- Email: [email protected]
Respiratory Gating Intermittent Radiation for Esophageal Cancer
Poster Viewing Session E135
Volume 93 Number 3S Supplement 2015 chemotherapy treatment after radiation therapy and symptom response. Two patients (5%) had grade 3 CTC toxicities (anorexia and gastritis). Conclusion: 3D conformal radiation therapy alone to a total dose of 36Gy in12 fractions is highly effective and well tolerated in the local palliation of gastric cancer. Author Disclosure: J. Tey: None. K. Lee: None. C. Leong: None. H. Zheng: None. W. Koh: None. K.H. Lim: None. Y. Soon: None. I. Tham: None. J.J. Lu: None.
2341 Respiratory Gating Intermittent Radiation for Esophageal Cancer A. Ohta,1 S. Tanabe,2 S. Utsunomiya,3 K. Tanaka,1 H. Sato,4 K. Maruyama,1 G. Kawaguchi,1 M. Kaidu,1 R. Sasamoto,5 and H. Aoyama1; 1Niigata University, Niigata, Japan, 2Departnent of Radiation Oncology, Niigata University Medical and Dental Hospital, Niigata-shi 951-8510, Japan, 3Niigata University, Niigata-shi 951-8510, Japan, 4Niigata Cancer Center Hospital, Niigata, Japan, 5Radiological Technology, School of Health Sciences Faculty of Medicine, Niigata University, Niigata-shi 951-8518, Japan Purpose/Objective(s): To investigate the benefit of respiratory gating intermittent radiation for the treatment of esophageal cancer. Materials/Methods: Consecutive 20 patients who were treated with respiratory gating radiation technique from April 2011 to February 2013 constitute the material. Using the four-dimensional (4D) computed tomography (CT) imaging, ITV of all respiratory phase (ITV-all) and of only expiratory phase (ITV-exp) were delineated. The 5 mm expansion of ITV creates PTV-all and PTV-exp. For the sake of comparison, 2-field plans (AP-PA) and 4-filed plans (AP-PA and two oblique fields) were created using PTV-all and PTV-exp. Therefore, 4 plans including Plan-2-field-all, Plan-2-field-exp, Plan-4-fieldall, and Plan-4-field-exp were created for each patient. The prescribed dose was 60 Gy. These 4 plans were compared regarding dose-volume histogram (DVH) parameters including V5Gy to V45Gy and mean dose of the lung, and V5Gy to V60Gy and mean dose of the heard. Student t test was used and pvalue <0.05 was considered to be significant. Results: By the use of respiratory gating technique, significant reduction in all DVH-parameters for lung and heart were achieved in the comparison of Plan-2-field-all vs. Plan-2-field-exp, and Plan-4-field-all vs. Plan-4-fieldexp. The degree of the reduction was, however, only 0.4% for Lung-V20Gy, 0.2 Gy in mean lung dose, 1.2%, 1.4%, and 1.0% for Heart-V35Gy, -V40Gy and -V45Gy, respectively. The maximum reduction was 0.7% for LungV5Gy and 1.4% for Heart-V40Gy. In the comparison of Plan-2-field-exp vs. Plan-4-field-exp, a significant reduction was achieved with Heart-V35Gy and Heart-V40Gy by 14.8% and 17.9%, although low-dose exposure slightly increased to the lung (i.e., 1.9%-5% for Lung-V5Gy to -V30Gy). Conclusion: Slightly but significant reduction of radiation exposure to the lung and heart could be obtained by respiratory gating radiation technique. The respiratory gating 4-field technique would achieve the maximum dosereduction to the organ-at-risk in the radiation therapy of esophageal cancer. Author Disclosure: A. Ohta: None. S. Tanabe: None. S. Utsunomiya: None. K. Tanaka: None. H. Sato: None. K. Maruyama: None. G. Kawaguchi: None. M. Kaidu: None. R. Sasamoto: None. H. Aoyama: None.
2342 Patterns of Recurrence and Its Value to Target of Postoperative Radiation Therapy in Patients of Stage III Thoracic Esophageal Carcinoma Y.X. Wang,1 Q. Yang,1 J. Li,1 M. He,2 J. Yao,2 Z. Qi,2 and X.Y. Qiao1; 1 Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China, 2Department of thoracic surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China Purpose/Objective(s): To explore the Patterns of recurrence and its value to project the target of postoperative radiation therapy(PORT) in patients of stage III thoracic esophageal carcinoma(EC) after two-field esophagectomy.
Materials/Methods: From Jan 2008 to Dec 2011, 401 patients of stage III thoracic EC were enrolled. Among them, males in 311 and females in 90 cases; the median age was 61 years old (range 37-80 ys). Site of lesion: 31 in upper-, 262 in middle-, and 108 patients in lower-thoracic; the median numbers of dissected lymph node were 10 (range 1-34). Squamous cell carcinoma (SCC) in 348 and no-SCC in 53 patients. 173 patients were treated with surgery alone and 264 patients with postoperative chemotherapy (POCT). Results: During follow-up, there were 275 patients(68.6%) occurred with recurrence; the rates of local regional recurrence(LR), distant metastasis (DM) and complexed recurrence were 46.1%, 16.2% and 6.2%. 183 out of 210 patients with LR could be analysis; the recurrence rates were 29.5% in cervical/supraclavicular, 61.7% in upper-mediastinum, 8.7% in middle or low-mediastinum, and 21.9% in upper abdomen; the recurrence rate were only 10.4% in anastomosis and 1.1% in tumor bed. The recurrence rate in cervical/supraclavicular, upper–mediastinum, middle/low-mediastinum and upper abdomen were 23.1%, 61.5%, 0%, 30.8% in upper-EC; 31.0%, 58.1%, 7.8%, 17.1% in middle-EC; and 24.4%, 56.1%, 9.8%, 31.7% in low-thoracic EC patients, respectively. x2 test showed, the factors that related with postoperative recurrence were level of hemoglobin(HB), the number of dissected lymph nodes, stage N, the percent or area number of metastatic lymph node, degree of resection(R0/R1), and type of pathology(p<0.05). Univariate analysis showed, site of lesion, length of lesion, HB, degree of adhesion during surgery, N and TNM, the percent or area number of metastatic lymph node, and degree of resection (R0/R1) were related with PFS; site of lesion, N and TNM, the percent or area number of metastatic lymph node, type of pathology, and degree of resection (R0/R1) were related with LR; HB, type of pathology, the percent and number of area of metastatic lymph node were related with MD (p<0.05). With multivariate analysis, the independent prognostic factors were site of lesion, HB, the degree of adhesion during surgery and stage N for PFS; site of lesion, degree of resection (R0/R1), type of pathology and stage N for LRR; HB, type of pathology and stage N for DMR. Conclusion: For patient of stage III thoracic EC, the recurrence rates was very high; local regional recurrence was the most common; the most frequent area of recurrence were upper-mediastinum, cervical/supraclavicular and para-aortic lymph node, and this position should be key target for PORT. The middle-thoracic EC, R1, SCC and N1-3 were associated with higher LR; higher level of HB, non-SCC and N1-3 were associated with higher DM. Author Disclosure: Y. Wang: None. Q. Yang: None. J. Li: None. M. He: None. J. Yao: None. Z. Qi: None. X. Qiao: None.
2343 Correlation of Dose to Bone Marrow With Hematological Toxicity and MRI Based Estimation of Conversion of Active to Inactive Bone Marrow in Long Course Neo adjuvant Chemoradiation for Locally Advanced Rectal Cancer J. Bhargav,1 T.S. Ram,2 B. Selvamani,3 A. Chandramohan,3 and B. Antonisamy3; 1Christian Medical College, Vellore 632004, India, 2 Christian Medical College & Hospital, Vellore 632004, India, 3Christian Medical College, Vellore, India Purpose/Objective(s): To correlate the dose to bone marrow with the incidence, the grade of hematological toxicity and to estimate the extent of inactivation of bone marrow in patients with locally advanced rectal cancer undergoing neo adjuvant chemoradiation. Materials/Methods: 20 patients with locally advanced rectal cancer were enrolled after clearance from the review board. All the patients had received preoperative long course radiation therapy using 3D conformal modality to a dose of 50.4Gy in 28 fractions along with concurrent chemotherapy with Capecitabine (825mg/m2). The lower lumbar vertebrae, entire pelvis and proximal femurs were contoured on the simulation CT. The active bone marrow in the above mentioned areas were delineated on both the pre and post chemo-radiation therapy MRI images of pelvis on T1W images. Baseline and weekly blood investigations were recorded during the course of therapy. The dosimetric parameters such as V5, V10,
Volume 93 Number 3S Supplement 2015 chemotherapy treatment after radiation therapy and symptom response. Two patients (5%) had grade 3 CTC toxicities (anorexia and gastritis). Conclusion: 3D conformal radiation therapy alone to a total dose of 36Gy in12 fractions is highly effective and well tolerated in the local palliation of gastric cancer. Author Disclosure: J. Tey: None. K. Lee: None. C. Leong: None. H. Zheng: None. W. Koh: None. K.H. Lim: None. Y. Soon: None. I. Tham: None. J.J. Lu: None.
2341 Respiratory Gating Intermittent Radiation for Esophageal Cancer A. Ohta,1 S. Tanabe,2 S. Utsunomiya,3 K. Tanaka,1 H. Sato,4 K. Maruyama,1 G. Kawaguchi,1 M. Kaidu,1 R. Sasamoto,5 and H. Aoyama1; 1Niigata University, Niigata, Japan, 2Departnent of Radiation Oncology, Niigata University Medical and Dental Hospital, Niigata-shi 951-8510, Japan, 3Niigata University, Niigata-shi 951-8510, Japan, 4Niigata Cancer Center Hospital, Niigata, Japan, 5Radiological Technology, School of Health Sciences Faculty of Medicine, Niigata University, Niigata-shi 951-8518, Japan Purpose/Objective(s): To investigate the benefit of respiratory gating intermittent radiation for the treatment of esophageal cancer. Materials/Methods: Consecutive 20 patients who were treated with respiratory gating radiation technique from April 2011 to February 2013 constitute the material. Using the four-dimensional (4D) computed tomography (CT) imaging, ITV of all respiratory phase (ITV-all) and of only expiratory phase (ITV-exp) were delineated. The 5 mm expansion of ITV creates PTV-all and PTV-exp. For the sake of comparison, 2-field plans (AP-PA) and 4-filed plans (AP-PA and two oblique fields) were created using PTV-all and PTV-exp. Therefore, 4 plans including Plan-2-field-all, Plan-2-field-exp, Plan-4-fieldall, and Plan-4-field-exp were created for each patient. The prescribed dose was 60 Gy. These 4 plans were compared regarding dose-volume histogram (DVH) parameters including V5Gy to V45Gy and mean dose of the lung, and V5Gy to V60Gy and mean dose of the heard. Student t test was used and pvalue <0.05 was considered to be significant. Results: By the use of respiratory gating technique, significant reduction in all DVH-parameters for lung and heart were achieved in the comparison of Plan-2-field-all vs. Plan-2-field-exp, and Plan-4-field-all vs. Plan-4-fieldexp. The degree of the reduction was, however, only 0.4% for Lung-V20Gy, 0.2 Gy in mean lung dose, 1.2%, 1.4%, and 1.0% for Heart-V35Gy, -V40Gy and -V45Gy, respectively. The maximum reduction was 0.7% for LungV5Gy and 1.4% for Heart-V40Gy. In the comparison of Plan-2-field-exp vs. Plan-4-field-exp, a significant reduction was achieved with Heart-V35Gy and Heart-V40Gy by 14.8% and 17.9%, although low-dose exposure slightly increased to the lung (i.e., 1.9%-5% for Lung-V5Gy to -V30Gy). Conclusion: Slightly but significant reduction of radiation exposure to the lung and heart could be obtained by respiratory gating radiation technique. The respiratory gating 4-field technique would achieve the maximum dosereduction to the organ-at-risk in the radiation therapy of esophageal cancer. Author Disclosure: A. Ohta: None. S. Tanabe: None. S. Utsunomiya: None. K. Tanaka: None. H. Sato: None. K. Maruyama: None. G. Kawaguchi: None. M. Kaidu: None. R. Sasamoto: None. H. Aoyama: None.
2342 Patterns of Recurrence and Its Value to Target of Postoperative Radiation Therapy in Patients of Stage III Thoracic Esophageal Carcinoma Y.X. Wang,1 Q. Yang,1 J. Li,1 M. He,2 J. Yao,2 Z. Qi,2 and X.Y. Qiao1; 1 Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China, 2Department of thoracic surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China Purpose/Objective(s): To explore the Patterns of recurrence and its value to project the target of postoperative radiation therapy(PORT) in patients of stage III thoracic esophageal carcinoma(EC) after two-field esophagectomy.
Materials/Methods: From Jan 2008 to Dec 2011, 401 patients of stage III thoracic EC were enrolled. Among them, males in 311 and females in 90 cases; the median age was 61 years old (range 37-80 ys). Site of lesion: 31 in upper-, 262 in middle-, and 108 patients in lower-thoracic; the median numbers of dissected lymph node were 10 (range 1-34). Squamous cell carcinoma (SCC) in 348 and no-SCC in 53 patients. 173 patients were treated with surgery alone and 264 patients with postoperative chemotherapy (POCT). Results: During follow-up, there were 275 patients(68.6%) occurred with recurrence; the rates of local regional recurrence(LR), distant metastasis (DM) and complexed recurrence were 46.1%, 16.2% and 6.2%. 183 out of 210 patients with LR could be analysis; the recurrence rates were 29.5% in cervical/supraclavicular, 61.7% in upper-mediastinum, 8.7% in middle or low-mediastinum, and 21.9% in upper abdomen; the recurrence rate were only 10.4% in anastomosis and 1.1% in tumor bed. The recurrence rate in cervical/supraclavicular, upper–mediastinum, middle/low-mediastinum and upper abdomen were 23.1%, 61.5%, 0%, 30.8% in upper-EC; 31.0%, 58.1%, 7.8%, 17.1% in middle-EC; and 24.4%, 56.1%, 9.8%, 31.7% in low-thoracic EC patients, respectively. x2 test showed, the factors that related with postoperative recurrence were level of hemoglobin(HB), the number of dissected lymph nodes, stage N, the percent or area number of metastatic lymph node, degree of resection(R0/R1), and type of pathology(p<0.05). Univariate analysis showed, site of lesion, length of lesion, HB, degree of adhesion during surgery, N and TNM, the percent or area number of metastatic lymph node, and degree of resection (R0/R1) were related with PFS; site of lesion, N and TNM, the percent or area number of metastatic lymph node, type of pathology, and degree of resection (R0/R1) were related with LR; HB, type of pathology, the percent and number of area of metastatic lymph node were related with MD (p<0.05). With multivariate analysis, the independent prognostic factors were site of lesion, HB, the degree of adhesion during surgery and stage N for PFS; site of lesion, degree of resection (R0/R1), type of pathology and stage N for LRR; HB, type of pathology and stage N for DMR. Conclusion: For patient of stage III thoracic EC, the recurrence rates was very high; local regional recurrence was the most common; the most frequent area of recurrence were upper-mediastinum, cervical/supraclavicular and para-aortic lymph node, and this position should be key target for PORT. The middle-thoracic EC, R1, SCC and N1-3 were associated with higher LR; higher level of HB, non-SCC and N1-3 were associated with higher DM. Author Disclosure: Y. Wang: None. Q. Yang: None. J. Li: None. M. He: None. J. Yao: None. Z. Qi: None. X. Qiao: None.
2343 Correlation of Dose to Bone Marrow With Hematological Toxicity and MRI Based Estimation of Conversion of Active to Inactive Bone Marrow in Long Course Neo adjuvant Chemoradiation for Locally Advanced Rectal Cancer J. Bhargav,1 T.S. Ram,2 B. Selvamani,3 A. Chandramohan,3 and B. Antonisamy3; 1Christian Medical College, Vellore 632004, India, 2 Christian Medical College & Hospital, Vellore 632004, India, 3Christian Medical College, Vellore, India Purpose/Objective(s): To correlate the dose to bone marrow with the incidence, the grade of hematological toxicity and to estimate the extent of inactivation of bone marrow in patients with locally advanced rectal cancer undergoing neo adjuvant chemoradiation. Materials/Methods: 20 patients with locally advanced rectal cancer were enrolled after clearance from the review board. All the patients had received preoperative long course radiation therapy using 3D conformal modality to a dose of 50.4Gy in 28 fractions along with concurrent chemotherapy with Capecitabine (825mg/m2). The lower lumbar vertebrae, entire pelvis and proximal femurs were contoured on the simulation CT. The active bone marrow in the above mentioned areas were delineated on both the pre and post chemo-radiation therapy MRI images of pelvis on T1W images. Baseline and weekly blood investigations were recorded during the course of therapy. The dosimetric parameters such as V5, V10,