Volume 90 � Number 1S � Supplement 2014 Poster Viewing Abstracts S341

Purpose/Objective(s): In spite of a little knowledge on symptomatic/

asymptomatic pericardial effusion (PCE) in patients treated with chemo-

radiation (CRT) for esophageal cancer (EC), relevant pericardial dosi-

metric factors have been still unclear because gettable values were too

limited to obtain meaningful values from the past 3D conformal radiation

therapy (3DCRT) experiences. The aim of this study is to assess retro-

spectively PCE occurrence observed in a pair of the cohorts of 3DCRT and

identify the limitation of dosimetric analysis for conformal plans. From the

results, we submit a novel treatment form which was composed from

3DCRT and arranging volumetric modulated arc therapy (VMAT) com-

ponents. The capability of VMAT to reduce cardiac dose, while main-

taining the institutional pulmonary constraint which pulmonary V10 were

<37%, was evaluated.

Materials/Methods: We compared PCE probability after at least two year

observation between two different 3DCRTcohorts whose cardiac dosi-

metric parameters were significantly different by t-test. Total 182 patients

(91 for each cohort group) treated with CRT (2 cycles of FP administered

while 50.4Gy/28F extended fields RT) from 2004. Ninety one patients

treated with the optimized 4-field arrangement (denominated E-plan) were

compared with 91 patients treated with the control plan (39.6Gy/ 22F AP-

PA & cord-off 10.8Gy/6F RAO-LPO) about pericardial V30-50 and mean

cardiac dose (MCD). Furthermore, an E-plan prescribed 50.4Gy/28F was

compared with the same 3DCRT plan prescribed 36Gy/20F and VMAT

(162 CPs) combination using PTV prescribed D95 of 14.4Gy/8F. Twenty

two 3DCRT/VMAT hybrid plans were evaluated and compared with

E-plans in lung V5-10, pericardial V30- 50, MCD and PTV conformity

index (CI, van’t Riet).

Results: Thirty seven of 182 patients (20%) had experienced only Grade 2

asymptomatic PCE (CTCAE ver. 4). Median onset of them was 13.8

months (95% CI Z 3.8-28.7). Between the group of 37 patients with PCE

and the group of 145 patients without PCE, there were no significant

differences in the pericardial dosimetric factors and MCD. There was no

significant PCE occurrence rate (18/91 vs 19/91) between the two cohorts

of 3DCRT plans, although there were significant differences (p<0.001)

about the average pericardial V30 (61.6 vs 68.8%), V40 (53.2 vs 60.8%)

and MCD (32.1 vs 35.2Gy), respectively E-plan vs control. On the other

hand, 3DCRT/ VMAT hybrid plan provided the significant reduction from

E-plan whose difference is more than 10% in the average pericardial V40

(34.9 vs 57.8%, p<0.001) and V45 (19.6 vs 32.9%, p< 0.001) without CI

deterioration from the conformal plan.

Conclusions: The 3DCRT plan contrived for pericardial dosimetric factors

could not reduce PCE occurrence. 3DCRT/VMAT hybrid plans to reduce

the pericardial V40-45 more than 10% from conformal plans may warrant

clinical implementation.

Author Disclosure: M. Myojin: None. S. Tanabe: None. K. Harada:

None. H. Shirato: None. M. Hosokawa: None.

2312Results and Prognostic Factors for Esophageal Cancer Treated WithIntensity Modulated Radiation TherapyJ.L. Tan and X.Z. Fen; Cancer Hospital, Chinese Academy of Medical

Sciences, Beijing, China

Purpose/Objective(s): To report the outcomes and prognostic factors of

esophageal cancer treated with Intensity-modulated radiation therapy

(IMRT).

Materials/Methods: An analysis was carried out of 429 esophageal cancer

patients treated with definitive IMRT at our hospital from Sep 2004 to Mar

2012. 250 patients received radiation therapy, 179 patients with radiation

therapy and chemotherapy. The endpoints of research were overall survival

(OS), progression-free survival (PFS), local control (LC). Kaplan-Meier

method was used to estimate the endpoints, Log-rank method to test and

single factor analysis, Cox method to complex factors analysis.

Results: The median follow-up time was 19 months. For an entire group of

patients, OS were 67.1%, 34.2%, 25.2%; PFS were 63.8%, 42.3%, 35.5%;

and LC were 83.2%, 67.4%, 57.9% at 1-yr, 3yr and 5-yr, respectively. For

the patients with stage I+II+III, OS were 69.2%, 38.2%, 28.9% at 1-yr, 3yr

and 5-yr, respectively. For the patents with stage IV (no including distant

metastasis), OS were 62.1%, 24.3%, 15.9% at 1-yr, 3yr and 5-yr, respec-

tively (chi-square Z 10.336, P Z 0.001). The independent prognostic

factor for OS were sex, T stage, N stage, TNM stage, differentiated

degree, presence of lose weight before treatment, smoke and drink (chi-

square Z 13.402, 4.392, 7.299, 11.745, 19.374, 25.077, 8.909, 7.097,

9.689, P Z 0.000, 0.036, 0.007, 0.003, 0.004, 0.000, 0.003, 0.008, 0.002).

The multiple prognostic factors for OS were M stage, differentiated

degree.

Conclusions: The results of esophageal cancer treated with intensity-

modulated radiation therapy were promising. The best predictor for sur-

vival was differentiated degree.

Author Disclosure: J.L. Tan: None. X.Z. Fen: None.

2313Multimodality Therapy Is Recommended for Limited-StageCombined Small-Cell Esophageal CarcinomaM. Meng,1 H. Wang,1 N. Zaorsky,2 C. Jiang,1 D. Qian,1 L. Zhao,1

Z. Yuan,1 and P. Wang1; 1Tianjin Medical University Cancer Hospital &

Institute, Tianjin, China, 2Fox Chase Cancer Center, Philadelphia, PA

Purpose/Objective(s): The overall clinical course of limited-stage com-

bined small cell esophageal carcinoma (C-SCEC), a disease with both

components of small cell esophageal cancer and non-small cell esophageal

cancer, is not determined currently. This retrospective study was designed

to evaluate the clinical features, optimal treatment strategy, and prognostic

factors in patients with limited-stage C-SCEC.

Materials/Methods: Eligible limited-stage C-SCEC patients included in

analysis (from our hospital and the literature) were reviewed between

January 1966 and December 2013. The primary end-point was overall

survival (OS), the secondary end-points including tumor response rates

(CRs), pattern of failure, and toxicity. Kaplan-Meier OS curve was

compared with the log-rank test. Cox regression analysis was used to

determine prognosticators for OS.

Results: A total of 72 patients were included in the analysis, 24 patients

(33.33%) from our hospital and 48 patients (66.67%) from literature. The

median OS of all patients was 15.0 months. Compared to patients without

chemotherapy, the analyses showed that patients with chemotherapy had

significant improvement in OS (p Z 0.03). In addition, compared with

patients underwent monotherapy (almost surgery), patients received

combination therapy (including RT+CT, S+CT, or S+RT+CT) have sig-

nificant improvement OS (8.0 months vs 26.5 months, p < 0.0001).

Intriguingly and importantly, the survival time showed a slight trend to-

wards superiority of S+RT+CT over RT+CT or S+CT, although these

differences were not statistically significant (pZ 0.73). The univariate and

multivariate analyses showed that tumor location (upper 1/3rd of esoph-

agus) and type of treatment (monotherapy) were associated with poorer

OS.

Conclusions: These results suggested that the standard multimodality

treatment should be considered as a primary approach for these patients

with limited-stage C-SCEC. However, considering the strength of the ev-

idence, additional studies are needed before it can be recommended

routinely.

Author Disclosure: M. Meng: None. H. Wang: None. N. Zaorsky: None.

C. Jiang: None. D. Qian: None. L. Zhao: None. Z. Yuan: None.

P. Wang: None.

2314Detection of Radiation-Induced Heart Disease by Gated MyocardialPerfusion Imaging in Patients With Esophageal Cancer During RTP. Zhang, X. Hu, J. Yue, G. Yang, X. Wang, X. Meng, X. Sun, and J. Yu;

Shandong Cancer Hospital Shandong Academy of Medical Sciences,

Jinan, China

Purpose/Objective(s): As an important treatment for thoracic cancers,

radiation therapy (RT) can cause definite cardiotoxicity, even with modern

techniques, such as 3D-CRT and IMRT. This prospective study was