during radiochemotherapy reflects the ability of tumor response: Those patients, who had no significant decline of tumor markervalues had a lower response rates and significantly worse outcome. These results were confirmed by multivariate Cox regressionshowing CA 19-9 serum levels to be a significantly independent prognostic marker.
In the follow-up CA 19-9 had a sensitivity of nearly 100 % in detection of recurrent disease with a specificity of 88 %. Themedian leading time was 22 weeks.
Conclusions: Our results indicate, that has a prognostic value in this patients and may serve a in-vivo marker for treatmentsensitivity. For detection of recurrent disease it shows a high sensitivity and specificity.
1092 The Impact of Overall Treatment Time on Local Control in Anal Cancer Treatment withRadiochemotherapy
R. Graf1, P. Wust1, B. Hildebrandt2, H. Goegler3, R. Ullrich1, H. Riess2, R. Felix1
1Center of Radiation Medicine, Charite Medical School, Campus Virchow Clinic, Berlin, Germany, 2Medical Clinic forHaematology and Oncology, Charite Medical School, Campus Virchow Clinic, Berlin, Germany, 3Surgical Department,DRK-Hospital, Westend Clinics, Berlin, Germany
Purpose/Objective: To evaluate the effect of the overall treatment time (OTT) on local control in patients with anal carcinomatreated with radiochemotherapy.
Materials/Methods: Between 1987 and 2000, 111 patients with epidermoid anal cancer (T1-4 Nx) were assigned to primarysimultaneous radiochemotherapy with a radiation dose of 45 Gy, performed as either split-course (one week planned gap) withsingle fractions of 2 Gy (group with schedule A, 1987-1996), or continuously with fractions of 1.8 Gy (group with scheduleB, 1996-2000). 88 patients (pts.)(A: 54 pts., B: 34 pts.) who completed radiochemotherapy with a total radiation dose of at least43 Gy and not exceeding 47 Gy were evaluated. Their median age was 60 years. 14 of the tumors were staged as T1, 39 as T2,28 as T3 and 6 as T4. The chemotherapy consisted of a continuous infusion of 5-fluorouracil (800 mg/sqm/d on 5 consecutivedays during weeks 1�5) together with a short infusion of mitomycin C (10 mg/sqm) during the first course (schedule A) or forboth courses (schedule B) of 5-fluorouracil. The anal region and the lymph nodes of the true pelvis were treated with photonenergies from 6 to 20 MeV using computer-assisted treatment planning and shrinking fields after 30 Gy. The inguinal regionwas treated separately by electron fields.
Results: The actuarial overall survival rate for all pts. was 71% after 5 and 54% after 8 years. The 5-year local control rate forall pts. was 67% after 5 and after 8 years. A univariate analysis of disease-related prognostic factors showed a significantcorrelation of local failure with T-category T3-T4 (p�0.03), tumor size of 6 cm ore more (p�0.00) and nodal stage N1-3(p�0.00). The OTT of the entire group ranged from 31 to 86 days, with a median of 40 days. The prescribed treatment timewas 35 days in schedule A (one week planned gap, 2 Gy fractions) and 31 days in schedule B (no planned gap, 1.8 Gy fractions).With additional occuring interruptions the resulting median OTT for pts. treated within schedule A and schedule B was 41 daysand 38 days. Pretherapeutic prognostic factors were well balanced between both groups. The (univariate) comparison of pts.with schedule A vs. those with schedule B showed that the 5-year actuarial control rates were similar (66% vs. 67%, p�0.88).Thus, the assignment of a patient to a continuous or split-course radiotherapy schedule had no prognostic implication.Subdividing all patients into groups with OTT of 40 days or less (47 pts.) and more than 40 days (41 pts.) with a resultingmedian OTT of 38 and 44 days, we found that the distributions of the pretherapeutic prognostic factors were well balancedbetween these both groups. The (univariate) comparison of both groups with shorter or longer OTT showed that the 5-yearactuarial control rate was 78% in the first group and 54% in the second thereby revealing a significant (p�0.05) difference.Subdividing the patients according to treatment interruptions of less than 7 days or 7 days or more in addition to the plannedschedule, the (univariate) comparison of both groups showed differences in actuarial local control which were even greater thanin the groups with different OTT with a higher level of significance (p�0.03). This shows the particular prognostic relevanceof treatment delays relative to the prescribed scheme. In a multivariate analysis tumor size (p�0.02) and OTT (p�0.03)remained significant when adjusted for T-stage, tumor size and nodal stage.
Conclusions: From these results, we conclude that in patients with anal carcinoma treated by radiochemotherapy with aradiation dose of 45 Gy, local control is predominantly determined by the resulting OTT but not by the prescription of asplit-course or continuous-course radiotherapy. Prolongation of the OTT is associated with a lower rate of local control.
1093 Chemoradiation-Induced Liver Disease for Patients with Post-Gastrectomy Adjuvant Chemoirradiation:Susceptible Factor Analysis and Dosimetric Implication
J.C. Cheng1,5, M. Liu2, S.Y. Tsai1, P. Yang3, H. Liu1, Y. Hsiao1, J. Wu4, W. Fang2, J.J. Jian1, A.T. Huang2
1Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, 2Department of MedicalOncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, 3Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, 4Department of Medical Physics, Koo Foundation Sun Yat-Sen Cancer Center, Taipei,Taiwan, 5Department of Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
Purpose/Objective: To report the unexpected chemoradiation-induced liver disease (CRILD) in patients with gastric orgastroesophageal adenocarcinoma (GC) after post-gastrectomy chemoirradiation, to investigate patient-related and dosimetricfactors, and to compare their hepatic tolerance with other patients with hepatocellular carcinoma (HCC) and radiation-inducedliver disease (RILD) after radiotherapy alone.
Materials/Methods: From December 1993 to December 2001, 71 patients with stage IB-IV GC underwent radical total/subtotal gastrectomy, lymph node dissection, and postoperative adjuvant chemoirradiation at Sun Yat-Sen Cancer Center,Taipei, Taiwan. Chemotherapy consisted of one cycle of etoposide, leucovorin, and 5-fluorouracil (ELF), given 3 weeks beforethe subsequent 5 weekly cycles of continuous infusion of high-dose 5-fluorouracil (2000mg/m2) and leucovorin (300mg/m2)
212 I. J. Radiation Oncology ● Biology ● Physics Volume 54, Number 2, Supplement, 2002
