ESTRO 36 Abstract Book

S333

ESTRO 36 2017

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University of Central Florida, College of Medicine,

Orlando, USA

UF Health Cancer Center-Orlando Health, Radiation

Oncology, Orlando, USA

Purpose or Objective

We examined the impact of patient and tumor-specific

factors on overall survival in patients with brain

metastases from breast cancer treated with stereotactic

radiosurgery.

Material and Methods

We performed an IRB-approved retrospective analysis of

patients treated at our institution with LINAC-based,

image-guided, frameless stereotactic radiosurgery for

brain metastases from breast cancer between November

2008 and July 2016. We identified 184 metastatic brain

lesions treated in 52 breast cancer patients. Out of the

184 treated brain metastases, 174 had at least one follow

up study. Patients were followed with serial brain MRIs

with contrast to assess for local progression and

recurrence every 2-3 months. Patient characteristics

collected included extracranial disease status, Karnofsky

performance status (KPS), tumor histology, history of

whole brain radiation therapy (WBRT), history of IMRT,

history of craniotomy, date of death or last clinical

contact, and age at initial SRS treatment. Treatment

characteristics evaluated included tumor volume, number

of tumors, prescription dose, prescription isodose, and

maximum dose. Actuarial patient survival was defined as

the time in months from initial SRS treatment to date of

death or date of last clinical contact. The overall survival

was calculated from date of first SRS treatment session to

date of death or progression via the Kaplan-Meier method.

Results

At the time of initial treatment, 21% of patients were

categorized as RPA class I, 69% as RPA class II, and 10% as

RPA class III. The median survival was 59.0 months for RPA

class I, 14.1 months for RPA class II, and 9.4 months for

RPA class III. The median overall survival was 15.0

months. The Kaplan-Meier overall survival estimates at 6

and 12 months were 80.1% and 57.5%, respectively, from

the time of initial SRS treatment. The median survival for

patients with active extracranial disease was 9.36 months,

compared to 59.0 months for patients with inactive

extracranial disease (p-value = 0.012). Other factors

examined including age, KPS, tumor histology (ductal vs.

lobular vs. unknown), ER, PR and Her 2-Neu status, did not

have a statistically significant impact on survival.

Conclusion

Breast cancer patients with brain metastases display a

broad range of survival outcomes following SRS, with RPA

class I having a median survival of 59 months in our

dataset. Those with inactive extracranial disease in our

group had the best prognosis following SRS. There was no

effect on post-SRS survival based on age, KPS score, pre-

SRS WBRT, concurrent WBRT, tumor histology, ER, PR, and

Her 2-Neu expression status. These data support the use

of SRS in a broad range of breast cancer patients and

further reveal no improvement in survival for patients

receiving WBRT during their brain metastasis treatment.

Poster: Clinical track: Haematology

PO-0645 The patterns of the relapses of aggressive non-

hodgkin lymphomas after chemoradiotherapy

V. Sotnikov

, G.A. Panshin

, N.V. Nudnov

, V.A. Solodkiy

Russian Scientific Center of Roentgenoradiology,

Radiation therapy, Moscow, Russian Federation

Purpose or Objective

Purpose: To study the number and the patterns of the

aggressive non-hodgkins lymphomas relapses after

chemoradiotherapy in the subgroups of the patients with

different demographic and disease characteristic as well

as the different short term results of the chemotherapy

and the chemoradiotherapy in its entirety.

Material and Methods

Material/methods: The study included 676 previously

untreated patients with morphologically proven aggressive

NHL who received combined modality therapy. The

characteristic of the patients: male - 319 (47,2%), female

- 357 (52,8%). Age 15 – 86 years (median age 45 years).

International prognostic index (IPI) 0-1 (favourable) - 314

(46,4%), 2-3 (intermediate) - 297 (43,9%), IPI 4-5

(unfavourable) - 65 (9,6%); stage I-II - 409 (60,5%), stage

III-IV - 267 (39,5%). All patients received initially 6-8

cycles of CHOP or CHOP-like regimens ± Rytuximab and

complete remission (CR) or partial remission (PR) was

achieved in all of them. Then the radiation therapy was

performed. All sites of initial involvement were irradiated

in local stages, patients with advanced stages get

radiation therapy on PET(+) lesions, partially regressed

tumors, sites of initial bulky tumors. Daily doses were 1,8-

2Gy, summary doses 30-50Гр. Relapses in the sites of

initial involvement were classified as local (true), in

initially uninvolved sites - as distant. Mixed relapses (local

and distant) were counted in both groups. After

completion of the treatment patients were followed up

during 1,17-30 years, mean – 5,2±0,2 years, median – 3,1

years.

Results

Results: The results of the study are presented in the

table.

Table 1. Relapses in the different groups of patients with

aggressive non-hodgkin lymphoma after chemoradiation

therapy

Conclusion

Conclusion: The probability of relapse of aggressive non-

hodgkin lymphoma after chemoradiation therapy is about

30%, but local relapse – only 10%. The probabilities and

patterns of the relapses are the same in the young and

aged patients. The local and advanced stages have

statistically proven differences in the probabilities of all

relapses and local relapses (+10%), but the risk of the

distant relapse is very close in this groups. Patients from

favourable prognostic group (IPI 0-1) have the minimal risk

of the relapse, both local and distant in comparison with

other IPI prognostic groups. Extranodal lymphomas differ

favourably from nodal lymphomas: after chemoradiation

therapy the relapses are less common in this group, to the

greatest extent – the local relapses (

p=0,04)

. The

immediate effect of chemotherapy significantly affects

the absolute risk of all relapses and the risk of distant

relapse, but only the response to radiotherapy determines

the probability of local relapse. At the same time, the

partial remission due to the partial regression of the

lesion after irradiation) is an additional poor prognostic

factor for all relapses and for distant relapses. These

effects persist after the separate analysis of the local and

advanced stages.