outcomes reported by cancer survivors after radiation therapy
TRANSCRIPT
S566 I. J. Radiation Oncology d Biology d Physics Volume 81, Number 2, Supplement, 2011
Materials/Methods: Between 1998 and 2001, 1310 patients with localized prostate cancer were treated with EBRT (n = 897) orBRT (n = 413). We compared the incidence rates of SM in our patients with the general population extracted from the NationalCancer Institute’s Surveillance, Epidemiology and End Results (SEER) dataset combined with the 2000 census data.
Results: The 10-year likelihoods for SM development in the EBRTand BRT groups were 25% and 15%, respectively (p = 0.02).The 10-year likelihoods for in-field (IF) SM development in these groups were 4.9% and 1.6%, respectively (p = 0.24). Multi-variate analysis of predictors for development of all SM showed that EBRT vs BRTwas the only significant variable identified (p= 0.05), with a trend for older patients to develop a SM. The increased incidence of SM for EBRT patients was explained bya higher incidence of skin cancers outside of the radiation field observed for this cohort compared with BRT patients (10.6%and 3.3%, respectively, p = 0.004). For the EBRT group, 5- and 10-year mortality rates were 1.96% and 5.1% due to out-of field(OOF) cancers; for IF-SM the corresponding mortality rates were 0.1% and 0.7%. Among the BRT group, the 5- and 10-yearmortality rates related to OOF-SM were 0.8% and 2.7%. When compared with cancer incidence rates in the general population,our observed SM rates after prostate irradiation were not significantly different.
Conclusions: Using modern sophisticated treatment techniques, we report low rates of IF bladder and rectal second-cancer risksafter prostate cancer radiotherapy. Further, the likelihood of mortality secondary to a SM was uncommon. Higher rates of SMobserved in the EBRT cohort compared with BRTwas related to a small but significantly increased number of skin cancers notedin the EBRT patients compared with the general population.
Author Disclosure: D.M. Housman: None. M.J. Zelefsky: None. X. Pei: None. Z. Alicikus: None. J.M. Magsanoc: None. Y. Ya-mada: None. M. Kollmeier: None. B. Cox: None. Z. Zhang: None.
2742 Creation of RTOG-Compliant Locally Advanced Breast, Postoperative Pancreas, and High Risk Prostate
Cancer Atlases Assisted by Slice- and Volume-Based CT Deformable RegistrationA. V. Louie1, V. Velker1, J. Hwee1, R. Dinniwell2, G. Rodrigues1
1University of Western Ontario, London, ON, Canada, 2University of Toronto, Toronto, ON, Canada
Purpose/Objective(s): Contouring of target and normal tissue structures can be a time consuming exercise associated with sig-nificant levels of inter- and intra-physician variability. The purpose of this investigation was to create and evaluate multiple RTOGcompliant atlas libraries ability to reduce overall contouring time, inter-physician variability, and to provide the radiation oncol-ogy community a standardized platform for teaching and research.
Materials/Methods: Anonymized CT datasets of 50 high risk breast post-lumpectomy (BR), 50 high risk prostate (PRO), and 9post-operative pancreas (POP) cases were created as part of the LocStar (London Ontario Consistently Segmented Tri-purposeAtlas Resource) library project. For each case, RTOG compliant organs at risk and clinical target volumes (CTV) were manuallycontoured using a slice-by-slice deformable contouring registration tool (Contour CoPilot, MIMVista, Cleveland OH). A boot-strap methodology was then utilized to sequentially create volume deformable registered atlas-based contours for subsequent pa-tients in each atlas. Statistical analyses included descriptive time statistics, Dice Similarity Coefficients, two-group Student’s test,and/or ANOVA.
Results:The average time tomanually contour a casewere: PRO - 19min 6 s; POP - 26min 57 s and BR - 50min 41 s.Mean timesfor MIMVista atlas based autocontouring were 1 min 25 s (BR), 2 min 14 s (PRO), and 1 min 11 s (POP). Mean DICE scores forPRO were: prostate 0.71, seminal vesicles 0.30, CTV nodes 0.71, bladder 0.83, rectum 0.48, penile bulb 0.39, and femoral heads0.91. For POP, mean DICE scores were: aorta 0.49, celiac axis 0.08, CTV 0.49, kidneys 0.68, liver 0.75, pancreas 0.08, portal vein0.01, superior mesenteric artery 0.04, spinal cord 0.77, spleen 0.62, and stomach 0.37. For BR, mean DICE were: chest wall 0.88,seroma 0.07, supraclavicular lymph nodes (SCV) 0.71, axillary lymph nodes 0.73, lungs 0.97, and heart 0.90. Statistically sig-nificant improvements in DICE with increased case number were observed for SCV (p = 0.003) and lung contours (p = 0.02),but not in any of the remaining targets (all p.0.1).
Conclusions: Creation of RTOG-compliant atlases is feasible and can be assisted by slice-based and volume-based deformableregistration contouring algorithms. While some targets can likely be auto-contoured; highly variable and individualized targetssuch as breast seromas, nodal target volumes, and targets for localization of contouring such as the portal vein, superior mesen-teric artery, aorta, and celiac axis should be contoured manually using slice-deformable assistive technologies.
Author Disclosure: A.V. Louie: None. V. Velker: None. J. Hwee: None. R. Dinniwell: None. G. Rodrigues: None.
2743 Outcomes Reported by Cancer Survivors after Radiation Therapy
C. E. Hill-Kayser, C. Vachani, M. K. Hampshire, G. A. Di Lullo, J. M. Metz
University of Pennsylvania, Philadelphia, PA
Purpose/Objective(s): Cancer survivors may be at significant risk for late effects after radiotherapy therapy. The impact of tox-icity after cancer treatment on survivors is not well described. This Internet based study evaluates patient perceptions of toxicityafter radiation therapy.
Materials/Methods: Patient-reported data was gathered via a convenience sample frame from cancer survivors voluntarily uti-lizing a publically available, free, Internet-based tool for creation of survivorship care plans. Available at www.livestrongcare-plan.com and through the OncoLink website, the tool allows survivors to enter data regarding diagnosis, demographics, andtreatments, and provides customized guidelines for future care. During use of the tool, survivors are queried regarding late effectsassociated with specific treatments, and asked to answer ‘‘yes,’’ ‘‘no,’’ or ‘‘I don’t know.’’ They are also asked to score GI and GUtoxicity using modified versions of validated scales. All data have been maintained with institutional review board approval.
Proceedings of the 53rd Annual ASTRO Meeting S567
Results: Of 3223 cancer survivors answering queries regarding late effects, 1785 (55%) had undergone radiotherapy (78%women, 88% Caucasian). Their most common diagnoses were breast (53%), lymphoma/leukemia (10%), GI (8%), and GU(8%) cancers. Median time from diagnosis was 2.3 years. Of the whole cohort, the most common late effects reported wereconcern regarding cognitive changes (58%), sexual changes (55%), changes in texture/color of skin (50%), and chronic pain/numbness/tingling (39%). Late effects by disease site are outlined in Table 1.
Conclusions: Cancer survivors choosing to use this tool after radiation therapy describe significant late toxicity. Cognitive andsexual changes appear more prominent than expected within this population. These findings have significant implications forpatient counseling, as well as management of patients after radiation therapy.
Most commonly reported late effects by cancer survivors after radiation according to diagnosis
Diagnosis
# Users Patient Reported OutcomesBreast Cancer
944 (53%) Cognitive changes (62%) Skin changes (53%) Chronic pain/ numbness/tingling (53%)
Loss of flexibility (34%)
Leukemia/
lymphoma
181 (10%)
Cognitive changes (50%) Sexual changes (49%) Skin changes (46%) Hypothyroid (40%)Gastrointestinal
160 (9%) Cognitive changes (50%) Sexual changes (44%) Chronic diarrhea (32%) Skin changes (23%)Genitourinary
145 (8%) Sexual changes (56%) Urinary incontinence (20%) Skin changes (18%) Osteoporosis (12%)Head and Neck
90 (5%) Decreased saliva (83%) Difficulty speaking/swallowing (80%)
Skin changes (70%)
Loss of neckflexibility (57%)
Gynecologic
88 (5%) Sexual changes (78%) Cognitive changes (49%) Skin changes (40%) Weight gain (33%)Lung
51 (3%) Skin changes (44%) Chronic pain/ numbness/tingling (43%)
Hearing loss (34%)
Hypothyroid (29%)Author Disclosure: C.E. Hill-Kayser: None. C. Vachani: None. M.K. Hampshire: None. G.A. Di Lullo: None. J.M. Metz: None.
2744 National Survey of Health Care Providers’ Views on the Risk of Inadvertent Exposure of Pregnant Patients
to Ionizing Radiation in Canadian Radiotherapy DepartmentsJ. D. Caon1, R. Olson2, S. Tyldesley1, A. Bergman3, M. Bobinski4, M. Fong5, V. Ma6, R. Vellani5, K. Goddard1
1BC Cancer Agency, Department of Radiation Oncology, Vancouver, BC, Canada, 2BC Cancer Agency, Department ofRadiation Oncology, Prince George, BC, Canada, 3BC Cancer Agency, Department of Medical Physics, Vancouver, BC,Canada, 4University of British Columbia, Faculty of Law, Vancouver, BC, Canada, 5BC Cancer Agency, Department ofRadiation Therapy, Vancouver, BC, Canada, 6University of British Columbia, Vancouver, BC, Canada
Purpose/Objective(s):Women of child-bearing age are at risk of developing a malignancy that requires treatment with radiationtherapy (RT). Radiation exposure to pregnant patients is associated with a risk of fetal malformation or death. A preliminary sur-vey in a Canadian province suggested that safety mechanisms to prevent inadvertent RT to pregnant patients were not clearlyestablished, and therefore a national survey was undertaken.
Materials/Methods:An online survey was created and distributed to all radiation oncologists (RO), radiation oncology residents(ROR), radiation therapists (RTT), and medical physicists (MP) who were members of their respective national agencies(n = 2146).
Results: 317 respondents (14.8%) completed the questionnaire, with the highest response rate from ROs (34.2%). The majoritywere RTTs (55.2%), followed by ROs (31.4%), MPs (9.5%), and RORs (3.8%). All Canadian provinces, with the exception ofNova Scotia, were represented. Only 58.2% of ROs/RORs remembered to discuss the risk of RT in pregnancy most of thetime. The majority (69.7%) of respondents did not believe or know if RTTs discussed the risks of radiation in pregnancy. In ad-dition, the majority (65.2%) either thought no warning signs existed in their department, or were unsure of their existence. Only8.3% of respondents believed their centre had patient information handouts. Few (9.0%) respondents encountered a situationwhere a pregnant patient was inadvertently treated with RT, and 13.2% encountered a situation where a pregnant patient was al-most inadvertently treated with RT; there was no significant difference by province (p = 0.79 and p = 0.18, respectively). Eachoccupation thought that discussion by ROs, education by RTTs, and routine pregnancy testing were the most effective methods toprevent inadvertent radiation exposure.
Conclusions: No consistent mechanisms appear to be in place across Canadian cancer centers to prevent inadvertent ionizingradiation exposure to pregnant patients. Furthermore, 19% of respondents encountered situations in which a pregnant patientwas, or was almost, inadvertently irradiated. This suggests that national guidelines together with detailed institutional policiesand procedures need to be developed.
Author Disclosure: J.D. Caon: None. R. Olson: None. S. Tyldesley: None. A. Bergman: None. M. Bobinski: None. M. Fong:None. V. Ma: None. R. Vellani: None. K. Goddard: None.
2745 Referral Patterns of Patients for Palliative Radiation Therapy in British Columbia: A Comparison
Between Northern and Urban Family PhysiciansS. Lengoc, J. Soo, J. French, C. McGahan, S. Tyldesley, R. Olson
British Columbia Cancer Agency, Vancouver, BC, Canada
Purpose/Objective(s): Previous studies have shown that Palliative Radiation Therapy (PRT) is often underutilized especiallyin rural and remote settings despite evidence that it is effective in managing symptoms from advanced or metastatic cancer.