2901
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Conclusions: HDR Brachytherapy (Ir-192), with standardized surface applicators (Leipzig applicators) offer an alternative in treatment of small superficial skin carcinomas. Patients’ setup and reproducibility were accurate and treatment time was short which added great convenience for the patients. Author Disclosure: M. Ghaly, None; R. Byrnes, None; J. Musmacher, None; J. Celano, None. 2901 Adjuvant Radiotherapy for Cutaneous Melanoma: Comparing Hypofractionation to Conventional Fractionation D. T. Chang, R. J. Amdur, C. G. Morris, W. M. Mendenhall University of Florida College of Medicine Department of Radiation Oncology, Gainesville, FL Purpose/Objective(s): To examine local-regional control after adjuvant radiotherapy (RT) for cutaneous melanoma and compare outcomes between conventional fractionation and hypofractionation. Materials/Methods: Between January 1980 and June 2004, 56 patients with high risk disease were treated with adjuvant RT. Indications for RT included recurrent disease, cervical lymph node involvement, lymph node 3 cm, 3 lymph nodes involved, extracapsular extension, gross residual disease, close or positive margins, and/or satellitosis. Hypofractionation was used in 41 patients (73%) and conventional fractionation was used in 15 patients (27%). Results: The median age was 61 years (21 - 90). The median follow-up among living patients was 4.4 years (0.6 - 14.4 years). The primary site was located in the head and neck in 49 patients (87%) and below the clavicles in 7 patients (13%). There were seven in-field local-regional failures (12%), 3 out-of-field regional failures (5%), and 24 (43%) distant failures. The 5-year in-field local-regional control (ifLRC) and freedom from distant metastases (FFDM) rates were 87% and 43%, respectively. The 5-year cause-specific (CSS) and overall survival (OS) was 57% and 46%, respectively. The only factor associated with ifLRC was satellitosis (p0.0002). Nodal involvement was the only factor associated with FFDM (p0.0007), CSS (p0.0065), and OS (p0.016). Two patients (4%) who experienced severe late complications, osteoradionecrosis of the temporal bone and radiation plexopathy, and both received hypofractionation (5%). Conclusions: Although surgery and adjuvant RT provides excellent local-regional control, but distant metastases remain the major cause of mortality. Hypofractionation and conventional fractionation are equally efficacious. Author Disclosure: D.T. Chang, None; R.J. Amdur, None; C.G. Morris, None; W.M. Mendenhall, None. 2902 Conservative Management of Recurrent Extremity Soft Tissue Sarcoma K. Meadows, R. Zlotecki, C. Morris University of Florida/Shands Cancer Center, Gainesville, FL Purpose/Objective(s): To report the outcomes of patients with recurrent extremity soft tissue sarcoma treated with a second trial of limb conservation including radiation or re-irradiation. Various clinico-pathologic and treatment-related factors were analyzed with respect to local control, overall survival, and complications. Materials/Methods: A retrospective chart review identified 26 patients with isolated recurrent soft tissue sarcoma treated at the University of Florida with limited surgery and radiation between January 1977 and March 2004. Twelve patients received a second course of radiation as part of their treatment plan. Median doses were 60 Gy and 109 Gy for the once-irradiated and re-irradiated cohorts respectively. Results: At a median follow-up of 4.3 years, serious complications occurred in 3 patients consisting of chronic wound or flap breakdown. Operative intervention was required in all cases including 2 amputations. Overall, 16 of 26 patients retained a functional limb. Local control at 5 years was significantly better for the patients irradiated once (93%) compared to the re-irradiated patients (58%; p 0.08), likely due to a preponderance of positive margins and larger tumor size in the latter cohort. There was a trend towards improved survival for the patients irradiated once (86%) compared to the re-irradiated patients (37%; p 0.06). Conclusions: Within the limits of this small review, similar local control and survival can be obtained for recurrent radiation-naı ¨ve patients compared to the de-novo treated patients. Re-irradiation represents a viable alternative for patients who would otherwise require amputation, but re-irradiation results in inferior local control and survival. Author Disclosure: K. Meadows, None; R. Zlotecki, None; C. Morris, None. 2903 Gemcitabine-Mediated Radiosensitization of Human Soft Tissue Sarcoma S. Markwart, J. D. Murphy, M. E. Ray University of Michigan Medical School, Ann Arbor, MI Purpose/Objective(s): Local and systemic control of soft tissue sarcoma (STS) remains a clinical challenge, particularly for retroperitoneal or advanced truncal or extremity disease. Gemcitabine is a potent radiosensitizer in many tumor types, but has not been studied in human STS. The purpose of this study was to determine the radiosensitizing potential of gemcitabine in preclinical models of human STS. Materials/Methods: In vitro proliferation assays (WST-1) and clonogenic survival assays were performed on three human STS cell lines: SK-LMS-1 (leiomyosarcoma), SW-872 (liposarcoma), and HT-1080 (fibrosarcoma). The IC-50 gemcitabine concentrations were determined for each cell line. To determine the radiosensitizing activity of gemcitabine, cells were exposed to gemcitabine concentrations ranging from 0 nM up to the IC-70 for 24 hours prior to irradiation. The cell cycle distribution S720 I. J. Radiation Oncology ● Biology ● Physics Volume 66, Number 3, Supplement, 2006
Transcript of 2901
Conclusions: HDR Brachytherapy (Ir-192), with standardized surface applicators (Leipzig applicators) offer an alternative intreatment of small superficial skin carcinomas. Patients’ setup and reproducibility were accurate and treatment time was shortwhich added great convenience for the patients.
Author Disclosure: M. Ghaly, None; R. Byrnes, None; J. Musmacher, None; J. Celano, None.
2901 Adjuvant Radiotherapy for Cutaneous Melanoma: Comparing Hypofractionation to ConventionalFractionation
D. T. Chang, R. J. Amdur, C. G. Morris, W. M. Mendenhall
University of Florida College of Medicine Department of Radiation Oncology, Gainesville, FL
Purpose/Objective(s): To examine local-regional control after adjuvant radiotherapy (RT) for cutaneous melanoma andcompare outcomes between conventional fractionation and hypofractionation.
Materials/Methods: Between January 1980 and June 2004, 56 patients with high risk disease were treated with adjuvant RT.Indications for RT included recurrent disease, cervical lymph node involvement, lymph node � 3 cm, � 3 lymph nodesinvolved, extracapsular extension, gross residual disease, close or positive margins, and/or satellitosis. Hypofractionation wasused in 41 patients (73%) and conventional fractionation was used in 15 patients (27%).
Results: The median age was 61 years (21 - �90). The median follow-up among living patients was 4.4 years (0.6 - 14.4 years).The primary site was located in the head and neck in 49 patients (87%) and below the clavicles in 7 patients (13%). There wereseven in-field local-regional failures (12%), 3 out-of-field regional failures (5%), and 24 (43%) distant failures. The 5-yearin-field local-regional control (ifLRC) and freedom from distant metastases (FFDM) rates were 87% and 43%, respectively. The5-year cause-specific (CSS) and overall survival (OS) was 57% and 46%, respectively. The only factor associated with ifLRCwas satellitosis (p�0.0002). Nodal involvement was the only factor associated with FFDM (p�0.0007), CSS (p�0.0065), andOS (p�0.016). Two patients (4%) who experienced severe late complications, osteoradionecrosis of the temporal bone andradiation plexopathy, and both received hypofractionation (5%).
Conclusions: Although surgery and adjuvant RT provides excellent local-regional control, but distant metastases remain themajor cause of mortality. Hypofractionation and conventional fractionation are equally efficacious.
Author Disclosure: D.T. Chang, None; R.J. Amdur, None; C.G. Morris, None; W.M. Mendenhall, None.
2902 Conservative Management of Recurrent Extremity Soft Tissue Sarcoma
K. Meadows, R. Zlotecki, C. Morris
University of Florida/Shands Cancer Center, Gainesville, FL
Purpose/Objective(s): To report the outcomes of patients with recurrent extremity soft tissue sarcoma treated with a secondtrial of limb conservation including radiation or re-irradiation. Various clinico-pathologic and treatment-related factors wereanalyzed with respect to local control, overall survival, and complications.
Materials/Methods: A retrospective chart review identified 26 patients with isolated recurrent soft tissue sarcoma treated at theUniversity of Florida with limited surgery and radiation between January 1977 and March 2004. Twelve patients received asecond course of radiation as part of their treatment plan. Median doses were 60 Gy and 109 Gy for the once-irradiated andre-irradiated cohorts respectively.
Results: At a median follow-up of 4.3 years, serious complications occurred in 3 patients consisting of chronic wound or flapbreakdown. Operative intervention was required in all cases including 2 amputations. Overall, 16 of 26 patients retained afunctional limb. Local control at 5 years was significantly better for the patients irradiated once (93%) compared to there-irradiated patients (58%; p � 0.08), likely due to a preponderance of positive margins and larger tumor size in the lattercohort. There was a trend towards improved survival for the patients irradiated once (86%) compared to the re-irradiatedpatients (37%; p � 0.06).
Conclusions: Within the limits of this small review, similar local control and survival can be obtained for recurrentradiation-naı̈ve patients compared to the de-novo treated patients. Re-irradiation represents a viable alternative for patients whowould otherwise require amputation, but re-irradiation results in inferior local control and survival.
Author Disclosure: K. Meadows, None; R. Zlotecki, None; C. Morris, None.
2903 Gemcitabine-Mediated Radiosensitization of Human Soft Tissue Sarcoma
S. Markwart, J. D. Murphy, M. E. Ray
University of Michigan Medical School, Ann Arbor, MI
Purpose/Objective(s): Local and systemic control of soft tissue sarcoma (STS) remains a clinical challenge, particularly forretroperitoneal or advanced truncal or extremity disease. Gemcitabine is a potent radiosensitizer in many tumor types, but hasnot been studied in human STS. The purpose of this study was to determine the radiosensitizing potential of gemcitabine inpreclinical models of human STS.
Materials/Methods: In vitro proliferation assays (WST-1) and clonogenic survival assays were performed on three human STScell lines: SK-LMS-1 (leiomyosarcoma), SW-872 (liposarcoma), and HT-1080 (fibrosarcoma). The IC-50 gemcitabineconcentrations were determined for each cell line. To determine the radiosensitizing activity of gemcitabine, cells were exposedto gemcitabine concentrations ranging from 0 nM up to the IC-70 for 24 hours prior to irradiation. The cell cycle distribution
S720 I. J. Radiation Oncology ● Biology ● Physics Volume 66, Number 3, Supplement, 2006
