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Surface Brachytherapy for Non-Melanoma Skin Cancers: A Retrospective Analysis of a Prospective Cohort
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Volume 99 Number 2S Supplement 2017 whose tumor volume was less than 5.0 cm3 (p Z 0.001). This relationship was independent of T stage (p Z 0.03) and did not vary by tumor subsite (pZ0.08). For T1-2 tumors less than 5.0 cm3, 5- and 10-year local control rates were 98% and 90%, respectively. For T1-2 tumors greater than or equal to 5.0 cm3, 5- and 10-year local control rates were 77% and 64%, respectively. For T3 tumors, 5- and 10-year local control rate was 84% if less than 5.0 cm3 and 71% if greater than or equal to 5.0 cm3. Only 1 patient had a T4 tumor less than 5.0 cm3 who did not fail locally. T4 tumors greater than or equal to 5.0 cm3 achieved local control of 74% at both 5 and 10 years. Overall survival was not significantly different by tumor volume. Six patients developed soft tissue necrosis, and 2 patients suffered fatal carotid blowouts. All patients with severe complications, grade 5 CTCAE complications, were treated with concomitant chemotherapy. Four patients (2%) required total laryngectomy for a non-functional larynx, fourteen (8%) additional patients went on to require a permanent tracheostomy or permanent gastrostomy tube. Conclusion: Calculation of pretreatment primary tumor volumes, as defined on high-quality pretreatment CT imaging, can be useful in identifying patients most likely to experience local control with definitive radiotherapy or combined chemoradiation. Local control for SCC of supraglottic larynx is optimal if the primary tumor volume is less than 5.0 cm3. Author Disclosure: S.R. Nurkic: None. T. Nurkic: None. C.G. Morris: None. R.J. Amdur: Partnership; RadOnc eLearning Center, Inc. ; ABR, ACGME, AJCO, JCO, PRO. W.M. Mendenhall: Employee; University of Florida.
2861 Surface Brachytherapy for Non-Melanoma Skin Cancers: A Retrospective Analysis of a Prospective Cohort D. Olek Jr,1 M.N. El-Ghamry,2 M.M. Gestaut,3 N. Deb,4 C. Shaver,1 and S. Mutyala5; 1Baylor Scott & White Healthcare Temple Clinic, Temple, TX, 2University of Louisville, Louisville, KY, 3Baylor Scott & White Texas A&M Radiation Oncology, Temple, TX, 4baylor, Temple, TX, 5University of Arizona Cancer Center / Dignity Health Saint Joseph Hospital, Phoenix, AZ Purpose/Objective(s): Surgery is the gold standard for treatment of early stage nonmelanoma skin cancers (NMSC); radiation therapy is an acceptable alternative for anatomical locations where definitive surgery is difficult due to healing or cosmesis. In 2010, we implemented a NMSC brachytherapy program using a modern version of surface brachytherapy, the ‘3D topographic applicator brachytherapy’ (3TAB). This study analyzes our 2010-2013 experience treating NMSC lesions with 3TAB in terms of acute toxicity, chronic toxicity, and recurrence rate. Materials/Methods: Of 172 consecutive patients with early stage NMSC lesions treated from 2010-2013, 273 lesions treated with 3TAB composed the prospective cohort registry. A custom applicator was created using a thermoplastic mold with HAM or Freiburg flap and parallel catheters. A 3D optimized plan was created to prescribe the dose to a depth of 3mm. Dose fractionation schemes included 40 Gy in 8 fractions (fxs) delivered twice per week, or 48 Gy in 16 fxs delivered 4 times per week. Acute toxicity was graded by RTOG criteria. Chronic toxicity was graded by the presence or lack of toxicity. Results: Outlined in Table: 23.8% of NMSC were on the nose and 14.7% were on the lower extremity; 54.2% were BCC, 76.2% were stage I, and 90.8% were treated definitively with 3TAB. Median tumor diameter was 1.00 cm (range: 0.20-7.7cm). 98.9% completed treatment. 76.6% received 40 Gy in 8 fxs. Median follow-up was 24.0 mo (range: 0 e 71.0 mo). Maximum acute toxicity was 0.4% for G0, 33.3% for G1, 48.7% for G2, 12.5% for G3, and 5.1% for G4. Of the 14 ulcerations, 7 healed, 6 developed into chronic ulcers, and 1 was due to recurrence. Recurrence rate was 4.76%, and median time to recurrence was 9.0 months (range 4.047.0). Chronic toxicities included erythema (4.4%), telangiectasia (2.6%), pigmentation changes (2.2%), chronic ulcer (2.2%), alopecia (0.7%), and hyperkeratosis (0.4%).
Abstract 2861 Parameter Patients Age Lesions SiteNose Ear Scalp/Forehead Cheek Other Site on Face + Neck Torso Upper Extremity Lower Extremity HistologyBCC SCC BCC/SCC Bowen’s T-Stage0 T1 T2 UNK Surgery TXT Primary Recurrence Adjuvant Completed TXT RT Schedule40 Gy in 8 fxs 48 Gy in 16 fxs Toxicity at 1st Follow-up G0 G1 G2 G3 Maximum Acute Toxicity G0 G1 G2 G3 G4
Number (%) 172 Mean: 78.9 (SD 10.16) 273 65 (23.81) 34 (12.45) 48 (17.58) 41 (15.02) 18 (6.59) 9 (3.30) 18 (6.59) 40 (14.65)
148 (54.21) 104 (38.10) 4 (1.47) 17 (6.23) 17 (6.23) 208 (76.19) 39 (14.29) 9 (3.30) 28 (10.26) 246 (90.11) 16 (5.86) 11 (4.03) 270 (98.90) 209 (76.56) 64 (23.44) 66 (24.18) 106 (38.83) 81 (29.67) 20 (7.33) 1 (0.37) 91 (33.33) 133 (48.72) 34 (12.45) 14 (5.13)
Conclusion: Treatment of NMSC with 3TAB was able to provide excellent local control (95.2%) with low rates of grade 3-4 acute toxicity. 3TAB is a reasonable alternative to definitive surgery when treating NMSC, with further investigation warranted. Author Disclosure: D. Olek: None. M.N. El-Ghamry: None. M.M. Gestaut: None. N. Deb: None. C. Shaver: None. S. Mutyala: Consultant; Elekta. Speaker’s Bureau; Elekta. ; Dignity Health, University of Arizona.
2862 Patterns of Care and Outcomes of Adjuvant Therapy for High Risk Head and Neck Cancer After Surgery V.W. Osborn,1,2 B. Givi,3,4 D.F. Roden,3,5 E. Katsoulakis,6 N. Sheth,2 A.J. Lederman,1,2 D. Schwartz,1,2 and D. Schreiber1,2; 1SUNY Downstate Medical Center, Brooklyn, NY, 2Veterans Affairs NY Harbor Healthcare System, Brooklyn, NY, 3Veterans Affairs NY Harbor Healthcare System, New York, NY, 4New York University School of Medicine, New York, NY, 5 NYU Langone Medical Center, New York, NY, 6New York Methodist Hospital, Brooklyn, NY Purpose/Objective(s): To analyze the patterns of care and survival for patients undergoing surgery for head and neck cancer and found to have locally advanced disease, positive margins, or extracapsular extension (ECE) Materials/Methods: The National Cancer Database was explored to identify patients’ 70 years old that were diagnosed with head and neck squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx between 2004-2012. Patients were included if they underwent surgery (> local excision) and were staged as pT3-4N0-3, pT1-4N2-3, or any stage with positive margins and/or ECE. Patients were then stratified into receipt of postoperative radiation alone (postopRT) or postoperative chemoradiation (postop chemoRT). Those who received surgery alone, and those who survived <6 months were excluded. Univariable and multivariable logistic regression was used to assess for predictors of chemoradiation. Univariable and multivariable Cox Regression was similarly performed to assess for covariables that had an impact on survival. Propensity matching was performed and the multivariable Cox Regression was repeated utilizing the propensity matched sample. Results: There were 12,224 patients included in this study, from which 4,636 (37.9%) received postop RT and 7,588 (62.1%) received postop chemoRT. Those with positive margins and/or ECE received chemoRT 67.1% of the time and those with negative margins and no ECE received
Volume 99 Number 2S Supplement 2017 whose tumor volume was less than 5.0 cm3 (p Z 0.001). This relationship was independent of T stage (p Z 0.03) and did not vary by tumor subsite (pZ0.08). For T1-2 tumors less than 5.0 cm3, 5- and 10-year local control rates were 98% and 90%, respectively. For T1-2 tumors greater than or equal to 5.0 cm3, 5- and 10-year local control rates were 77% and 64%, respectively. For T3 tumors, 5- and 10-year local control rate was 84% if less than 5.0 cm3 and 71% if greater than or equal to 5.0 cm3. Only 1 patient had a T4 tumor less than 5.0 cm3 who did not fail locally. T4 tumors greater than or equal to 5.0 cm3 achieved local control of 74% at both 5 and 10 years. Overall survival was not significantly different by tumor volume. Six patients developed soft tissue necrosis, and 2 patients suffered fatal carotid blowouts. All patients with severe complications, grade 5 CTCAE complications, were treated with concomitant chemotherapy. Four patients (2%) required total laryngectomy for a non-functional larynx, fourteen (8%) additional patients went on to require a permanent tracheostomy or permanent gastrostomy tube. Conclusion: Calculation of pretreatment primary tumor volumes, as defined on high-quality pretreatment CT imaging, can be useful in identifying patients most likely to experience local control with definitive radiotherapy or combined chemoradiation. Local control for SCC of supraglottic larynx is optimal if the primary tumor volume is less than 5.0 cm3. Author Disclosure: S.R. Nurkic: None. T. Nurkic: None. C.G. Morris: None. R.J. Amdur: Partnership; RadOnc eLearning Center, Inc. ; ABR, ACGME, AJCO, JCO, PRO. W.M. Mendenhall: Employee; University of Florida.
2861 Surface Brachytherapy for Non-Melanoma Skin Cancers: A Retrospective Analysis of a Prospective Cohort D. Olek Jr,1 M.N. El-Ghamry,2 M.M. Gestaut,3 N. Deb,4 C. Shaver,1 and S. Mutyala5; 1Baylor Scott & White Healthcare Temple Clinic, Temple, TX, 2University of Louisville, Louisville, KY, 3Baylor Scott & White Texas A&M Radiation Oncology, Temple, TX, 4baylor, Temple, TX, 5University of Arizona Cancer Center / Dignity Health Saint Joseph Hospital, Phoenix, AZ Purpose/Objective(s): Surgery is the gold standard for treatment of early stage nonmelanoma skin cancers (NMSC); radiation therapy is an acceptable alternative for anatomical locations where definitive surgery is difficult due to healing or cosmesis. In 2010, we implemented a NMSC brachytherapy program using a modern version of surface brachytherapy, the ‘3D topographic applicator brachytherapy’ (3TAB). This study analyzes our 2010-2013 experience treating NMSC lesions with 3TAB in terms of acute toxicity, chronic toxicity, and recurrence rate. Materials/Methods: Of 172 consecutive patients with early stage NMSC lesions treated from 2010-2013, 273 lesions treated with 3TAB composed the prospective cohort registry. A custom applicator was created using a thermoplastic mold with HAM or Freiburg flap and parallel catheters. A 3D optimized plan was created to prescribe the dose to a depth of 3mm. Dose fractionation schemes included 40 Gy in 8 fractions (fxs) delivered twice per week, or 48 Gy in 16 fxs delivered 4 times per week. Acute toxicity was graded by RTOG criteria. Chronic toxicity was graded by the presence or lack of toxicity. Results: Outlined in Table: 23.8% of NMSC were on the nose and 14.7% were on the lower extremity; 54.2% were BCC, 76.2% were stage I, and 90.8% were treated definitively with 3TAB. Median tumor diameter was 1.00 cm (range: 0.20-7.7cm). 98.9% completed treatment. 76.6% received 40 Gy in 8 fxs. Median follow-up was 24.0 mo (range: 0 e 71.0 mo). Maximum acute toxicity was 0.4% for G0, 33.3% for G1, 48.7% for G2, 12.5% for G3, and 5.1% for G4. Of the 14 ulcerations, 7 healed, 6 developed into chronic ulcers, and 1 was due to recurrence. Recurrence rate was 4.76%, and median time to recurrence was 9.0 months (range 4.047.0). Chronic toxicities included erythema (4.4%), telangiectasia (2.6%), pigmentation changes (2.2%), chronic ulcer (2.2%), alopecia (0.7%), and hyperkeratosis (0.4%).
Abstract 2861 Parameter Patients Age Lesions SiteNose Ear Scalp/Forehead Cheek Other Site on Face + Neck Torso Upper Extremity Lower Extremity HistologyBCC SCC BCC/SCC Bowen’s T-Stage0 T1 T2 UNK Surgery TXT Primary Recurrence Adjuvant Completed TXT RT Schedule40 Gy in 8 fxs 48 Gy in 16 fxs Toxicity at 1st Follow-up G0 G1 G2 G3 Maximum Acute Toxicity G0 G1 G2 G3 G4
Number (%) 172 Mean: 78.9 (SD 10.16) 273 65 (23.81) 34 (12.45) 48 (17.58) 41 (15.02) 18 (6.59) 9 (3.30) 18 (6.59) 40 (14.65)
148 (54.21) 104 (38.10) 4 (1.47) 17 (6.23) 17 (6.23) 208 (76.19) 39 (14.29) 9 (3.30) 28 (10.26) 246 (90.11) 16 (5.86) 11 (4.03) 270 (98.90) 209 (76.56) 64 (23.44) 66 (24.18) 106 (38.83) 81 (29.67) 20 (7.33) 1 (0.37) 91 (33.33) 133 (48.72) 34 (12.45) 14 (5.13)
Conclusion: Treatment of NMSC with 3TAB was able to provide excellent local control (95.2%) with low rates of grade 3-4 acute toxicity. 3TAB is a reasonable alternative to definitive surgery when treating NMSC, with further investigation warranted. Author Disclosure: D. Olek: None. M.N. El-Ghamry: None. M.M. Gestaut: None. N. Deb: None. C. Shaver: None. S. Mutyala: Consultant; Elekta. Speaker’s Bureau; Elekta. ; Dignity Health, University of Arizona.
2862 Patterns of Care and Outcomes of Adjuvant Therapy for High Risk Head and Neck Cancer After Surgery V.W. Osborn,1,2 B. Givi,3,4 D.F. Roden,3,5 E. Katsoulakis,6 N. Sheth,2 A.J. Lederman,1,2 D. Schwartz,1,2 and D. Schreiber1,2; 1SUNY Downstate Medical Center, Brooklyn, NY, 2Veterans Affairs NY Harbor Healthcare System, Brooklyn, NY, 3Veterans Affairs NY Harbor Healthcare System, New York, NY, 4New York University School of Medicine, New York, NY, 5 NYU Langone Medical Center, New York, NY, 6New York Methodist Hospital, Brooklyn, NY Purpose/Objective(s): To analyze the patterns of care and survival for patients undergoing surgery for head and neck cancer and found to have locally advanced disease, positive margins, or extracapsular extension (ECE) Materials/Methods: The National Cancer Database was explored to identify patients’ 70 years old that were diagnosed with head and neck squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx between 2004-2012. Patients were included if they underwent surgery (> local excision) and were staged as pT3-4N0-3, pT1-4N2-3, or any stage with positive margins and/or ECE. Patients were then stratified into receipt of postoperative radiation alone (postopRT) or postoperative chemoradiation (postop chemoRT). Those who received surgery alone, and those who survived <6 months were excluded. Univariable and multivariable logistic regression was used to assess for predictors of chemoradiation. Univariable and multivariable Cox Regression was similarly performed to assess for covariables that had an impact on survival. Propensity matching was performed and the multivariable Cox Regression was repeated utilizing the propensity matched sample. Results: There were 12,224 patients included in this study, from which 4,636 (37.9%) received postop RT and 7,588 (62.1%) received postop chemoRT. Those with positive margins and/or ECE received chemoRT 67.1% of the time and those with negative margins and no ECE received