Late Toxicity In Patients Research Articles

Tolerance of Orthotopic Ileal Neobladders to Radiotherapy: A Multi-institutional Retrospective Study.

The present retrospective study analyzed the tolerance of orthotopic ileal neobladders to radiotherapy by reviewing the acute and late toxicity in patients who underwent postoperative radiotherapy after radical cystectomy/cystoprostatectomy. A multi-institutional database was created for patients who had undergone radical cystectomy/cystoprostatectomy and neobladder reconstruction, followed by adjuvant radiotherapy (RT). The patient and tumor characteristics were recorded. The RT data were reviewed to determine the treatment technique used, the radiation dose received by the neobladder, and acute and late toxicity evaluated using the Common Terminology Criteria for Adverse Events, version 4.0, scale. A total of 25 patients were included, with a median age of 64 years. Of the 25 patients, 18 received a dose of 45 to 50.4 Gy. The most common reasons for postoperative radiotherapy were close or positive surgical margins and pT3-pT4 or N+ disease. Ten patients underwent intensity modulated RT. All but 1 patient completed the RT course. Of the patients who completed their RT schedule, none had grade≥ 3 acute gastrointestinal toxicity. One patient who received concurrent chemotherapy developed grade 3 acute genitourinary toxicity. Three patients reported late grade 1 genitourinary toxicity (frequency of urination, mild leakage at night), with no reports of chronic gastrointestinal toxicity. None of the patients experienced neobladder perforation, leak, or fistula. The use of moderate doses of pelvic RT (range, 45-50.4 Gy) was well tolerated among the 25 patients who underwent RT after cystoprostatectomy with orthotopic neobladder creation. This finding supports the use of postoperative RT to moderate doses in this patient population when clinically indicated.

Acute toxicity and surgical complications after preoperative (chemo)radiation therapy for rectal cancer in patients with inflammatory bowel disease

PurposePreoperative therapy reduces local recurrences and may facilitate surgery in rectal cancer patients. However, in patients with inflammatory bowel disease (IBD) this treatment is often withheld due to the perceived risk of excessive side-effects, even though evidence is limited. The purpose of this study is to investigate the effects of preoperative therapy on acute toxicity and post-operative complications in IBD patients with rectal cancer. MethodsThe Dutch pathology registry (PALGA) was searched for patients with IBD and rectal cancer treated between January 1991 and May 2010. Histopathology and clinical charts were reviewed to confirm IBD diagnosis and evaluate clinical and pathological characteristics. ResultsOut of 161 patients, 66 received preoperative therapy (41%), including short-course radiation therapy (SC-RT), long course radiation therapy (LC-RT), and chemoradiation therapy (CRT) in 32, 13, and 21 patients respectively. Grade≥3 acute toxicity occurred in 0 patients (0.0%), 1 patient (7.7%), and 6 patients (28.6%) respectively (p=0.004). Systemic corticosteroids were used by 10.5% of patients at time of treatment. Grade≥3 post-operative 30-day complication rate (28.1% overall) was not associated with type of preoperative therapy. ConclusionResults did not show excessive rates of toxicity or post-operative complications and support the use of standard preoperative therapies for rectal cancer (especially SC-RT) in IBD patients with relatively indolent disease. Caution is warranted in patients with active IBD, since the exact impact of active bowel inflammation could not be determined retrospectively. Prospective studies should investigate the influence of active IBD on acute and late toxicity in patients receiving pelvic irradiation.

PO-118: Acute and late toxicities in patients with oral cancer treated with intensity-modulated radiotherapy

PO-118: Acute and late toxicities in patients with oral cancer treated with intensity-modulated radiotherapy

Acute and late toxicity in high-risk prostate cancer patients treated with androgen suppression and hypofractionated pelvic radiotherapy.

47 Background: Two recent large randomized trials confirm that 60Gy in 20 fractions is an effective regimen compared to conventionally fractionated escalated doses in localized prostate cancer. However, in these two trials the prostate was the only target volume irradiated. The purpose of this study is to report acute and late toxicity in patients with high-risk prostate cancer treated with the same moderate hypofractionated radiotherapy (HypoRT) to two target volumes at the same time: prostate and pelvic nodes. Methods: High-risk prostate cancer patients received 60Gy/20 fractions (4 weeks) to the prostate while the pelvic-nodes received 44Gy delivered with intensity modulated radiation therapy (IMRT) with a simultaneous integrated boost (SIB) during the same 20 fractions. ADT started 2-3 months before HypoRT. Acute and late toxicity were prospectively assessed according to CTCAE.v3. Results: 105 patients treated between September/2010 and November/2013 were reviewed. Median follow up is 41 months. Median ADT duration was 18 months. Acute grade > 2 gastrointestinal (GI) or genitourinary (GU) toxicity was seen in 17% and 17% respectively, with only 1 and 3 patients experiencing GI and GU acute grade 3 toxicity, respectively. The worst grade > 2 late GI and GU toxicity was seen in 7% and 8% of patients, respectively. There was no grade 4-5 toxicity. At the last follow-up, the rates of grade = 2 GI and GU toxicity were 5% and 3%, respectively with no residual grade > 3 toxicity. The 48-month actuarial progression free survival is 82%. We found only 8 publications on this topic, all delivered the HypoRT in 25-28 fractions, but only one has long-term toxicity. Conclusions: ADT with HypoRT delivered with IMRT and SIB to the prostate (60Gy) and pelvic nodes (44Gy) in 20 fractions is feasible and well tolerated after 41months of median follow-up. Our approach shortens treatment duration, is convenient and its results support a needed randomized trial. Clinical trial information: NCT02107287.

Development of Late Toxicities in Patients with Oral Tongue Cancer Treated with Surgical Resection and Adjuvant Radiation Therapy.

The late effects of RT are not well reported in patients with oral tongue cancer (OTC). This study reports the incidence of late effects and factors associated with the development of late effects in OTC patients. Patients with OTC treated in our institution from 2003 to 2013 were evaluated. The association between RT doses, including mandible maximum and minimum doses and total 3D maximum dose, and late toxicity, defined as development of osteoradionecrosis (ORN), percutaneous endoscopic gastrostomy (PEG) tube dependence for >6 months after treatment, and narcotic dependency >6 months posttreatment were assessed using both univariate and multivariable (MV) analysis. Seventy-six patients with OTC (45% males and 55% females) were treated with definitive surgical resection followed by adjuvant RT. The median follow-up was 4.3 years. Combined late toxicities were reported in 38% of patients. Thirty-four percent of the patients had narcotic dependency and, 3.9% of the patients had ORN of the mandible. Thirteen percent of patients developed PEG tube dependency that was significantly associated with a higher 3D maximum radiation dose on univariate analysis (p < 0.01). On MV analysis, 3D maximum dose remained significantly associated with long-term PEG tube dependency (p = 0.05). Patients with OTC treated with adjuvant RT are at significant risk for development of late toxicities. Increasing maximum dose is associated with long-term PEG tube dependence, and care should be taken to reduce the "hot spot" within radiation treatment plans as much as possible.

6th Annual Conference of Indian Brachytherapy Society 2016 (IBSCON 2016) Proceedings

PurposeTo report the incidence, severity, and time of onset of late toxicities in patients of endometrial adenocarcinoma (EA) treated with external beam radiotherapy (EBRT) + brachytherapy (BT), or vaginal brachytherapy (VBT) alone.Material and methodsArchives of a single institution from 2008-2015 were studied. The indications for EBRT and VBT were based on standard recommendations. EBRT was planned to 50 Gy/25 fractions/5 weeks/3DCRT with 4-field ‘box’ technique on a dual energy linear accelerator. VBT was planned using appropriate vaginal cylinder treating upper half of vaginal cuff, prescribed 5 mm from vaginal surface using Ir-192 micro-Selectron to doses of 4 Gy x 4 fractions/4 days or 6 Gy x 5 fractions/ 7 days with or without EBRT, respectively. Intra-cavitary BT (ICBT) was prescribed to point A to 7 Gy x 3 fractions once weekly. Survival was calculated from Kaplan-Meier curves, and toxicity was recorded using CTCAE V3.ResultsOf 120 patients registered, 19 were excluded due to inadequate follow-up. Among the 63 patients who received RT, 18 received VBT alone and 40 received adjuvant EBRT + VBT. Five patients received definitive EBRT + ICBT, all of whom are disease free with median follow-up of 36.5 (range: 18-76) months. With median follow-up of 30 (range: 0.8-81) months, median DFS and OS were 79.2% and 75.7%, respectively in the adjuvant RT setting. Cystitis, proctitis, and enteritis was reported in 7% (all grade I/II), 17% (9% grade I/II and 8% grade III), and 5% (all grade I/II), respectively. All toxicities were seen in the EBRT arm. EBRT resulted in significantly higher proctitis than VBT alone (p = 0.02). The median time to cystitis, proctitis, and enteritis were 27, 17, and 28 months, respectively.ConclusionWith the use of 3D-CRT in endometrial adenocarcinoma, late toxicity rates appear low and mild, however EBRT leads to significantly higher proctitis than VBT alone.

The Effect of Concurrent Tumor Bed Boost Delivery on Acute and Late Toxicity in Patients With Breast Cancer: Update of a Systematic Review

Poster viewing abstract, Proceedings of the American Society for Radiation Oncology 58th Annual Meeting of the American Society for Radiation Oncology

Hypofractionated Radiotherapy for Prostate Cancer

Hypofractionated Radiotherapy for Prostate Cancer

Impact of tumour bed boost integration on acute and late toxicity in patients with breast cancer: A systematic review

The purpose of this systematic review was to summarise the evidence from studies investigating the integration of tumour bed boosts into whole breast irradiation for patients with Stage 0-III breast cancer, with a focus on its impact on acute and late toxicities. A comprehensive systematic electronic search through the Ovid MEDLINE, EMBASE and PubMed databases from January 2000 to January 2015 was conducted. Studies were considered eligible if they investigated the efficacy of hypo- or normofractionated whole breast irradiation with the inclusion of a daily concurrent boost. The primary outcomes of interest were the degree of observed acute and late toxicity following radiotherapy treatment. Methodological quality assessment was performed on all included studies using either the Newcastle–Ottawa Scale or a previously published investigator-derived quality instrument. The search identified 35 articles, of which 17 satisfied our eligibility criteria. Thirteen and eleven studies reported on acute and late toxicities respectively. Grade 3 acute skin toxicity ranged from 1 to 7% whilst moderate to severe fibrosis and telangiectasia were both limited to 9%. Reported toxicity profiles were comparable to historical data at similar time-points. Studies investigating the delivery of concurrent boosts with whole breast radiotherapy courses report safe short to medium-term toxicity profiles and cosmesis rates. Whilst the quality of evidence and length of follow-up supporting these findings is low, sufficient evidence has been generated to consider concurrent boost techniques as an alternative to conventional sequential techniques.

Perioperative Morbidity, Long-term Outcomes, and Late Toxicity in Survivors of Carcinoma of the Cervix Treated With Brachytherapy

Purpose/Objective(s): To evaluate perioperative morbidity and long-term outcome and quantify the incidence of late toxicity in patients with carcinoma of the cervix treated with a radical intent using brachytherapy. Materials/Methods: Two hundred and six consecutive patients with carcinoma of the cervix treated with a radical intent using brachytherapy at the 2 cancer centers serving our entire Health Authority region, from January 1998 to January 2013, were included in this study. Median age at diagnosis was 54 years, 29% of patients were single or separated, 82% had squamous cell carcinoma, 13% adenocarcinoma, and 1.5% had small cell carcinoma. Thirty-eight percent had FIGO stage I, 38% had stage II, 19% had stage II, and 5% had stage IV cancers. All patients underwent a combination of external beam RT and brachytherapy, and 77% of patients also had concurrent chemotherapy. The patients underwent a total of 602 brachytherapy procedures. While 75 (36.5%) patients had high-dose-rate (HDR) brachytherapy, 131(63.5%) were treated with low-dose-rate (LDR) brachytherapy. Results: After a median follow-up of 59.6 months, the 5-year local control rate, progression-free survival, and overall survival were 75.7%, 68.3%, and 66.9%, respectively. Age, histology, and stage were found to be significant prognostic factors. Marital status was found to strongly predict for improved outcomes: 5yr OS for married versus separated patients was 73.7% versus 45.3%, PZ.013. There was no statistically significant difference in outcomes for patients who received HDR versus LDR brachytherapy (5-year OS: 77.8% vs 65.2%, PZ.436), or for patients who did or did not receive concurrent chemotherapy (5-year OS: 77.9% vs 64.7%, PZ.908). The 3-year cumulative incidence of late grade 3-4 radiation proctitis and radiation cystitis for patients treated with HDR versus LDR brachytherapy were: 10.5% versus 9.3%, PZ.737, and 9.9% versus 5.7%, PZ.297, respectively. Six patients developed RT-related bowel obstruction or strictures for which surgery was required, 3 patients developed treatment-related fistulas, 4 had pelvic insufficiency fractures, 2 developed lumbosacral plexopathy, and 2 had second cancers. Perioperative morbidity for the 602 consecutive procedures included: 3 patients who developed deep vein thrombosis, 2 who had pulmonary embolism, 4 who had procedural perforation of the uterus, 2 who had significant hemorrhage requiring transfusion, 1 who had vaginal laceration requiring surgical repair, and one patient who died during the procedure from pulmonary embolism. Conclusion: There appears to be no significant difference in long-term outcomes or late toxicities with the use of HDR versus LDR brachytherapy techniques. Apart from known prognostic factors such as age, histology, and stage, we report a significant impact of the patients’ marital status on the results of treatment. Author Disclosure: G. Bahl: Independent Contractor; BC Cancer Agency. E. Woo: None. B. Lester: None. F. Wong: medical credentialing; BC Cancer Agency.

Predictors of late bowel toxicity using three different methods of contouring in patients undergoing post-operative radiation for cervical cancer

This study investigates the correlation between dose-volume histogram derived from three bowel contouring methods and late toxicity in patients undergoing post-operative radiation therapy (PORT) for cervical cancer. From June 2010 to May 2013, 103 patients undergoing PORT were included. Three different contouring methods were used: (a) individual small bowel (SB) and large bowel (LB) loops, (b) total bowel (TB; including SB and LB) and (c) peritoneal cavity (PC). The volume of SB, LB, TB and PC receiving 15, 30 and 40 Gy was calculated. Acute and late bowel toxicities were scored using Common Terminology Criteria for Adverse events v. 3.0. Receiver operating characteristic curve identified thresholds predicting late toxicity with the highest specificity. All data were dichotomized across these thresholds. Univariate and multivariate analyses were performed using SPSS(®) v. 20 (IBM Corporation, Armonk, NY; formerly SPSS Inc., Chicago, IL). On univariate analysis, V30 PC ≥ 900 cm(3) (p = 0.01), V40 PC ≥ 750 cm(3) (p = 0.03) and V40 TB ≥ 280 cm(3) (p = 0.03) and use of concurrent chemotherapy (p = 0.03) predicted grade ≥II acute toxicity. On multivariate analysis, use of concurrent chemotherapy [odds ratio (OR) 3.5, 95% confidence interval (CI) 1.1-11.1, p = 0.03] and V30 PC ≥ 900 cm(3) (OR 2.3, 95% CI 1-5.5, p = 0.05) predicted acute grade ≥II toxicity. On univariate analysis for late toxicity, SB (V30 ≥ 190 cm(3), p = 0.009; V40 ≥ 150 cm(3), p = 0.03), LB (V15 ≥ 250 cm(3), p = 0.04), V40 PC (V40 ≥ 750 cm(3), p = 0.001) and presence of acute grade ≥III toxicity (p = 0.006), treatment technique (three-dimensional conformal radiation or intensity modulated radiotherapy, p = 0.02) predicted more than or equal to grade ll late bowel toxicity. On multivariate analysis, only body mass index ≥25 kg m(-2) (OR 7.3, 95% CI 1.6-31.6, p = 0.008) and presence of acute grade III toxicity predicted toxicity (OR 5.1, 95% CI 1.4-18.1, p = 0.007). V30 PC ≥ 900 cm(3) and use of concurrent chemotherapy independently predicts acute toxicity. Presence of acute grade ≥III toxicity independently predicts late toxicity. Minimizing dose to PC subvolumes can therefore reduce both acute and late toxicities. Study establishes PC thresholds that can minimize both acute and late bowel toxicities.

Intensity-modulated radiation therapy versus 2D-RT or 3D-CRT for the treatment of nasopharyngeal carcinoma: A systematic review and meta-analysis

To compare clinical treatment outcomes and late toxicities of intensity-modulated radiation therapy (IMRT) with those obtained with two-dimensional radiation therapy (2D-RT) or three-dimensional conformal radiation therapy (3D-CRT) in nasopharyngeal carcinoma (NPC). We searched all the eligible studies from the Cochrane Library, PubMed, Medline, and Embase. The meta-analysis was performed to compare odds ratio (OR) for overall survival (OS), tumor local control (LC), and late toxicities. A total of eight studies met the criteria to perform a meta-analysis including 3570 participants, with 1541 patients in the IMRT group and 2029 in the 2D-RT or 3D-CRT group. The IMRT group was associated with a better 5-year overall survival (OR=1.51; 95% confidence interval (CI) 1.23-1.87; p=0.0001), and tumor local control (LC) (OR=1.94; 95% CI 1.53-2.46; p<0.00001). According to CTCAE v3.0 (Common Terminology Criteria for Adverse Events) and RTOG/EORTC (Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer), the incidence of late xerostomia in those who received IMRT was significantly lower than that of the control group (OR=0.18; 95% CI, 0.07-0.46; p=0.0004). In addition, the radiation-induced chronic toxicities rate of trismus and temporal lobe neuropathy (TLN) were also significantly lower in the IMRT group than in the control group (OR=0.18; 95% CI 0.04-0.83; p=0.03; OR=0.44; 95% CI 0.28-0.69; p=0.0003, respectively). This systematic review and meta-analysis demonstrated that IMRT mayobtain a better antitumor effect, and significantly decrease the incidence of radiation-induced late toxicities in patients with NPC.

Excellent local control and survival after postoperative or definitive radiation therapy for sarcomas of the head and neck.

BackgroundTo report our results with postoperative or definitive radiation therapy in head and neck sarcomas.MethodsWe performed a retrospective analysis of 26 patients suffering from head and neck sarcomas, who received postoperative or definitive radiation therapy between 2003 and 2012. Median age was 64 years (19–88) and 69 % were male. Tumor locations were skull (including skin) in 31 %, paranasal sinus/orbita in 27 % and neck (including pharynx/larynx) in 42 %. Median tumor size was 4.6 cm (1-12 cm). 22 patients (85 %) presented in primary situation. Stage at presentation (UICC 7th for soft tissue sarcomas) was as follows: Ia:4 %, IIa:50 %, IIb:15 %, III:31 %. All except one patient suffered from high grade lesions (G2/3 FNCLCC), predominantly angiosarcoma (35 %), MFH (19 %) and synovial sarcoma (15 %). Surgery was performed in 21 pts (81 %), resulting in free margins in 10 (38 %), microscopically positive margins in 6 (23 %) and gross residual disease in 5 (19 %). Median dose to the primary tumor region was 66Gy (45-72Gy) in conventional fractionation, using 3D-CRT in 65 %, IMRT in 27 % and electrons in 8 %. 50 % of the patients also received sequential chemotherapy.ResultsMedian follow up was 39 months (8–136). We observed three local recurrences, transferring into estimated 3- and 5-year local control rates of 86 %. One additional patient failed distantly, resulting in 3- and 5-year freedom from treatment failure rates of 82 %. Four patients have deceased, transferring into 3- and 5-year overall survival rates of 88 % and 82 %, respectively. Only two of the four deaths were sarcoma related. Maximum acute toxicity (CTCAE 3.0) was grade 1 in 27 % of the patients, grade 2 in 50 % and grade 3 in 23 %. Severe acute toxicity was mainly represented by mucositis and dysphagia. Maximum late toxicity was grade 1 in 31 %, grade 2 in 15 % and grade 3 in 19 % of the patients. Severe late toxicity included skin ulceration (n = 1), dysphagia with persistent tube dependency (n = 1), persistent sinusitis (n = 1) and hearing loss (n = 2).ConclusionExcellent local control and overall survival rates can be achieved with postoperative or definitive radiation therapy with acceptable acute and late toxicities in patients suffering from sarcomas of the head and neck region.

Interstitial Brachytherapy for the Treatment of Locally Recurrent Anorectal Cancer.

Local tumor control (LC), overall survival (OS), symptom palliation, and late toxicity for patients with locally recurrent anorectal cancer treated with a computed tomography (CT)-guided interstitial brachytherapy implant were examined. The medical records of 20 consecutive patients who had received interstitial brachytherapy for locally recurrent anorectal cancer from 2000 through 2012 were reviewed. Seventeen patients (85 %) had rectal cancer and three had anal cancer [median follow-up time for living patients, 23 months (range 13-132)]. Brachytherapy was used most commonly at the second pelvic recurrence (n = 13, 65 %). The implant dose was prescribed to 80 Gy to a 1-cm margin or 120 Gy to 100 % of the gross tumor volume. Endpoints were OS, LC, toxicity, and symptom palliation rate, all calculated from the time of implant. The actuarial 1-year rates of LC and OS were 80 and 95 %, respectively. At presentation, 17 patients (85 %) had symptoms related to the treated tumor which were palliated in 13 patients (76 %) at a median time of 3 months (range 1-6); palliation was permanent for seven patients (54 %), and the other six patients lost palliation after a median 8 months (range 5-17). One patient experienced a grade 3 late complication requiring a stent for hydronephrosis; five had grade 2 toxicity, and four had grade 1 toxicity. CT-guided interstitial brachytherapy for locally recurrent anorectal tumors produced durable tumor control and long-term survival, with effective palliation and minimal long-term morbidity.

Perioperative high-dose-rate interstitial brachytherapy combined with external beam radiation therapy for soft tissue sarcoma.

The aim of our study was to evaluate the role of perioperative high-dose-rate interstitial brachytherapy (PHDRIBT) in combination with external beam radiation therapy (EBRT) in patients with localized soft tissue sarcoma (STS). From year 2004 to 2010, 52 patients with localized STS were treated with wide local excision plus PHDRIBT followed by EBRT. Median size of the tumor was 8 cm (range, 4-19 cm). A single-plane interstitial brachytherapy implant with an average of nine catheters was performed during the surgical resection. The PHDRIBT was started on third postoperative day to deliver a high-dose-rate dose of 16 Gy in four fractions over 2 days using twice-a-day fractionation schedule. After 4 weeks, EBRT was started for a prescription dose of 50 Gy by conventional fractionation. Subsequently, chemotherapy was administered, if indicated as per our institutional policy. Patients were followed up regularly to study local control, survival, and toxicity. At a median followup of 46 months, no patient developed local recurrence, but 12 patients developed distant metastases. The 5-year overall survival and disease-free survival were 67% and 63%, respectively. Main acute toxicity was delayed wound healing observed in 3 patients (5.7%). Commonest late toxicity was chronic skin/subcutaneous fibrosis noticed in 5 patients (9.6%). The PHDRIBT combined with EBRT provides excellent local control and survival rates with acceptable acute and late toxicity in patients with localized STS.

Radiosensitivity of orthotopic ileal neobladders.

350 Background: A prior report from our institution documented that Kock ileal reservoirs can tolerate doses of 45-50.4Gy. This study provides retrospective information on the radiosensitivity of orthotopic neobladders by reviewing the acute and late toxicity in patients who underwent post-operative radiotherapy following radical cystoprostatectomy with orthotopic ileal neobladder reconstruction. Methods: The USC bladder cancer database was queried for all patients who underwent cystoprostatectomy and neobladder reconstruction followed by adjuvant radiation therapy related to their bladder cancer. The original patient charts and radiation therapy records were reviewed to determine the dose of radiation received by the neobladder. The patient charts were also reviewed to determine acute and late toxicity related to radiation. Results: From 1980 to 2013, 1,742 patients underwent radical cystoprostatectomy with orthotopic neobladder reconstruction. Of those 1,742 patients, 10 patients met the criteria of the study. The median age of the patients who received post-operative radiotherapy was 66.9 years. Forty percent of the study population received a dose of 50.4Gy, 50% received a dose of 45-46.8Gy and one patient, while prescribed a dose of 61.2Gy, only received 39.6Gy secondary to progression of disease on treatment that required termination of RT. All patients received 1.7-1.8Gy per fraction. The most common indications for radiotherapy were close or positive surgical margins. Two patients were treated with IMRT while the rest of the patients received 4 field or AP-PA beam arrangements. Of the patients that completed radiation, 3 had grade 2 or less CTCAE v4.0 acute GI toxicity; no patients reported acute GU toxicity. Two patients reported chronic grade 1 GU toxicity, likely related to their neobladders, with no reports of chronic GI toxicity. No patients experienced neobladder perforation, leak, or fistula. Conclusions: The use of moderate doses of pelvic radiotherapy (45-50.4Gy) was well tolerated among the 10 patients who had radiotherapy following cystoprostatectomy with orthotopic neobladder creation. This data supports the use of post-operative radiotherapy to moderate doses in this patient population when clinically indicated.

P042 Late toxicity in patients treated with salvage radical radiotherapy following primary High-Intensity Focal Ultrasound (HIFU) for localized prostate cancer

P042 Late toxicity in patients treated with salvage radical radiotherapy following primary High-Intensity Focal Ultrasound (HIFU) for localized prostate cancer

P3-13-1 - Volumetric Modulated Arc Therapy(Vmat) for the Treatment of Localized Prostate Cancer

Objective: To report the initial biochemical outcomes and acute and late toxicities in patients with clinically localized prostate cancer treated with volumetric modulated arc therapy (VMAT).Methods: Between November 2007 and September 2011, 200 patients with clinically localized prostate cancer were treated with VMAT. A total of 181 patients received 76 Gy, and 17 patients received 72 Gy. Acute and late toxicities were scored according to the CTCAE grading scales. PSA relapse was defined according to the Phoenix definition.Results: The median follow-up duration was 50 months. Two patients (1%) developed acute Grade 2 or higher GI toxicity. Thirty-nine patients (19%) developed acute Grade 2 GU symptoms, and no patient experienced Grade 3 GU toxicity. Six patients (3%) developed late Grade 2 rectal bleeding. Two patients (1%) experienced Grade 3 rectal toxicity. The 5-year actuarial likelihood of late Grade 2 or higher rectal bleeding was 3.4%.Twenty patients (10%) experienced late Grade 2 or worse GU toxicities. The 5-year actuarial likelihood of late Grade 2 or higher GU toxicity was 11.6%.The 5-year actuarial PSA relapse-free survival rates for low-, intermediate-, and high-risk group patients, stratified according to NCCN criteria, were 100%, 91.8%, and 85.3%, respectively.Conclusions: Our initial data demonstrates the feasibility of VMAT in patients with localized prostate cancer.The rates of acute and late rectal toxicities were very low.Based on our promising initial experiences, VMAT is an established novel conformal radiation delivery method for localized prostate cancer at our institution. Further studies in a larger population are required.

Treatment outcomes and late toxicities in patients with embryonal central nervous system tumors.

BackgroundStandard treatment strategies for embryonal central nervous system (CNS) tumors have not yet been established. We treated these tumors using an original chemoradiation therapy protocol; the clinical outcomes and toxicities were retrospectively evaluated.MethodsTwenty-four patients were enrolled including sixteen with medulloblastoma, four with supratentorial primitive neuroectodermal tumor (sPNET), three with atypical teratoid/rhabdoid tumor, and one with pineoblastoma. Immediately after diagnosis, all patients underwent surgery initially. They were then categorized as high- or average-risk groups independent of tumor type/pathogenesis. The average-risk group included patients who were aged ≥3 years at diagnosis, had non-metastatic disease at diagnosis (M0), and had undergone gross total resection. Other patients were categorized as the high-risk group; this group received more intensive treatment than the average-risk group, including high-dose chemotherapy with autologous stem-cell transplantation. All patients received craniospinal irradiation (CSI). The CSI dose was 23.4 Gy for M0 patients aged ≥5 years, 18 Gy for M0 patients aged <5 years, and 30–36 Gy for all patients with M + disease. The total dose to the primary tumor bed was 54 Gy.ResultsThe median follow-up time was 73.5 (range, 19–118) months. The 5-year progression-free survival (PFS) and overall survival (OS) rates were 71.1 and 88.9%, respectively in the average-risk group (n = 9) and 66.7 and 71.1%, respectively in the high-risk group (n = 15). The PFS and OS rates were not significantly different between the average- and high-risk groups. In patients with medulloblastoma only, these rates were also not significantly different between the average- and high-risk groups. Three of four patients with sPNET were disease free. The height standard deviation score (SDS) was significantly decreased at the last assessment relative to that at diagnosis (P < 0.0001). The latest median height SDS was -1.6 (range, 0.9 to -4.8), and the latest median full-scale intelligence quotient (FSIQ) score was 86 (range, 59–128). The CSI doses and age at the start of radiation therapy did not influence clinical outcomes, height SDSs, and FSIQ scores.ConclusionsOur original protocol for patients with embryonal CNS tumors was feasible and yielded favorable clinical outcomes.

Comparison of Postoperative Intensity Modulated Radiation Therapy With 2-Dimensional Radiation Therapy in Patients With Soft-Tissue Sarcoma of Extremities and Trunk

To compare directly clinical outcomes and late toxicities of postoperative intensity-modulated radiation therapy (IMRT) with two-dimensional radiation therapy (2D-RT) for patients with soft tissue sarcoma (STS) of extremities and trunk. 145 consecutive patients with non-metastatic STS of extremities and trunk treated with postoperative IMRT (n = 84) and 2D-RT (n = 61) from January 2005 to December 2011 were analyzed. All patients were treated with wide local excision and radiation therapy-naive. Average age was 44.7 years (range, 5-77) and 83 (57.2%) patients were female. The characteristics of the patients were shown in Table 1. The IMRT group had more patients over 50 years (51.2% vs 32.8%; p = 0.029), less proportion of tumors in extremities (64.3% vs 88.5%; p<0.001) and lower median radiation dose (63.2 ± 4.5 Gy vs 66 ± 3.3 Gy; p = 0.014), compared with the 2D-RT group. Other parameters of demographics, disease and treatment characteristics were comparable (p>0.05) between the two groups. The median follow-up time was 46.3 months (39.0 months for patients treated with IMRT and 67.9 months for 2D-RT). Nineteen local recurrences, 40 distant metastases and 30 deaths have occurred. The 5-year actuarial Local control (LC), distant-metastasis free survival (DMFS), disease-free survival (DFS) and overall survival rates (OS) for the cohort were 84.1%, 73.1%, 64.7% and 77.6%, respectively. Compared to 2D-RT group, the IMRT group had higher 5-year LC (87.3% vs 81.4%; p = 0.54), DMFS (75.8% vs 67.9%; p = 0.44), DFS (72.0% vs 58.1%; p = 0.36) and OS (83.0% vs 75.8%; p = 0.74), but without statistically significant differences. On multivariate analysis, large tumor (>5cm) [HR = 2.60 (95% CI, 1.20-5.66); p = 0.016] and disease stage [HR = 1.98 (95% CI, 1.00-3.89); p = 0.05] emerged as independent risk factor of OS, and no factor was identified to be related with LC. In terms of late toxicities, the patients in IMRT group enjoyed lower incidences and less serious edema (10.6% vs 19.7%; p = 0.53) and joint stiffness (9.2% vs 13.0%; p = 0.78) than those in 2D-RT group. Fractures (CTCAE grade 3) were found in 2 patients of 2D-RT group and none in IMRT group. When compared with conventional techniques, postoperative IMRT seems to provide better LC and OS and less severe late toxicities in patients with STS of extremities and trunk, though the differences were not statistically significant. Demographic and treatment characteristics of 145 patients with postoperative IMRT or conventional RTScientific Abstract 3377; TableVariablesNo. of patients (%)VariablesNo. of patients (%)VariablesNo. of patients (%)VariablesNo. of patients (%)VariablesNo. of patients (%)Age(years)PresentationHistologyGradeStage>5063(43.3)primary90(62.1)malignant fibrous histiocytoma31(21.4)G129(20.0)I29(20.0)≤5082(56.6)recurrent55(37.9)liposarcoma31(21.4)G292(63.4)II109(75.2)SexTumor size(cm)synovial sarcoma24(16.6)G324(16.6)III7(4.8)men83(57.2)≤581(55.9)fibrosarcoma26(17.9)MarginDose(Gy)women62(42.8)>564(44.1)rhabdomyosarcoma3(2.1)negative128(88.3)≤6493(64.1)LocationDepthothers30(20.7)Microscopic positive10(6.9)>6452(35.9)extremities108(74.5)superfacial46(31.7)Macroscopic positive7(4.8)trunk37(25.5)deep99(68.3) Open table in a new tab