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Significance of Hormone Therapy and Bisphosphonate Use on Vertebral Compression Fracture (VCF) Incidence Following Spine Stereotactic Body Radiation Therapy (SBRT) for Breast Cancer Metastases
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Volume 96 Number 2S Supplement 2016 Author Disclosure: S. Aggarwal: None. N.D. Prionas: None. J.N. Carter: None. K.A. Kumar: None. P. Pradhan: None. J.L. Bui: None. R. von Eyben: None. A.C. Koong: None. D.T. Chang: None.
3249 Impact of Baseline Cachexia in Non-Small Cell Lung Cancer on Radiation Therapy Utilization and Survival F. Giap,1 S.K.M. Lau,1 B.S. Gannavaparu,1 and P. Iyengar2; 1University of Texas Southwestern, Dallas, TX, 2University of Texas Southwestern Medical Center, Dallas, TX Purpose/Objective(s): Cancer cachexia is a well-described syndrome of progressive functional impairment characterized by unintentional weight loss. However, the presence of cachexia at the time of cancer diagnosis and its influence on disease management and treatment outcomes for patients receiving radiotherapy are poorly described. Here, we assess the role of cachexia at baseline in patients with NSCLC on first-line treatment modality and clinical outcomes. Materials/Methods: Retrospective review of medical records identified 1,334 patients with NSCLC consecutively treated at a tertiary care health system between 1/1/06 and 12/31/13. Cachexia was defined using the wellaccepted and validated international consensus definition. The delivery of radiotherapy and its treatment intent, whether curative or palliative, were abstracted. Results: The cohort included a representative group of patients with a median age at diagnosis of 64 years, 623 (46.7%) females, and 422 (31.6%) patients of non-White race. Stage at diagnosis was 0, I, II, III, and IV, in 4 (0.3%), 291 (21.8%), 105 (7.9%), 356 (26.7%), and 578 (43.3%) patients, respectively. Cachexia was present at the time of diagnosis in 403 (30.2%) patients including 17.5%, 14.3%, and 32.0% of stage I, II, and III patients, respectively. Curative intent radiotherapy was prescribed to 48.4% and 45.8% of stage I+II patients with and without cachexia, respectively (PZ.69). Curative intent radiation was administered to 75.4% and 76.0% of stage III patients with and without cachexia, respectively (PZ.98). Palliative intent radiation therapy (RT) was received by significantly more stage IV patients with cachexia (74.4%) than without cachexia (63.4%) (X2, PZ.006). 857 deaths have been observed, with a median follow-up of 23.7 months for patients alive at the time of analysis. Cachexia at the time of diagnosis was prognostic for worse survival by stage. For patients with stage I NSCLC, median survival was 67.1 months for patients without cachexia but 45.0 months with cachexia at diagnosis (PZ.033). For stage I patients receiving curative intent RT, median survival was 39.9 and 25.2 months for patients without and with cachexia, respectively (PZ.31). Cachexia remained significant in stage III NSCLC, with median survival of 20.5 and 13.8 months with or without cachexia at diagnosis, respectively (PZ.013). For stage III patients receiving curative intent RT, median survival was 23.9 and 15.0 months for patients without and with cachexia, respectively (PZ.009). Conclusion: Cancer cachexia at the time of diagnosis is common in patients with NSCLC even with early stage disease. The presence of cachexia at diagnosis does not appear to influence the utilization of RT as a curative modality. However, cachexia at diagnosis of NSCLC, even with early stage disease, is prognostic of worse outcomes despite curative intent therapy. Further studies on the biologic mechanisms and treatment of cancer cachexia may provide novel therapeutic avenues. Author Disclosure: F. Giap: None. S.K. Lau: None. B.S. Gannavaparu: None. P. Iyengar: None.
3250 Significance of Hormone Therapy and Bisphosphonate Use on Vertebral Compression Fracture (VCF) Incidence Following Spine Stereotactic Body Radiation Therapy (SBRT) for Breast Cancer Metastases E. Elibe, D. Boyce-Fappiano, E.M. Walker, I.Y. Lee, J. Rock, S. Siddiqui, and F. Siddiqui; Henry Ford Health System, Detroit, MI Purpose/Objective(s): Spinal metastases are increasingly being treated with SBRT. Though effective, a potential toxicity of SBRT is VCF. Breast cancer (BC) is one of the most common primary sites to metastasize to the spine, and due to factors such as hormone therapy (HT) use, these patients may be at higher risk for VCF following SBRT. Our study aimed to determine the rate of SBRT induced VCF (S-VCF) in BC patients, and to understand if there is a significant relationship between HT and bisphosphonate (Bp) use on this risk. Materials/Methods: 335 vertebral bodies (VB) (nZ131 patients) were treated with spine SBRT for BC metastases at a single institution between June 2001 and December 2014. EMRs were retrospectively reviewed in this IRB approved study, and data on the use of Bp, selective estrogen receptor modulators (SERMs), and aromatase inhibitors (AIs) were recorded. Development of a new VCF, progression of an existing VCF and requirement of stabilization surgery after SBRT were the primary endpoints of this study. These were evaluated using computed tomography and magnetic resonance images. Only VCF development/progression occurring in VBs treated with SBRT were considered. VBs with concurrent tumor progression, or stabilization surgery prior to SBRT were not included. Statistical significance of SVCF, and the use of Bp and HT concurrent to, within 6 months, 1 year, and 2 years of SBRT, was evaluated using the Chi-Square Test for Independence, and Fisher’s Exact Test. Results: Follow up was available for 91 patients (69%) & 233 VBs. Median survival post SBRT was 21 m. 58.8% of patients were white, 33.6% African American, and 7.6% were of other ethnicities. Bone density was low in 59% of patients. Median SBRT dose was 18 Gy/1 fx. Median tumor volume was 35.83 cc. Median follow-up was 15.6 m. 33 VCFs in 20 patients were observed. 16 (48%) were new VCFs, 8 (24%) progressed, & 9 (27%) were VBs that required surgical stabilization after SBRT. The overall S-VCF rate was 14%. Of the patients evaluable for follow-up, 70 patients (192 VBs) 50 patients (146 VBs), & 78 patients (221 VBs) were exposed to AIs, SERMs, and Bp, with S-VCF rates of 14.6%, 14%, and 13% respectively. The following were found to be statistically significant in relation to VCF rate: SERM use concurrent to (PZ0.003), within 6 m of (PZ0.028), and within 2 yrs of (PZ0.021) SBRT. Also significant was Bp use within 1 yr of SBRT (P< 0.0001). AI use was not found to be statistically significant for any of the time frames evaluated in our study. Conclusion: Rate of developing an S-VCF in our cohort was 14%. The overall rate of S-VCF in BC patients is not considerably higher than S-VCF rates previously reported in non-histology specific series. We will further analyze our cohort to better understand the protective or adverse effects of HT and Bp use in BC patients receiving spine SBRT. To the best of our knowledge, this is the only reported series analyzing S-VCFs in BC with an emphasis on the relation of Bp and HT use. Author Disclosure: E. Elibe: None. D. Boyce-Fappiano: None. E.M. Walker: None. I.Y. Lee: Honoraria; Varian Medical Systems. Consultant; Medtronic. Travel Expenses; Varian Medical Systems. J. Rock: None. S. Siddiqui: Research Grant; Varian Medical Systems, Inc., Phillips Medical. Directs QA program; Henry Ford Hospital. F. Siddiqui: Research Grant; Varian Medical Systems, Inc., Phillips Medical. Oversees the department; Henry Ford Hospital.
Volume 96 Number 2S Supplement 2016 Author Disclosure: S. Aggarwal: None. N.D. Prionas: None. J.N. Carter: None. K.A. Kumar: None. P. Pradhan: None. J.L. Bui: None. R. von Eyben: None. A.C. Koong: None. D.T. Chang: None.
3249 Impact of Baseline Cachexia in Non-Small Cell Lung Cancer on Radiation Therapy Utilization and Survival F. Giap,1 S.K.M. Lau,1 B.S. Gannavaparu,1 and P. Iyengar2; 1University of Texas Southwestern, Dallas, TX, 2University of Texas Southwestern Medical Center, Dallas, TX Purpose/Objective(s): Cancer cachexia is a well-described syndrome of progressive functional impairment characterized by unintentional weight loss. However, the presence of cachexia at the time of cancer diagnosis and its influence on disease management and treatment outcomes for patients receiving radiotherapy are poorly described. Here, we assess the role of cachexia at baseline in patients with NSCLC on first-line treatment modality and clinical outcomes. Materials/Methods: Retrospective review of medical records identified 1,334 patients with NSCLC consecutively treated at a tertiary care health system between 1/1/06 and 12/31/13. Cachexia was defined using the wellaccepted and validated international consensus definition. The delivery of radiotherapy and its treatment intent, whether curative or palliative, were abstracted. Results: The cohort included a representative group of patients with a median age at diagnosis of 64 years, 623 (46.7%) females, and 422 (31.6%) patients of non-White race. Stage at diagnosis was 0, I, II, III, and IV, in 4 (0.3%), 291 (21.8%), 105 (7.9%), 356 (26.7%), and 578 (43.3%) patients, respectively. Cachexia was present at the time of diagnosis in 403 (30.2%) patients including 17.5%, 14.3%, and 32.0% of stage I, II, and III patients, respectively. Curative intent radiotherapy was prescribed to 48.4% and 45.8% of stage I+II patients with and without cachexia, respectively (PZ.69). Curative intent radiation was administered to 75.4% and 76.0% of stage III patients with and without cachexia, respectively (PZ.98). Palliative intent radiation therapy (RT) was received by significantly more stage IV patients with cachexia (74.4%) than without cachexia (63.4%) (X2, PZ.006). 857 deaths have been observed, with a median follow-up of 23.7 months for patients alive at the time of analysis. Cachexia at the time of diagnosis was prognostic for worse survival by stage. For patients with stage I NSCLC, median survival was 67.1 months for patients without cachexia but 45.0 months with cachexia at diagnosis (PZ.033). For stage I patients receiving curative intent RT, median survival was 39.9 and 25.2 months for patients without and with cachexia, respectively (PZ.31). Cachexia remained significant in stage III NSCLC, with median survival of 20.5 and 13.8 months with or without cachexia at diagnosis, respectively (PZ.013). For stage III patients receiving curative intent RT, median survival was 23.9 and 15.0 months for patients without and with cachexia, respectively (PZ.009). Conclusion: Cancer cachexia at the time of diagnosis is common in patients with NSCLC even with early stage disease. The presence of cachexia at diagnosis does not appear to influence the utilization of RT as a curative modality. However, cachexia at diagnosis of NSCLC, even with early stage disease, is prognostic of worse outcomes despite curative intent therapy. Further studies on the biologic mechanisms and treatment of cancer cachexia may provide novel therapeutic avenues. Author Disclosure: F. Giap: None. S.K. Lau: None. B.S. Gannavaparu: None. P. Iyengar: None.
3250 Significance of Hormone Therapy and Bisphosphonate Use on Vertebral Compression Fracture (VCF) Incidence Following Spine Stereotactic Body Radiation Therapy (SBRT) for Breast Cancer Metastases E. Elibe, D. Boyce-Fappiano, E.M. Walker, I.Y. Lee, J. Rock, S. Siddiqui, and F. Siddiqui; Henry Ford Health System, Detroit, MI Purpose/Objective(s): Spinal metastases are increasingly being treated with SBRT. Though effective, a potential toxicity of SBRT is VCF. Breast cancer (BC) is one of the most common primary sites to metastasize to the spine, and due to factors such as hormone therapy (HT) use, these patients may be at higher risk for VCF following SBRT. Our study aimed to determine the rate of SBRT induced VCF (S-VCF) in BC patients, and to understand if there is a significant relationship between HT and bisphosphonate (Bp) use on this risk. Materials/Methods: 335 vertebral bodies (VB) (nZ131 patients) were treated with spine SBRT for BC metastases at a single institution between June 2001 and December 2014. EMRs were retrospectively reviewed in this IRB approved study, and data on the use of Bp, selective estrogen receptor modulators (SERMs), and aromatase inhibitors (AIs) were recorded. Development of a new VCF, progression of an existing VCF and requirement of stabilization surgery after SBRT were the primary endpoints of this study. These were evaluated using computed tomography and magnetic resonance images. Only VCF development/progression occurring in VBs treated with SBRT were considered. VBs with concurrent tumor progression, or stabilization surgery prior to SBRT were not included. Statistical significance of SVCF, and the use of Bp and HT concurrent to, within 6 months, 1 year, and 2 years of SBRT, was evaluated using the Chi-Square Test for Independence, and Fisher’s Exact Test. Results: Follow up was available for 91 patients (69%) & 233 VBs. Median survival post SBRT was 21 m. 58.8% of patients were white, 33.6% African American, and 7.6% were of other ethnicities. Bone density was low in 59% of patients. Median SBRT dose was 18 Gy/1 fx. Median tumor volume was 35.83 cc. Median follow-up was 15.6 m. 33 VCFs in 20 patients were observed. 16 (48%) were new VCFs, 8 (24%) progressed, & 9 (27%) were VBs that required surgical stabilization after SBRT. The overall S-VCF rate was 14%. Of the patients evaluable for follow-up, 70 patients (192 VBs) 50 patients (146 VBs), & 78 patients (221 VBs) were exposed to AIs, SERMs, and Bp, with S-VCF rates of 14.6%, 14%, and 13% respectively. The following were found to be statistically significant in relation to VCF rate: SERM use concurrent to (PZ0.003), within 6 m of (PZ0.028), and within 2 yrs of (PZ0.021) SBRT. Also significant was Bp use within 1 yr of SBRT (P< 0.0001). AI use was not found to be statistically significant for any of the time frames evaluated in our study. Conclusion: Rate of developing an S-VCF in our cohort was 14%. The overall rate of S-VCF in BC patients is not considerably higher than S-VCF rates previously reported in non-histology specific series. We will further analyze our cohort to better understand the protective or adverse effects of HT and Bp use in BC patients receiving spine SBRT. To the best of our knowledge, this is the only reported series analyzing S-VCFs in BC with an emphasis on the relation of Bp and HT use. Author Disclosure: E. Elibe: None. D. Boyce-Fappiano: None. E.M. Walker: None. I.Y. Lee: Honoraria; Varian Medical Systems. Consultant; Medtronic. Travel Expenses; Varian Medical Systems. J. Rock: None. S. Siddiqui: Research Grant; Varian Medical Systems, Inc., Phillips Medical. Directs QA program; Henry Ford Hospital. F. Siddiqui: Research Grant; Varian Medical Systems, Inc., Phillips Medical. Oversees the department; Henry Ford Hospital.