Volume 90 � Number 1S � Supplement 2014 Poster Viewing Abstracts S719

the RN 3 weeks after RT, with response rates of 92% and 76%, respec-

tively. 63% of the RN calls took < 5 minutes. RN assistance to organize

radiation oncologist or family physician symptom-management appoint-

ments were required for only 3% and 6% of patients, respectively. 13% of

patients received symptom-management support from the RN. The most

common treatment site (47%) was the spine. There were highly statisti-

cally significant improvements in pain severity, function, and distress (p <

0.001 for all 3 domains), which did not vary significantly by treatment site

(p Z 0.50). Of those with a concern, 88% reported at least a 1-point

improvement in one domain, while 55% reported improvement in all 3

domains.

Conclusions: Population-based collection of PROMs was feasible during

routine clinical care without incremental staff resources. The burden on

RNs to collect information and offer support was low. The beneficial ef-

fects of palliative RT for bone metastases to improve pain severity, func-

tion, and distress were confirmed in a real world population.

Author Disclosure: R.A. Olson: E. Research Grant; Varian Medical Sys-

tems. H. Daudt: None. J. Stephen: None. J. French: E. Research Grant;

Varian Medical Systems. R. Halperin: None. G. Bahl: None. W. Beck-

ham: E. Research Grant; Varian Medical Systems. I.A. Olivotto: E.

Research Grant; Varian Medical Systems.

3291Correlation of the Incidence of Hypothyroidism and the Dose-Volume Histogram in Head and Neck Cancer Patients Treated WithIntensity Modulated Radiation TherapyA. Shimizu, K. Takehana, C. Makita, N. Tomita, H. Tachibana,

and T. Kodaira; Aichi Cancer Center, Chikusa-ku Nagoya, Aichi, Japan

Purpose/Objective(s): To evaluate the predictive factor of development

of hypothyroidism (HT) after definitive intensity-modulated radiation

therapy (IMRT) for head and neck cancer patients (HNC).

Materials/Methods: We identified 104 patients definitively treated with

IMRT for HNC between 2006 and 2013, who had their records of the

thyroidal function after completion of IMRT. A total dose of 60-70 Gy / 6-

7 weeks was delivered to the primary and involved lymph node. Eighty-

seven out of 104 patients received concurrent chemotherapy. HT was

graded using modified criteria from CTCAE ver.4; such as Gr. 0 for normal

function, Gr. 1 for TSH > 5.0 mU/ml or f-T4 < 0.7 ng/dl without medi-

cation, Gr. 2 for requiring prescription of thyroid hormone. After 2011, we

started to take dose parameter of the thyroidal gland (TG), and 53 patients

having those data were entered into the dose-volume histogram (DVH)

analysis regarding development of HT (DVH analysis group).

Results: Among the entire group (N Z 104), there were 83 males and 21

females with median age of 59 years (18-83). Clinical stage (CS)

distributed as I: II: III: IV for 2: 16: 32: 54. Primary sites (PS) comprised

43 (41%) of nasopharynx, 39 (38%) of oropharynx, and 12 (12%) of hy-

popharynx, respectively. Median follow-up time was 894 days (126-2750).

HT developed in 67 (64%) for Gr. 0, 25 (24%) for Gr. 1, and 12 (12%) for

Gr. 2, respectively. The incidence of HT of Gr. 1-2 was 36%. Median

duration period between the start of IMRT and onset of HT (DP) of Gr. 2

was 953 days (287-2680). Younger patients than 40 years (P Z 0.007) and

female proved to be significantly unfavorable factors of occurrence of HT

(P Z 0.02).Among DVH analysis group (N Z 53), there included 46

males and 7 females with median age of 62 years (35-80). CS distributed

as I: II: III: IV for 1: 5: 17: 30. Regarding PS, they comprised 13 (24%) of

nasopharynx, 22 (42%) of oropharynx, and 9 (17%) of hypopharynx,

respectively. The difference of distribution of patient’s characteristics

otherwise follow-up period between entire group and DVH analysis group

was not statistically significant. Median follow-up time of DVH analysis

group was significantly shorter than that of the entire group (582 days; 126

-951 ; p < 0.0001 ). HT developed in 41 (78%) for Gr. 0, 6 (11%) for Gr. 1,

and 6 (11%) for Gr. 2, respectively. Incidence of HTwith Gr. 1-2 was 22%.

DP of development of HT of Gr. 2 was 570 days (287-726). V70 of TG of

group with HT of Gr. 2 was significantly higher than that with group of Gr.

0-1 (Median 22.3 % vs 1.0 %; pZ 0.03). Group of HTwith Gr. 2 showed a

tendency for having larger mean dose of TG than group with Gr. 0-1

(Median 55.4 Gy vs 51.1 Gy; p Z 0.07).

Conclusions: Our analyzed data supported that considerable correlation of

HT with dose constraint of the TG. Further DVH analysis with longer

follow-up warrants leading to the practical guidance of management of HT

in patients treated with definitive IMRT.

Author Disclosure: A. Shimizu: None. K. Takehana: None. C. Makita:

None. N. Tomita: None. H. Tachibana: None. T. Kodaira: None.

3292Stereotactic Body Radiation Therapy in the ElderlyL. Larrea, E. Lopez-Munoz, P. Antonini, J. Bea, M. Banos, and M. Garcia;

Hospital NISA Virgen del Consuelo, Valencia, Spain

Purpose/Objective(s): To evaluate stereotactic body radiation therapy

(SBRT) in elderly patients (over 75 years old).

Materials/Methods: Between 2002 and 2013, 73 elderly patients with 84

tumors (primary or oligometastic) were treated using SBRT. Lesions were

located in: lung (90%), liver (6%), vertebral body (2%), bones (1%) or

pancreas (1%). Treatment outcomes, toxicity and technique were analyzed

retrospectively. SBRT involved: Computed tomography (CT) slow-scan

simulation with immobilization devices, contouring the target volume in 3

sets of CTs, superimposing the volumes in the planning system to represent

the internal target volume (ITV), dose calculation using heterogeneity

correction and assuring very conformal dose distribution and a steep fall-

off of the radiation dose outside treatment volume and radiation delivery

with multiple static non-coplanar beams and arc therapy. The prescribed

dose was ablative, either 3 fractions of 14-16 Gy each or a single 30-Gy

fraction (corresponding to biologically equivalent doses > 100). Dose

constraints were set for surrounding organs at risk. Toxicity and radiologic

response were assessed in follow-up visits, using conventional criteria

(RTOG, EORTC scores and radiologist reviewed reports). Survival rates

and cumulative incidences of toxicities were calculated by the Kaplan-

Meier method.

Results: Median patient age was 80.2 years (75-89). Mean tumor volume

was 6.62 cm3 (0.6-292.7). Transient grade 1 or 2 acute toxicities occurred

in 8% of all cases. No acute toxicities grade > 3 were identified. There

were no chronic toxicities of any grade. The median follow-up was 18

months (3-65). The 1-year overall survival was 68% for all patients and

74% for primary tumors (in lung lesions the values were: 69% and 75,2%).

Local control in the irradiated volume is 97%, the only relapse occurring in

a lung metastatic nodule.

Conclusions: SBRT is an excellent treatment option for elderly patients.

Our encouraging results in terms of survival, local control and toxicity are

in line with those reported in recent literature for younger patients.

Author Disclosure: L. Larrea: None. E. Lopez-Munoz: None. P. Anto-

nini: None. J. Bea: None. M. Banos: None. M. Garcia: None.

3293Pitfalls and Predictors of Poor Press Ganey Patient SatisfactionScoresA.B. Patel,1 T. LaCouture,1 K. Hunter,2 A. Tartaglia,3 and G.J. Kubicek1;1MD Anderson Cancer Center at Cooper, Camden, NJ, 2Cooper Research

Institute, Camden, NJ, 3Cooper University Hospital, Camden, NJ

Purpose/Objective(s): Patient satisfaction scores are becoming increas-

ingly more important in today’s health care environment; in the near

future, institutions will have reimbursement affected by these scores. Press

Ganey (PG) has become one of the leading patient satisfaction surveys. PG

scores are from 1 (poor) to 5 (very good) and the survey for radiation

oncology consists of 21 questions. Institutions are ranked according to

percentage of patients scoring all 5s. Institutions with low percentile ranks

will receive reimbursement cuts, while institutions with higher percentile

International Journal of Radiation Oncology � Biology � PhysicsS720

ranks will receive bonuses. In this study, we present an analysis of factors

that predict for PG scores.

Materials/Methods: PG scores were analyzed over a time span of 7

months including 71 patients and 1409 survey questions for an academic

institution with two satellite centers. Multiple variables (i.e., age, perfor-

mance status, diagnosis, treatment venue, presence of pain, concurrent

chemotherapy) were analyzed for correlations with scores using the In-

dependent T Test, Pearson Chi Square, and Fisher Exact Test.

Results: 26 patients (36%) filled out all questions with scores of all 5, 16

patients (22%) had all 5s but incomplete survey, 39 patients (55%) had at

least one non-5 score. 4 patients had a single non-5 score while 35 patients

had multiple non-5 scores. For complete surveys, the median score was

104 (range 84 to 105), the average score was 102.5. Pain, increasing age,

and treatment venue were predictive for non-5 scores.

Conclusions: PG scores are becoming a vital metric as department reim-

bursement is tied into these scores. Patients with unsatisfactory scores

tended to give non-5 scores across multiple questions, patients are seldom

dissatisfied in a single area. We found several modifiable (treatment venue)

and non-modifiable (older age and presence of pain) factors related to poor

scores. While there is some potential methods for improving PG scores

there are limitations, departments that see a disproportionate number of

elderly palliative cases will likely have lower scores.

Author Disclosure: A.B. Patel: None. T. LaCouture: None. K. Hunter:

None. A. Tartaglia: None. G.J. Kubicek: None.

3294Neurocognitive Outcomes in Relationship to Hippocampal andBrain Doses After Partial Brain Proton Radiation Therapy inChildrenA. Mahajan,1,2 D. Grosshans,1 D. Ris,2 M. Chintagumpala,2 F. Okcu,2

M. McAleer,1 B. Moore,1 H. Stancel,2 C. Minard,2 D. Guffey,2

and L. Kahalley2; 1M.D. Anderson Cancer Center, Houston, TX, 2Baylor

College of Medicine, Houston, TX

Purpose/Objective(s): We evaluated the relationship between IQ and

hippocampal RT doses in pediatric patients with brain tumors treated with

proton radiation therapy (PRT).

Materials/Methods: IQ scores were abstracted for patients treated with

partial brain PRT who underwent serial neurocognitive testing. Hippo-

campal delineation was performed according to RTOG guidelines. The

PRT dosimetric data were compiled. The relationships between IQ and 1)

median hippocampal doses and 2) percentage of hippocampus receiving

50, 30 and 10 GyRBE were evaluated using general linear mixed models

while controlling for mean brain-GTV dose, CTV volume, tumor location,

and age-at-RT.

Results: Data were collected for 25 patients (13 males, 12 females)

receiving PRT from 2007-2012. The mean interval between first-last IQ

testing was 2.1 y (range 0.9-6.0). The median age-at-PRT was 9.4 y (range

1.7-15.4 y). Tumors were supratentorial in 17 patients (9 glial, 5 cranio-

pharyngioma, 2 germinoma, 1 meningeal tumors) and infratentorial in 7

patients (3 anaplastic ependymoma, 2 medulloblastoma, 2 glial tumor). 17,

2 and 6 tumors were midline, right and left, respectively. The median dose

was 50.4 GyRBE (range 45.0-60.0 GyRBE). The median CTV volume was

43.3 cc (range 12.3-234.4 cc). The median mean brain-GTV dose was 9.4

GyRBE (range 3.9-19.7 GyRBE). The median mean right and left hip-

pocampal doses were 17.0 and 16.3 GyRBE (range 0.2-54.8 and 0.0-46.2

GyRBE), respectively. After controlling for the factors mentioned above,

patients who received any right hippocampal dose >50 GyRBE exhibited

significant IQ decline (6.4 points/y, p Z 0.01). Patients who received 30

GyRBE to �10% of the right hippocampal volume also experienced sig-

nificant IQ decline (4.0 points/y, p<0.01), while patients with less right

hippocampal dose/volume maintained stable IQ over time (p Z 0.67). Left

hippocampal dose/volume was not associated with IQ decline in this

cohort.

Conclusions: Preliminary findings suggest right hippocampal dose is

associated with steeper IQ decline post-PRT in this cohort of patients.

Author Disclosure: A. Mahajan: None. D. Grosshans: None. D. Ris:

None. M. Chintagumpala: None. F. Okcu: None. M. McAleer: None. B.

Moore: None. H. Stancel: None. C. Minard: None. D. Guffey: None. L.

Kahalley: None.

3295Patterns of Failure Following Proton Therapy in Medulloblastoma:LET Distributions and RBE Associations for RelapsesR. Sethi,1 D. Giantsoudi,2 M. Raiford,2 I. Malhi,2 A. Niemierko,2

O. Rapalino,3 P. Caruso,1 T.I. Yock,2 N.J. Tarbell,2 H. Paganetti,2

and S. MacDonald2; 1Harvard Medical School, Boston, MA,2Massachusetts General Hospital, Boston, MA, 3Massachussetts General

Hospital, Boston, MA

Purpose/Objective(s): The pattern of failure in medulloblastoma patients

treated with proton radiation therapy is unknown. For this increasingly

used modality, it is important to ensure that outcomes are comparable to

modern photon series. It has been suggested this pattern may differ from

photons due to variations in linear energy transfer (LET) and relative

biological effectiveness (RBE). In addition, the use of matching fields for

delivery of craniospinal (CSI) radiation may influence patterns of relapse.

We seek to report the patterns of failure following protons, compare to the

available photon literature, and determine the LET and RBE values in

areas of recurrence.

Materials/Methods: Retrospective review of patients with medulloblas-

toma treated with proton radiation therapy at *** between 2002 and 2011.

We documented the locations of first relapse. Discrete failures were con-

toured on the original planning computed tomography scan. Monte Carlo

calculation methods were used to estimate the proton LET distribution.

Models were used to estimate RBE values based on the LET distributions.

Results: One hundred and nine patients were followed for a median of

38.8 months (range, 1.4 to 119.2). Sixteen (16) patients experienced

relapse. Relapse involved the supratentorial compartment (n Z 8), spinal

compartment (n Z 11) and posterior fossa (n Z 5). Eleven failures were

isolated to a single compartment; six failures in the spine, four failures in

the supratentorium and one failure in the posterior fossa. The remaining

patients had multiple sites of disease. One isolated spinal failure occurred

at the spinal junction of two fields. None of the 70 patients treated with an

involved-field-only boost failed in the posterior fossa outside of the tumor

bed. We found no correlation between Monte Carlo-calculated LET dis-

tribution and regions of recurrence.

Conclusions: The most common site of failure in patients treated with

protons for medulloblastoma was outside of the posterior fossa. The most

common site for isolated local failure was the spine. We recommend

consideration of spinal imaging in follow-up and careful attention to dose

distribution in the spinal junction regions. Development of techniques that

do not require field matching may be of benefit. We did not identify a

direct correlation between lower LET values and recurrence in medullo-

blastoma patients treated with proton therapy. Patterns of failure do not

differ from patients treated with photon therapy.

Author Disclosure: R. Sethi: None. D. Giantsoudi: None. M. Raiford:

None. I. Malhi: None. A. Niemierko: None. O. Rapalino: None. P.

Caruso: None. T.I. Yock: None. N.J. Tarbell: K. Advisory Board; Spouse

is on medical advisory board of ProCure. NJT was on medical advisory

board until 2008. H. Paganetti: None. S. MacDonald: None.

3296Impact of Molecular Subtype and Craniospinal Irradiation (CSI)Dose on Relapse of MedulloblastomaA. Wang,1 S. Partap,1 K. Yeom1, M. Martinez,2 H. Vogel,1

S. S. Donaldson,1 P. G. Fisher,1 S. Perreault,3 Y.-J. Cho,1 and I. C. Gibbs1;1Stanford University/Lucile Packard Children’s Hospital, Stanford, CA,