World Congress of Brachytherapy 2012 PO-383 CESIUM-131 BRACHYTHERAPY FOR HEAD AND NECK CANCERS: FIRST REPORT OF OUTCOMES, TOXICITY AND RADIATION EXPOSURE B. Parashar1, S. Arora1, A. Pavese2, D. Kutler3, W. Kuhel3, S. Trichter1, A.G. Wernicke1, D. Nori1, K.S.C. Chao1 1 New York Hospital/Cornell Med.Cente, Radiation Oncology, New York, USA 2 New York Hospital/Cornell Med.Cente, Health Physics, New York, USA 3 New York Hospital/Cornell Med.Cente, Otorhinolaryngology, New York, USA Purpose/Objective: Cesium-131 is an encapsulated radioactive isotope that is approved for head and neck cancer (HNC) brachytherapy. It has a shorter half-life (9.7 days) but similar energy to Iodine-125 (I-125). Recurrent HNC are common and pose a significant therapeutic challenge. This report evaluates the outcomes, toxicity and radiation exposure in patients with high risk and recurrent HN cancers treated with surgery followed by Cs-131 brachytherapy. Materials and Methods: Eighteen Cs-131 implants were performed in 14 patients from 2009-2011. There were 6 males and 8 females. Most common histology was squamous cell carcinoma. Other histologies were merkel cell carcinoma, carcinosarcoma and osteosarcoma. Twelve patients had previously received a full course of radiation therapy. Of the patients without prior RT, one received a neck implant after surgery for tonsil primary since he refused external radiation. Another patient with Merkel cell skin cancer received a neck implant after nodal disease progression during adjuvant radiation. After surgical resection, Cs-131 seeds were placed 0.5-1cm apart on the tumor bed to deliver 80Gy at 0.5 cm (based on Cs-131 nomogram). Lead shields and gowns were used by radiation oncologists and surgeons. Dosimetric CT scan was performed within a week of the implant. Patients were followed by clinical exam and imaging. Local control was defined as no clinical/radiological evidence of recurrence in the area of implant. In keeping with Nuclear Regulatory Commission (NRC) guidelines, exposure rate at 1 meter (m) was measured following the procedure using a Keithley survey counter (ion chamber). Results: Median age was 71y (range 22-88y). Primary tumors that were included were those of oral cavity, oropharynx, paranasal sinus and skin with neck nodes. Seventeen of eighteen implants were performed in recurrent tumor after surgical resection. Median number of seeds were 21 (Range 10-58). Median seed activity was 2.4 µGy m2/h (range 0.95-2.5). Median follow-up was 10 months (range 2-24 months). Local control was 77.7% (14/18 implants). Four patients (28.5%) developed distant metastasis. Four patients have died at the time of last follow-up due to distant metastasis. There was no RTOG grade 3 or 4 toxicity related to the implants. The median RT exposure rate at 1 meter post-implant was 2.3mrem/hr post-implant (recommended limits to radiation exposure to professionals-5000 mrem/y for stochastic effects, 15000 mrem/yr for lens of the eye and and 50,000mrem/yr for all others).
Conclusions: Cs-131 LDR brachytherapy is a safe and effective option for high risk Head and neck cancers. It produces high control rates,
S 153 limited toxicity and is safe for health personnel in terms of radiation exposure. PO-384 COMBINED EXTERNAL BEAM RADIOTHERAPY AND INTRALUMINAL BRACHYTHERAPY IN THE TREATMENT OF ESOPHAGEAL CANCER D. Scepanovic1, M. Pobijakova1, P. Lukacko1, M. Masar1, Z. Dolinska1, A. Masarykova1 1 National Oncology Institute, Radiation Oncology, Bratislava, Slovakia Purpose/Objective: The main objective of treatment for locally advanced esophageal cancer remains palliation of dysphagia. Radiotherapy for palliation can be external beam alone, intraluminal brachytherapy (ILBT) alone, or a combination of both. The purpose of our study was to compare the effect of combined external and intraluminal radiation treatment versus external beam radiotherapy alone (EBRT). Materials and Methods: Between 2006 and 2010, 66 patients (pts) with locally advanced esophageal cancer received radiation therapy (RT) with/without chemotherapy (CT). Patients without evidence of metastatic disease were identified. Combined EBRT/ILBT and EBRT alone were performed in 26 and 40 pts, respectively. ILBT with high dose-rate Ir-192 source was applied after pts completed EBRT as a boost therapy. The external radiation was performed with a median total dose of 46Gy given in 23 fractions. On the average a week after the external radiation a median total dose of 10Gy ILBT was given in 2 fractions. The long-term outcomes were investigated with a median follow-up time of 20 months. Results: The overall cumulative survival rate was 10% at 5 years for whole group of pts. The cause specific survival rate at 5 years was 4% in the external irradiation alone group and 22% in ILBT combined group. There was statistically significant difference between two groups of patients regarding overall survival (OS) (p = 0.0002). The incidence of early and late complications did not differ according to whether ILBT was used. Conclusions: The usefulness of ILBT, as additional irradiation in large advanced tumors has been shown similar results for dysphagia-free survival, stenosis, and fistulas and is equally effective in palliation of advanced esophageal cancer. ILBT as a boost treatment seems to contribute to the prolonged survival of these pts (p=0.0279). PO-385 SUBLOBAR RESECTION AND BRACHYTHERAPY FOR NON SMALL CELL LUNG CANCER IN PATIENTS WITH HISTORY OF PRIOR MALIGNANCY A. Jain1, C. Connery2, F. Bhora2, W. Choi1, A. Evans1 1 St. Luke's-Roosevelt Hospital, Department of Radiation Oncology, New York, USA 2 St. Luke's-Roosevelt Hospital, Department of Surgery, New York, USA Purpose/Objective: Patients with a history of malignancy and a new diagnosis of early stage lung cancer can pose a challenging clinical problem. Previous oncologic treatments or comorbidities may limit the use of conventional treatment options. Patients in this group who are not candidates for lobectomy have been offered sublobar resection plus brachytherapy at our institution and clinical outcomes are reported here. Materials and Methods: Records of patients who underwent sublobar resection plus brachytherapy for a new diagnosis of early stage lung cancer from 2006 to 2011 at our institution were reviewed to identify patients with prior malignancies. Patients were determined by pretreatment evaluation to have T1 or T2 lung cancer with tumors<5cm, technically resectable, and with no evidence of nodal or distant metastases from lung cancer. Pathologic mediastinal assessment was performed by either endobronchial ultrasound or mediastinoscopy. Patients underwent wedge resection by thoracotomy or video-assisted thoracoscopy (VATS). This was followed followed by I-125 brachytherapy seed implantation, done using either open, VATS, or da Vinci robot, to deliver 120-144 Gy to 1 cm from the suture line. Patients were followed postoperatively with history and physical exam, and imaging studies as clinically indicated. Surgical outcomes, postoperative course, and local, regional and distant disease status at follow up were reviewed. Results: 42 patient records were reviewed. Of this group, 17 patients who had a history of prior malignancy were identified for analysis.