results of novel multichannel hdr brachytherapy applicators in the treatment of nonmelanoma skin...
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International Journal of Radiation Oncology � Biology � PhysicsS760
Surgery involved bone prosthesis in 9%, skin graft in 6% and musculo-
skeletal flap in 7%. RTwas given as sole modality (2%), pre-operatively to
50Gy (12%) or post-operatively (86%). 60% received 60Gy and 15%
received 66Gy. Conventional 3D conformal RT (3DCRT) was used in
81%. One patient was treated with intensity modulated RT (IMRT). Me-
dian field length was 21.7cm (range 8 - 40); RT fields crossed a joint in
46%. Co-morbidities that might affect limb function were present in 12%;
at the time of assessment 4% were receiving chemotherapy. Most patients
were working or retired, 9% were unemployed and 6% classified them-
selves as disabled. A walking aid was required in 22%, 19% used daily
analgesia, and 37% reported that treatment had negatively affected their
lifestyle. Of these, 17% felt this was unacceptable. Mean TESS score was
81 (range 10 - 100). RTOG/EORTC �grade 2 late effects were present in
77% and grade 3/4 effects in 26%. Rate of late bone fracture was 2%.
Subcutaneous fibrosis �grade 2 was seen in 28%. When stratified ac-
cording to RT dose (66Gy, 60Gy and 50Gy) the incidence of fibrosis was
54%, 24% and 24% respectively. Logistic regression analysis of potential
prognostic factors for the full cohort will be presented with the final
analysis.
Conclusions: This cohort includes patients treated over a 21 year period,
the majority with 3DCRT. The majority had �grade 2 late effects, 26% had
�grade 3 toxicity, and a third reported a negative impact on their lifestyle.
Practice is evolving toward the use of more IMRT for limb sarcomas, with
the hope of reducing late toxicity. These results provide a benchmark for
comparison in future research.
Author Disclosure: F. le Grange: None. A. Cassoni: None. B. Seddon:
None.
3395Results of Novel Multichannel HDR Brachytherapy Applicators inthe Treatment of Nonmelanoma Skin CancerH.E. Gayar,1 K. Devisetty,1 V.K. Sharma,1 K. Gayar,2 T. Dillon,1
K. Gaffney,1 R. Soderstrom,1 F. Khan,3 and J.L. Nettleton1; 1McLaren
Cancer Institute, Flint, MI, 2University of Michigan, Flint, MI, 3Michigan
State University, Lansing, MI
Purpose/Objective(s): Radiation therapy is under-utilized in the man-
agement of non-melanoma skin cancer primarily due to lengthy treatment
course associated with electron beam radiation therapy. Single source
topical skin brachytherapy applicators provide a non-uniform radiation
distribution to skin which hinder appropriate dose delivery and are limited
in size. We designed four multi-channel topical HDR skin brachytherapy
applicators in different sizes and shapes which allow for pre-set source
positions to provide a more uniform radiation dose as well as the ability to
treat a larger surface area. The objective of our study is to determine the
treatment outcomes using these new applicators in patients with non-
melanoma skin cancers.
Materials/Methods: Following IRB approval, we retrospectively identified
163 patients with 187, biopsy proven, non-melanoma skin cancer. Patients
were treated between July 2010 and June 2013. Basal cell carcinoma
constituted 69% (128 lesions) and squamous cell carcinoma constituted
31% (59 lesions). Applicators diameters were 2, 3 & 4 cm round as well as
an elliptical applicator of 2x3 cm. Each of the applicators had multiple
parallel channels (2-4). Pre-set source dwell positions for each applicator
were used.
Results:Median follow-up for the study cohort was 17 months (range 7-38
months) and 6 patients were lost to follow-up. Median delivered dose was
42 Gy (range 42-50 Gy). The treatment was delivered at 6 Gy per fraction
prescribed to the 80 % isodose line for a total of 7 fractions (75%), or 8
fractions (24%); 2 patients (1%) received 9 and 10 fractions of 5 Gy.
Treatments were delivered 2-3 times per week. A photo of each lesion was
taken before each treatment and at the time of follow-up. The majority of
the patients treated had lesions of the face (77%), primarily the nose,
whereas the remainder had lesions in other locations including the scalp
and extremities (23%). Only 6 local failures were identified for a crude
local control rate of 97%. Two patients (1%) had CTCAE v4.03 skin
toxicity grade 3: one patient had small patchy necrosis without ulceration
that healed spontaneously and one patient with vascular problems had
widening of an ulcerated lesion of the shin that required hyperbaric oxygen
and several weeks to heal. Good to excellent cosmesis was reported by
physicians in 170 (94%) of 181 lesions followed.
Conclusions:Multi-channel HDR skin brachytherapy applicators with pre-
set dwell positions offer a good modality for treating non-melanoma skin
carcinomas for lesions measuring up to 4 cm in size with an excellent local
control and cosmesis.
Author Disclosure: H.E. Gayar: None. K. Devisetty: None. V.K.
Sharma: None. K. Gayar: None. T. Dillon: None. K. Gaffney: None. R.
Soderstrom: None. F. Khan: None. J.L. Nettleton: None.
3396Single Institutional Series of Intraoperative Radiation Therapy(IORT) for Primary and Recurrent Retroperitoneal and PelvicSarcomasJ.A. Johnson, V. Weinberg, C.L. Tinkle, N. Eric, and A. Gottschalk;
University of California San Francisco, San Francisco, CA
Purpose/Objective(s): to investigate the local control (LC), freedom from
metastatic disease (MFS), disease free survival (DFS), overall survival
(OS) and toxicity associated with intraoperative radiation therapy (IORT)
for retroperitoneal and pelvic sarcomas (RPS).
Materials/Methods: This is a retrospective analysis of patients with
primary or recurrent pelvic and retroperitoneal sarcomas treated with
surgery and IORT at a single institution from 1997 to 2012. Twenty
eight pts with primary and 48 patients with recurrent RPS were
identified. The median follow up was 35.3 mos for primary disease and
25.5 mos for recurrent disease. Low, intermediate and high grade tu-
mors comprised 18, 21, and 43% of all primary disease, and 32, 15,
and 29% of all recurrent disease. Tumor grade was unavailable for
18% of all primary and 21% of recurrent RPS. Margins were negative
in 18% of all primary and 15% of all recurrent cases. The median size
of all primary RPS was 12.3cm [range 5-30] and 9cm [range 1.1-42]
for all recurrent. Twenty-nine % of recurrent pts received prior EBRT,
27% had post-operative EBRT and 8% had both. EBRT data was un-
available for 19% of all recurrent RPS. Fifty % of all primary RPS had
post-operative and 1 other (4%) had preoperative EBRT. Range adju-
vant EBRT 45-60.58Gy. The median number of prior surgeries for
recurrent pts was 1 (range 1-5). The median IORT dose was 1500 cGy
for both groups of pts [range 1000-2000]. 34% patients received
chemotherapy at some point after diagnosis.
Results: The 4-yr LC estimate is 72% (95% CI 50-86%) for primary
disease and 45% (29-61%) for recurrent disease. The 4-yr MFS is 74%
(50-88%) vs 69% (46-84%), respectively. To date 10/28 pts with pri-
mary disease are alive without progression and 9/48 recurrent pts are
alive without progression, resulting in an overall 4-yr DFS of 44% (24-
62%) and 17% (8-30%), respectively. The 4-yr Kaplan-Meier estimate
for OS is 68% (44-83%) for primary disease and 38% (23-52%) for
recurrent disease. No relationship was seen between grade, margin
status or EBRT treatment on LC for each cohort, although subsets are
small. Cox’s regression model was used to determine whether tumor
size is a predictor of outcome. After adjusting for disease (primary/
recurrent), tumor size was a significant predictor of LC (p Z 0.03) but
not DFS (p Z 0.10). Grade 3 toxicities of any kind occurred in 22% of
patients. Gr3 GI toxicity was observed in 14%. Neurologic toxicity
was observed in only 10%.
Conclusions: Intraoperative radiation therapy has been successfully
implemented at a single institution. In our series, size predicts for local
control. Local control was acceptable in spite of the low rates of negative
margins, and significant toxicity was limited.
Author Disclosure: J.A. Johnson: None. V. Weinberg: None. C.L.
Tinkle: None. N. Eric: None. A. Gottschalk: None.