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Prognostic Factors in Patients with Locally Advanced Pancreatic Cancer Treated with Concurrent Chemoradiotherapy
Proceedings of the 50th Annual ASTRO Meeting endoscopic ultrasound (uT stage). The median radiation dose was 50.4 Gy (range, 45-52 Gy) at 1.8 Gy per fraction and concurrent 5-FU based chemotherapy. Low anterior resection or abdominoperineal resection occurred at a median of 46 days (range, 27-112 days) after completing CRT. For the pre-CRT PET scans, metabolically active primary tumor regions were delineated semi-automatically using custom software, and the maximum SUV (SUVmax), mean SUV (SUVmean), and the metabolic tumor volume (MTV) were recorded. Post-CRT PET scans were done at a median of 26 days following CRT (range, 15-59 days). A .35% decrease in SUVmax was classified as a ‘‘PET-response,’’ and a #35% decrease in SUVmax were classified as a ‘‘PET-non-response’’. Pathologic response was defined as a decrease of 2 or 3 from the uT stage to the post CRT T stage (yT stage), and pathologic non-response was defined as a decrease of 0 or 1 from uT stage to yT stage. Results: Five patients had a pathologic response (22%) and 18 patients had a pathologic non-response (78%). Nineteen patients had PET-response (83%) and 4 patients had PET-non-response (17%). For the pre-CRT PET, the median SUVmax , SUVmean, and MTV for pathologic response vs. non-response was 16.1 and 9.9 (p = 0.01), 9.5 vs.6.3 (p = 0.008),and 176.2 and 220.4 (p = 0.27), respectively. The post-CRT PET showed a sensitivity, specificity, negative predictive value, and positive predictive value of 22%, 100%, 26%, and 100%, respectively, for predicting pathologic response. Conclusions: These findings show that for locally advanced rectal adenocarcinoma, pre-CRT PET predicts for pathologic response to preoperative CRT. Post-CRT PET predicts for a pathologic response with a 100% specificity and PPV. Author Disclosure: S.K. Chennupati, None; M. Welton, None; A. Shelton, None; G.A. Fisher, None; J.M. Ford, None; R.K. Pai, None; A. Quon, None; A. Kamaya, None; A.C. Koong, None; D.T. Chang, None.
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Prognostic Factors in Patients with Locally Advanced Pancreatic Cancer Treated with Concurrent Chemoradiotherapy
P. Huang1,2, Y. Chao1,2, C. Li3,2, R. Lee4,2, K. Chi5,2, C. Shiau1,2, L. Wang1,2, S. Yen1,2 1 Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan, 2National Yang-Ming University School of Medicine, Taipei, Taiwan, 3Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, 4 Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, 5Division of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
Purpose/Objective(s): To review a single institute experience for patients with locally advanced pancreatic cancer (LAPC) treated with gemcitabine (GEM) concurrent chemoradiotherapy (CCRT). Prognostic factors affecting outcomes were investigated. Materials/Methods: Between January 2002 and June 2007, 79 patients with histological or cytologically confirmed LAPC treated with GEM (400 mg/m2/week) concurrently with radiotherapy (median dose: 50.4 Gy, range, 26-61.2) at Taipei Veterans General Hospital were enrolled. The GEM 1,000 mg/m2 was continued after CCRT as maintenance once weekly for 3 weeks and repeated every 4 weeks. Overall survival (OS) and time to progression (TTP) were estimated by the Kaplan-Meier method. Univariate and multivariate analyses were performed using Cox’s proportional hazard model to explore potential variables affecting OS and TTP. Results: There were 56 males and 23 females, with a median age of 66 years (range, 31-88). The median follow-up time was 11.8 months (range, 3.5-39.8) for all patients with the 1- and 2-year survival rates of 52% and 14%, respectively. Initial presenting symptoms were abdominal/back pain in 53 patients (67%), anorexia in 35 patients (44%), body weight loss .5% in 42 patients (53%), nausea/vomiting in 30 patients (38%), and jaundice in 45 patients (57%). Median TTP and median OS were 6.1 and 12.4 months, respectively. Locoregional progression was observed in 19 patients (24%), distant failure in 28 patients (35%), and both locoregional and distant failure in 33 patients (42%). On univariate analysis, KPS .80 (p = 0.003) and CA 19-9 level\=1,000 U/mL (p = 0.01) were found to be associated with better survival. Multivariate analysis showed that KPS and serum CA 19-9 were the most independent predictive factors of OS. For TTP, the significant prognostic factors remained KPS .80 (p = 0.002) and CA 19-9 level \=1,000 U/mL (p = 0.01). Multivariate analysis showed that KPS and serum CA 19-9 were the most important factors of TTP. Patients were further classified into 3 groups according to prognostic factors as follows: group I: KPS .80 and CA 19-9 \=1,000 (n = 38); group II: KPS .80 and CA 19-9 .1,000, or, KPS\=80 and CA 19-9\=1,000 (n = 33); group III: KPS\=80 and CA 199 .1,000 (n = 8). Median OS in group I, II, and III were 14.5, 10.8, and 5.9 months (p\0.001), respectively, and median TTP were 6.8, 5.9, and 2.8 months (p = 0.007). Conclusions: For LAPC, KPS, and CA 19-9 are the most important factors impacting OS and TTP. Patients with good prognostic factors can benefit from the GEM CCRT, however, this benefit is limited for patients with poor performance and high CA 19-9 levels. A better understanding of the factors impacting outcomes may attribute to the selection of patients in this heterogeneous population who can benefit from the combined treatment modality. Author Disclosure: P. Huang, None; Y. Chao, None; C. Li, None; R. Lee, None; K. Chi, None; C. Shiau, None; L. Wang, None; S. Yen, None.
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Respiratory Liver Tumor Motion Reduction using an Abdominal Arc Compression Device
A. Srisuthep1, J. Kalpathy-Cramer2, D’Souza W.2, M. Fuss2 1
Bhumibol Adulyadej Hospital, Bangkok, Thailand, 2Oregon Health and Science University, Portland, OR
Purpose/Objective(s): To investigate how the use of an abdominal arc compression device impacts on respiration-induced liver motion as assessed by volumetric 4D-CT imaging. Materials/Methods: Fourteen patients with primary (n = 12), and secondary liver tumors (n = 2) have undergone simulation for a course of Stereotactic Body Radiation Therapy (SBRT) treatment using a novel abdominal arc compression device adapted to a clinically established double-vacuum whole body immobilization device (BodyFix, Medical Intelligence). The compression device consists of a carbon fiber arc, and a choice of abdomen compression plates that are placed caudal to the xyphoid on the anterior abdomen with the intent to restrict liver respiration motion. All patients underwent 4D-CT imaging with and without the compression device in place; when no abdominal compression was used, the double vacuum was still utilized. Target volumes were delineated in free breathing (FB) scans, 10 respiratory phases, and maximum-intensity projection (MIP) reconstructions. We assessed the range of tumor motion with and without abdominal compression in place, and compared planning target volumes
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Prognostic Factors in Patients with Locally Advanced Pancreatic Cancer Treated with Concurrent Chemoradiotherapy
P. Huang1,2, Y. Chao1,2, C. Li3,2, R. Lee4,2, K. Chi5,2, C. Shiau1,2, L. Wang1,2, S. Yen1,2 1 Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan, 2National Yang-Ming University School of Medicine, Taipei, Taiwan, 3Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, 4 Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, 5Division of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
Purpose/Objective(s): To review a single institute experience for patients with locally advanced pancreatic cancer (LAPC) treated with gemcitabine (GEM) concurrent chemoradiotherapy (CCRT). Prognostic factors affecting outcomes were investigated. Materials/Methods: Between January 2002 and June 2007, 79 patients with histological or cytologically confirmed LAPC treated with GEM (400 mg/m2/week) concurrently with radiotherapy (median dose: 50.4 Gy, range, 26-61.2) at Taipei Veterans General Hospital were enrolled. The GEM 1,000 mg/m2 was continued after CCRT as maintenance once weekly for 3 weeks and repeated every 4 weeks. Overall survival (OS) and time to progression (TTP) were estimated by the Kaplan-Meier method. Univariate and multivariate analyses were performed using Cox’s proportional hazard model to explore potential variables affecting OS and TTP. Results: There were 56 males and 23 females, with a median age of 66 years (range, 31-88). The median follow-up time was 11.8 months (range, 3.5-39.8) for all patients with the 1- and 2-year survival rates of 52% and 14%, respectively. Initial presenting symptoms were abdominal/back pain in 53 patients (67%), anorexia in 35 patients (44%), body weight loss .5% in 42 patients (53%), nausea/vomiting in 30 patients (38%), and jaundice in 45 patients (57%). Median TTP and median OS were 6.1 and 12.4 months, respectively. Locoregional progression was observed in 19 patients (24%), distant failure in 28 patients (35%), and both locoregional and distant failure in 33 patients (42%). On univariate analysis, KPS .80 (p = 0.003) and CA 19-9 level\=1,000 U/mL (p = 0.01) were found to be associated with better survival. Multivariate analysis showed that KPS and serum CA 19-9 were the most independent predictive factors of OS. For TTP, the significant prognostic factors remained KPS .80 (p = 0.002) and CA 19-9 level \=1,000 U/mL (p = 0.01). Multivariate analysis showed that KPS and serum CA 19-9 were the most important factors of TTP. Patients were further classified into 3 groups according to prognostic factors as follows: group I: KPS .80 and CA 19-9 \=1,000 (n = 38); group II: KPS .80 and CA 19-9 .1,000, or, KPS\=80 and CA 19-9\=1,000 (n = 33); group III: KPS\=80 and CA 199 .1,000 (n = 8). Median OS in group I, II, and III were 14.5, 10.8, and 5.9 months (p\0.001), respectively, and median TTP were 6.8, 5.9, and 2.8 months (p = 0.007). Conclusions: For LAPC, KPS, and CA 19-9 are the most important factors impacting OS and TTP. Patients with good prognostic factors can benefit from the GEM CCRT, however, this benefit is limited for patients with poor performance and high CA 19-9 levels. A better understanding of the factors impacting outcomes may attribute to the selection of patients in this heterogeneous population who can benefit from the combined treatment modality. Author Disclosure: P. Huang, None; Y. Chao, None; C. Li, None; R. Lee, None; K. Chi, None; C. Shiau, None; L. Wang, None; S. Yen, None.
2223
Respiratory Liver Tumor Motion Reduction using an Abdominal Arc Compression Device
A. Srisuthep1, J. Kalpathy-Cramer2, D’Souza W.2, M. Fuss2 1
Bhumibol Adulyadej Hospital, Bangkok, Thailand, 2Oregon Health and Science University, Portland, OR
Purpose/Objective(s): To investigate how the use of an abdominal arc compression device impacts on respiration-induced liver motion as assessed by volumetric 4D-CT imaging. Materials/Methods: Fourteen patients with primary (n = 12), and secondary liver tumors (n = 2) have undergone simulation for a course of Stereotactic Body Radiation Therapy (SBRT) treatment using a novel abdominal arc compression device adapted to a clinically established double-vacuum whole body immobilization device (BodyFix, Medical Intelligence). The compression device consists of a carbon fiber arc, and a choice of abdomen compression plates that are placed caudal to the xyphoid on the anterior abdomen with the intent to restrict liver respiration motion. All patients underwent 4D-CT imaging with and without the compression device in place; when no abdominal compression was used, the double vacuum was still utilized. Target volumes were delineated in free breathing (FB) scans, 10 respiratory phases, and maximum-intensity projection (MIP) reconstructions. We assessed the range of tumor motion with and without abdominal compression in place, and compared planning target volumes
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