To Compare Quality of Life (QOL) of Patients with Early Stage Nasopharyngeal Carcinoma (NPC) Treated With Intensity Modified Intensity Modulated Radiation Therapy (IMRT) Versus Conventional Radiotherapy

Proceedings of the 49th Annual ASTRO Meeting

2692

A Quality of Life (QOL) Asessment of Genitourinary Toxicity at Three Years for Prostate Cancer Patients Undergoing Different Radiation Treatment Modalities

K. A. Saputo1, A. Calcaterra2, M. Balasubramaniam1, G. Boyea1, C. Flynn1, M. Wallace1, A. Martinez1, M. Ghilezan1 1

William Beaumont Hospital, Royal Oak, MI, 2William Beaumont Hospital, Troy, MI

Purpose/Objective(s): To assess and compare GU toxicities (sexual excluded) of prostate cancer patients receiving external beam radiation therapy (EBRT) or brachytherapy (BRACHY) using a validated QOL questionnaire. Materials/Methods: Between November 2001 and February 2004, 105 patients, receiving EBRT, high dose rate (HDR) Alone, or Palladium (Pd) were included in the study and completed the 36-month QOL questionnaire addressing GU function using the International Prostate Symptom Score. Patients filled out a QOL questionnaire prior to treatment, at treatment completion (EBRT) or two weeks post BRACHY, and at 6 months, 12 months, 24 months, and 36 months post treatment. The responses were analyzed for significance or trends in QOL issues comparing treatment modality and time intervals using the Generalized Estimating Equation (GEE) approach. Results: There were statistically significant GU findings for both time and different treatment modalities. When looking at Incomplete Emptying, Frequency, Intermittency, Urgency and Weak Stream, patients who received HDR alone had the best response followed by EBRT and then Pd (p = 0.0324, 0.0064, 0.0137, 0.038, 0.0279 respectively). For the above variables, this trend was consistent over all time points and patients did the worst at treatment completion (p = \0.0001). Patients who received HDR alone were the least affected. For Nocturia, responses were significantly affected by time and treatment modality. HDR Alone again did the best, however, was followed by Pd and then EBRT (p = 0.042). This trend was consistent over all treatment times. For Straining and QOL-GU symptoms, time points but not treatment modality significantly affected responses. Patients had the worst responses at treatment completion and the best responses at three years (p = \0.0001). Conclusions: Treatment modality and follow up time points all significantly affected Incomplete Emptying, Frequency, Intermittency, Urgency, Weak Stream and Nocturia. HDR Alone did the best in all these domains. Straining and QOLGU were significant for time but not treatment modality, again with HDR patients doing better. When looking at overall GU QOL using the IPSS score system, it can be concluded that at 3 years HDR is still doing the best being followed by EBRT and then Pd treated patients. Author Disclosure: K.A. Saputo, None; A. Calcaterra, None; M. Balasubramaniam, None; G. Boyea, None; C. Flynn, None; M. Wallace, None; A. Martinez, None; M. Ghilezan, None.

2693

Analyzing the Effects the Quality of the Images Contained in a CT Data Set has on the Accuracy of an Automated Fusion Computer Program for the Purposes of Image-Guided Radiation Therapy (IGRT)

S. A. Merrick, J. Wong Morristown Memorial Hospital, Morristown, NJ Purpose/Objective(s): To determine if the quality of images taken from different technologically advanced CT scanners decreases a computer’s ability to accurately determine daily organ movement using an automated fusion process during IGRT. Materials/Methods: A total of 70 CT data sets were taken from 10 prostate cancer patients during the course of IMRT treatment with IGRT. The two CT scanner models used were a 1997 Siemens Somatom Express and a 2006 Siemens Sensation (Primatom). The IGRT process uses the Siemens Adaptive Targeting software, which possesses an automated and manual fusion tool that aligns a planning CT set with daily treatment CT sets. The initial planning CT is obtained for the purposes of creating the physics treatment plan. The daily treatment CT scans are for obtaining precise prostate locations just prior to the radiation treatments so that interfractional organ movements can be measured and corrected. The Adaptive Targeting program first performs an initial automatic fusion of the two CT data sets. Next, the physics operator decides the final precise organ shifts using a manual registration tool. To test the accuracy of the computer’s automated fusion, two different methods were analyzed on the same set of patients. The first method uses an initial planning CT from the older Somatom CT and fuses it with 5 different daily treatment CT sets from the newer Sensation model. The resulting shifts from the automated fusion were then compared to the final organ shift results obtained from the manual registration. For the second method, this process was repeated in the same manner, except the initial planning CT was also taken from the newer Sensation scanner and fused to the same 5 daily treatment CT sets. Results: On average, the first method differed from the final precise calculated organ shifts by 1.32 mm in the right/left direction, 4.47 mm in the superior/inferior direction, and 8.47 mm in the anterior/posterior direction. The average difference that the second method differed from the final calculated organ shifts was 0.40 mm in the right/left direction, 1.51 mm in the superior/inferior direction, and 2.67 mm in the anterior/posterior direction. Conclusions: The second method’s results were significantly closer to the true organ shifts in the anterior/posterior directions by an average of 5.80 mm. Therefore, the automated process was more accurate in determining organ movement when it used CT data sets exclusively from the newer CT scanner with higher quality images. In addition, anterior/posterior movement is the most crucial aspect for prostate treatment, since the rectum is very radiosensitive and planning margins on the rectal side of the prostate are minimal. This study’s results suggest that the importance of the IGRT process in the future should not only consider the computer program’s ability, but also the quality of images being used within the process. Author Disclosure: S.A. Merrick, None; J. Wong, None.

2694

To Compare Quality of Life (QOL) of Patients with Early Stage Nasopharyngeal Carcinoma (NPC) Treated With Intensity Modified Intensity Modulated Radiation Therapy (IMRT) Versus Conventional Radiotherapy

G. Zhu, X. Wang, Y. Wu, C. Hu Cancer Hospital of Fudan University, Shanghai, China Purpose/Objective(s): To assess and compare the Quality of Life (QOL) of patients with early stage nasopharyngeal carcinoma (NPC) treated with intensity modulated radiation therapy (IMRT) versus conventional radiotherapy (CRT) with EORTC C30 and H&N 35 modules.

S585

I. J. Radiation Oncology d Biology d Physics

S586

Volume 69, Number 3, Supplement, 2007

Materials/Methods: The QOL of patients with AJCC (2002) stage I/II accrued from our department comparing IMRT versus CRT were assessed with EORTC C30 and H&N 35 modules questionnaire. The questionnaire was administered at the time of diagnosis, the end of radiotherapy, 3 months, 6 months and 12 months after radiotherapy. Each patient’s QOL scores including function and symptoms were calculated as instructed in EORTC C30 and H&N 35 modules scoring manual. 66 Gy/30Fx was prescribed to the GTV for the patients who had received IMRT. 70 Gy/35Fx was prescribed to the isocenter for the CRT group patients. Results: From January 2005 to June 2006 38 patients were available to enter this study (IMRT = 21, CRT = 17). After one year follow up, there was no any treatment failure detected. No significant difference between the baseline QOL scores of the two groups was observed. The changing pattern of QOL scores with time was similar for both groups. The IMRT group showed severe deterioration of QOL at the end of radiotherapy, even worse than the CRT group. Partial recovery was showed in both groups at 3 months end of the treatment. The better function and symptoms subscale score were found in IMRT group at 6 months and 12 months, especially for dry mouth (p = 0.02). Conclusions: The patients with early stage NPC treated with IMRT had rapider recovery of QOL when compared with patients treated by CRT alone. Author Disclosure: G. Zhu, None; X. Wang, None; Y. Wu, None; C. Hu, None.

2695

Computerized Symptom and Quality of Life Self-Reporting for Radiation Oncology Patients: Identifying Clinically Significant Symptoms Before and During Therapy

J. Keam1, M. Austin-Seymour1, B. Halpenny2, N. Bush3, J. Fann1,3, B. Lober1,2, S. Wolpin1, D. Berry3,2 1 3

University of Washington Medical Center, Seattle, WA, 2University of Washington School of Nursing, Seattle, WA, Fred Hutchinson Cancer Research Center, Seattle, WA

Purpose/Objective(s): For cancer patients, inadequate symptom assessment may profoundly impact quality of life (QOL), compliance, and outcomes. Studies suggest that although oncologists are attentive to side effects, communication tends to be clinicianoriented with frequent interruptions and closed-ended questions, which may prevent full symptom reporting. Studies indicate that computerized self-reporting tools can enhance communication. The use of wireless, touchscreen notebook computers by cancer patients to score symptom and QOL measures is being investigated at the University of Washington/Seattle Cancer Care Alliance (UW/SCCA). This study sought to identify clinically significant symptoms and changes in symptom scores reported by radiation therapy (RT) patients at the time of initial consultation (T1) and during therapy (T2), using a web-based, electronic self-report assessment program for cancer (ESRA-C). Materials/Methods: A total of 113 RT patients included in this analysis completed ESRA-C at T1 and T2, from 2005–2007. The computerized surveys were completed in clinic before visits. Technical feasibility, physician usability, and patient acceptability of ESRA-C at UW/SCCA RT clinics amidst a diverse patient demographic have been previously validated. ESRA-C includes demographic questions and validated surveys: Symptom Distress Scale (13-item, cancer specific assessment using 5-point Likert scales), Pain Intensity Numerical Score (PINS, 0–10 scale), Patient Health Questionnaire-9 (PHQ-9, a DSM-IV-based depression screen). Threshold scores for clinical intervention were: SDS $3 (moderate to serious distress), PINS $5, and PHQ-9 $10 (moderate to severe depression). A total of 54 patients triggered and completed the entire PHQ-9 module at T1 and T2. T-tests were used to compare changes in mean scores from T1 to T2. McNemar’s tests were used to assess differences between proportions below or at/above threshold at T1 and T2. Results: Patient characteristics included: median age = 53 years (range 20–89), 43% male, 57% female, 93% Caucasian, 69% with post-secondary education. Most common cancer diagnoses were: head/neck 24%, breast 23%, prostate 10%. Median number of days between T1 and T2 was 48. Frequencies of symptom scores at or above threshold reported at T1 and T2 were, respectively: sexual activity/interest impact (44% vs. 51%), pain frequency (39% vs. 38%), fatigue (34% vs. 45%), insomnia (31% vs. 31%), appetite change (15% vs. 28%), nausea (4% vs. 18%), PINS $5 (10% vs. 13%), depression (23% vs. 35%). When comparing mean scores for these symptoms, there were significant differences between T1 and T2 for nausea (p \ 0.001), appetite (p = 0.003), and fatigue (p = 0.018). McNemar’s tests showed significant differences in proportions of patients reporting at/above threshold at T1 vs. T2 for nausea (p = 0.001) and appetite (p = 0.021). Conclusions: Computerized self-assessment is a novel way for patients to fully report a comprehensive spectrum of symptoms, subsequently improving clinical care and quality of life. It can identify prevalent conditions that may not be typically addressed, such as depression and sexual dysfunction. It can efficiently identify symptoms that are changing in severity over time, reaching a critical threshold, or being inadequately alleviated. Author Disclosure: J. Keam, None; M. Austin-Seymour, None; B. Halpenny, None; N. Bush, None; J. Fann, None; B. Lober, None; S. Wolpin, None; D. Berry, None.

2696

Lithium-Mediated Neuroprotection During Cranial Irradiation: A Phase I Trial

E. S. Yang, B. Lu, D. E. Hallahan Vanderbilt University Medical Center, Nashville, TN Purpose/Objective(s): Cranial irradiation often results in long-term neurocognitive deficiencies, especially in children. These deficits have been associated with radiation-induced hippocampal damage. GSK3 enzyme inhibition leads to neuroprotection through the inhibition of program cell death. Preclinical studies show that lithium inhibits GSK3 and blocks radiation-induced apoptosis in hippocampal neurons without protecting cancer cells. Lithium also improved neurocognitive function in mice treated with whole brain irradiation. These data suggest the potential use of lithium to attenuate radiation-induced cognitive defects to improve the quality of life in cancer survivors. To determine whether lithium is tolerated in patients treated with whole brain irradiation, we studied patients with brain metastases receiving lithium prior to and during radiation. We present a pilot study to evaluate the feasibility of neoadjuvant and concurrent lithium treatment in patients receiving whole brain radiotherapy. Materials/Methods: Patients with histologically confirmed extracranial primary malignancy and associated brain metastases were given lithium treatment one week prior to as well as during whole brain radiotherapy. Dose of lithium was started at one-half