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Utility of Surveillance Imaging for Endometrial Cancer After Local Therapy
S204
International Journal of Radiation Oncology Biology Physics
Conclusion: This is the first report finding a correlation between VS, VP volume, and vaginal dose. Further studies on a larger dataset are needed. Author Disclosure: M. Federico: None. A. Tornero: None. S. Torres Pozas: None. B. Pinar: None. D. Rey Baltar Oramas: None. P. Lara: None. R. Martin Oliva: None.
1115
1113 Withdrawn
1114 Utility of Surveillance Imaging for Endometrial Cancer After Local Therapy J.E. Shabason, P. Yalamanchi, X. Zhang, and L.L. Lin; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA Purpose/Objective(s): Current guidelines do not recommend routine surveillance imaging as part of follow-up care for patients treated for locoregional endometrial cancer. This study seeks to determine the potential benefit of routine surveillance imaging by evaluating outcomes of patients whose recurrences were detected on routine surveillance compared to those whose recurrences were detected as a result of symptoms. Materials/Methods: We conducted a retrospective review of patients who developed recurrence after treatment for locoregional endometrial cancer. Specifically, patients were treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy with or without adjuvant therapy, from 1990 to 2014 at an urban academic medical center. A total of 149 patients were identified with adequate clinical information regarding the recurrence. Cox proportional hazard regression analysis was used to estimate overall survival (OS) and progression-free survival (PFS). Results: The median age of patients at diagnosis was 69.2 years (range, 38.0-99.5 years). Initial stages included 49.0% stage I, 9.9% stage II, 37.8% stage III, and 3.3% stage IV. Histologies included 47.0% with endometrioid adenocarcinoma and 53.0% with other histologies including papillary serous, clear cell, and carcinosarcoma. Patients were initially treated with a variety of therapies: surgery alone in 13.4%, surgery and radiation in 24.8%, surgery and chemotherapy in 12.1%, and trimodality therapy in 40.3%. Sites of recurrence included 20.7% vaginal, 14.3% pelvic, and 65.0% distant sites. Recurrences were detected asymptomatically in 86 patients (57.7%) and symptomatically in 63 patients (42.3%). Of those detected asymptomatically, 80.2% were detected by imaging. Overall, when comparing symptomatic versus asymptomatic recurrences, there was no difference in OS (HR Z 1.24, P Z .29, 95% CI Z 0.84-1.83) or PFS (HR Z 1.14, P Z .52, 95% CI Z 0.77-1.70). Statistically significant prognostic factors affecting overall survival after recurrence included stage, histology, and location of recurrence (Table 1). Conclusion: Patients who develop asymptomatic recurrences of their endometrial cancer do not appear to have a better prognosis than those patients who present with symptomatic recurrences. Thus, these results do not support routine imaging surveillance for patients treated for locoregional endometrial cancer. Further prospective evaluation is needed. Author Disclosure: J.E. Shabason: None. P. Yalamanchi: None. X. Zhang: None. L.L. Lin: None. ePoster Abstracts 1114; Table 1
Overall Survival Hazard Ratio
Symptoms Stage Histology
Site of Recurrence
Asymptomatic Symptomatic I/II III/IV Endometrioid Adenocarcinoma Papillary Serous/ Clear Cell/ Carcinosarcoma Vaginal Pelvic Distant
P Value
95% CI:
.29
0.84-1.83
<.01
1.31-2.89
1.90
<.01
1.27-2.83
Reference 1.92 1.97
.09 .02
0.89-4.11 1.12-3.46
Reference 1.24 Reference 1.94 Reference
Impact of Endorectal Balloon on Margins and Target Immobilization in Gynecologic Cancers J.G. Dise,1 B.K.K. Teo,1 L. Yin,1 and L.L. Lin2; 1University of Pennsylvania, Philadelphia, PA, 2Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA Purpose/Objective(s): To determine the impact of a daily endorectal balloon on vaginal motion in posthysterectomy women receiving whole pelvic radiation therapy and the optimal planning target volume margins required. Materials/Methods: Seventeen posthysterectomy women were enrolled on a prospective image guided radiotherapy study and were scanned at simulation with both a full and empty bladder with an endorectal balloon in place and underwent weekly or biweekly CT scans. Fiducials were placed at the vaginal apex and the vagina was contoured on each dataset. Three different techniques were used to assess vaginal motion: whole organ motion, fiducial marker motion, and partial organ motion. Whole organ motion approximated the contoured vagina as a point represented by the centroid. Fiducial marker motion used the surgically placed marker at the apex of the vagina as a surrogate for target motion. In partial organ motion, the target was split into 3 equal sections in the superior-inferior direction. In each section, a centroid-based approach was used. Margin recipes were calculated for each tracking technique so that 95% of target volumes would receive at least 95% of the prescribed dose. For partial organ motion, a margin recipe was calculated for each section. Results: A total of 82 scans were evaluated. The average motion of the vagina when evaluated as a whole organ was 1.3 1.1 mm and 3.4 3.0 mm in the left-right (LR) and anterior-posterior (AP) directions, respectively. The average motion of the fiducials was 1.9 2.2 mm and 2.4 2.7 mm in the LR and AP directions, respectively. The average LR motion of the vagina when taken as a partial organ was 1.0 1.0, 1.2 1.2, and 1.6 1.8 mm in the lower, middle, and upper third, respectively. The average AP motion of the vagina when taken as a partial organ was 3.2 3.0, 3.2 3.3, and 3.9 4.3 mm in the lower, middle, and upper third, respectively. The whole organ motion margin calculated to achieve the goal stated was 3.8 and 6.9 mm in the LR and AP directions, respectively. The fiducial tracking motion margin calculated was 3.0 and 7.4 mm in the LR and AP directions, respectively. The AP partial organ motion margin was 3.8 mm, 4.4 mm, and 6.5 mm in the lower, middle, and upper third, respectively. The LR partial organ motion margin was 3.5 mm, 3.9 mm, and 5.8 mm. Conclusion: The implementation of endorectal balloon can reduce treatment margins due to organ motion. Because of endorectal balloon placement, anisotropic margins can be created to spare normal tissue. Author Disclosure: J.G. Dise: None. B. Teo: None. L. Yin: None. L.L. Lin: None.
1116 Early Apparent Diffusion Coefficient Changes During Concurrent Chemoradiation Therapy Predicting Survival for Women With Bulky Cervical Cancer Y.Y. Chiang, G. Lin, and C.C. Wang; Chang Gung Memorial Hospital, Taoyuan, Taiwan Purpose/Objective(s): The objective of the prospective study was to investigate the predictive value of apparent diffusion coefficient (ADC) for patients with bulky cervical cancer. Materials/Methods: From 2007 to 2010, 45 women with clinically bulky cervical cancer treated with concomitant chemoradiation therapy (CCRT) were included in this study. Patients received 3.0 T MRI examinations at 5 timepoints: before CCRT (PreCCRT), 2 and 4 weeks during the CCRT (CCRT2wk and CCRT4wk), and 1 week and 2 months after treatment. Half of the patients had residual tumor volumes >3 cm3 at CCRT4wk; therefore, our analysis focused on the data of PreCCRT and
International Journal of Radiation Oncology Biology Physics
Conclusion: This is the first report finding a correlation between VS, VP volume, and vaginal dose. Further studies on a larger dataset are needed. Author Disclosure: M. Federico: None. A. Tornero: None. S. Torres Pozas: None. B. Pinar: None. D. Rey Baltar Oramas: None. P. Lara: None. R. Martin Oliva: None.
1115
1113 Withdrawn
1114 Utility of Surveillance Imaging for Endometrial Cancer After Local Therapy J.E. Shabason, P. Yalamanchi, X. Zhang, and L.L. Lin; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA Purpose/Objective(s): Current guidelines do not recommend routine surveillance imaging as part of follow-up care for patients treated for locoregional endometrial cancer. This study seeks to determine the potential benefit of routine surveillance imaging by evaluating outcomes of patients whose recurrences were detected on routine surveillance compared to those whose recurrences were detected as a result of symptoms. Materials/Methods: We conducted a retrospective review of patients who developed recurrence after treatment for locoregional endometrial cancer. Specifically, patients were treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy with or without adjuvant therapy, from 1990 to 2014 at an urban academic medical center. A total of 149 patients were identified with adequate clinical information regarding the recurrence. Cox proportional hazard regression analysis was used to estimate overall survival (OS) and progression-free survival (PFS). Results: The median age of patients at diagnosis was 69.2 years (range, 38.0-99.5 years). Initial stages included 49.0% stage I, 9.9% stage II, 37.8% stage III, and 3.3% stage IV. Histologies included 47.0% with endometrioid adenocarcinoma and 53.0% with other histologies including papillary serous, clear cell, and carcinosarcoma. Patients were initially treated with a variety of therapies: surgery alone in 13.4%, surgery and radiation in 24.8%, surgery and chemotherapy in 12.1%, and trimodality therapy in 40.3%. Sites of recurrence included 20.7% vaginal, 14.3% pelvic, and 65.0% distant sites. Recurrences were detected asymptomatically in 86 patients (57.7%) and symptomatically in 63 patients (42.3%). Of those detected asymptomatically, 80.2% were detected by imaging. Overall, when comparing symptomatic versus asymptomatic recurrences, there was no difference in OS (HR Z 1.24, P Z .29, 95% CI Z 0.84-1.83) or PFS (HR Z 1.14, P Z .52, 95% CI Z 0.77-1.70). Statistically significant prognostic factors affecting overall survival after recurrence included stage, histology, and location of recurrence (Table 1). Conclusion: Patients who develop asymptomatic recurrences of their endometrial cancer do not appear to have a better prognosis than those patients who present with symptomatic recurrences. Thus, these results do not support routine imaging surveillance for patients treated for locoregional endometrial cancer. Further prospective evaluation is needed. Author Disclosure: J.E. Shabason: None. P. Yalamanchi: None. X. Zhang: None. L.L. Lin: None. ePoster Abstracts 1114; Table 1
Overall Survival Hazard Ratio
Symptoms Stage Histology
Site of Recurrence
Asymptomatic Symptomatic I/II III/IV Endometrioid Adenocarcinoma Papillary Serous/ Clear Cell/ Carcinosarcoma Vaginal Pelvic Distant
P Value
95% CI:
.29
0.84-1.83
<.01
1.31-2.89
1.90
<.01
1.27-2.83
Reference 1.92 1.97
.09 .02
0.89-4.11 1.12-3.46
Reference 1.24 Reference 1.94 Reference
Impact of Endorectal Balloon on Margins and Target Immobilization in Gynecologic Cancers J.G. Dise,1 B.K.K. Teo,1 L. Yin,1 and L.L. Lin2; 1University of Pennsylvania, Philadelphia, PA, 2Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA Purpose/Objective(s): To determine the impact of a daily endorectal balloon on vaginal motion in posthysterectomy women receiving whole pelvic radiation therapy and the optimal planning target volume margins required. Materials/Methods: Seventeen posthysterectomy women were enrolled on a prospective image guided radiotherapy study and were scanned at simulation with both a full and empty bladder with an endorectal balloon in place and underwent weekly or biweekly CT scans. Fiducials were placed at the vaginal apex and the vagina was contoured on each dataset. Three different techniques were used to assess vaginal motion: whole organ motion, fiducial marker motion, and partial organ motion. Whole organ motion approximated the contoured vagina as a point represented by the centroid. Fiducial marker motion used the surgically placed marker at the apex of the vagina as a surrogate for target motion. In partial organ motion, the target was split into 3 equal sections in the superior-inferior direction. In each section, a centroid-based approach was used. Margin recipes were calculated for each tracking technique so that 95% of target volumes would receive at least 95% of the prescribed dose. For partial organ motion, a margin recipe was calculated for each section. Results: A total of 82 scans were evaluated. The average motion of the vagina when evaluated as a whole organ was 1.3 1.1 mm and 3.4 3.0 mm in the left-right (LR) and anterior-posterior (AP) directions, respectively. The average motion of the fiducials was 1.9 2.2 mm and 2.4 2.7 mm in the LR and AP directions, respectively. The average LR motion of the vagina when taken as a partial organ was 1.0 1.0, 1.2 1.2, and 1.6 1.8 mm in the lower, middle, and upper third, respectively. The average AP motion of the vagina when taken as a partial organ was 3.2 3.0, 3.2 3.3, and 3.9 4.3 mm in the lower, middle, and upper third, respectively. The whole organ motion margin calculated to achieve the goal stated was 3.8 and 6.9 mm in the LR and AP directions, respectively. The fiducial tracking motion margin calculated was 3.0 and 7.4 mm in the LR and AP directions, respectively. The AP partial organ motion margin was 3.8 mm, 4.4 mm, and 6.5 mm in the lower, middle, and upper third, respectively. The LR partial organ motion margin was 3.5 mm, 3.9 mm, and 5.8 mm. Conclusion: The implementation of endorectal balloon can reduce treatment margins due to organ motion. Because of endorectal balloon placement, anisotropic margins can be created to spare normal tissue. Author Disclosure: J.G. Dise: None. B. Teo: None. L. Yin: None. L.L. Lin: None.
1116 Early Apparent Diffusion Coefficient Changes During Concurrent Chemoradiation Therapy Predicting Survival for Women With Bulky Cervical Cancer Y.Y. Chiang, G. Lin, and C.C. Wang; Chang Gung Memorial Hospital, Taoyuan, Taiwan Purpose/Objective(s): The objective of the prospective study was to investigate the predictive value of apparent diffusion coefficient (ADC) for patients with bulky cervical cancer. Materials/Methods: From 2007 to 2010, 45 women with clinically bulky cervical cancer treated with concomitant chemoradiation therapy (CCRT) were included in this study. Patients received 3.0 T MRI examinations at 5 timepoints: before CCRT (PreCCRT), 2 and 4 weeks during the CCRT (CCRT2wk and CCRT4wk), and 1 week and 2 months after treatment. Half of the patients had residual tumor volumes >3 cm3 at CCRT4wk; therefore, our analysis focused on the data of PreCCRT and