Mayo Clinic, Phoenix, AZ. Purpose/Objective(s): The ... analyzed using Kaplan-Meier, chi-square, and logistic regression analyses. The median follow-up was ...
Proceedings of the 53rd Annual ASTRO Meeting tests are still ongoing and additional results and more comprehensive analysis will be presented to evaluate the effectiveness of the technique. Author Disclosure: S. Yu: None. H. Wang: None. C. Yang: None. Y. Feng: None. Y. Wang: None. J. Lu: None. X. Hu: None.
2997
Neoadjuvant Chemoradiation Compared to Neoadjuvant Radiation or to Surgery Alone for Soft Tissue Sarcoma of the Extremity
J. B. Ashman, K. K. Curtis, C. P. Beauchamp, A. J. Schwartz, M. D. Callister, A. C. Dueck, L. L. Gunderson, T. R. Fitch Mayo Clinic, Phoenix, AZ Purpose/Objective(s): The benefit of concurrent chemoradiation has not been established as preoperative therapy for soft tissue sarcoma (STS) of the extremity. This report describes our institutional experience using either neoadjuvant radiation (NR) or chemoradiation (NCR) compared to surgery alone (SA) for extremity STS. Materials/Methods: A retrospective chart review identified 112 consecutive patients (pts) with Stages II and III extremity STS treated between January, 1998 and December, 2009. Pts with either primary (n = 91) or recurrent (n = 21) disease were included. Treatment regimens included SA (n = 36), NR (n = 37), or NCR (n = 39). Approximately half of the NCR cohort (n = 20) were treated with concurrent weekly cisplatin (20 - 40 mg/m2 intravenous). The median radiation dose was 50.4 Gy (range 25.2 - 54). A boost dose was delivered using either intraoperative electrons or brachytherapy for 44 and 14 pts, respectively. Outcomes were analyzed using Kaplan-Meier, chi-square, and logistic regression analyses. The median follow-up was 22.1 months (range 2.5 - 96.4). Results: The median tumor size was significantly larger for pts treated with NR or NCR compared to SA (8.0 vs. 10.6 vs. 4.0 cm; p = 0.01). The median age was older for pts treated with NR compared to NCR or SA (71 vs. 58 vs. 54.5 years; p = 0.03). R0 and R1 resections were achieved in 87% and 13% of pts, respectively. Rates of actuarial 3-year local control (LC), distant metastasisfree survival (DMFS), and overall survival (OS) were 87%, 69%, and 68%, respectively. Despite the differences in initial tumor size, no significant differences were identified between NR, NCR, or SA cohorts with respect to rates of R0 resection, LC, DMFS, or OS. However, improved 3-year OS was observed for pts with tumors . 5cm treated with NR or NCR compared to SA (63 vs. 70 vs. 40%; p = 0.03). Pts treated with SA compared to either NR or NCR were significantly more likely to require limb amputation (39% vs. 3% vs. 8%; p\0.001). Higher rates of wound complications were observed after NCR or NR compared to SA (50 vs. 43 vs. 9%; p \ 0.001), but NCR and NR were not significantly different (p = 0.4). On multivariate analysis for predictors of wound complications, use of NCR or NR approached but did not reach significance (OR 4.57; p = 0.07). Conclusions: NCR did not improve outcomes compared to NR. Wound complications were not significantly increased using NCR compared to NR, but further analysis is ongoing for predictors of clinically relevant post-operative wound complications. An OS benefit was observed in pts with larger tumors who received either NR or NCR as compared to SA. Ongoing and future studies of the molecular genetics of sarcoma may provide a foundation for the identification of patient subgroups who would most benefit from a NCR strategy. Author Disclosure: J.B. Ashman: None. K.K. Curtis: None. C.P. Beauchamp: None. A.J. Schwartz: None. M.D. Callister: None. A.C. Dueck: None. L.L. Gunderson: None. T.R. Fitch: None.
2998
Clinical Outcomes and Toxicity using Stereotactic Body Radiotherapy (SBRT) for Stage IV Melanoma
B. M. Barney1, K. R. Olivier1, Z. C. Wilson1, R. C. Miller1, O. K. Macdonald2, P. D. Brown3, R. L. Foote1, S. N. Markovic1 1 3
Mayo School of Graduate Medical Education, Rochester, MN, 2Therapeutic Radiologists, Incorporated, Kansas City, MO, MD Anderson Cancer Center, Houston, TX
Purpose/Objective(s): Radiotherapy has often been omitted as an option for palliation of Stage IV melanoma due to the perception that melanoma is a radioresistant tumor. As evidence emerges that metastasectomy may improve symptoms and even survival in patients with oligometastatic disease, clinical indications for SBRT continue to evolve. At our institution, we have taken an aggressive approach to treating Stage IV melanoma that includes metastasectomy and/or SBRT in select patients in addition to systemic therapy. We retrospectively reviewed our clinical outcomes and toxicity associated with SBRT for patients with Stage IV melanoma. Materials/Methods: Thirty-seven consecutive patients with 52 metastatic lesions underwent SBRT. All patients had previously received systemic therapy, and at the time of SBRT, all but 5 of these patients had at least one other site of active disease. Sites treated included lung (N = 19), spine and bony pelvis (N = 12), liver (N = 11), abdominal lymph node (N = 6), lower extremity (N = 1), adrenal gland (N = 1), and parotid gland (N = 1). SBRT was delivered in 1 (N = 10), 3 (N = 20), 4 (N = 4), or 5 (N = 18) consecutive daily fractions over one week. For soft tissue lesions, the most commonly prescribed dose was 54 Gy in 3 fractions (median 54 Gy, range 28 to 60 Gy). For bony lesions, the most commonly prescribed dose was 20 Gy in 1 fraction (median 21 Gy, range 18 to 50 Gy). Patients were followed closely after SBRT for treatment response and toxicity, with most patients undergoing FDG-PET scans within 2 months of completion of SBRT. Treatment response was graded by the EORTC Nuclear Imaging Response Criteria, and toxicities were scored by CTCAE v.3. Results: The median follow-up period for living patients was 9 months. Fourteen patients (27%) showed a complete metabolic response (CMR), 16 patients (31%) showed a partial metabolic response (PMR), and 15 patients (29%) showed stable metabolic disease (SMD). Only 3 patients experienced a progression within the SBRT field (6%), and the 6- and 12- month estimates of in-field control were 95% and 92%, respectively. Survival estimates for the cohort at 6- and 12- months were 85% and 63%. Although most patients initiated systemic therapy soon after completion of SBRT, the median time to progression at any site was only 2 months. In general SBRT was well-tolerated, with 18 patients (49%) reporting toxicity, the majority of which was Grade 1 or 2. Two patients (5%) experienced Grade 3 toxicities, including one patient with late obstructive uropathy, and one patient with a gastric ulcer. There were no reported toxicities of Grades 4 or 5. Conclusions: SBRT is a safe and effective local therapy for oligometastases in patients with Stage IV melanoma. Further followup is needed to better quantify the risk of late complications associated with SBRT. Author Disclosure: B.M. Barney: None. K.R. Olivier: None. Z.C. Wilson: None. R.C. Miller: None. O.K. Macdonald: None. P.D. Brown: None. R.L. Foote: None. S.N. Markovic: None.
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