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Salvage Radiation Therapy for Chemotherapy Refractory Cutaneous Mycosis Fungoides
E452
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
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