25 Gy, 30 Gy, 35 Gy, 40 Gy, 45 Gy, and 50 Gy (V5-V50, respectively), and mean lung dose (MLD) were analyzed. RP was graded according to Common Terminology Criteria for Adverse Events version 3.0. Results: Of 37 patients, 24 (65%) developed RP of grade 0 or 1; 10 (27%), grade 2; 2 (5%), grade 3; 0 (0%), grade 4; 1 (3%), grade 5. By univariate analysis, all DVH parameters (i.e., V5-V50, and MLD) were found to be significantly associated with grade 2 or higher RP (p \ 0.01). Close correlations between all DVH parameters were found (range of Pearson r, 0.797–0.998; p \ 0.01). Incidences of grade 2 or higher RP were 13% (2/16), 33% (4/12), and 78% (7/9) in patients with a V20 of #24%, 25–36%, and $37%, respectively. Conclusions: DVH parameters were the predictors of symptomatic RP after concurrent chemoradiotherapy for esophageal cancer. Author Disclosure: H. Asakura, None; T. Hashimoto, None; S. Zenda, None; H. Harada, None; K. Hirakawa, None; M. Mizumoto, None; H. Yamashita, None; H. Fuji, None; S. Murayama, None; T. Nishimura, None.
2182
Prognostic Factors for Locally Advanced Pancreatic Cancer Treated With Chemoradiation
S. Rudra1, M. J. Swartz2, F. Asrari2, D. A. Laheru3, T. J. Pawlik4, K. Cavallio5, J. M. Herman2 1 Johns Hopkins University School of Medicine, Baltimore, MD, 2The Departments of Radiation Oncology & Molecular Radiation Sciences, 3Department of Medical Oncology, 4Department of Surgery, 5The Departments of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, MD
Purpose/Objective(s): At many institutions in the United States, chemoradiation is the standard treatment for locally advanced pancreatic cancer (LAPC). Currently, there is limited information on which prognostic factors impact outcome following chemoradiaton therapy of LAPC. The purpose of the current study was to review a single-center experience with LAPC patients treated with chemoradiation. Materials/Methods: The records of all pancreatic cancer patients treated at the Johns Hopkins Hospital between 1997 and 2005 were reviewed to identify patients with LAPC. LAPC was defined as primary pancreatic lesions deemed to be unresectable based on pre-operative cross-sectional imaging or surgical exploration. Univariate analysis and multivariate analysis were performed. Metastasis-free survival (MFS) and overall survival (OS) were assessed using Kaplan-Meier and Cox proportional hazard methods. Results: 80 patients with unresectable LAPC had received chemoradiation treatment at our institution. The median age at diagnosis was 61 (range 35–90 years). 57.5% of patients were male, 72.5% were white, and 21.3% were black. Common presenting symptoms were abdominal pain (78.8%), weight loss (73.8%), jaundice (57.5%), and pruritis (18.8%). The median radiation dose was 50.4 Gy (1.8 Gy/fraction). 73 patients (91.0%) received concurrent chemotherapy (75% 5-FU based, 15% gemcitabine, and 10% other), and 38 patients (47.5%) received subsequent chemotherapy for maintenance or secondary to disease progression. Following chemoradiation, 16 patients (20.0%) had local response, 38 (47.5%) had stable disease, 16 (20.0%) had local progression, and 15 (18.8%) did not receive follow-up imaging. Median follow-up was 60 months. Median MFS was 7.1 mos (range 1.5–28 mos) and the median OS was 11.2 mos (range 2.5– 30 mos). Bypass surgery or stent placement was not associated with a statistically significant change in OS: 14.6 mos (bypass) vs 8.7 mos (stent) vs. 8.2 mos (neither), p = 0.15. On univariate analysis, stable or decreased primary tumor size after chemoradiation was associated with improved MFS (11.4 mos vs. 7.0 mos, p = 0.04). Poor prognostic factors for OS on univariate analysis were age $65 (12.7 mos vs. 7.6 mos, p = 0.04) and need for a RT treatment break (12.7 mos vs 8.2 mos, p = 0.01). Factors including tumor size, histology, treatment response, radiation dose, chemotherapy regimen, and tumor location (head vs. other) were not associated with OS. On multivariate analysis, a RT treatment break was independently associated with shorter OS after controlling for RT dose, age at diagnosis, and treatment response (p = 0.02). Following chemoradiation, 8 patients (13.3%) underwent attempted Whipple procedure, of which 2 (3.3%) were successful. Median OS was 18.6 mos (Whipple) vs. 12.2 mos (aborted Whipple). Conclusions: In our experience with LAPC patients treated with chemoradiation, median MFS was 7.1 mos and median OS was 11.2 months. While chemotherapy regimen did not appear to impact survival, the need for a treatment break during RT was associated with inferior survival. Patients with poor functional status who are likely to require a treatment break may be more appropriately managed with less intense initial therapy in order to maximize therapeutic benefit. Author Disclosure: S. Rudra, None; M.J. Swartz, None; F. Asrari, None; D.A. Laheru, None; T.J. Pawlik, None; K. Cavallio, None; J.M. Herman, None.
S302
2181
Volume 69, Number 3, Supplement, 2007
Analysis of Dose-volume Histogram Parameters for Radiation Pneumonitis After Concurrent Chemoradiotherapy for Esophageal Cancer
H. Asakura1, T. Hashimoto1, S. Zenda1,2, H. Harada1, K. Hirakawa1,3, M. Mizumoto1, H. Yamashita4, H. Fuji4, S. Murayama4, T. Nishimura1 1 Division of Radiation Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan, 2Division of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan, 3Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan, 4Division of Proton Therapy, Shizuoka Cancer Center Hospital, Shizuoka, Japan
Purpose/Objective(s): To evaluate Dose-Volume Histogram (DVH) parameters as predictors of radiation pneumonitis (RP) in esophageal cancer patients treated with concurrent chemoradiotherapy. Materials/Methods: Records of all esophageal cancer patients treated with concurrent chemoradiotherapy at Shizuoka Cancer Center between September 2002 and December 2004 were retrospectively reviewed. Thirty-seven patients with squamous cell carcinoma, a follow-up time of .1 year from start of treatment, and concomitant chemotherapy consists of 5-fluorouracil and cisplatin were analyzed. Patients with carcinoma of cervical esophagus, 76 years of age or older, or previous treatment were excluded. Radiotherapy was delivered at 2 Gy per fraction to a total of 54–60 Gy (median, 60 Gy) with a conventional beam arrangements (i.e., AP/PA fields followed by off-cord oblique fields). Percentage of lung volume that receiving more than 5 Gy, 10 Gy, 15 Gy, 20 Gy, 25 Gy, 30 Gy, 35 Gy, 40 Gy, 45 Gy, and 50 Gy (V5-V50, respectively), and mean lung dose (MLD) were analyzed. RP was graded according to Common Terminology Criteria for Adverse Events version 3.0. Results: Of 37 patients, 24 (65%) developed RP of grade 0 or 1; 10 (27%), grade 2; 2 (5%), grade 3; 0 (0%), grade 4; 1 (3%), grade 5. By univariate analysis, all DVH parameters (i.e., V5-V50, and MLD) were found to be significantly associated with grade 2 or higher RP (p \ 0.01). Close correlations between all DVH parameters were found (range of Pearson r, 0.797–0.998; p \ 0.01). Incidences of grade 2 or higher RP were 13% (2/16), 33% (4/12), and 78% (7/9) in patients with a V20 of #24%, 25–36%, and $37%, respectively. Conclusions: DVH parameters were the predictors of symptomatic RP after concurrent chemoradiotherapy for esophageal cancer. Author Disclosure: H. Asakura, None; T. Hashimoto, None; S. Zenda, None; H. Harada, None; K. Hirakawa, None; M. Mizumoto, None; H. Yamashita, None; H. Fuji, None; S. Murayama, None; T. Nishimura, None.
2182
Prognostic Factors for Locally Advanced Pancreatic Cancer Treated With Chemoradiation
S. Rudra1, M. J. Swartz2, F. Asrari2, D. A. Laheru3, T. J. Pawlik4, K. Cavallio5, J. M. Herman2 1 Johns Hopkins University School of Medicine, Baltimore, MD, 2The Departments of Radiation Oncology & Molecular Radiation Sciences, 3Department of Medical Oncology, 4Department of Surgery, 5The Departments of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, MD
Purpose/Objective(s): At many institutions in the United States, chemoradiation is the standard treatment for locally advanced pancreatic cancer (LAPC). Currently, there is limited information on which prognostic factors impact outcome following chemoradiaton therapy of LAPC. The purpose of the current study was to review a single-center experience with LAPC patients treated with chemoradiation. Materials/Methods: The records of all pancreatic cancer patients treated at the Johns Hopkins Hospital between 1997 and 2005 were reviewed to identify patients with LAPC. LAPC was defined as primary pancreatic lesions deemed to be unresectable based on pre-operative cross-sectional imaging or surgical exploration. Univariate analysis and multivariate analysis were performed. Metastasis-free survival (MFS) and overall survival (OS) were assessed using Kaplan-Meier and Cox proportional hazard methods. Results: 80 patients with unresectable LAPC had received chemoradiation treatment at our institution. The median age at diagnosis was 61 (range 35–90 years). 57.5% of patients were male, 72.5% were white, and 21.3% were black. Common presenting symptoms were abdominal pain (78.8%), weight loss (73.8%), jaundice (57.5%), and pruritis (18.8%). The median radiation dose was 50.4 Gy (1.8 Gy/fraction). 73 patients (91.0%) received concurrent chemotherapy (75% 5-FU based, 15% gemcitabine, and 10% other), and 38 patients (47.5%) received subsequent chemotherapy for maintenance or secondary to disease progression. Following chemoradiation, 16 patients (20.0%) had local response, 38 (47.5%) had stable disease, 16 (20.0%) had local progression, and 15 (18.8%) did not receive follow-up imaging. Median follow-up was 60 months. Median MFS was 7.1 mos (range 1.5–28 mos) and the median OS was 11.2 mos (range 2.5– 30 mos). Bypass surgery or stent placement was not associated with a statistically significant change in OS: 14.6 mos (bypass) vs 8.7 mos (stent) vs. 8.2 mos (neither), p = 0.15. On univariate analysis, stable or decreased primary tumor size after chemoradiation was associated with improved MFS (11.4 mos vs. 7.0 mos, p = 0.04). Poor prognostic factors for OS on univariate analysis were age $65 (12.7 mos vs. 7.6 mos, p = 0.04) and need for a RT treatment break (12.7 mos vs 8.2 mos, p = 0.01). Factors including tumor size, histology, treatment response, radiation dose, chemotherapy regimen, and tumor location (head vs. other) were not associated with OS. On multivariate analysis, a RT treatment break was independently associated with shorter OS after controlling for RT dose, age at diagnosis, and treatment response (p = 0.02). Following chemoradiation, 8 patients (13.3%) underwent attempted Whipple procedure, of which 2 (3.3%) were successful. Median OS was 18.6 mos (Whipple) vs. 12.2 mos (aborted Whipple). Conclusions: In our experience with LAPC patients treated with chemoradiation, median MFS was 7.1 mos and median OS was 11.2 months. While chemotherapy regimen did not appear to impact survival, the need for a treatment break during RT was associated with inferior survival. Patients with poor functional status who are likely to require a treatment break may be more appropriately managed with less intense initial therapy in order to maximize therapeutic benefit. Author Disclosure: S. Rudra, None; M.J. Swartz, None; F. Asrari, None; D.A. Laheru, None; T.J. Pawlik, None; K. Cavallio, None; J.M. Herman, None.