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Salvage Stereotactic Radiosurgery for Locally Recurrent Previously Irradiated Pancreatic Cancer
I. J. Radiation Oncology d Biology d Physics
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Volume 72, Number 1, Supplement, 2008
unresectable. Histopathological evaluation showed adenocarcinoma in 85 patients and signet ring cell carcinoma in 27 patients. The median number of dissected and positive lymph nodes were 13, 4, respectively. The stage distribution AJCC was as follows: Stage I, 3 patients; Stage II, 26; Stage IIIA, 32; Stage IIIB, 22; and Stage IV, 29 patients. Radiotherapy at a median dose of 45 Gy in 25 fractions, was delivered to the primary region and to the lymphatics. Concurrent 5-FU-based chemotherapy was administered in 109 patients. Dose volume histograms were calculated for target and the organs at risk (kidneys, liver, and medulla spinalis). Patients were analyzed in regard to prognostic factors, response, and toxicity. Acute and late toxicity was assessed by using RTOG scoring system. Results: Median follow-up was 14 months (range, 3-53). At the time of analysis, 54% of patients had died, 7% were alive with disease, and 39% alive without disease. Loco-regional recurrence was observed in 11 patients. Median overall survival for this study was 18.3 months (95% CI, 3-89 mos). Univariate and multivariate analysis demonstrated that age, type of surgery, stage, presence of adjuvant chemotherapy, and the percentage of positive/dissected lymph nodes were statistically significant predictors of overall survival (p \ 0.05). The 2-year locoregional, distant recurrence-free survival and overall survival were 16%, 10%, and 22%, respectively. Grade 3 acute gastrointestinal toxicity occurred in 1 patient, Grade 3 acute hematologic toxicity in 2 patients. Conclusions: This study demonstrated that patients aged #55-years-old with early stage tumors having #50% ratio of positive/ dissected lymph nodes were significantly associated with better survival when treated with radiotherapy and planned adjuvant chemotherapy regimen. Author Disclosure: A.F. Korcum, None; G. Aksu, None; D. Ural, None; M. Samur, None.
2238
The Impact of Concurrent Chemoradiotherapy for Patients with Stage II-III Squamous Cell Carcinoma of the Esophagus
T. Nonaka1, H. Sakurai1, H. Ishikawa1, M. Shioya1, M. Murata1, K. Shirai1, K. Harashima1, H. Kato2, H. Kuwano2, T. Nakano1 1 Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan, 2Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, Maebashi, Japan
Purpose/Objective(s): The aim of this study is to evaluate the outcome of the patients with Stage II-III esophageal cancer treated with radiation therapy, especially focusing on the impact of concurrent chemoradiotherapy on prognosis. Materials/Methods: Between 1999 and 2006, 88 patients with squamous cell esophageal carcinoma were treated with radiation therapy (RT) or concurrent chemoradiotherapy (CCRT) at Gunma University Hospital. Seventy-four patients were men and 14 patients were women, and the median age was 71 years (range, 48-93 years). According to TNM staging system (UICC, 2002), 29 patients were Stage II (IIA: 23, IIB: 6), and 59 patients were Stage III. Radiation therapy consisted of 40-46 Gy with anteroposterior opposing field including the primary tumor and positive regional lymph nodes with optimal margins with conventional fraction followed by external beam boost up to 50-70 Gy (median: 64 Gy). Chemotherapy was administered concurrently with radiation therapy to 51 patients, and the 31 patients received the regimen containing cisplatin or nedaplatin, and the 20 patients received the regimen consisting of docetaxel. Results: At the end of this study, there were 23 survivors with a median follow-up period of 23 months. The 3-year disease-specific survival rate (DSS) was 30% for all 88 patients, 44% for Stage II, and 24% for Stage III, and the difference between Stage II and Stage III was statistically significant (p = 0.003). The 3-year DSS of CCRT group and RT were 75%, 29% for Stage II, and 33%, 12% for Stage III. The DSS of the patients with CCRT was better than that with RT, especially of patients with Stage II, however, the differences observed were not statistically significant (p = 0.069 for Stage II, p = 0.126 for Stage III). There was no significant impact on DSS by the regimens of chemotherapy. Cox regression analysis revealed that clinical stage of patients was the single independent prognostic factor for DSS (HR: 0.44, 95% CI, 0.20-0.98). Conclusions: Our results revealed that definitive radiation therapy with concurrent chemotherapy for squamous cell carcinoma of the esophagus is effective. Further investigations of the protocol of radiation therapy technique or chemotherapy are needed to improve the outcome of the patients with advanced esophageal cancer. Author Disclosure: T. Nonaka, None; H. Sakurai, None; H. Ishikawa, None; M. Shioya, None; M. Murata, None; K. Shirai, None; K. Harashima, None; H. Kato, None; H. Kuwano, None; T. Nakano, None.
2239
Salvage Stereotactic Radiosurgery for Locally Recurrent Previously Irradiated Pancreatic Cancer
C. E. Lominska, N. M. Nasr, N. L. Silver, G. J. Gagnon Georgetown University Hospital, Washington, DC Purpose/Objective(s): Local and distant progression are both frequent occurrences after definitive treatment of pancreatic cancer and salvage treatments are of limited efficacy. In the subset of patients who have isolated local recurrence after conventional radiotherapy, we feel there may be a role for additional local therapy with radiosurgery in addition to the standard systemic therapies. We review our experience with salvage radiosurgery for previously irradiated patients. Materials/Methods: We reviewed the records of patients treated for pancreatic cancer using stereotactic radiosurgery at Georgetown from June 2002 through July 2007. Twenty-eight patients were identified who were treated for locally recurrent disease after either definitive chemoradiation (20 patients), or surgery followed by adjuvant chemoradiation (8 patients). Disease recurrence was demonstrated by serial CT imaging or by PET/CT findings characteristic of recurrent malignancy. Acute toxicity was assessed. Follow-up was obtained via chart review, imaging review, and social security death index database review. Results: Median patient age was 63 years. Prior radiation consisted of a median dose of 5,040 cGy with concurrent chemotherapy. Stereotactic radiosurgery was performed using the CyberKnife system (CK) with a median dose of 2,250 cGy (range, 2,000-3,000 cGy) prescribed to the 75% isodose line in 3 fractions (range, 3-5). As of March 2008, 26/28 patients have died. Follow-up was available on 24 of 28 patients. Median survival from the date of CK treatment was 5.3 months (range, 1-27 months), with the conservative assumption that the patients lost to follow-up were deceased. Seven patients (25%) lived more than 8 months after treatment. Two patients experienced serious GI toxicity (1 peripancreatic abscess, 1 bowel obstruction). Both of these patients were treated with 3 fractions. Review of radiographic studies revealed local control in 6 patients, local control with distant progression
Proceedings of the 50th Annual ASTRO Meeting in 6 patients, and local and distant progression in 2 patients with no follow-up imaging available on the remaining patients. The 2 surviving patients remain locally controlled without evidence of distant disease on follow-up of 3 and 8 months. Conclusions: We demonstrate an ability to perform stereotactic radiosurgery for previously irradiated patients with pancreatic adenocarcinoma with acceptable toxicity. We now typically use 5 fractions. Subsequent local control is frequent and radiosurgery is easily incorporated with at maximum a 2-3 week break from systemic therapy. A subset of patients has encouraging survival. We feel that radiosurgery deserves further investigation in the treatment of recurrent pancreas cancer. Author Disclosure: C.E. Lominska, None; N.M. Nasr, None; N.L. Silver, None; G.J. Gagnon, Speaker’s fees for Accuray Corporation, Sunnyvale CA, D. Speakers Bureau/Honoraria.
2240
Patterns of Care Study on Radiotherapy for Locally Advanced Hepatocellular Carcinoma (HCC)
1
J. Seong , I. Lee1, S. Shim1, D. Lim2, T. Kim3, J. Kim4, H. Jang5, M. Kim6, E. Chie7, J. Kim8, et al. 1 Yonsei University College of Medicine, Seoul, Republic of Korea, 2Samsung Medical Center, Seoul, Republic of Korea, 3 National Cancer Center, Seoul, Republic of Korea, 4Asan Medical Center, Seoul, Republic of Korea, 5Catholic University College of Medicine, Seoul, Republic of Korea, 6Korea Cancer Center Hospital, Seoul, Republic of Korea, 7Seoul National University College of Medicine, Seoul, Republic of Korea, 8Keimyung University College of Medicine, Taeku, Republic of Korea Purpose/Objective(s): We examined the records of patients with hepatocellular carcinoma (HCC) treated with radiation to determine national care processes and their outcomes in Korea. Materials/Methods: After survey of 53 institutions nationwide, detailed information was collected in 10 major cancer hospitals between January 2004 and December 2005. Eligible patients were those treated for primary tumors, regional lymph nodes, or portal vein tumor thrombosis excluding those treated for distant metastasis. Results: The study covered treatment of 398 HCC patients for 2 years. The male-to-female ratio was 8.5: 1.5 with the median age 57. Most patients (78%) were in Stage III (199) or IV (111). Radiotherapy was chosen after the failure of other treatments, most frequently transarterial chemoembolization. Radiotherapy was performed predominantly using the 3-dimensional conformal technique (80%) mostly with a total dose of 45-54 Gy (64%). In 9% of the patients, radiotherapy was performed using radiosurgery techniques. In biologically effective dose (BED) with 10 Gy of a/b, 4.2-124.3 Gy10 was delivered. The median survival time was 12 months, and the 2-year survival rate was 27.9%. A tumor size smaller than 5 cm and BED higher than 53.1 Gy10 were shown by multivariate analysis to be significant factors for a better prognosis. Conclusions: Radiotherapy has been used to treat HCC in various modes, but mostly as a last resort after failure of other modalities. Although the study was retrospective and thus limited, it indicates that radiotherapy is a valuable treatment modality for HCC. Author Disclosure: J. Seong, None; I. Lee, None; S. Shim, None; D. Lim, None; T. Kim, None; J. Kim, None; H. Jang, None; M. Kim, None; E. Chie, None; J. Kim, None.
2241
Carcinoma of the Ampulla of Vater: Patterns of Failure after Resection and Possible Benefit of Adjuvant Radiotherapy
B. Czito, R. Clough, T. Pappas, D. Tyler, R. White, H. Hurwitz, M. Morse, H. Uronis, B. Clary, C. Willett Duke University Medical Center, Durham, NC Purpose/Objective(s): Ampullary carcinoma is a rare malignancy. Despite radical resection, survival rates remain low with high rates of local failure. To define the role of radiation therapy and chemotherapy with surgery, an analysis of the outcome of a very large single institution experience was performed. Materials/Methods: From 1976 to 2006, 118 patients with ampullary adenocarcinoma underwent resection with curative intent at Duke University Hospitals. Forty-seven patients undergoing resection received adjuvant or neoadjuvant radiation therapy, usually with concurrent chemotherapy (CMT). Median radiation dose was 50 Gy. Median follow-up was 2.2 years in all patients and 3.0 years in survivors. Results: Patients receiving radiation therapy were more likely to have involved nodes (40% vs. 24%, p =.05), poorly differentiated tumors (40% vs. 18%, p = 0.008), higher Stage ($IIB disease i.e., N+ and/or T4 disease) (56% vs. 36%, p = 0.04) and involved margins (15% vs. 4%, p = 0.05). Despite this, 5-year actuarial overall survival rates were similar between the groups (32% CMT vs. 31% surgery only). Five-year actuarial local control was significantly improved in patients receiving CMT (73% vs. 34%, p = 0.006). No significant difference was seen in 5-year disease-free (51% CMT vs. 30% surgery only, p = 0.17) or metastases-free (54% CMT vs. 49% surgery only, p = 0.99) survivals. Five of 12 patients treated preoperatively (42%) had a pathologic complete response. Age .66-year-old, $Stage IIB disease, poorly differentiated disease, and involved margins adversely affected survival by univariate analysis. Conclusions: Long-term survival rates are low. Local failure rates are high with surgery only and improved with CMT. Despite more advanced disease and adverse pathologic features in patients receiving CMT, survival outcomes were similar to the more favorable group of patients undergoing surgery only. Given patterns of relapse with surgery alone and favorable outcomes in poor-prognosis patients receiving CMT, the use of CMT in selected patients should be considered. Author Disclosure: B. Czito, None; R. Clough, None; T. Pappas, None; D. Tyler, None; R. White, None; H. Hurwitz, None; M. Morse, None; H. Uronis, None; B. Clary, None; C. Willett, None.
2242
IGRT Stereotactic Hypofractionated Radiotherapy for Treatment of Focal Liver Malignancies
F. Casamassima, L. Masi, C. Menichelli, D’Imporzano E., C. Polli, I. Bonucci U.O. Radiobiologia Clinica, Florence, Italy Purpose/Objective(s): We analyze the feasibility, efficacy and safety of SRT for focal liver disease. Response evaluation (CT, PET, and markers) toxicity and the impact on survival were investigated.
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Volume 72, Number 1, Supplement, 2008
unresectable. Histopathological evaluation showed adenocarcinoma in 85 patients and signet ring cell carcinoma in 27 patients. The median number of dissected and positive lymph nodes were 13, 4, respectively. The stage distribution AJCC was as follows: Stage I, 3 patients; Stage II, 26; Stage IIIA, 32; Stage IIIB, 22; and Stage IV, 29 patients. Radiotherapy at a median dose of 45 Gy in 25 fractions, was delivered to the primary region and to the lymphatics. Concurrent 5-FU-based chemotherapy was administered in 109 patients. Dose volume histograms were calculated for target and the organs at risk (kidneys, liver, and medulla spinalis). Patients were analyzed in regard to prognostic factors, response, and toxicity. Acute and late toxicity was assessed by using RTOG scoring system. Results: Median follow-up was 14 months (range, 3-53). At the time of analysis, 54% of patients had died, 7% were alive with disease, and 39% alive without disease. Loco-regional recurrence was observed in 11 patients. Median overall survival for this study was 18.3 months (95% CI, 3-89 mos). Univariate and multivariate analysis demonstrated that age, type of surgery, stage, presence of adjuvant chemotherapy, and the percentage of positive/dissected lymph nodes were statistically significant predictors of overall survival (p \ 0.05). The 2-year locoregional, distant recurrence-free survival and overall survival were 16%, 10%, and 22%, respectively. Grade 3 acute gastrointestinal toxicity occurred in 1 patient, Grade 3 acute hematologic toxicity in 2 patients. Conclusions: This study demonstrated that patients aged #55-years-old with early stage tumors having #50% ratio of positive/ dissected lymph nodes were significantly associated with better survival when treated with radiotherapy and planned adjuvant chemotherapy regimen. Author Disclosure: A.F. Korcum, None; G. Aksu, None; D. Ural, None; M. Samur, None.
2238
The Impact of Concurrent Chemoradiotherapy for Patients with Stage II-III Squamous Cell Carcinoma of the Esophagus
T. Nonaka1, H. Sakurai1, H. Ishikawa1, M. Shioya1, M. Murata1, K. Shirai1, K. Harashima1, H. Kato2, H. Kuwano2, T. Nakano1 1 Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan, 2Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, Maebashi, Japan
Purpose/Objective(s): The aim of this study is to evaluate the outcome of the patients with Stage II-III esophageal cancer treated with radiation therapy, especially focusing on the impact of concurrent chemoradiotherapy on prognosis. Materials/Methods: Between 1999 and 2006, 88 patients with squamous cell esophageal carcinoma were treated with radiation therapy (RT) or concurrent chemoradiotherapy (CCRT) at Gunma University Hospital. Seventy-four patients were men and 14 patients were women, and the median age was 71 years (range, 48-93 years). According to TNM staging system (UICC, 2002), 29 patients were Stage II (IIA: 23, IIB: 6), and 59 patients were Stage III. Radiation therapy consisted of 40-46 Gy with anteroposterior opposing field including the primary tumor and positive regional lymph nodes with optimal margins with conventional fraction followed by external beam boost up to 50-70 Gy (median: 64 Gy). Chemotherapy was administered concurrently with radiation therapy to 51 patients, and the 31 patients received the regimen containing cisplatin or nedaplatin, and the 20 patients received the regimen consisting of docetaxel. Results: At the end of this study, there were 23 survivors with a median follow-up period of 23 months. The 3-year disease-specific survival rate (DSS) was 30% for all 88 patients, 44% for Stage II, and 24% for Stage III, and the difference between Stage II and Stage III was statistically significant (p = 0.003). The 3-year DSS of CCRT group and RT were 75%, 29% for Stage II, and 33%, 12% for Stage III. The DSS of the patients with CCRT was better than that with RT, especially of patients with Stage II, however, the differences observed were not statistically significant (p = 0.069 for Stage II, p = 0.126 for Stage III). There was no significant impact on DSS by the regimens of chemotherapy. Cox regression analysis revealed that clinical stage of patients was the single independent prognostic factor for DSS (HR: 0.44, 95% CI, 0.20-0.98). Conclusions: Our results revealed that definitive radiation therapy with concurrent chemotherapy for squamous cell carcinoma of the esophagus is effective. Further investigations of the protocol of radiation therapy technique or chemotherapy are needed to improve the outcome of the patients with advanced esophageal cancer. Author Disclosure: T. Nonaka, None; H. Sakurai, None; H. Ishikawa, None; M. Shioya, None; M. Murata, None; K. Shirai, None; K. Harashima, None; H. Kato, None; H. Kuwano, None; T. Nakano, None.
2239
Salvage Stereotactic Radiosurgery for Locally Recurrent Previously Irradiated Pancreatic Cancer
C. E. Lominska, N. M. Nasr, N. L. Silver, G. J. Gagnon Georgetown University Hospital, Washington, DC Purpose/Objective(s): Local and distant progression are both frequent occurrences after definitive treatment of pancreatic cancer and salvage treatments are of limited efficacy. In the subset of patients who have isolated local recurrence after conventional radiotherapy, we feel there may be a role for additional local therapy with radiosurgery in addition to the standard systemic therapies. We review our experience with salvage radiosurgery for previously irradiated patients. Materials/Methods: We reviewed the records of patients treated for pancreatic cancer using stereotactic radiosurgery at Georgetown from June 2002 through July 2007. Twenty-eight patients were identified who were treated for locally recurrent disease after either definitive chemoradiation (20 patients), or surgery followed by adjuvant chemoradiation (8 patients). Disease recurrence was demonstrated by serial CT imaging or by PET/CT findings characteristic of recurrent malignancy. Acute toxicity was assessed. Follow-up was obtained via chart review, imaging review, and social security death index database review. Results: Median patient age was 63 years. Prior radiation consisted of a median dose of 5,040 cGy with concurrent chemotherapy. Stereotactic radiosurgery was performed using the CyberKnife system (CK) with a median dose of 2,250 cGy (range, 2,000-3,000 cGy) prescribed to the 75% isodose line in 3 fractions (range, 3-5). As of March 2008, 26/28 patients have died. Follow-up was available on 24 of 28 patients. Median survival from the date of CK treatment was 5.3 months (range, 1-27 months), with the conservative assumption that the patients lost to follow-up were deceased. Seven patients (25%) lived more than 8 months after treatment. Two patients experienced serious GI toxicity (1 peripancreatic abscess, 1 bowel obstruction). Both of these patients were treated with 3 fractions. Review of radiographic studies revealed local control in 6 patients, local control with distant progression
Proceedings of the 50th Annual ASTRO Meeting in 6 patients, and local and distant progression in 2 patients with no follow-up imaging available on the remaining patients. The 2 surviving patients remain locally controlled without evidence of distant disease on follow-up of 3 and 8 months. Conclusions: We demonstrate an ability to perform stereotactic radiosurgery for previously irradiated patients with pancreatic adenocarcinoma with acceptable toxicity. We now typically use 5 fractions. Subsequent local control is frequent and radiosurgery is easily incorporated with at maximum a 2-3 week break from systemic therapy. A subset of patients has encouraging survival. We feel that radiosurgery deserves further investigation in the treatment of recurrent pancreas cancer. Author Disclosure: C.E. Lominska, None; N.M. Nasr, None; N.L. Silver, None; G.J. Gagnon, Speaker’s fees for Accuray Corporation, Sunnyvale CA, D. Speakers Bureau/Honoraria.
2240
Patterns of Care Study on Radiotherapy for Locally Advanced Hepatocellular Carcinoma (HCC)
1
J. Seong , I. Lee1, S. Shim1, D. Lim2, T. Kim3, J. Kim4, H. Jang5, M. Kim6, E. Chie7, J. Kim8, et al. 1 Yonsei University College of Medicine, Seoul, Republic of Korea, 2Samsung Medical Center, Seoul, Republic of Korea, 3 National Cancer Center, Seoul, Republic of Korea, 4Asan Medical Center, Seoul, Republic of Korea, 5Catholic University College of Medicine, Seoul, Republic of Korea, 6Korea Cancer Center Hospital, Seoul, Republic of Korea, 7Seoul National University College of Medicine, Seoul, Republic of Korea, 8Keimyung University College of Medicine, Taeku, Republic of Korea Purpose/Objective(s): We examined the records of patients with hepatocellular carcinoma (HCC) treated with radiation to determine national care processes and their outcomes in Korea. Materials/Methods: After survey of 53 institutions nationwide, detailed information was collected in 10 major cancer hospitals between January 2004 and December 2005. Eligible patients were those treated for primary tumors, regional lymph nodes, or portal vein tumor thrombosis excluding those treated for distant metastasis. Results: The study covered treatment of 398 HCC patients for 2 years. The male-to-female ratio was 8.5: 1.5 with the median age 57. Most patients (78%) were in Stage III (199) or IV (111). Radiotherapy was chosen after the failure of other treatments, most frequently transarterial chemoembolization. Radiotherapy was performed predominantly using the 3-dimensional conformal technique (80%) mostly with a total dose of 45-54 Gy (64%). In 9% of the patients, radiotherapy was performed using radiosurgery techniques. In biologically effective dose (BED) with 10 Gy of a/b, 4.2-124.3 Gy10 was delivered. The median survival time was 12 months, and the 2-year survival rate was 27.9%. A tumor size smaller than 5 cm and BED higher than 53.1 Gy10 were shown by multivariate analysis to be significant factors for a better prognosis. Conclusions: Radiotherapy has been used to treat HCC in various modes, but mostly as a last resort after failure of other modalities. Although the study was retrospective and thus limited, it indicates that radiotherapy is a valuable treatment modality for HCC. Author Disclosure: J. Seong, None; I. Lee, None; S. Shim, None; D. Lim, None; T. Kim, None; J. Kim, None; H. Jang, None; M. Kim, None; E. Chie, None; J. Kim, None.
2241
Carcinoma of the Ampulla of Vater: Patterns of Failure after Resection and Possible Benefit of Adjuvant Radiotherapy
B. Czito, R. Clough, T. Pappas, D. Tyler, R. White, H. Hurwitz, M. Morse, H. Uronis, B. Clary, C. Willett Duke University Medical Center, Durham, NC Purpose/Objective(s): Ampullary carcinoma is a rare malignancy. Despite radical resection, survival rates remain low with high rates of local failure. To define the role of radiation therapy and chemotherapy with surgery, an analysis of the outcome of a very large single institution experience was performed. Materials/Methods: From 1976 to 2006, 118 patients with ampullary adenocarcinoma underwent resection with curative intent at Duke University Hospitals. Forty-seven patients undergoing resection received adjuvant or neoadjuvant radiation therapy, usually with concurrent chemotherapy (CMT). Median radiation dose was 50 Gy. Median follow-up was 2.2 years in all patients and 3.0 years in survivors. Results: Patients receiving radiation therapy were more likely to have involved nodes (40% vs. 24%, p =.05), poorly differentiated tumors (40% vs. 18%, p = 0.008), higher Stage ($IIB disease i.e., N+ and/or T4 disease) (56% vs. 36%, p = 0.04) and involved margins (15% vs. 4%, p = 0.05). Despite this, 5-year actuarial overall survival rates were similar between the groups (32% CMT vs. 31% surgery only). Five-year actuarial local control was significantly improved in patients receiving CMT (73% vs. 34%, p = 0.006). No significant difference was seen in 5-year disease-free (51% CMT vs. 30% surgery only, p = 0.17) or metastases-free (54% CMT vs. 49% surgery only, p = 0.99) survivals. Five of 12 patients treated preoperatively (42%) had a pathologic complete response. Age .66-year-old, $Stage IIB disease, poorly differentiated disease, and involved margins adversely affected survival by univariate analysis. Conclusions: Long-term survival rates are low. Local failure rates are high with surgery only and improved with CMT. Despite more advanced disease and adverse pathologic features in patients receiving CMT, survival outcomes were similar to the more favorable group of patients undergoing surgery only. Given patterns of relapse with surgery alone and favorable outcomes in poor-prognosis patients receiving CMT, the use of CMT in selected patients should be considered. Author Disclosure: B. Czito, None; R. Clough, None; T. Pappas, None; D. Tyler, None; R. White, None; H. Hurwitz, None; M. Morse, None; H. Uronis, None; B. Clary, None; C. Willett, None.
2242
IGRT Stereotactic Hypofractionated Radiotherapy for Treatment of Focal Liver Malignancies
F. Casamassima, L. Masi, C. Menichelli, D’Imporzano E., C. Polli, I. Bonucci U.O. Radiobiologia Clinica, Florence, Italy Purpose/Objective(s): We analyze the feasibility, efficacy and safety of SRT for focal liver disease. Response evaluation (CT, PET, and markers) toxicity and the impact on survival were investigated.
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