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The Impact of Substance Use on Incidence and Survival in Locally Advanced Cervical Cancer Treated With Radiation Therapy
S486
International Journal of Radiation Oncology Biology Physics
coverage and OAR sparing to pre-treatment metrics can determine the optimal applicator for each patient. Materials/Methods: Retrospective analysis of 4 patients treated for cervical cancer with a 6 cm FSD-style T&O applicator was performed. Each fraction was imaged using CT and fused retrospectively using rigid registration with the pretreatment MR for contouring of the intermediate risk (IR) CTV. The high risk (HR) CTV, bladder, rectum, and sigmoid were contoured on each CT. The dose prescription was 6 Gy/fraction, normalized to Pt. A. Plans were manually optimized if critical structure doses were too high. Four patients were retrospectively replanned using volume-optimization in the original plan, as well as two Utrecht-style applicator (25 and 30 mm ovoids) models. The Utrecht applicators include a T&O as well as needles to optimize cervical and parametrial dose. We optimized for coverage of HR-CTV and IR-CTV while keeping the D2cc of OARs within tolerance. We examined dose-metric differences between the FSD and Utrecht applicators, and differences in the T&O applicator with and without volume optimization of source placement. Coverages of the CTVs were examined, as well as dose metrics to bladder, rectum, and sigmoid. Results: The Utrecht applicators were able to provide better coverage of larger IR-CTVs than the FSD as shown by D90 (Table 1) as well as D100 and V100. Only the larger IR-CTVs were better covered by the Utrecht applicators.
Materials/Methods: The outcomes of 192 patients with locally advanced cervical carcinoma (stage IB2-IIA) , treated with primary chemoradiotherapy approach between January 2006 and May 2013 in our institution were retrospectively analysed. 0ut of 192, 89 patients’ pretreatment blood cell counts could be recorded from electronic database due to loss of information via system changing. Results: Median follow up period was 25 (range,3-100) months. For the all study population overall survival rates for , 2,3 and 5 years were 81%, 67% and 57% respectively. Locoregional control rates for 2,3 and 5 years were 79.6%, 73.7% and 66%,respectively. For the purpose of analysis, 89 patients were divided into 2 groups according to a NLR of 5 or <5. Similarly for a PLR 150 was taken as a threshold for grouping (150 or <150). 2 years overall survival and locoregional control rates for NLR <5 and 5 were 81,7% vs. 65 % (p Z 0,087) and 85% vs. 50 % (p Z 0,032) , respectively. There was no statistically significant difference according to PLR for overall survival (p Z 0,645) and locoregional control (p Z 0,908). Conclusions: There are a few studies in literature investigating systemic inflammatory response role on treatment outcomes for cervical cancer. With small numbers of patient we found pretreatment NLR can be related with locoregional outcome for cervical squamous cell carcinoma and worth to investigate with larger studies. Author Disclosure: E. Karakaya: None. F. Alioglu: None. Y. Guney: None. E. Keven: None. Z. Ozdogan: None. S. Aytac Arslan: None. G. Olcay: None. G. Altinisik Inan: None. A. Dizman: None.
Scientific Abstract 2694; Table
IR-CTV D90 vs Applicator and Loading
IR-CTV volume:
15.8 cc
46.9 cc
88.5cc
146.5 cc
T&O Manual T&O Vol. Opti. 25 mm Utrecht 30 mm Utrecht
102% 95% 103% 102%
85% 82% 88% 90%
36% 60% 76% 78%
47% 67% 77% 78%
Table 1: IR-CTV coverage for manual vs optimized planning of a T&O, as well as a volume-optimized Utrecht applicators. Smaller IRCTVs show no benefit, while larger IR-CTVs show improved coverage. The OAR metrics were not affected by varying the applicator or planning method. Conclusions: This study shows use of Utrecht-style applicators for the treatment of cervical brachytherapy can lead to better dosimetric coverage of the larger volume IR-CTVs. Since the IR-CTV can be pre-contoured from MR, a physician can use the IR-CTV to decide whether to use a traditional FSD or Utrecht applicator. The advantages of Utrecht applicators must be balanced against the increased complexity of the treatment as well use of anesthesia for each insertion. Use of higher dose per fraction could alleviate these concerns. Author Disclosure: R.C. Best: None. P. Petric: None. J. Morrison: None. T.N. Showalter: None. B. Libby: None.
2695 Is Pretreatment Neutrophil to Lymphosite Ratio a Predictive Factor for Cervical Cancer Control? E. Karakaya, F. Alioglu, Y. Guney, E. Keven, Z. Ozdogan, S. Aytac Arslan, G. Olcay, G. Altinisik Inan, and A. Dizman; Ankara Oncology Hospital, Ankara, Turkey Purpose/Objective(s): Concurrent chemoradiotherapy (CRT) is a standart approach for patients with locally advanced cervical carcinoma.In various cancer types, a few inflammatory biomarkers were thought to be prognostic for both survival and locoregional control. The purpose of the current study was to investigate whether the host systemic inflammatory response evaluated with neutrophile to lymphosite ratio (NLR) and platelet to lymphosite ratio (PLR) can be prognostic factor for cervical cancer control or not.
2696 The Impact of Substance Use on Incidence and Survival in Locally Advanced Cervical Cancer Treated With Radiation Therapy J. Lim,1 B. Durbin-Johnson,2 E.A. Alvarez,1 and J.S. Mayadev1; 1UC Davis School of Medicine, Sacramento, CA, 2UC Davis School of Public Health, Sacramento, CA Purpose/Objective(s): We examined the effects of substance abuse with alcohol, tobacco, and recreational drugs on cervical cancer recurrence and mortality in patients undergoing definitive treatment of locally advanced cervical cancer with radiation. Materials/Methods: Between July 2007 and September 2013, 96 consecutive patients received definitive treatment of locally advanced cervical cancer with external beam radiation therapy (EBRT) and chemotherapy, followed by brachytherapy. A retrospective chart review was conducted to determine patient, treatment and tumor characteristics. Heavy alcohol use was defined based on the Centers for Disease Control and Prevention (CDC) definition of greater than one drink per day. Smoking habits were quantified based on pack-years. Recreational drugs included cocaine, heroin, methamphetamines, and marijuana. Time to event endpoints (overall survival [OS], disease-free survival [DFS], and pelvic control) were analyzed by patient and disease characteristics using multivariable Cox proportional hazards models. Results: The study population consisted of 96 patients with an average age of 54.8 years (range, 27-91 years). Alcohol history included 10 (10.5%) patients who met the CDC criteria for heavy alcohol use. Smoking history included 51 (53.1%) patients with no history of smoking, 20 (20.8%) patients with one to twenty pack-years, and 25 (26%) patients with twenty-one or more pack-years. For drug use, 6 (6.3%) of the patients were using recreational drug at time of treatment. The impact of heavy alcohol use on pelvic control, DFS and OS was hazards ratio 3.30 (CI:1.13-8.28; P Z 0.031), 2.60 (CI: 0.69-7.65; P Z 0.150), and 6.31 (CI:1.73-21.1; P Z 0.007) respectively. The impact of 1 to 20 packyears smoking history on pelvic control, DFS, and OS relative to nonsmokers was hazards ratio 3.00 (CI:0.75-13.16; P Z 0.121), 5.10 (CI:0.95-36.7; P Z 0.058), and 4.68 (CI:1.02-29.0; P Z 0.047) respectively. For patients with 21 or over pack-years smoking history, the impact on pelvic control, DFS, and OS was hazards ratio 5.66 (CI:1.70-
Volume 90 Number 1S Supplement 2014 21.18; P Z 0.004), 6.98 (CI: 1.54-42.2; P Z 0.011), and 4.30 (CI:0.7926.8; P Z 0.090) respectively. The impact of recreational drug use during treatment on pelvic control, DFS and OS was hazards ratio 1.50 (CI:0.365.36; P Z 0.550), 1.44 (CI: 0.30-6.11; P Z 0.625), and 41.89 (CI:0.379.17; P Z 0.26) respectively. Conclusions: Our data suggests that heavy alcohol use and smoking both increase the risk of cancer recurrence and mortality in patients with locally advanced cervical cancer. Concerted efforts should be aimed at smoking cessation and preventing alcohol abuse to promote survival after definitive therapy in cervical cancer patients. Author Disclosure: J. Lim: None. B. Durbin-Johnson: None. E.A. Alvarez: None. J.S. Mayadev: None.
2697 Prognostic Factors for Toxicity and Survival in Advanced Cervical Cancer Patients Treated With High-Dose-Rate (HDR)-Intracavitary Brachytherapy (ICBT) Combined With Complementary Intensity Modulated Radiation Therapy (IMRT) F. Mei,1 J. Lang,2 Z. Li,3 G. Yin,3 Y. Tan,3 B. Fu,3 Z. Tan,3 B. Wang,4 and P. Wang3; 1Si Chuan Cancer Hospital, Chengdu, China, 2Sichuan Cancer Hospital & Institute, Chengdu, China, 3si Chuan Cancer Hospital, Chengdu, China, 4Si Chuan Cancer Hospital, Chengdu, China Purpose/Objective(s): Our previous study has found this new BT technique could not only improve the target dose coverage, but also maintain the organ at risk (OARs) to a reasonable lower dose for advanced cervical cancer patients. The aim of this study is to explore potentially prognostic factors for survival and toxicity for the first time in the world. Materials/Methods: Sixty-three cervical cancer patients (FIGO stage IIB-IVA) who received ICBT+IMRT were retrospectively analyzed. They all received concomitent chemoradiotherapy. External body radiotherapy was performed with IMRT. A total dose of 45-50Gy was applied in 25 fractions for 5 weeks. The patients underwent 4 fractions BT at 6-6.5Gy/fraction twice a week. The targets and OARs were contoured by the professional physicians according to the GEC ESTRO recommendations. The complementary IMRT plan was delivered immediately after HDR-ICBT, with the applicator in position. D90, D100, V100, Vpd, V2xpd, volumes of target and D0.1cc, D1cc, D2cc, DICRU of OARs were recorded. CTCAE was used to evaluate the acute and late toxicities. The log-rank test and Cox regression mode were used for univariate and multivariate survival prognostic analyses. Logistic regression analysis was used for the toxic prognostic analyses. Results: The 2-year local control rate (LC), distant metastasis free rate and overall survival rate were 94.8%, 84.9% and 91.6%. Both acute and late incidence of proctitis, rectal hemorrhage, small intestine obstruction and cystitis were low, the grade was not exceed G4 (Table 1.). None rectum and bladder perforation has occurred. The mean D90 of GTV, HRCTV and IR-CTV were 93.34.3Gy, 81.82.5Gy, and 72.81.1Gy, and the mean D2cc of bladder, rectum, sigmoid and small intestine were lower than 75Gy. For BT dose, the mean D100 of GTV, HR-CTV and IR-CTV were 32.12.6, 23.22.2 and 14.71.3Gy, the mean V100 of HR-CTV and IR-CTV were 92.9%1.2%, 92.7%1.3%, and the mean DICRU of rectum and bladder were 22.34.6Gy and 18.33.3Gy. The D100 of IRCTV was a prognostic factor for LC in univariate analyses among these factors (p Z 0.041), but it had no statistical significance in multivariate analysis. The DICRU of bladder was a prognostic factor for the late cystitis (p Z 0.045). Conclusions: This promising new technique could achieve the relatively higher local control rate and lower acute and late toxicity incidence. D100 of IR-CTV might be considered as a new potentially prognostic indicator for LC. DICRU of bladder still remained a prognostic factor for late cystitis, and it might have a more important role than D2cc.
Poster Viewing Abstracts S487 Scientific Abstract 2697; Table toxicity
Incidence and grade of acute and late
Toxicity
G1-2(%)
G3(%)
G4-5(%)
Acute proctitis Acute rectal hemorrhage Acute small intestinal obstruction Acute cystitis Late proctitis Late small intestinal obstruction Late cystitis Late rectal hemorrhage
30.2 1.6 1.6 15.9 3.2 1.6 4.8 0
0 0 0 1.6 0 1.6 1.6 0
0 0 0 0 0 0 0 0
Author Disclosure: F. Mei: None. J. Lang: None. Z. Li: None. G. Yin: None. Y. Tan: None. B. Fu: None. Z. Tan: None. B. Wang: None. P. Wang: None.
2698 Prospective Evaluation of Patient Satisfaction Following the Use of Education Materials for Cervical Cancer Brachytherapy D.L. Rash, S. Lentz, L. Tait, A. Michaud, C. Hess, and J. Mayadev; University of California Davis, Sacramento, CA Purpose/Objective(s): There is growing emphasis on incorporating patient education tools in oncology. Preparatory patient education results in greater treatment-related knowledge and less emotional stress at the completion of cancer treatment, possibly as it relates to the development of effective patient coping mechanisms. To improve patient quality of life and promote understanding of intracavitary and interstitial gynecologic brachytherapy, we developed and investigated the role of an illustrated, educational flipbook as a part of the standard consent process. We also assessed the utility of take-home patient education materials on patient satisfaction. Materials/Methods: Female patients greater than 18 years old, with a diagnosis of cervical cancer undergoing definitive chemoradiation were prospectively randomized to undergo informed consent without (Arm A) or with (Arm B) supplemental education materials. These materials consisted of a descriptive, take-home illustrated flipbook outlining the brachytherapy rationale, workflow process, applicators, and perioperative care. Patients in both arms were given a 12 question, 5-point Likert scale-based survey adapted from a previously validated version to measure patient satisfaction with cancer treatment information. A second survey was given to Arm B patients to assess the educational impact of the take-home materials. The mean score from the patient satisfaction surveys were compared between treatment groups using a two-sample t-test. Results: From October 2012 to January 2013, 14 patients were randomized equally between 2 treatment arms. The mean age was 51 years (range 26-75). Twelve patients completed all 14 patient satisfaction survey questions. Using 5-point Likert items the highest possible total score was 60. The mean total patient satisfaction scores standard deviations in Arm A and Arm B were 53.4 6.4 and 58.3 1.6, respectively (P Z 0.12). As the study progressed, the mean total scores in Arm A increased. Overall, patients were satisfied with their ability to make informed decisions regarding their cancer treatment. Analysis of satisfaction subscales showed Arm B patients were more satisfied with educational resources, and the opportunity to ask questions about managing side effects. Patients in both groups were least satisfied with information regarding interactions between prescribed cancer treatment and alternative treatments that patients may pursue independently. Arm B patients responded positively to all metrics of adequacy of the takehome educational materials. Conclusions: Brachytherapy educational take-home materials improve patient satisfaction with information regarding gynecologic brachytherapy.
International Journal of Radiation Oncology Biology Physics
coverage and OAR sparing to pre-treatment metrics can determine the optimal applicator for each patient. Materials/Methods: Retrospective analysis of 4 patients treated for cervical cancer with a 6 cm FSD-style T&O applicator was performed. Each fraction was imaged using CT and fused retrospectively using rigid registration with the pretreatment MR for contouring of the intermediate risk (IR) CTV. The high risk (HR) CTV, bladder, rectum, and sigmoid were contoured on each CT. The dose prescription was 6 Gy/fraction, normalized to Pt. A. Plans were manually optimized if critical structure doses were too high. Four patients were retrospectively replanned using volume-optimization in the original plan, as well as two Utrecht-style applicator (25 and 30 mm ovoids) models. The Utrecht applicators include a T&O as well as needles to optimize cervical and parametrial dose. We optimized for coverage of HR-CTV and IR-CTV while keeping the D2cc of OARs within tolerance. We examined dose-metric differences between the FSD and Utrecht applicators, and differences in the T&O applicator with and without volume optimization of source placement. Coverages of the CTVs were examined, as well as dose metrics to bladder, rectum, and sigmoid. Results: The Utrecht applicators were able to provide better coverage of larger IR-CTVs than the FSD as shown by D90 (Table 1) as well as D100 and V100. Only the larger IR-CTVs were better covered by the Utrecht applicators.
Materials/Methods: The outcomes of 192 patients with locally advanced cervical carcinoma (stage IB2-IIA) , treated with primary chemoradiotherapy approach between January 2006 and May 2013 in our institution were retrospectively analysed. 0ut of 192, 89 patients’ pretreatment blood cell counts could be recorded from electronic database due to loss of information via system changing. Results: Median follow up period was 25 (range,3-100) months. For the all study population overall survival rates for , 2,3 and 5 years were 81%, 67% and 57% respectively. Locoregional control rates for 2,3 and 5 years were 79.6%, 73.7% and 66%,respectively. For the purpose of analysis, 89 patients were divided into 2 groups according to a NLR of 5 or <5. Similarly for a PLR 150 was taken as a threshold for grouping (150 or <150). 2 years overall survival and locoregional control rates for NLR <5 and 5 were 81,7% vs. 65 % (p Z 0,087) and 85% vs. 50 % (p Z 0,032) , respectively. There was no statistically significant difference according to PLR for overall survival (p Z 0,645) and locoregional control (p Z 0,908). Conclusions: There are a few studies in literature investigating systemic inflammatory response role on treatment outcomes for cervical cancer. With small numbers of patient we found pretreatment NLR can be related with locoregional outcome for cervical squamous cell carcinoma and worth to investigate with larger studies. Author Disclosure: E. Karakaya: None. F. Alioglu: None. Y. Guney: None. E. Keven: None. Z. Ozdogan: None. S. Aytac Arslan: None. G. Olcay: None. G. Altinisik Inan: None. A. Dizman: None.
Scientific Abstract 2694; Table
IR-CTV D90 vs Applicator and Loading
IR-CTV volume:
15.8 cc
46.9 cc
88.5cc
146.5 cc
T&O Manual T&O Vol. Opti. 25 mm Utrecht 30 mm Utrecht
102% 95% 103% 102%
85% 82% 88% 90%
36% 60% 76% 78%
47% 67% 77% 78%
Table 1: IR-CTV coverage for manual vs optimized planning of a T&O, as well as a volume-optimized Utrecht applicators. Smaller IRCTVs show no benefit, while larger IR-CTVs show improved coverage. The OAR metrics were not affected by varying the applicator or planning method. Conclusions: This study shows use of Utrecht-style applicators for the treatment of cervical brachytherapy can lead to better dosimetric coverage of the larger volume IR-CTVs. Since the IR-CTV can be pre-contoured from MR, a physician can use the IR-CTV to decide whether to use a traditional FSD or Utrecht applicator. The advantages of Utrecht applicators must be balanced against the increased complexity of the treatment as well use of anesthesia for each insertion. Use of higher dose per fraction could alleviate these concerns. Author Disclosure: R.C. Best: None. P. Petric: None. J. Morrison: None. T.N. Showalter: None. B. Libby: None.
2695 Is Pretreatment Neutrophil to Lymphosite Ratio a Predictive Factor for Cervical Cancer Control? E. Karakaya, F. Alioglu, Y. Guney, E. Keven, Z. Ozdogan, S. Aytac Arslan, G. Olcay, G. Altinisik Inan, and A. Dizman; Ankara Oncology Hospital, Ankara, Turkey Purpose/Objective(s): Concurrent chemoradiotherapy (CRT) is a standart approach for patients with locally advanced cervical carcinoma.In various cancer types, a few inflammatory biomarkers were thought to be prognostic for both survival and locoregional control. The purpose of the current study was to investigate whether the host systemic inflammatory response evaluated with neutrophile to lymphosite ratio (NLR) and platelet to lymphosite ratio (PLR) can be prognostic factor for cervical cancer control or not.
2696 The Impact of Substance Use on Incidence and Survival in Locally Advanced Cervical Cancer Treated With Radiation Therapy J. Lim,1 B. Durbin-Johnson,2 E.A. Alvarez,1 and J.S. Mayadev1; 1UC Davis School of Medicine, Sacramento, CA, 2UC Davis School of Public Health, Sacramento, CA Purpose/Objective(s): We examined the effects of substance abuse with alcohol, tobacco, and recreational drugs on cervical cancer recurrence and mortality in patients undergoing definitive treatment of locally advanced cervical cancer with radiation. Materials/Methods: Between July 2007 and September 2013, 96 consecutive patients received definitive treatment of locally advanced cervical cancer with external beam radiation therapy (EBRT) and chemotherapy, followed by brachytherapy. A retrospective chart review was conducted to determine patient, treatment and tumor characteristics. Heavy alcohol use was defined based on the Centers for Disease Control and Prevention (CDC) definition of greater than one drink per day. Smoking habits were quantified based on pack-years. Recreational drugs included cocaine, heroin, methamphetamines, and marijuana. Time to event endpoints (overall survival [OS], disease-free survival [DFS], and pelvic control) were analyzed by patient and disease characteristics using multivariable Cox proportional hazards models. Results: The study population consisted of 96 patients with an average age of 54.8 years (range, 27-91 years). Alcohol history included 10 (10.5%) patients who met the CDC criteria for heavy alcohol use. Smoking history included 51 (53.1%) patients with no history of smoking, 20 (20.8%) patients with one to twenty pack-years, and 25 (26%) patients with twenty-one or more pack-years. For drug use, 6 (6.3%) of the patients were using recreational drug at time of treatment. The impact of heavy alcohol use on pelvic control, DFS and OS was hazards ratio 3.30 (CI:1.13-8.28; P Z 0.031), 2.60 (CI: 0.69-7.65; P Z 0.150), and 6.31 (CI:1.73-21.1; P Z 0.007) respectively. The impact of 1 to 20 packyears smoking history on pelvic control, DFS, and OS relative to nonsmokers was hazards ratio 3.00 (CI:0.75-13.16; P Z 0.121), 5.10 (CI:0.95-36.7; P Z 0.058), and 4.68 (CI:1.02-29.0; P Z 0.047) respectively. For patients with 21 or over pack-years smoking history, the impact on pelvic control, DFS, and OS was hazards ratio 5.66 (CI:1.70-
Volume 90 Number 1S Supplement 2014 21.18; P Z 0.004), 6.98 (CI: 1.54-42.2; P Z 0.011), and 4.30 (CI:0.7926.8; P Z 0.090) respectively. The impact of recreational drug use during treatment on pelvic control, DFS and OS was hazards ratio 1.50 (CI:0.365.36; P Z 0.550), 1.44 (CI: 0.30-6.11; P Z 0.625), and 41.89 (CI:0.379.17; P Z 0.26) respectively. Conclusions: Our data suggests that heavy alcohol use and smoking both increase the risk of cancer recurrence and mortality in patients with locally advanced cervical cancer. Concerted efforts should be aimed at smoking cessation and preventing alcohol abuse to promote survival after definitive therapy in cervical cancer patients. Author Disclosure: J. Lim: None. B. Durbin-Johnson: None. E.A. Alvarez: None. J.S. Mayadev: None.
2697 Prognostic Factors for Toxicity and Survival in Advanced Cervical Cancer Patients Treated With High-Dose-Rate (HDR)-Intracavitary Brachytherapy (ICBT) Combined With Complementary Intensity Modulated Radiation Therapy (IMRT) F. Mei,1 J. Lang,2 Z. Li,3 G. Yin,3 Y. Tan,3 B. Fu,3 Z. Tan,3 B. Wang,4 and P. Wang3; 1Si Chuan Cancer Hospital, Chengdu, China, 2Sichuan Cancer Hospital & Institute, Chengdu, China, 3si Chuan Cancer Hospital, Chengdu, China, 4Si Chuan Cancer Hospital, Chengdu, China Purpose/Objective(s): Our previous study has found this new BT technique could not only improve the target dose coverage, but also maintain the organ at risk (OARs) to a reasonable lower dose for advanced cervical cancer patients. The aim of this study is to explore potentially prognostic factors for survival and toxicity for the first time in the world. Materials/Methods: Sixty-three cervical cancer patients (FIGO stage IIB-IVA) who received ICBT+IMRT were retrospectively analyzed. They all received concomitent chemoradiotherapy. External body radiotherapy was performed with IMRT. A total dose of 45-50Gy was applied in 25 fractions for 5 weeks. The patients underwent 4 fractions BT at 6-6.5Gy/fraction twice a week. The targets and OARs were contoured by the professional physicians according to the GEC ESTRO recommendations. The complementary IMRT plan was delivered immediately after HDR-ICBT, with the applicator in position. D90, D100, V100, Vpd, V2xpd, volumes of target and D0.1cc, D1cc, D2cc, DICRU of OARs were recorded. CTCAE was used to evaluate the acute and late toxicities. The log-rank test and Cox regression mode were used for univariate and multivariate survival prognostic analyses. Logistic regression analysis was used for the toxic prognostic analyses. Results: The 2-year local control rate (LC), distant metastasis free rate and overall survival rate were 94.8%, 84.9% and 91.6%. Both acute and late incidence of proctitis, rectal hemorrhage, small intestine obstruction and cystitis were low, the grade was not exceed G4 (Table 1.). None rectum and bladder perforation has occurred. The mean D90 of GTV, HRCTV and IR-CTV were 93.34.3Gy, 81.82.5Gy, and 72.81.1Gy, and the mean D2cc of bladder, rectum, sigmoid and small intestine were lower than 75Gy. For BT dose, the mean D100 of GTV, HR-CTV and IR-CTV were 32.12.6, 23.22.2 and 14.71.3Gy, the mean V100 of HR-CTV and IR-CTV were 92.9%1.2%, 92.7%1.3%, and the mean DICRU of rectum and bladder were 22.34.6Gy and 18.33.3Gy. The D100 of IRCTV was a prognostic factor for LC in univariate analyses among these factors (p Z 0.041), but it had no statistical significance in multivariate analysis. The DICRU of bladder was a prognostic factor for the late cystitis (p Z 0.045). Conclusions: This promising new technique could achieve the relatively higher local control rate and lower acute and late toxicity incidence. D100 of IR-CTV might be considered as a new potentially prognostic indicator for LC. DICRU of bladder still remained a prognostic factor for late cystitis, and it might have a more important role than D2cc.
Poster Viewing Abstracts S487 Scientific Abstract 2697; Table toxicity
Incidence and grade of acute and late
Toxicity
G1-2(%)
G3(%)
G4-5(%)
Acute proctitis Acute rectal hemorrhage Acute small intestinal obstruction Acute cystitis Late proctitis Late small intestinal obstruction Late cystitis Late rectal hemorrhage
30.2 1.6 1.6 15.9 3.2 1.6 4.8 0
0 0 0 1.6 0 1.6 1.6 0
0 0 0 0 0 0 0 0
Author Disclosure: F. Mei: None. J. Lang: None. Z. Li: None. G. Yin: None. Y. Tan: None. B. Fu: None. Z. Tan: None. B. Wang: None. P. Wang: None.
2698 Prospective Evaluation of Patient Satisfaction Following the Use of Education Materials for Cervical Cancer Brachytherapy D.L. Rash, S. Lentz, L. Tait, A. Michaud, C. Hess, and J. Mayadev; University of California Davis, Sacramento, CA Purpose/Objective(s): There is growing emphasis on incorporating patient education tools in oncology. Preparatory patient education results in greater treatment-related knowledge and less emotional stress at the completion of cancer treatment, possibly as it relates to the development of effective patient coping mechanisms. To improve patient quality of life and promote understanding of intracavitary and interstitial gynecologic brachytherapy, we developed and investigated the role of an illustrated, educational flipbook as a part of the standard consent process. We also assessed the utility of take-home patient education materials on patient satisfaction. Materials/Methods: Female patients greater than 18 years old, with a diagnosis of cervical cancer undergoing definitive chemoradiation were prospectively randomized to undergo informed consent without (Arm A) or with (Arm B) supplemental education materials. These materials consisted of a descriptive, take-home illustrated flipbook outlining the brachytherapy rationale, workflow process, applicators, and perioperative care. Patients in both arms were given a 12 question, 5-point Likert scale-based survey adapted from a previously validated version to measure patient satisfaction with cancer treatment information. A second survey was given to Arm B patients to assess the educational impact of the take-home materials. The mean score from the patient satisfaction surveys were compared between treatment groups using a two-sample t-test. Results: From October 2012 to January 2013, 14 patients were randomized equally between 2 treatment arms. The mean age was 51 years (range 26-75). Twelve patients completed all 14 patient satisfaction survey questions. Using 5-point Likert items the highest possible total score was 60. The mean total patient satisfaction scores standard deviations in Arm A and Arm B were 53.4 6.4 and 58.3 1.6, respectively (P Z 0.12). As the study progressed, the mean total scores in Arm A increased. Overall, patients were satisfied with their ability to make informed decisions regarding their cancer treatment. Analysis of satisfaction subscales showed Arm B patients were more satisfied with educational resources, and the opportunity to ask questions about managing side effects. Patients in both groups were least satisfied with information regarding interactions between prescribed cancer treatment and alternative treatments that patients may pursue independently. Arm B patients responded positively to all metrics of adequacy of the takehome educational materials. Conclusions: Brachytherapy educational take-home materials improve patient satisfaction with information regarding gynecologic brachytherapy.