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Total eye plaque activity (U) as a prognostic factor of visual outcome of uveal melanoma patients treated with custom-made Nag Iodine-125 eye plaque
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Abstracts / Brachytherapy 6 (2007) 77e118
intent was curative in 103 patients and as boost therapy in 20 patients. Catheters were implanted at the time of lumpectomy in 27 patients and under US guidance post lumpectomy in 96 patients. All patients were treated with prophylactic antibiotics. In 4 cases the MS was removed prior to completion of therapy (1 with MS nonconformity, 2 with unexpected adverse pathologic findings and 1 with unrelated medical problems). The remaining 119 patients represent the study group. Seromas were observed in 28 patients (6 in the boost group and 22 in the curative group). Curative cases received 34 Gy in 10 fractions and boost patients received 10 Gy in two fractions prescribed to 1 cm from the MS surface using Ir-192 HDR brachytherapy. Patients were assessed by a radiation oncologist at week 4 and every 6 months thereafter. Factors possibly related to the development of seromas were analyzed in all patients including total time MS was in place, use of chemotherapy, BMI, breast size as measured by bra cup size and concomitant use of hypertensive medications (HTN meds). Logistic regression was used to determine significant variables for seroma development. Results: Median followup time was 20 months. The median patient age was 60 years with a range of 41e83. Mean tumor size was 1.4 cm with a range of 0.1e3.7 cm. Pathologic staging was T0 in 1 patient, T1 in 109 patients and T2 in 13 patients. Total time of balloon placement ranged from 2 to 23 days with a median of 8 in non-seroma patients and 1e14 days with a median of 9 in seroma patients. Chemotherapy was used in 28 patients. BMI index ranged from 20.1 to 52.5 with a median of 29. Breast size was A cup in 1, B cup in 21, C cup in 41 and D cup in 56. In 71 patients with no history of use of HTN meds, 12 seromas were observed (16.9%), while in 48 patients with a history of use of HTN meds, 16 seromas were observed for a rate of 33.3% (p 5 0.04). No variables other than use of HTN meds were statistically significant for seroma formation. Conclusions: The rate of seroma formation for patients using HTN meds was 33.3% as compared to 16.9% for patients not using HTN meds. The potential risk of seroma formation in patients using HTN meds should be considered when offering MammoSiteÔ brachytherapy, and warrants further clinical study. Drs. Tomberlin and Brian are participating in the MammoSiteÔ Registry trial and receive nominal compensation for participation. This money is donated to The Texas Chrysalis Foundation, a 501c corporation for education and support of breast cancer patients.
MISCELLANEOUS PAPER SESSION Sunday April 29, 2007 2:30 PMe3:00 PM OR-12 Presentation Time: 2:30 PM Total eye plaque activity (U) as a prognostic factor of visual outcome of uveal melanoma patients treated with custom-made Nag Iodine125 eye plaque Moataz N. El-Ghamry, M.D.1 Subir Nag, M.D.2 Mohammed A. Rahman, Ph.D.4 Robert Chamber, D.O.3 Fred Davidorf, M.D.3 1Radiation Medicine, Ohio State University, Columbus, OH; 2Radiation Oncology, Kaiser Permanente Healthcare, Santa Clara, CA; 3Ophthalmology, Ohio State University, Columbus, OH; 4Information Technology, Ohio State University, Columbus, OH. Purpose: To evaluate the role of total plaque activity (U) on the visual outcome of uveal melanoma patients treated with Nag Iodine-125 (I-125) eye plaque. Methods and Materials: Between November 1989 and January 2004, 119 patients with uveal melanomas were treated with custom-made Nag I-125 eye plaque; mean followup was 67 months. The median activity of the I125 seeds was 66 U; the dose rate was 89 cGy/hour; duration of therapy was 95 hours, and prescription dose was 8500 cGy. Statistical analysis was performed using SPSS version 14.0. Results: Correlation analysis was performed, and significant positive correlations between plaque activity [U] and tumor dimensions (maximum diameter [d], height [h] and width [w] in mm) were observed. The results were also confirmed by a multiple linear regression analysis, which
showed that tumor dimensions were significant independent variables in predicting plaque activity. The plaque activity could be predicted by the formula: U 5 1.399 + 5.123d + 9.259h 2.2842w. There was a positive correlation between the predicted activity and the actual activity (R sq. linear 5 0.55). The rate of preservation of intact vision at 5 years was 81% for patients with tumors treated with !60 U activity and 59% for those treated with O60 U (p 5 NS). For those with tumors with diameters O9 mm treated with !60 U, vision preservation at 5 years was 100%, versus 55% for those treated with O60 U (p 5 0.011). The rate of preservation of useful vision at 5 years was 80% for patients with no retinopathy versus 53% for those in whom it developed (p 5 0.003). The rate of 5-year survival with intact vision for patients treated with !60 U who did not develop retinopathy was 93% as compared to 60% for those treated with O60 U and in whom retinopathy developed (p 5 0.01). Similarly, survival with intact vision at 5 years was 32% for patients with tumors located !4 mm from the optic disc and treated with O60 U compared to 88% for those with tumors O4 mm from the optic disc and treated with !60 U (p 5 0.008). Patients with plaque areas O100 mm2 with activity !60 U had a 5-year intact survival rate of 100% compared to 54% for those with treated with O60 U (p 5 0.046). Local control was achieved in 97.5% of patients. Conclusions: I-125 Nag plaque brachytherapy achieves good local control and survival with intact vision. Higher plaque activity is a poor visual prognostic factor when it is associated with larger tumor diameter, close proximity to the optic disc or macula, and larger plaque area.
OR-13 Presentation Time: 2:40 PM Penile brachytherapy: Results for 60 patients Juanita M. Crook, M.D.1 Laval Grimard, M.D.2 Bernd Esche, M.D.2 Gregory Pond, M.Sc.3 1Radiation Oncology, Princess Margaret Hospital, Toronto, ON, Canada; 2Radiation Oncology, Ottawa Regional Cancer Center, Ottawa, ON, Canada; 3Biostatistics, Princess Margaret Hospital, Toronto, ON, Canada. Purpose: Squamous cell carcinoma (SCC) of the penis is an uncommon but psychologically devastating malignancy. At the Ottawa Regional Cancer Center and the Princess Margaret Hospital in Toronto, brachytherapy has been used as the treatment of choice for penile preservation in T1 and T2 tumors. Methods and Materials: From 09/89 to 09/06, 60 men had brachytherapy for penile SCC. Mean age was 58 years (range 22e93). 53% of tumors were T1, 32% T2 and 8% T3, while 3% were in situ and 3% Tx. 35% were well differentiated, 45% moderately and 2% poorly, while 17% were unspecified and one tumor was verrucous. All tumors in Toronto had PDR brachytherapy (n 5 34) while those in Ottawa had either Iridium wire (n 5 22) or seeds (n 5 4). Six patients had a single plane implant using a plastic tube technique while all others had a volume implant using predrilled Plexi-glass templates and 2 or 3 parallel planes of needles (median 6). Mean needle spacing was 14 mm (range 10e18), mean dose rate 65 cGy/hr (range 33e160) and mean duration 98.8 hours (range 21e188). PDR dose rates were 50 cGy/hre61.2 cGy/hr with no correction in total dose which was 60 Gy in all cases. Results: Median followup is 47.6 months (range 0.2e140). At 5 years, actuarial overall survival is 81.0%, cause specific survival 90.2%. Six men died of penile cancer, and 6 died of other causes with no evidence of recurrence. Actuarial rate of never having experienced any type of failure at 5 years is 70.0% and for local failure (LF) is 88.3%. All 6 LF were successfully salvaged by surgery; 2 other penectomies were for necrosis. The soft tissue necrosis rate is 13% and the urethral stenosis rate 10%. Six of 12 regional failures (RF) were salvaged by lymph node dissection external radiation. All 6 RF with concurrent or subsequent DF have died of disease. 51 of 60 men had an intact and tumor free penis at last followup or death. The actuarial penile preservation rate at 5 years is 87.1%. Conclusions: Brachytherapy is an effective treatment for T1, T2 and selected T3 SCC of the penis. Close followup is mandatory as local failures and many regional failures can be salvaged by surgery.
Abstracts / Brachytherapy 6 (2007) 77e118
intent was curative in 103 patients and as boost therapy in 20 patients. Catheters were implanted at the time of lumpectomy in 27 patients and under US guidance post lumpectomy in 96 patients. All patients were treated with prophylactic antibiotics. In 4 cases the MS was removed prior to completion of therapy (1 with MS nonconformity, 2 with unexpected adverse pathologic findings and 1 with unrelated medical problems). The remaining 119 patients represent the study group. Seromas were observed in 28 patients (6 in the boost group and 22 in the curative group). Curative cases received 34 Gy in 10 fractions and boost patients received 10 Gy in two fractions prescribed to 1 cm from the MS surface using Ir-192 HDR brachytherapy. Patients were assessed by a radiation oncologist at week 4 and every 6 months thereafter. Factors possibly related to the development of seromas were analyzed in all patients including total time MS was in place, use of chemotherapy, BMI, breast size as measured by bra cup size and concomitant use of hypertensive medications (HTN meds). Logistic regression was used to determine significant variables for seroma development. Results: Median followup time was 20 months. The median patient age was 60 years with a range of 41e83. Mean tumor size was 1.4 cm with a range of 0.1e3.7 cm. Pathologic staging was T0 in 1 patient, T1 in 109 patients and T2 in 13 patients. Total time of balloon placement ranged from 2 to 23 days with a median of 8 in non-seroma patients and 1e14 days with a median of 9 in seroma patients. Chemotherapy was used in 28 patients. BMI index ranged from 20.1 to 52.5 with a median of 29. Breast size was A cup in 1, B cup in 21, C cup in 41 and D cup in 56. In 71 patients with no history of use of HTN meds, 12 seromas were observed (16.9%), while in 48 patients with a history of use of HTN meds, 16 seromas were observed for a rate of 33.3% (p 5 0.04). No variables other than use of HTN meds were statistically significant for seroma formation. Conclusions: The rate of seroma formation for patients using HTN meds was 33.3% as compared to 16.9% for patients not using HTN meds. The potential risk of seroma formation in patients using HTN meds should be considered when offering MammoSiteÔ brachytherapy, and warrants further clinical study. Drs. Tomberlin and Brian are participating in the MammoSiteÔ Registry trial and receive nominal compensation for participation. This money is donated to The Texas Chrysalis Foundation, a 501c corporation for education and support of breast cancer patients.
MISCELLANEOUS PAPER SESSION Sunday April 29, 2007 2:30 PMe3:00 PM OR-12 Presentation Time: 2:30 PM Total eye plaque activity (U) as a prognostic factor of visual outcome of uveal melanoma patients treated with custom-made Nag Iodine125 eye plaque Moataz N. El-Ghamry, M.D.1 Subir Nag, M.D.2 Mohammed A. Rahman, Ph.D.4 Robert Chamber, D.O.3 Fred Davidorf, M.D.3 1Radiation Medicine, Ohio State University, Columbus, OH; 2Radiation Oncology, Kaiser Permanente Healthcare, Santa Clara, CA; 3Ophthalmology, Ohio State University, Columbus, OH; 4Information Technology, Ohio State University, Columbus, OH. Purpose: To evaluate the role of total plaque activity (U) on the visual outcome of uveal melanoma patients treated with Nag Iodine-125 (I-125) eye plaque. Methods and Materials: Between November 1989 and January 2004, 119 patients with uveal melanomas were treated with custom-made Nag I-125 eye plaque; mean followup was 67 months. The median activity of the I125 seeds was 66 U; the dose rate was 89 cGy/hour; duration of therapy was 95 hours, and prescription dose was 8500 cGy. Statistical analysis was performed using SPSS version 14.0. Results: Correlation analysis was performed, and significant positive correlations between plaque activity [U] and tumor dimensions (maximum diameter [d], height [h] and width [w] in mm) were observed. The results were also confirmed by a multiple linear regression analysis, which
showed that tumor dimensions were significant independent variables in predicting plaque activity. The plaque activity could be predicted by the formula: U 5 1.399 + 5.123d + 9.259h 2.2842w. There was a positive correlation between the predicted activity and the actual activity (R sq. linear 5 0.55). The rate of preservation of intact vision at 5 years was 81% for patients with tumors treated with !60 U activity and 59% for those treated with O60 U (p 5 NS). For those with tumors with diameters O9 mm treated with !60 U, vision preservation at 5 years was 100%, versus 55% for those treated with O60 U (p 5 0.011). The rate of preservation of useful vision at 5 years was 80% for patients with no retinopathy versus 53% for those in whom it developed (p 5 0.003). The rate of 5-year survival with intact vision for patients treated with !60 U who did not develop retinopathy was 93% as compared to 60% for those treated with O60 U and in whom retinopathy developed (p 5 0.01). Similarly, survival with intact vision at 5 years was 32% for patients with tumors located !4 mm from the optic disc and treated with O60 U compared to 88% for those with tumors O4 mm from the optic disc and treated with !60 U (p 5 0.008). Patients with plaque areas O100 mm2 with activity !60 U had a 5-year intact survival rate of 100% compared to 54% for those with treated with O60 U (p 5 0.046). Local control was achieved in 97.5% of patients. Conclusions: I-125 Nag plaque brachytherapy achieves good local control and survival with intact vision. Higher plaque activity is a poor visual prognostic factor when it is associated with larger tumor diameter, close proximity to the optic disc or macula, and larger plaque area.
OR-13 Presentation Time: 2:40 PM Penile brachytherapy: Results for 60 patients Juanita M. Crook, M.D.1 Laval Grimard, M.D.2 Bernd Esche, M.D.2 Gregory Pond, M.Sc.3 1Radiation Oncology, Princess Margaret Hospital, Toronto, ON, Canada; 2Radiation Oncology, Ottawa Regional Cancer Center, Ottawa, ON, Canada; 3Biostatistics, Princess Margaret Hospital, Toronto, ON, Canada. Purpose: Squamous cell carcinoma (SCC) of the penis is an uncommon but psychologically devastating malignancy. At the Ottawa Regional Cancer Center and the Princess Margaret Hospital in Toronto, brachytherapy has been used as the treatment of choice for penile preservation in T1 and T2 tumors. Methods and Materials: From 09/89 to 09/06, 60 men had brachytherapy for penile SCC. Mean age was 58 years (range 22e93). 53% of tumors were T1, 32% T2 and 8% T3, while 3% were in situ and 3% Tx. 35% were well differentiated, 45% moderately and 2% poorly, while 17% were unspecified and one tumor was verrucous. All tumors in Toronto had PDR brachytherapy (n 5 34) while those in Ottawa had either Iridium wire (n 5 22) or seeds (n 5 4). Six patients had a single plane implant using a plastic tube technique while all others had a volume implant using predrilled Plexi-glass templates and 2 or 3 parallel planes of needles (median 6). Mean needle spacing was 14 mm (range 10e18), mean dose rate 65 cGy/hr (range 33e160) and mean duration 98.8 hours (range 21e188). PDR dose rates were 50 cGy/hre61.2 cGy/hr with no correction in total dose which was 60 Gy in all cases. Results: Median followup is 47.6 months (range 0.2e140). At 5 years, actuarial overall survival is 81.0%, cause specific survival 90.2%. Six men died of penile cancer, and 6 died of other causes with no evidence of recurrence. Actuarial rate of never having experienced any type of failure at 5 years is 70.0% and for local failure (LF) is 88.3%. All 6 LF were successfully salvaged by surgery; 2 other penectomies were for necrosis. The soft tissue necrosis rate is 13% and the urethral stenosis rate 10%. Six of 12 regional failures (RF) were salvaged by lymph node dissection external radiation. All 6 RF with concurrent or subsequent DF have died of disease. 51 of 60 men had an intact and tumor free penis at last followup or death. The actuarial penile preservation rate at 5 years is 87.1%. Conclusions: Brachytherapy is an effective treatment for T1, T2 and selected T3 SCC of the penis. Close followup is mandatory as local failures and many regional failures can be salvaged by surgery.