T-Cell Lymphoma

Volume 93  Number 3S  Supplement 2015 Conclusion: Tonsil NKTCL appears to have several different clinical characteristics. A better PFS can be achieved by CMT compared with RT alone or CT alone. RT significantly decreased the locoregional failure compared with CT alone. Author Disclosure: X. Yang: None. Y. Li: None. Q. Liu: None. Z. Yuan: None. X. Li-ming: None. J. Cao: None. Y. Zhu: None. Y. Zhang: None. F. Zhang: None. X. Hou: None. J. Wu: None. W. Wang: None.

3124 Long-term Efficacy of Sequential DICE Chemotherapy With Regional Field Radiation Therapy for Stages I-II Natural Killer/ T-Cell Lymphoma, Nasal Type: Analysis of 118 Cases Y. Wang, X. Ma, Y. Guo, and X. Li; Fudan University Shanghai Cancer Center, Shanghai, China Purpose/Objective(s): Extranodal natural killer/T-cell lymphoma, nasal type (ENKTL) is an aggressive entity of non-Hodgkin’s lymphoma with poor prognosis. ENKTL is sensitive to radiation but resistant to anthracycline-containing chemotherapy. This study aims to evaluate the efficacy of the chemoradiation therapy composed of DICE regimen and regional field radiation therapy in early stage ENTKL. Materials/Methods: In this study, we employed DICE regimen (dexamethasone, ifosfamide, mensa, cisplatin and etoposide) chemotherapy followed by regional field radiation therapy to treat patients with stages I ENKTL with risk factors in the upper aerodigestive tract and stage II ENKTL with cervical lymph nodes involved. The risk factors included elevated LDH, B symptom, ECOG2 and locally extensive disease involved more than two anatomic structures. Inductive chemotherapy was given 2 to 4 cycles and radiation was delivered with intensity-modulated radiation therapy (IMRT) to a prescribed dose of 50 Gy in 25 fractions. Treatment toxicities, locoregional, and systemic failure were observed, while treatment response and survival data were analyzed as well. Results: In the cohort of 118 patients who met the enrollment criteria, 28.8% patients achieved complete response (CR) and 41.5% had partial response (PR) after DICE treatment. Subsequently, the CR rate climbed to 90.7%, with the PR rate of 6.8% after completion of definitive radiation therapy (RT). Patients tolerated chemotherapy and radiation therapy well. Grade II-III neutrophilic granulocytopenia was the main toxicity after chemotherapy. Long term mild xerostomia and hypogeusia after radiation therapy were observed in few patients. Among the patients who had CR after RT, 11 of them got local relapses in 3-46 months after the start of treatment, with the 5-year local control rate of 90.2%. Thirty-two patients developed systemic disseminations in 3-72 months after treatment. The most frequent recurrent site was skin, followed by organs in abdominopelvic cavity and central nervous system. Except for one patient died of diabetes and one died of secondary malignance, all the other 34 dead patients had distant metastasis or hemophagocytosis, with four concurrent local relapses. Totally, within a median follow-up time of 68 months (3-88 months), the 5-year overall survival (OS) and progression free survival (PFS) were 71.3% and 62.4%, respectively. Conclusion: In conclusion, DICE chemotherapy followed by involved field radiation therapy is a feasible and effective treatment for newly diagnosed stages I-II ENKTL. Author Disclosure: Y. Wang: None. X. Ma: None. Y. Guo: None. X. Li: None.

3125 Histologic Evaluation of Acute Graft-Versus-Host Disease After Stem Cell Transplantation With or Without Total Body Irradiation Y. Oguma,1 K. Okajima,1 T. Matsuura,1 K. Ishikawa,2 H. Tatebe,2 K. Fukuda,3 and Y. Nishimura2; 1Nara Hospital, Kinki University, Ikoma, Japan, 2Kinki University Faculty of Medicine, Osaka-Sayama, Japan, 3 Kinki University Faculty of Medicine, Osaka, Japan

Poster Viewing Session E451 Purpose/Objective(s): To evaluate the influence of radiation dose on histologic features of skin with graft-versus-host disease (GVHD) after stem cell transplantation (SCT). Materials/Methods: We analyzed 69 consecutive patients who underwent SCT for hematologic malignancies between 2008 and 2014, comprising 51 men and 18 women, aged 16 to 70 (median 43) years. SCT was performed for acute myelogenous leukemia in 19, acute lymphocytic leukemia in 10, and other diseases in 40 patients. Conditioning regimens were chemotherapy consisting of busulfan and cyclophosphamide without radiation therapy in 31 patients, and total body irradiation (TBI) with chemotherapy in 38 patients. The total dose of TBI was 2e4 Gy and 10e12 Gy (2 Gy/ fraction) in 20 and 18 patients, respectively. TBI was performed with 10 MV X-ray from a linear accelerator with side-to-side, long SAD method. After SCT, the skin lesions of all patients with an acute skin rash suggestive of GVHDs were histologically examined. GVHDs were histologically evaluated according to the grading system proposed by Lehner et al., and the correlation between the pathologic features and radiation doses was examined. Histopathologic appearances include vacuolar alteration or liquefaction degeneration of the basal cell layer (grade 1), dyskeratotic squamous cells in the epidermis/hair follicles (grade 2), subepidermal vesicle formation or intracellular edema (grade 3), and complete separation of the epidermis from the dermis (grade 4). Results: Thirty-four patients had a rash mainly on the hands, back, and thighs, and underwent a skin biopsy 14e778 days after SCT. GVHDs was identified in 28 of 69 patients (40%), and 16 of 28 were diagnosed within 100 days. Subsequently, we evaluated 16 patients with acute GVHDs and compared their radiation doses. Incidences of acute GVHDs were 7/16 (44%), 4/16 (25%), and 5/16 (31%) in the no TBI group, 2e4 Gy TBI group, and 10e12 Gy TBI group, respectively. The histological grade did not correlate with the radiation dose. Patients of histological GVHD grade £ 2 were 6/7, 4/4, and 3/5 in no TBI group, 2-4 Gy TBI group, and 10-12 Gy TBI group, respectively. Acute radiation dermatitis characterized by epidermal desquamations was not observed in any patient, even in skin that was irradiated with more than 10 Gy. Conclusion: Acute radiation dermatitis was not pathologically evident in patients who had undergone TBI with a dose £ 12 Gy (2 Gy/fraction). When a patient had skin lesions of acute GVHDs after SCT, the histologic grade was not influenced by the radiation dose. Author Disclosure: Y. Oguma: None. K. Okajima: None. T. Matsuura: None. K. Ishikawa: None. H. Tatebe: None. K. Fukuda: None. Y. Nishimura: None.

3126 Radiation Therapy Alone Not Inferior to Chemoradiation in the Patients With Stage I Nasal Natural Killer/T-Cell Lymphoma X. Ma, Y. Guo, Z. Pan, and X. Li; Fudan University Shanghai Cancer Center, Shanghai, China Purpose/Objective(s): To analyze the treatment outcomes of radiation therapy alone or chemoradiation in patients with limited disease in nasal cavity of stage I extranodal natural killer/T-cell lymphoma (ENKTL). Materials/Methods: Patients with stage I nasal ENKTL were treated with definitive radiation therapy alone or followed introductive chemotherapy of 2 to 4 cycles CHOP or DICE regimens. Curative radiation therapy was delivered to the regional field with a total dose of 50Gy. Clinical target volume of radiation was defined as the regional field covering involved anatomic structure(s) and the adjacent structures. No prophylactic irradiation was applied to neck. Radiation therapy was delivered with threedimensional conformal radiation therapy (3DCRT) or intensity-modulated radiation therapy (IMRT). Treatment responses were recorded and survival data were analyzed. Results: From Sept, 2005 to Dec, 2012, a total of 129 patients with stage I ENKTL limited in nasal cavity at our institute were enrolled. Among them, 57 patients received curative radiation therapy alone, 72 had chemoradiation. Fifty-six of 57 patients who received radiation therapy alone achieved complete remission (CR). In the chemoradiation group, 48.6% patients had CR and 22.2% partial remission (PR) after inductive

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International Journal of Radiation Oncology  Biology  Physics

chemotherapy, and the CR rate inclined to 94.4% after radiation. With a median follow-up of 58.5 month, the five year overall survival (OS), progress-free survival (PFS) and local control probability (LCP) were 83.2%, 79.3%, and 92.8% respectively for all the patients. The 5y OS, PFS, and LCP were not statistically different between the radiation and chemoradiation groups. Up to the last follow-up, 9 patients had locoregional recurrence and 22 developed systemic failure. Pre-treatment ECOG2 were associated with poor OS and PFS in univariate and multivariate analysis, and elevation of lactate dehydrogenase (LDH) was also related to worse overall survival. Chemotherapy with DICE regimen did not show survival advantage over CHOP regimen. Conclusion: Stage I extranodal NK/T-cell lymphoma with disease limited in nasal cavity had a relative good prognosis. Definitive radiation therapy alone achieved equivalent survival and local control as chemoradiation therapy did. Systemoic recurrence was the main reason of treatment failure. Further investigation may be focused on optimization of chemotherapy. Author Disclosure: X. Ma: None. Y. Guo: None. Z. Pan: None. X. Li: None.

Author Disclosure: T.R. Heumann: None. H. Danish: None. J. Switchenko: None. N. Esiashvili: None. M. Lechwoicz: None. C.R. Flowers: None. M.K. Khan: None.

3127 Cutaneous CD30+ Mycosis Fungoides: Response to Rotational Total Skin Electron Irradiation T.R. Heumann,1 H. Danish,2,3 J. Switchenko,4 N. Esiashvili,2,4 M.J. Lechwoicz,2,5 C.R. Flowers,2,5 and M.K. Khan2,4; 1Emory University School of Medicine, Atlanta, GA, 2Emory University, Atlanta, GA, 3 Department of Radiation Oncology, Winship Cancer Institute (WCI), Atlanta, GA, 4Winship Cancer Institute of Emory University, Atlanta, GA, 5 Department of Hematology and Oncology, Winship Cancer Institute (WCI), Atlanta, GA Purpose/Objective(s): Total skin electron irradiation (TSEI) is an effective therapy for treatment-persistent cutaneous T-cell lymphoma (CTCL) and mycosis fungoides (MF). CD30 expression has been identified as an adverse prognostic factor in MF. Therefore we investigated CD30 status, treatment response, and survival in our cohort of MF patients treated with rotational total skin electron irradiation (RTSEI). Materials/Methods: MF patients treated with RTSEI (>Z30 Gy) between 2000 and 2013 at our institution were identified, and clinical and pathologic data were reviewed, retrospectively. Primary outcomes were complete clinical response (CCR, defined as >90% reduction of skin disease burden), recurrence-free survival (RFS), and overall survival (OS). Survival outcomes were estimated using the Kaplan Meier method, and logrank tests and Fisher’s Exact tests were used to compare groups. Results: Sixty-eight MF patients treated with RTSEI were identified. Median age at diagnosis was 52 years. Patients received the following treatments prior to RTSEI: 38 (56%) topical agents, 35 (52%) systemic antineoplastic agents, 13 (19%) systemic dermatologic agents, and 33 (49%) phototherapy. Median time from diagnosis to RTSEI was 20 months. Median OS was 76 months, median RFS was 11 months, and median follow-up was 61 months. Fourteen patients (21%) had CD30+ lymphocytes on initial pathology. In the CD30+ cohort, there were 0 T2, 9 T3, and 5 T4 cases. In comparison, in the CD30- cohort, there were 18 T2, 28 T3, and 8 T4 cases (pZ0.011). Six weeks post RTSEI, CCR was 85% in CD30+ and 81% in CD30- cases (pZ1). Six months post RTSEI, CCR was 21% in CD30+ and 51% in CD30- cases (pZ0.05). RFS and OS were not significantly different between CD30+ and CD30- cases. Tumor stage was not associated with RFS or OS. Conclusion: RTSEI resulted in excellent CCR at 6 weeks in our cohort of MF patients, with a median RFS of 11 mos. This is consistent with and improves upon treatment results reported previously. We found CD30+ patients presented with significantly higher stage at time of RTSEI and had decreased CCR at 6 months post RTSEI compared with the CD30- group. The difference in CCR at 6 months was driven mainly by patients with T3 disease. This retrospective review is the first report of outcomes following conventional dose RTSEI in CD30+ MF patients.

3128 Salvage Radiation Therapy for Chemotherapy Refractory Cutaneous Mycosis Fungoides D. Padro,1 R. Eisch,1 S. Bates,1 C.B. Simone, II,2 H. Ning,1 D.K. Smart,1 J.C. Jones,3 A.V. Krauze,1 D.E. Citrin,1 A.H. Kesarwala,1 K.A. Camphausen,1 and A. Kaushal1; 1National Cancer Institute, National Institutes of Health, Bethesda, MD, 2University of Pennsylvania, Philadelphia, PA, 3National Cancer Institute, Vaccine Branch, Bethesda, MD Purpose/Objective(s): Mycosis fungoides (MF) is a rare cutaneous T-cell lymphoma for which topical therapy is the most common initial treatment. Chemotherapy and radiation therapy (RT) are typically reserved for patients who experience disease recurrence. Due to the rarity of this disease, very few prospective studies exist, with RT doses and fractionation largely extrapolated from other disease sites. We assessed salvage RT response rates and toxicities for locally advanced MF patients who have failed all prior local and systematic therapies. Materials/Methods: We conducted a retrospective review of patient charts and radiation treatment plans from all patients treated at our institution for recurrent cutaneous MF following topical and systemic therapy. Patients with all stages of disease and any number of cutaneous lesions treated between 1996 and 2013 were included. Patients were assessed for local disease control and symptomatic response at the end of treatment. All responses were assessed interpreting the modified severity weighted assessment tool score. Results: One hundred and thirty three lesions from 10 patients treated with external beam RT were included. Lesions were treated with 6MeV (nZ31), 9Mev (nZ99), 12MeV (nZ1) electron beams and 6MV (nZ2) photon beams to a mean dose of 12 Gray (Gy) (range 6-36 Gy) in 1.5- 2Gy daily fractions. Prior to RT, 7 patients with 36 lesions progressed on Romidepsin, of which an average of 7 cycles were given (range 1-14 cycles). There were 3 patients with 97 lesions who failed multiple other systematic (mean 2) and local therapies (mean 2). At a median follow-up of 1 month, all lesions demonstrated a complete (CR) or partial response except for one that had a 25% response at the end of treatment but then was lost to follow-up. No difference in response rate was seen according to RT dose administered. The most common toxicity during RT was grade 1 erythema which did not affect patients’ ability to complete treatment. There was no acute or late grade 2 toxicities observed. Conclusion: Patients treated with external beam RT for recurrent MF following local and systemic therapy uniformly had durable disease response and limited toxicity with a mean dose of 12 Gy in 2 Gy daily fractions. The high rate of disease response and lack of difference seen according to RT dose, support consideration of dose de-escalation even in this challenging cohort. Author Disclosure: D. Padro: None. R. Eisch: None. S. Bates: None. C.B. Simone: Editor-in-Chief; Annals of Palliative Medicine. Chair, Lung Committee; Proton Collaborative Group. H. Ning: None. D.K. Smart: None. J.C. Jones: None. A.V. Krauze: None. D.E. Citrin: None. A.H. Kesarwala: Research Grant; ASTRO. K.A. Camphausen: None. A. Kaushal: None.

3129 Breath Hold Technique in Conventional APPA or Intensity Modulated Radiation Therapy for Patients With Hodgkin Lymphoma: Testing the ILROG “IS-RT” Versus the GHSG “IF-RT” J. Kriz,1 M. Spickermann,2 P. Lehrich,2 H. Schmidberger,3 G. Reinartz,1 U. Haverkamp,1 and H.T.T. Eich1; 1University Hospital Muenster, Muenster, Germany, 2Department of Radiation Oncology, University Muenster, Muenster, Germany, 3University Medical Center Mainz, Mainz, Germany