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Retrospective Analysis of 271 Patients with T1N0M0 Glottic Laryngeal Cancer
Proceedings of the 50th Annual ASTRO Meeting images, FDG avid lesions as gross target volume (GTV) were contoured visually by a team of radiation oncologist, neuroradiologist and nuclear medicine physician. All patients were treated in 33 fractions using dose painting, extended whole field IMRT with a dose of 70 Gy to the GTV and 59.4 Gy and 54 Gy to the high risk and low risk clinical tumor volumes, respectively. All patients received neoadjuvant and/or concurrent platinum based chemotherapy. Toxicity data were scored using CTCAE v3.0. Results: Median follow-up from initiation of treatment was 24 months (14-28 months). PET/CT simulation revealed a second malignancy in the lung in 1 patient and a solitary bone metastasis in another patient. No stage migration was observed according to the N status. All patients had follow-up PET/CT imaging within a period of median 5 months (3-12 months) after the treatment and all of them had complete response. Follow-up PET/CT suspected a second malignancy in the colorectal system which turned out to be a rectosigmoid cancer after colonoscopic biopsy in 1 patient at 12 months. One patient failed within the high dose (70 Gy) volume at 24 months and one patient failed in the lungs at 20 months. All patients had regional control and all patients were alive at the time of this analysis. Grade 3 acute toxicity rates for mucositis was 36%, for pharyngeal dysphagia 22%, and grade 2 acute toxicity for mouth dryness was 86%. Ten percent and 26% of the patients experienced grade 2 late dysphagia and mouth dryness, respectively. One patient who presented with intracranial extension developed temporal lobe necrosis which resolved clinically after steroid therapy. Conclusions: Early findings of this single institution experience suggest that PET/CT guided, dose painting IMRT results in high locoregional disease control with acceptable toxicity in NPC patients. In addition PET/CT detected 2 second primaries and 1 distant disease in 3 different patients leading to alterations in patient management during different steps of the treatment process. ¨ nalan, None; C. Tecimer, Author Disclosure: S. Igdem, None; M. Altun, None; G. Alc¸o, None; T. Ercan, None; B. Kara, None; B. U None; G. Ko¨ksal, None; S. Turkan, None; S. Okkan, None.
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Retrospective Analysis of 271 Patients with T1N0M0 Glottic Laryngeal Cancer
M. Gultekin, E. Ozyar, M. Cengiz, U. Selek, G. Ozyigit, F. Akyol Hacettepe University, Department of Radiation Oncology, Ankara, Turkey Purpose/Objective(s): To analyze treatment results and prognostic factors in patients with T1N0M0 glottic laryngeal cancer treated with radiotherapy. Materials/Methods: In this study, 271 T1N0M0 glottic laryngeal cancer patients treated at our department with definitive radiotherapy between 1993 and 2007 were retrospectively evaluated. All patients were treated with curative intent. Thirteen patients were excluded from this analysis. There were 6 (2%) female and 252 (98%) male with a median age of 59 years (range, 35-86 years). Of the 258 patients, 226 (88%) had Stage T1a and 32 (12%) had Stage T1b according to AJCC staging system. The anterior commissure was involved in 40 (15%) patients. Patients were diagnosed with biopsy (76%), stripping (18%) or cordectomy (4%). Radiotherapy doses were given 2 to 2.3 Gy per fraction (median 2.3 Gy) to the total dose of 59.8-70 Gy (median 64.4 Gy). The overall treatment time ranged from 30 to 70 days (median 38). Median field size was 38 cm2 (range 22-132 cm2). The follow-up ranged from 4 to 159 months (Median 43 months). Results: Two and 5 year overall survival rate (OS) was 96% and 89%, locoregional control rate (LRC) was 89% and 88% and cause-specific survival rate (CSS) was 98% and 94%, respectively. Thirty-one patients (12%) had local recurrence and 2 patients (0.8%) had regional recurrence during follow-up. Two patients (1%) died due to second primary cancer and 5 patients died due to intercurrent disease. The patient and treatment variables tested included; sex (female vs. male), age (\60 vs. $60), T stage (T1a vs. T1b), subglottic extension (present vs. absent), anterior commissure involvement (present vs. absent) and fraction dose (2 vs. 2.3 Gy). The multivariate analysis did not reveal any significant factor. No grade IV or V acute complications were observed. Late complications were observed in a patient with tracheoesophageal fistula). Fifteen patients (6%) developed various second primary malignancies. Conclusions: Radiotherapy is an effective modality in patients with T1N0M0 glottic carcinoma which is a parallel finding to the literature. Author Disclosure: M. Gultekin, None; E. Ozyar, None; M. Cengiz, None; U. Selek, None; G. Ozyigit, None; F. Akyol, None.
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Prehistory of the M.D. Anderson Cancer Center Ovoids for the Treatment of Cervical Cancer
J. S. Yordy, P. Almond M.D. Anderson Cancer Center, Houston, TX Dr. Gilbert Fletcher published his first paper on the gynecological radiation applicators he had developed at the MD Anderson Hospital (MDAH) in Houston in 1955. At the beginning of the 1940s there were three main systems for treating gynecological cancer with radiation: the Paris, Manchester and Stockholm systems. During that decade, detailed analyses and the development of variations of these systems took place, especially in the United Kingdom. From the citations in Fletcher’s original paper it is clear that his thinking was influenced by the work of Neary and Donaldson at the Mt. Vernon Hospital in London, where they developed a single metal ovoid applicator with built-in shielding, as well as that of Lederman and Lamerton at the Royal Cancer Hospital, also in London, where they used the Spiers stereo-radiographic tube-shift method to determine dose around their applicators, following this up with in vivo measurements. Examination of the newly discovered primary notebook of Dr. Leonard Grimmett (chair of the Physics Department at MDAH), as well as published articles, provides evidence that Dr. Fletcher merged ideas from the London, Stockholm and Paris systems when creating the MDAH gynecological applicators. He retained the two-ovoid system from Manchester but made them from stainless steel instead of plastic and added tungsten shielding, the first time these two materials were combined in an ovoid. The metal vaginal vault-measuring instrument discussed by Lederman was modified to hold two ovoids, creating a colpostat, and in vivo measurements were initiated using a scintillation detector. Dr. Grimmett was involved in all aspects of the development of the gynecological radiation applicator system at MDAH. Original unpublished hand-written data from Dr. Grimmett’s laboratory notebook show the initial measured comparisons of dose distribution using small condenser chambers between the plastic unshielded ovoids and the shielded stainless steel ovoids, demonstrating a 10% attenuation of dose by the stainless steel compared to the plastic ovoids while retaining similar dose distributions, and also document the shielding effect of tungsten. From May through July 1950, Dr. Grimmett conducted a detailed analysis and modification of the Spiers tube-shift method for use
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Retrospective Analysis of 271 Patients with T1N0M0 Glottic Laryngeal Cancer
M. Gultekin, E. Ozyar, M. Cengiz, U. Selek, G. Ozyigit, F. Akyol Hacettepe University, Department of Radiation Oncology, Ankara, Turkey Purpose/Objective(s): To analyze treatment results and prognostic factors in patients with T1N0M0 glottic laryngeal cancer treated with radiotherapy. Materials/Methods: In this study, 271 T1N0M0 glottic laryngeal cancer patients treated at our department with definitive radiotherapy between 1993 and 2007 were retrospectively evaluated. All patients were treated with curative intent. Thirteen patients were excluded from this analysis. There were 6 (2%) female and 252 (98%) male with a median age of 59 years (range, 35-86 years). Of the 258 patients, 226 (88%) had Stage T1a and 32 (12%) had Stage T1b according to AJCC staging system. The anterior commissure was involved in 40 (15%) patients. Patients were diagnosed with biopsy (76%), stripping (18%) or cordectomy (4%). Radiotherapy doses were given 2 to 2.3 Gy per fraction (median 2.3 Gy) to the total dose of 59.8-70 Gy (median 64.4 Gy). The overall treatment time ranged from 30 to 70 days (median 38). Median field size was 38 cm2 (range 22-132 cm2). The follow-up ranged from 4 to 159 months (Median 43 months). Results: Two and 5 year overall survival rate (OS) was 96% and 89%, locoregional control rate (LRC) was 89% and 88% and cause-specific survival rate (CSS) was 98% and 94%, respectively. Thirty-one patients (12%) had local recurrence and 2 patients (0.8%) had regional recurrence during follow-up. Two patients (1%) died due to second primary cancer and 5 patients died due to intercurrent disease. The patient and treatment variables tested included; sex (female vs. male), age (\60 vs. $60), T stage (T1a vs. T1b), subglottic extension (present vs. absent), anterior commissure involvement (present vs. absent) and fraction dose (2 vs. 2.3 Gy). The multivariate analysis did not reveal any significant factor. No grade IV or V acute complications were observed. Late complications were observed in a patient with tracheoesophageal fistula). Fifteen patients (6%) developed various second primary malignancies. Conclusions: Radiotherapy is an effective modality in patients with T1N0M0 glottic carcinoma which is a parallel finding to the literature. Author Disclosure: M. Gultekin, None; E. Ozyar, None; M. Cengiz, None; U. Selek, None; G. Ozyigit, None; F. Akyol, None.
2574
Prehistory of the M.D. Anderson Cancer Center Ovoids for the Treatment of Cervical Cancer
J. S. Yordy, P. Almond M.D. Anderson Cancer Center, Houston, TX Dr. Gilbert Fletcher published his first paper on the gynecological radiation applicators he had developed at the MD Anderson Hospital (MDAH) in Houston in 1955. At the beginning of the 1940s there were three main systems for treating gynecological cancer with radiation: the Paris, Manchester and Stockholm systems. During that decade, detailed analyses and the development of variations of these systems took place, especially in the United Kingdom. From the citations in Fletcher’s original paper it is clear that his thinking was influenced by the work of Neary and Donaldson at the Mt. Vernon Hospital in London, where they developed a single metal ovoid applicator with built-in shielding, as well as that of Lederman and Lamerton at the Royal Cancer Hospital, also in London, where they used the Spiers stereo-radiographic tube-shift method to determine dose around their applicators, following this up with in vivo measurements. Examination of the newly discovered primary notebook of Dr. Leonard Grimmett (chair of the Physics Department at MDAH), as well as published articles, provides evidence that Dr. Fletcher merged ideas from the London, Stockholm and Paris systems when creating the MDAH gynecological applicators. He retained the two-ovoid system from Manchester but made them from stainless steel instead of plastic and added tungsten shielding, the first time these two materials were combined in an ovoid. The metal vaginal vault-measuring instrument discussed by Lederman was modified to hold two ovoids, creating a colpostat, and in vivo measurements were initiated using a scintillation detector. Dr. Grimmett was involved in all aspects of the development of the gynecological radiation applicator system at MDAH. Original unpublished hand-written data from Dr. Grimmett’s laboratory notebook show the initial measured comparisons of dose distribution using small condenser chambers between the plastic unshielded ovoids and the shielded stainless steel ovoids, demonstrating a 10% attenuation of dose by the stainless steel compared to the plastic ovoids while retaining similar dose distributions, and also document the shielding effect of tungsten. From May through July 1950, Dr. Grimmett conducted a detailed analysis and modification of the Spiers tube-shift method for use
S425