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Prognostic Value of Nodal SUVmax of Pretreatment FDG Positron Emission Tomography Imaging in Patients With Esophageal Cancer
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Volume 96 Number 2S Supplement 2016 radiation therapy in the context of isolated or limited lymph node metastases. We analyzed the dosimetric and clinical results of oligometastatic patients treated with SBRT for isolated lymph node metastases in abdomen and/or pelvis. Materials/Methods: In the analysis we included patients with a maximum of 5 lymph node sites of disease with diameter less than 5 cm, located in the abdomen or pelvis. Radiation therapy was administered with Volumetric Modulated Arc Therapy Rapid-Arc (VMAT-RA) and flattening filter-free (FFF) beams; prescribed dose was 45 Gy in 6 fractions of 7.5 Gy each. We analyzed dosimetric data and correlated them with acute toxicity (CTCAE 3.0), local and distant control of disease, progression free survival, and overall survival. Results: From January 2006 to May 2015, we treated 97 patients with lymph node metastases, of which 26 were lost at follow-up. We analyzed than 71 patients with a total of 79 treated lesions, with a mean follow-up of 1.44 years (range 0.14 e 6.21 years). At revaluation, complete response was achieved in 39 (49.3%) lesions and partial response in 28 (35.4%) lesions. Stable disease was demonstrated in 10 (12.6%) cases while only 2 (2.5%) lesions showed progression of disease. The overall clinical benefit rate was 97.5% (77/79 lesions). Acute toxicity was mild: 10 (14%) patients reported G1 toxicity (notably nausea and fatigue); 2 (2.8%) patients reported G2 toxicity (nausea and diarrhea). No Grade 3 and 4 toxicities were reported. In-field progression of disease during follow-up was demonstrated in 18 sites (22.7%) with a median time of 10.7 months. Out-field lymph node progression was demonstrated in 22 (27.8%) cases while distant metastases occurred in 25 (31.6%) cases. Local control rate and overall survival rate at 1 year were 83% and 93%, respectively. Conclusion: In consideration of our dosimetric and clinical results, SBRT with VMAT-RA and FFF beams can be considered a safe and effective approach in oligometastatic patients with abdomino-pelvic isolated lymph node metastases. Although this can be considered an initial experience, these results may be potentially significant for preserving quality of life of patients and delaying further systemic treatments. Author Disclosure: C. Franzese: None. L. Cozzi: None. E. Clerici: None. G. D’Agostino: None. P. Navarria: None. T. Comito: None. F. De Rose: None. A. Ascolese: None. D. Franceschini: None. P. Mancosu: None. S. Tomatis: None. M. Scorsetti: None.
2349 Adjuvant Chemoradiation for Resected Gallbladder Cancer: Single-Center 25-Year Experience C.V. Sole, V. Sole, and S. Sole; Clinica Instituto de Radiomedicina (IRAM), Santiago, Chile Purpose/Objective(s): Patients with locally advanced gallbladder cancer (LAGC) have a dismal prognosis. We investigated outcomes and risk factors for overall survival (OS) in patients treated with radical surgery and adjuvant chemoradiation therapy (CRT). Materials/Methods: A total of 212 patients with LAGC [cT3 59% and/ or cN+ 52%) were studied. The primary endpoint of the analysis was OS. The KaplaneMeier method was used to estimate the probabilities of OS. For survival outcomes potential associations were assessed in univariate and multivariate analyses using the Cox proportional hazards model. We constructed a risk scoring system in which points were assigned to each risk factor by dividing each ß coefficient in the final model by the lowest ß coefficient and rounding to the nearest integer. A risk score was assigned to each subject by adding up the points for each risk factor present. Subjects were then divided into three risk groups based on their risk scores (0 points Z low risk, 1-2 points Z intermediate risk, 3-6 points Z high risk). Results: Median follow-up was 46.2 months (2-235). Five-year OS for the entire cohort was 50.2%. In multivariate analysis higher pT stage [HR: 2.43 (1.29-3.68), P Z 0.01], R1 resection [HR 5.06 (3.12-8.19), P < 0.001], and number of surgical procedures [HR 1.41 (1.01-2.16),
P Z 0.05] were associated with an increased risk of death. Five-year OS for patients with low (n Z 63), intermediate (n Z 94) and high (n Z 55) risk was 79.1%, 59.2% and 9.5%, respectively. Conclusion: Overall results after multimodality treatment of LAGC are promising. A risk model was generated to determine a prognostic index for individual patients with LAGC. Classification of risk factors for death has contributed to propose a prognostic index that could allow us to guide riskadapted tailored treatment. Author Disclosure: C.V. Sole: None. V. Sole: None. S. Sole: None.
2350 Prognostic Value of Nodal SUVmax of Pretreatment FDG Positron Emission Tomography Imaging in Patients With Esophageal Cancer W.K. Yap, T.M. Hung, C.K. Tseng, and Y.C. Chang; Chang Gung Memorial Hospital, Taoyuan, Taiwan Purpose/Objective(s): To assess whether the pretreatment [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) maximum standardized uptake value (SUVmax) of metastatic lymph nodes can predict the prognosis of patients with esophageal cancer and can select patients who may not benefit from planned esophagectomy after chemoradiation. Materials/Methods: We retrospectively reviewed electronic medical records of 102 patients with histologically confirmed stage IIA to IIIC esophageal cancer (97.1% squamous cell carcinoma, 96.1% stage III) receiving chemoradiation therapy with or without resection. All patients received an initial FDG-PET for staging purposes. All patients received surgical evaluation after first course of chemoradiation therapy. Primary tumor SUVmax and metastatic lymph node SUVmax were separately recorded and the best cut-off value for survival analyses were determined by log-rank test and receiver operating characteristic (ROC) curve analysis. The influence of clinicopathological factors including primary tumor SUVmax and nodal SUVmax on freedom from local failure (LFF), freedom from nodal failure (NFF), freedom from distant failure (DFF), overall survival (OS) and progression-free survival (PFS) were evaluated using univariate and multivariate analysis. Results: Forty patients received trimodality therapy and 62 received definitive chemoradiotherapy (dCRT). Patients receiving trimodality therapy had better outcomes than patients receiving dCRT (2-year OS, 71% v 34%, P Z .001; 2-year PFS, 45% v 17%, P Z .0001; 2-year LFF, 89% v 39%, P Z .0001; 2-year NFF, 78% v 50%, P Z .004; 2-year DFF, 70% v 50%, P Z .054). Nodal SUVmax <7 predicted for improved outcomes for dCRT (2-year DFF, 92% v 17%, P Z .0001; 2-year RFF, 81% v 14%, P Z .001; 2-year OS, 50% v 21%, P Z .003; 2-year PFS, 36% v 3%, P Z .001; No significant difference in LFF), but not trimodality therapy. Primary tumor SUVmax <18.67 only predicted for better 2-year DFF (59% v 37%, P Z .005) for dCRT, but not trimodality therapy. Compared to patients receiving trimodality, patients receiving dCRT with nodal SUVmax <7 were not different on OS (P Z .22), PFS (P Z .17), DFF (P Z .19) and NFF (P Z .60) despite having more advanced disease at baseline, but did worse on LFF (P Z .002); Patients receiving dCRT with nodal SUVmax >7 did significantly worse in OS (P Z .0001), PFS (P Z .0001), DFF (P Z .0001), NFF (P Z .0001) and LFF (P Z .0001) comparing to patients receiving trimodality. On multivariate analysis of patients receiving dCRT, nodal SUVmax <7 is the strongest independent prognostic variable (OS hazard ratio [HR], 3.08 P Z .002; PFS HR, 2.17 P Z .018; DFF HR, 8.33 P Z .002; NFF HR, 3.55 P Z .025). Conclusion: Pretreatment nodal SUVmax was a strong prognostic indicator on nodal failure, distant failure, progression free survival, and overall survival for patients receiving definitive chemoradiotherapy. Planned esophagectomy only improved local control but not nodal control, distant failure and survivals in patients whose pretreatment nodal SUVmax <7. Author Disclosure: W. Yap: None. T. Hung: None. C. Tseng: None. Y. Chang: None.
Volume 96 Number 2S Supplement 2016 radiation therapy in the context of isolated or limited lymph node metastases. We analyzed the dosimetric and clinical results of oligometastatic patients treated with SBRT for isolated lymph node metastases in abdomen and/or pelvis. Materials/Methods: In the analysis we included patients with a maximum of 5 lymph node sites of disease with diameter less than 5 cm, located in the abdomen or pelvis. Radiation therapy was administered with Volumetric Modulated Arc Therapy Rapid-Arc (VMAT-RA) and flattening filter-free (FFF) beams; prescribed dose was 45 Gy in 6 fractions of 7.5 Gy each. We analyzed dosimetric data and correlated them with acute toxicity (CTCAE 3.0), local and distant control of disease, progression free survival, and overall survival. Results: From January 2006 to May 2015, we treated 97 patients with lymph node metastases, of which 26 were lost at follow-up. We analyzed than 71 patients with a total of 79 treated lesions, with a mean follow-up of 1.44 years (range 0.14 e 6.21 years). At revaluation, complete response was achieved in 39 (49.3%) lesions and partial response in 28 (35.4%) lesions. Stable disease was demonstrated in 10 (12.6%) cases while only 2 (2.5%) lesions showed progression of disease. The overall clinical benefit rate was 97.5% (77/79 lesions). Acute toxicity was mild: 10 (14%) patients reported G1 toxicity (notably nausea and fatigue); 2 (2.8%) patients reported G2 toxicity (nausea and diarrhea). No Grade 3 and 4 toxicities were reported. In-field progression of disease during follow-up was demonstrated in 18 sites (22.7%) with a median time of 10.7 months. Out-field lymph node progression was demonstrated in 22 (27.8%) cases while distant metastases occurred in 25 (31.6%) cases. Local control rate and overall survival rate at 1 year were 83% and 93%, respectively. Conclusion: In consideration of our dosimetric and clinical results, SBRT with VMAT-RA and FFF beams can be considered a safe and effective approach in oligometastatic patients with abdomino-pelvic isolated lymph node metastases. Although this can be considered an initial experience, these results may be potentially significant for preserving quality of life of patients and delaying further systemic treatments. Author Disclosure: C. Franzese: None. L. Cozzi: None. E. Clerici: None. G. D’Agostino: None. P. Navarria: None. T. Comito: None. F. De Rose: None. A. Ascolese: None. D. Franceschini: None. P. Mancosu: None. S. Tomatis: None. M. Scorsetti: None.
2349 Adjuvant Chemoradiation for Resected Gallbladder Cancer: Single-Center 25-Year Experience C.V. Sole, V. Sole, and S. Sole; Clinica Instituto de Radiomedicina (IRAM), Santiago, Chile Purpose/Objective(s): Patients with locally advanced gallbladder cancer (LAGC) have a dismal prognosis. We investigated outcomes and risk factors for overall survival (OS) in patients treated with radical surgery and adjuvant chemoradiation therapy (CRT). Materials/Methods: A total of 212 patients with LAGC [cT3 59% and/ or cN+ 52%) were studied. The primary endpoint of the analysis was OS. The KaplaneMeier method was used to estimate the probabilities of OS. For survival outcomes potential associations were assessed in univariate and multivariate analyses using the Cox proportional hazards model. We constructed a risk scoring system in which points were assigned to each risk factor by dividing each ß coefficient in the final model by the lowest ß coefficient and rounding to the nearest integer. A risk score was assigned to each subject by adding up the points for each risk factor present. Subjects were then divided into three risk groups based on their risk scores (0 points Z low risk, 1-2 points Z intermediate risk, 3-6 points Z high risk). Results: Median follow-up was 46.2 months (2-235). Five-year OS for the entire cohort was 50.2%. In multivariate analysis higher pT stage [HR: 2.43 (1.29-3.68), P Z 0.01], R1 resection [HR 5.06 (3.12-8.19), P < 0.001], and number of surgical procedures [HR 1.41 (1.01-2.16),
P Z 0.05] were associated with an increased risk of death. Five-year OS for patients with low (n Z 63), intermediate (n Z 94) and high (n Z 55) risk was 79.1%, 59.2% and 9.5%, respectively. Conclusion: Overall results after multimodality treatment of LAGC are promising. A risk model was generated to determine a prognostic index for individual patients with LAGC. Classification of risk factors for death has contributed to propose a prognostic index that could allow us to guide riskadapted tailored treatment. Author Disclosure: C.V. Sole: None. V. Sole: None. S. Sole: None.
2350 Prognostic Value of Nodal SUVmax of Pretreatment FDG Positron Emission Tomography Imaging in Patients With Esophageal Cancer W.K. Yap, T.M. Hung, C.K. Tseng, and Y.C. Chang; Chang Gung Memorial Hospital, Taoyuan, Taiwan Purpose/Objective(s): To assess whether the pretreatment [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) maximum standardized uptake value (SUVmax) of metastatic lymph nodes can predict the prognosis of patients with esophageal cancer and can select patients who may not benefit from planned esophagectomy after chemoradiation. Materials/Methods: We retrospectively reviewed electronic medical records of 102 patients with histologically confirmed stage IIA to IIIC esophageal cancer (97.1% squamous cell carcinoma, 96.1% stage III) receiving chemoradiation therapy with or without resection. All patients received an initial FDG-PET for staging purposes. All patients received surgical evaluation after first course of chemoradiation therapy. Primary tumor SUVmax and metastatic lymph node SUVmax were separately recorded and the best cut-off value for survival analyses were determined by log-rank test and receiver operating characteristic (ROC) curve analysis. The influence of clinicopathological factors including primary tumor SUVmax and nodal SUVmax on freedom from local failure (LFF), freedom from nodal failure (NFF), freedom from distant failure (DFF), overall survival (OS) and progression-free survival (PFS) were evaluated using univariate and multivariate analysis. Results: Forty patients received trimodality therapy and 62 received definitive chemoradiotherapy (dCRT). Patients receiving trimodality therapy had better outcomes than patients receiving dCRT (2-year OS, 71% v 34%, P Z .001; 2-year PFS, 45% v 17%, P Z .0001; 2-year LFF, 89% v 39%, P Z .0001; 2-year NFF, 78% v 50%, P Z .004; 2-year DFF, 70% v 50%, P Z .054). Nodal SUVmax <7 predicted for improved outcomes for dCRT (2-year DFF, 92% v 17%, P Z .0001; 2-year RFF, 81% v 14%, P Z .001; 2-year OS, 50% v 21%, P Z .003; 2-year PFS, 36% v 3%, P Z .001; No significant difference in LFF), but not trimodality therapy. Primary tumor SUVmax <18.67 only predicted for better 2-year DFF (59% v 37%, P Z .005) for dCRT, but not trimodality therapy. Compared to patients receiving trimodality, patients receiving dCRT with nodal SUVmax <7 were not different on OS (P Z .22), PFS (P Z .17), DFF (P Z .19) and NFF (P Z .60) despite having more advanced disease at baseline, but did worse on LFF (P Z .002); Patients receiving dCRT with nodal SUVmax >7 did significantly worse in OS (P Z .0001), PFS (P Z .0001), DFF (P Z .0001), NFF (P Z .0001) and LFF (P Z .0001) comparing to patients receiving trimodality. On multivariate analysis of patients receiving dCRT, nodal SUVmax <7 is the strongest independent prognostic variable (OS hazard ratio [HR], 3.08 P Z .002; PFS HR, 2.17 P Z .018; DFF HR, 8.33 P Z .002; NFF HR, 3.55 P Z .025). Conclusion: Pretreatment nodal SUVmax was a strong prognostic indicator on nodal failure, distant failure, progression free survival, and overall survival for patients receiving definitive chemoradiotherapy. Planned esophagectomy only improved local control but not nodal control, distant failure and survivals in patients whose pretreatment nodal SUVmax <7. Author Disclosure: W. Yap: None. T. Hung: None. C. Tseng: None. Y. Chang: None.