Appropriateness Criteria for Spinal Bone Metastases and practice in agreement with these ... Using HDR Planning Principles: A Single-Institution Experience of.
E476 Radiology (ACR) guidelines, and to see if time to initiation of treatment differs when the initial treatment is surgery versus radiation therapy (RT). Materials/Methods: Surveys were emailed to all 79 VHA ROs at 38 VHA centers and included questions on use of steroids, surgery, palliative care services, fractionation, re-irradiation, and management of three common MSCC case scenarios. This was followed by phone calls to encourage response to surveys. Chi-square analysis was used to evaluate for significant interactions. Results: The survey yielded an 81.0% response rate, representing 89.5% of VHA Radiation Oncology centers. All respondents are board certified (96.9%) or board eligible (3.1%). Of the respondents, 37.5% see 1-5, 37.5% see 6-10, and 25% see >10 cases per year. 79.4% have read the ACR Appropriateness Criteria for Spinal Bone Metastases. The majority (87.3%) prefers 30 Gy/3 Gy over shorter or longer fractionation schemes for MSCC, and all respondents recommend steroids. When required, RT is more often initiated within 24 hours as compared to neurosurgery (83.9% vs 34.5%, p75%) management concurred with ACR guidelines. Case scenario responses demonstrate that most ROs refer for surgical decompression when appropriate and are more likely to select RT alone for radiosensitive tumors compressing the cord. Having read the ACR guidelines was not significantly associated with selection of responses concordant with the guidelines. Seeing more cases of MSCC per year also did not predict for increased concordance of responses with the guidelines. Conclusion: The majority of VHA ROs are familiar with the ACR Appropriateness Criteria for Spinal Bone Metastases and practice in agreement with these guidelines. Treatment is more quickly initiated for MSCC when RT is the primary modality compared to when surgical decompression precedes RT. All respondents report use of Palliative Care Services in MSCC patients within VHA. Author Disclosure: R. Gutt: None. S. Malhotra: None. S. Jolly: None. D. Moghanaki: Member; ASTRO Scientific Committee. A.V. Cheuk: None. H. Fosmire: Employee; Indiana University. VA employee with faculty appointment; Indiana University. Chief; RADIATION ONCOLOGY DEPARTMENT, ROUDEBUSH VA. Co-Chair; CLINICAL PRODUCT REVIEW COMMITTEE. Chair; VISN 11 CLINICAL HIGH COST ACQUISITION COMMITTEE, ROUDEBUSH VA CANCER PROGRAM, MACHINE PRODUCED RADIATION SAFETY COMMITTEE. M.D. Kelly: Chair; VHA Radiation Oncology Field Advisory Committee. Board Member; AAWR. L. Hoffman-Hogg: None. S. Lutz: Member; ASTRO. Chair; ASTRO. M.S. Anscher: Employee; National Rehabilitation Hospital, Duke Regional Hospital. Stock Options; CivaTech. advisory board for Virginia Life Sciences Investments; Virginia Life Sciences Investments. scientific advisory board for CivaTech; CivaTech. Co-leader; Massey Cancer Center. Chair; Virginia Commonwealth University Health System. G.A. Dawson: None.
International Journal of Radiation Oncology Biology Physics Poster Viewing Abstracts 3190; Table 1 Frequency and distribution of symptoms prompting acupuncture referral among RT patients Symptom
n
Men (%)
Women (%)
Arthralgia Nausea Neuropathy Fatigue Hot flashes Myalgia Cancer pain Headache Xerostomia Insomnia Dysphagia Diarrhea Rectal pain
6 6 6 4 4 4 4 3 3 1 1 1 1
17 50 17 25 0 25 50 0 67 0 0 0 0
83 50 83 75 100 75 50 100 33 100 100 100 100
therapy (RT) induced side effects such as RT-induced xerostomia in head and neck cancer and RT-related fatigue. In this study, we analyzed the demographics among RT patients who chose acupuncture, which symptoms prompted referral, and the prevalence of combined treatment modalities among these patients. Materials/Methods: Records of 50 cancer patients who utilized acupuncture between May 2013 and April 2014 were reviewed at our institution. The subset chosen for final analysis was limited to those patients who underwent radiation therapy either alone or in combination with other standard cancer treatment modalities. Variables measured included gender, age, cancer disease site, treatment modalities, chemotherapy agent, and type and number of symptoms prompting acupuncture referral. Results: Among 50 pts analyzed in our initial set of acupuncture patients, 26 pts, 8 men (mean ageZ64.5 yrs) and 18 women (mean ageZ58.5 yrs) received radiation therapy. Twenty-two pts also received chemotherapy, and 15 pts among the chemoradiation cohort underwent surgery. Breast cancer pts (nZ11) were the most prevalent users of acupuncture followed by head and neck cancer (nZ4) and lung cancer (nZ3) pts. Most pts (nZ20) requested acupuncture for assistance with 12 symptoms with the most common symptoms being neuropathy (nZ6), arthralgia (nZ6), and nausea (nZ6). Among the breast cancer cohort, the most common chief complaints were arthralgia (nZ6), myalgia (nZ5), and neuropathy (nZ4), and the most commonly used chemotherapy were taxanes (nZ9). Conclusion: Among RT patients, women were more prevalent users of acupuncture with a majority diagnosed with breast cancer. The majority of RT patients also received chemotherapy. Neuromusculoskeletal complaints were the most common reason for acupuncture referral. These data will be used in future analyses to further delineate symptom qualities in order to strengthen outcomes evaluations and tailor attention to cancer subpopulations’ specific symptoms that may benefit from acupuncture. Author Disclosure: S. Rana: None. A. Rademacher: None. Y. Chen: None. O.V. Sostin: None. C.R. Thomas: None.
3190 Factors Promoting Utilization of Acupuncture Among Radiation Therapy Patients S. Rana,1 A. Rademacher,1 Y. Chen,1 O.V. Sostin,2 and C.R. Thomas, Jr1; 1 Oregon Health and Science University, Portland, OR, 2Oregon Health and Science University, Portland, OR Purpose/Objective(s): The management of cancer treatment-related side effects is a continuous challenge to patients and healthcare providers alike. In the therapeutic armamentarium, alternative medicine is slowly gaining popularity as a complementary or substitutive management option. Among well-known alternative medicine modalities, acupuncture has been shown in several studies to reduce or eliminate radiation
3191 Photodynamic Therapy (PDT) With Porfimer Sodium Sensitizer Using HDR Planning Principles: A Single-Institution Experience of an Alternative Cancer Treatment M. Goldberg,1 J.E. Hayward,2 R. Singh,3 and R. Sur4; 1McMaster University, Hamilton, ON, Canada, 2Juravinski Cancer Centre, Hamilton, ON, Canada, 3Walker Family Cancer Centre, St. Catharines, ON, Canada, 4 Juravinski Cancer Centre-McMaster University, Hamilton, ON, Canada Purpose/Objective(s): PDT was approved for use in Canada in the 1990s, yet is not widely used due to cost and photosensitivity. We present a series
Volume 93 Number 3S Supplement 2015 of patients treated with PDT, using HDR principles for planning, to review its role in cancer therapy. Materials/Methods: Between 2005 and 2009 23 patients were treated with PDT and 21 charts were retrospectively reviewed. Patients were pretreated with Porfimer Sodium, 1-2mg/kg intravenously, 48 hours prior to PDT. A Diomed 630nm light source was used in all cases. In one case an LED light source was also used. Fiber type, diffuser length, and illumination were predetermined based on lesion size and histology, according to published guidelines. Custom immobilization devices and light field defining apertures were created for skin treatments. Endobronchial fibers and cylindrical diffuser balloons were used for lung and esophageal PDT, respectively. Local control and toxicity was assessed. Results: Average age was 69 years. 27 lesions were treated in 21 patients. Sites and histologies included squamous cell carcinoma (SCC) of the face (nZ4), SCC of the extremities (nZ1), melanoma on the anterior chest (nZ1), basal cell carcinoma (BCC) of the face (nZ4), non-small cell carcinoma of a lung bronchus (nZ4), adenocarcinoma of the esophagus (nZ3), high grade dysplasia of the esophagus (nZ2), and invasive/in situ SCC of the vulva/vagina (nZ2). One patient had two BCCs treated, while another had multiple extremity SCCs. In 67% of patients PDT was used curatively, 43% for recurrent tumors. Intent was palliative in 33%. Three patients received chemotherapy prior to PDT, 7 patients had previously received external beam radiation therapy (EBRT) (EQD2 using a / bZ3, of 36-87.5Gy), brachytherapy (minimum dose 18Gy/3 for esophagus, or 14Gy/2 to bronchus), or both. Three patients underwent surgery alone prior to PDT, and 5 patients were treated with surgery and EBRT (EQD2 using a / bZ3, of 54-61.6Gy). The most common indication for PDT was prior RT dose or surgery precluding further local therapy. Median follow-up was 5.5 (range, 0- 68) months. Complete response or adequate palliation was seen in 44% of treated lesions. Acute toxicities of edema, necrosis, and pain were self-limited and managed conservatively. Chronic stricturing was seen after esophageal PDT. No significant sunburns were seen. An unexpected toxicity was seen in a patient with SCC extending from the palmar to dorsal portion of the hand who had received EBRT, surgery, and 2 PDT treatments given 70 days apart. They developed extremity swelling and subsequent infection requiring amputation 23 days post PDT. Conclusion: The use of HDR principles for PDT planning at multiple disease sites results in acceptable control and toxicity for palliative salvage therapy when prior surgery or RT preclude further treatment. Side effects must be discussed with the patient and potential benefit must be individually assessed. Author Disclosure: M. Goldberg: None. J.E. Hayward: None. R. Singh: None. R. Sur: None.
3192 Urinary Cytokines/Chemokines as Markers of Pain Flare in Patients With Painful Bone Metastases Undergoing External Beam Radiation Therapy A. Bushehri,1 M. Pasetka,2 K. Dennis,3 A. Hird,4 A. Azad,5 E. Chow,6 and C. de Angelis2; 1Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada, ON, Canada, 2Department of Pharmacy, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada, 3The Ottawa Cancer Centre, Ottawa, ON, Canada, 4Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 5Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada, 6Sunnybrook Health Sciences Centre-Odette Cancer Centre, Toronto, ON, Canada Purpose/Objective(s): Pain is experienced by 50%-75% of patients with bone metastases. External beam radiation therapy (EBRT) is a mainstay for treatment of painful bone metastases. Worsening of pain (“pain flare”) within 10 days of radiation therapy to bone metastases occurs in 40% of patients. The pathophysiology of pain flare is poorly understood. In this study, we are investigating the pathophysiology of pain flare through
Poster Viewing Session E477 assessment of changes in urinary cytokines/chemokines in patients receiving EBRT for painful bone metastases. Materials/Methods: Urine samples were collected from patients receiving a single 8 Gy radiation therapy fraction for painful bone metastases pre, day 1 or 2 and on an additional day between days 3 to 5 post radiation. Patients completed a pain and analgesic use diary daily for 10 days following radiation. Patients were deemed to have pain flare if they had a two-point increase from baseline pain on 0-10 scale and no decrease in analgesic intake or a 25% increase in analgesic intake with no decrease in pain. The Millipore Milliplex 42-Plex Cytokine/Chemokine KitÔ was used to measure urinary levels of a panel of cytokines/ chemokines. Results: 28 patients were enrolled. 83/84 urine samples were collected for analysis. Pain flare was experienced by 11 patients (39%). Of the 42 possible cytokines/chemokines measured at least 50% of the patients had measurable EGF, Fractalkine, GRO, IL-4, IL-8, IP-10, MCP-1, MDC, PDGF-AA, sIL-2Ra, TGF-alpha and VEGF. Comparing patients with or without pain flare EGF, Fractalkine, GRO, IL-8, IP-10, MCP-1, MDC, sIL2Ra, and TGF-alpha increased following radiation. There was a decrease in PDGF-AA and no change in IL-4 and VEGF. Conclusion: Measurable changes in urinary cytokine/chemokine levels occurred following radiation for painful bone metastases. Patients who experience pain flare appear to have a different pattern in urinary cytokine/ chemokine levels than patients without pain flare. Author Disclosure: A. Bushehri: None. M. Pasetka: None. K. Dennis: None. A. Hird: None. A. Azad: None. E. Chow: None. C. de Angelis: None.
3193 The Outcome of Reirradiation With Curative Intent: Analysis of 247 Patients in 6 Years R. Oh,1 H. Shiomi,1 O. Suzuki,2 N. Masai,1 and D. Tatsumi1; 1Miyakojima iGRT Clinic, Osaka, Japan, 2Miyakojima iGRT Clinic, Osaka University, Osaka, Japan Purpose/Objective(s): In recent decades, the number of long-term cancer survivors has increased. This has caused increasing requests for the delivery of a second course of radiation to recurrent tumors that occurred in previous radiation therapy fields. Most radiation oncologists are reluctant to offer reirradiation due to a lack of experience and potential toxicity. We reviewed our experience during 6 years and analyzed the outcome, in terms of tumor response, survival rates, and toxicity. Materials/Methods: A total of 247 patients reirradiated with IMRT between 01/2008 and 06/2014 at Miyakojima iGRT Clinic were analyzed. The prescribed doses were corrected to the biologically effective dose (BED) using the linear-quadratic (LQ) formulation for intercomparison over a wide variety of fraction sizes. The median BED10 of the first radiation therapy was 60Gy (12-134Gy). The median interval between the first and second radiation therapy courses was 18 months (1-308 months). The median BED10 of reirradiation was 77Gy (20-107Gy). Results: The median follow-up after reirradiation was 9 months (1e66 months). All patients completed the prescribed course of reirradiation and acute toxicity was limited. A total of 23 (9.3%) patients developed grade>3 late toxicity with the reirradiated sites including head and neck, chest, and abdomen/pelvis in 56.5%, 21.7%, and 21.7% of patients, respectively. Local recurrence was observed in 31 patients (12.6%). Median overall survival and 2-year overall survival rate after reirradiation were 18.5 months and 45.0% (95% CI, 37.1-52.5%). Conclusion: The low toxicity of reirradiation by using modern techniques should allow the delivery of higher doses and, as a consequence, lead to an improvement in the reirradiation outcome. Author Disclosure: R. Oh: None. H. Shiomi: None. O. Suzuki: None. N. Masai: None. D. Tatsumi: None.
