|Year : 2019 | Volume
| Issue : 9 | Page : 298-300
Best proffered paper less than 40
|Date of Web Publication||28-Nov-2019|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Best proffered paper less than 40. J Can Res Ther 2019;15, Suppl S2:298-300
| > Abstract: Toxicity and outcomes of ultra hypofractionation with stereotactic body radiation therapy for high risk and node positive prostate cancer|| |
Tejshri Telkhade, Jince Matthew, Tejaswi Kanala, Dipika Chourasia, Gitanjali Panigrahi, Rahul Krishnatry, Vedang Murthy
Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India, E-mail: [email protected]
Background: Stereotactic body radiotherapy (SBRT) in low and intermediate risk prostate cancer has shown encouraging results, however its use in high-risk patients is limited due to lack of data regarding radiotherapy dose, pelvic nodal treatment and androgen deprivation therapy (ADT). Herein we report our experience of SBRT in high risk group which is the largest and first report of SBRT in node positive prostate cancer in the world. Materials and Methods: Analysis of prospectively maintained database of 120 consecutive patients of NCCN high risk and node positive adenocarcinoma prostate treated with SBRT was undertaken. All patients were treated with rotational intensity modulated radiotherapy with daily image guidance. Dose delivered to the prostate and gross node was 35-37.5Gy in 5 alternate day fractions. Node positive patients received 25Gy to pelvic nodal regions till the common iliac nodes. Treatment was delivered in 7-10 days. All patients received long term ADT (79% medical and 21% surgical). Results: Majority of patients (61%) had a Gleason Score (GS) ≥8. Median PSA was 34. Thirty three were high risk (27%), 37 (32%) very high risk and 49 node positive (41%). No acute RTOG grade 3 genitourinary (GU) or gastrointestinal (GI) toxicity was noted, but one patient had acute grade IV urinary toxicity in the form of urinary retention. Acute grade 2 GU and GI toxicity were 7% and 6%, respectively. Late grade 3 GU and GI toxicity was 2% and 0% respectively. There was no increase in acute or late GI toxicity with prophylactic pelvic nodal RT. At the end of four years 95% were alive and 88% biochemically controlled. Conclusion: SBRT is safe in the treatment of high risk and node positive prostate cancer. Longer follow up is required to determine efficacy.
| > Abstract: Radical chemoradiation with adaptive modulated simultaneous integrated boost for locally advanced nonmetastatic squamous cell carcinomas of head and neck: Preliminary outcome|| |
Trinanjan Basu, Bhavya Patineedi, Hirak Vyaas, Indoo Ambulkar, Deepika Nayek, Satish Rao, Upasna Saxena, Shankar Vangipuram
Department of Radiation Oncology, Medical and Surgical Oncology, HCG Cancer Centre, Mumbai, Maharashtra, India, E-mail: [email protected]
Purpose and Objective: To evaluate early clinical results from a uniform protocol of adaptive modulated simultaneous integrated boost (SIB) chemoradiation (CRT) as definite treatment for non-metastatic locally advanced squamous cell carcinoma of head and neck (SCHNC). It also analysed efficacy of adaptive radiotherapy (ART), PETCT surveillance, failure patterns and toxicity profiles. Materials and Methods: One hundred patients were treated over twenty months. All had baseline radiological, fibre-optic laryngoscopy (FOL) and biopsy with HPV as needed. CRT was uniform protocol with modulated RT SIB of 66-70Gy in 33 fractions over 6.5 weeks and 80% received concurrent chemotherapy mostly with cisplatin. ART was planned at 4 weeks and 70% had replan. First surveillance PETCT was between 10-14 weeks post CRT. The failure patterns were assessed by Hopkins scoring in PETCT and types A-E after deformable image registration. PETCT and modulated RT failures were reviewed by two blinded nuclear medicine physician and radiation oncologists separately. The toxicities were graded as per CTCAE version 3.0. Patients were followed up every 3 months and second surveillance PETCT scheduled between 5-6 months depending on 1st response. Statistical analyses were carried out using SPSS version 20. Results: Median follow-up was 15 months and median age 60 years. 30% were beyond 70 years with median G8 screening score of 15. 85% patients were male and 50% had oropharyngeal primaries with 13% HPV positive. 93.5% received SIB-IMRT 70Gy in 33 fractions and 80% had concurrent cisplatin. 50% had 3 weekly cisplatin. Baseline PETCT was available in 50% cases. At 1st follow up complete response (CR) at primary site was 85% on both FOL and PETCT (Hopkins score 1-2). Till last follow up 60% had complete response, 16% had loco-regional failure and 2% distant metastases. Nine patients died till last follow up and 5 were lost to follow up. As per modulated RT failure patterns 40% had Type A or C and 10% had type B or D indicating marginal failures. ART volume change beyond 50% indicated 90% chance of Hopkins score 1-2 at 1st follow up PETCT. All P16 positive patients had Hopkins score 1-2 in 1st follow up and remained disease free till last follow up. The acute grade 2 mucositis and dysphagia were 70% and 90% respectively with 40% grade 3 dysphagia. Beyond 3 months tube dependency rates were 10% mostly beyond 70 years. 20% had haematological grade 2 plus toxicity with 3 weekly cisplatin. Conclusion: This single Institution uniform adaptive modulated SIB CRT protocol shows promising early clinical results. It revalidates need of ART and documenting PETCT response score and modulated RT failure patterns. Future large cohort prospective documentation with longer follow up would answer concerns related to disease control and quality of life.
| > Abstract: Hypofractionated accelerated radiotherapy with concurrent and adjuvant temozolomide in newly diagnosed glioblastoma: A Phase 2 randomized trial (HART-GBM trial)|| |
Supriya Mallick, K. P. Haresh, S. Gupta, D. N. Sharma, P. K. Julka, Seema Sharma, A. Upadhyay, Rony Benson, G. K. Rath
All India Institute of Medical Sciences, New Delhi, India, E-mail: [email protected]
Purpose and Objective(s): Maximal safe surgical resection followed by adjuvant CTRT: standard for newly diagnosed GBM. Hypofractionated accelerated radiotherapy (HART) has the potential to improve outcome as:
- It reduces the OTT
- Increases biological effective dose.
Materials and Methods: Between October 2011 and July 2017, a total of 89 patients were randomized to conventional fractionated radiotherapy (CRT) or Hypofractionated accelerated radiotherapy (HART). Primary endpoint of the trial was Overall Survival (OS). A p value of <0.05 was taken as significant. STATA version 12 software was used for statistical analysis. Results: After a median follow-up of 11.4 months (Range: 2.9-42.5 months), 26 patients died and 39 patients had progression of the disease. Median OS for the entire cohort was 23.4 months. Median OS in the CRT and HART arms were 18.07 months [95% CI: 14.52-NR] and 25.18 months [95% CI: 12.89-NR] respectively, p=0.3. Median progression free survival (PFS) for the entire cohort was 13.5 months (Range: 11.7-15.7 months). In multivariate analysis patients younger than 40 years of age, patients with a gross total resection of tumor and a mutated IDH-1 had significantly better OS. PFS was significantly better for patients with a gross total resection of tumor and a mutated IDH-1. All patients included in the trial completed the planned course of radiation. Only two patients required hospital admission for features. Summary and Conclusion: HART shows promising comparable survival outcomes to CRT. HART showed no excess treatment interruption with acceptable toxicity when compared to CRT Dose escalation, reduction in overall treatment time, and reduction in waiting seems to be the advantages with HART. However, a phase III trial will be able to establish the possibility of incorporating HART as the new standard of care in newly diagnosed GBM.
| > Abstract: Assessment of toxicity and survival outcome of neoadjuvant chemotherapy followed by reduced dose radiotherapy in human papillomaviruspositive oropharyngeal cancer|| |
Manjinder Singh Sidhu, Rajesh Vashistha, Balbir Singh
Department of Radiation Oncology, Max Superspeciality Hospital, Bathinda, Punjab, India
Aim and Objectives: Assessment of toxicity and survival outcome of neoadjuvant chemotherapy followed by reduced dose radiotherapy in HPV positive oropharyngeal cancer. Methods: It is single-arm, phase 2 trial. Newly diagnosed biopsy-proven locally advanced squamous-cell carcinoma of the oropharynx, positive for HPV by p16 testing, PS score of 0 or 1 were included. Patients received 3 cycles of induction chemotherapy with TIP regime given 21 days apart, followed by IMRT plus 30 mg/m2 cisplatin per week concomitantly. Complete or partial responders to induction chemotherapy received 54 Gy in 27 fractions, and those with less than partial or no responses received 60 Gy in 30 fractions. The primary endpoint was progression-free survival at 1 years. Results: Between 2016, and 2018, 20 patients were enrolled with a median age of 52 years. All were included in the analysis. 65% patients with complete or partial responses to induction chemotherapy received 54 Gy radiation, and 35% with less than partial responses received 60 Gy. Median follow-up was 12 months. 10% had locoregional recurrence and one had distant metastasis; 1-year progression-free survival was 95%. 50% patients had grade 3 adverse events, but no grade 4 events were reported. The most common grade 3 events during induction chemotherapy were leucopenia (60%), and during chemoradiotherapy was mucositis (20%). No patient was dependent on a gastrostomy tube at 3 months and none was dependent 6 months after treatment. Conclusion: Neoadjuvant chemotherapy followed by reduced dose (20%) radiotherapy in HPV positive oropharyngeal cancer was associated with high progression-free survival and an improved toxicity profile compared with historical regimens using standard doses.
| > Abstract: Retrospective review of prognostic significance of anemia and neutrophil-to-lymphocyte ratio in head and neck cancer treated with neoadjuvant chemotherapy|| |
Abhishek Soni, Anil Khurana, Om Parkash, Yashpal Verma, Ashok Chauhan, Paramjeet Kaur
Department of Radiation Oncology, Pt. BDS PGIMS, Rohtak, Haryana, India, E-mail: [email protected]
Background: Neoadjuvant chemotherapy (NACT) before local (radiation/surgical) treatment can decrease the tumor volume, and can alter systemic inflammatory response and tumor oxygenation. However, there are no validated prognostic markers to predict the response to chemotherapy. The pretreatment anemia is an established poor prognostic marker for head and neck squamous cell carcinoma (HNSCC) treatment as hemoglobin is a marker of the oxygen-binding capacity and is required for cancer oxygenation and for the efficacy of cytotoxic chemotherapy and radiotherapy. Neutrophil-to-lymphocyte ratio (NLR) is the ratio of absolute neutrophil count to the absolute lymphocyte count, and is a marker of systemic inflammation. Its association with survival outcomes is established in literature. But, the association of the anemia and NLR with either response to NACT or treatment outcomes has not been established. Purpose: We retrospectively analyzed the prognostic value of anemia and NLR in HNSCC patients treated with NACT. The endpoints were the response to chemotherapy and survival outcomes. Methodology: Histopathologically proven HNSCC patients treated from 2013 to 2016 were included in the study. The NLR was calculated as described above and anemia was considered according to the reference values of <12 g/dL. NACT was comprised of a combination of platin and fluorouracil (PF), or more recently taxane, platin, and fluorouracil (TPF) administered every 3 weekly for 3-4 cycles. Hematologic parameters were analyzed before and after (3-4 weeks) NACT. Response evaluation was done using RECIST 1.1 and WHO criteria. Correlation analyses were carried out using linear regression and NLR was analyzed as a dichotomous variable. NLR cutoff was chosen as high (>5) or low (≤5) based on previous literature. The statistical analyses were performed using IBM SPSS Statistics version 23. The p values were two sided and p<0.05 was considered significant. Results: Total 139 patients were included in study. The median hemoglobin and NLR level before NACT were 12.5 g/dL (range, 9.2 to 14.7 g/dL) and 3.45 (range, 0.54 to 10.25), and were not dependent on the local extent of the disease. The median hemoglobin and NLR level after NACT were 10.3 g/dL (range, 8.2 to 12.4 g/dL) and 2.42 (range, 0.21 to 15.17), respectively. Seventeen patients were having anemia and NLR > 5 both prior to NACT. The anemia and NLR before NACT were not correlated, and they were also not associated with the response to NACT. Even anemia or NLR >5 before NACT were not associated with poor response to NACT. However, anemia and NLR > 5 before treatment were both associated with shorter overall survival (OS), (p=0.02 and p=0.04 respectively) and disease free survival (DFS), (p=0.02 and p=0.03 respectively). These factors were associated significantly with survival outcomes. Conclusion: In head and neck cancer patients treated with NACT, anemia and high NLR ratio before NACT were associated with shorter overall survival and shorter disease free survival, and were independent of response to chemotherapy.
| > Abstract: Short course radiation therapy and chemotherapy followed by delayed surgery in locally advanced rectal adenocarcinoma: Initial results of prospective study from a tertiary care centre|| |
Sumeet Aggarwal, Swarupa Mitra, Abhinav Dewan, Inderjeet Kaur, Soumitra Barik, Abhiramsundari Vivekananda, Kiran Dobriyal, Jwala Mukhee
Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India, E-mail: [email protected]
Introduction: Short Course RT (scRT) and chemotherapy followed by delayed surgery and adjuvant chemotherapy was hypothesized to increase the pathological complete response (pCR), decrease distant failures and improves survival in locally advanced rectal cancer patients. Methods: Patients who underwent neoadjuvant short course radiation therapy, chemotherapy and underwent surgery were included in the present analysis. All scRT patients were planned by IMRT technique and given as continuous daily single fraction to the dose of 25Gy/5fractions/5 days. These patients then received FOLFOX based chemotherapy for 4-6 cycles, surgery and adjuvant chemotherapy. T3/T4 including synchronous liver metastasis patients was included in the study. Radiological evaluation was done by PET MRI at baseline and after completion of chemotherapy prior to surgery. Pathological response and toxicity evaluation was noted and analyzed in current study. Results: Twenty-three patients were analyzed in an intention to treat analysis enrolled between November 2018 and April 2019. All patients completed scRT. Metastatic (Liver) vs Non metastatic: 6/23 vs 17/23. Local surgery was done in 16 patients: 2/6 in metastatic group (post resection of metastatic disease) and 14/17 in non metastatic group till date. In metastatic cohort, 2 patients had progressive disease and 2 patients were lost to follow up. In non metastatic cohort, 1 patient refused for surgery and 2 patients were lost to follow up. Surgery was done in 16 patients: 10/16 had APR, 5/16 had LAR and 1/16 had total proctocolectomy (due to underlying ulcerative colitis). All patients achieved negative resection margins. AJCC pathological tumour regression grade (pTRG) was assessed: 5/16 (31%) has TRG 0 (Complete response), 7/16 (44%) patients had TRG 1 (Moderate/significant response), 4/16 (25%) had TRG 2 (Minimal response), No patient (0%) had TRG3 (Poor response). Four patients had node positivity and tumour deposits in surgical specimen in which 75% had a minimal response (TRG2). PNI positivity was found in 1/16 patients and it had a minimal response (TRG2). No patient had any break or required admission during radiotherapy. While on chemotherapy, >50% patients had grade 2 or more hematological toxicity. GI toxicity was assessed in terms of diarrhea, pain abdomen (colitis), need of supportive care and admission. No patient had grade 4 GI toxicity. Two patients had subacute intestinal obstruction which was successfully managed conservatively. Conclusion: Short course radiation therapy followed by adjuvant chemotherapy and delayed surgery is a well tolerated regimen with encouraging results and good pathological response rates. Long term results related to late effects and survival analysis are awaited.
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