S724 3rd ESTRO Forum 2015
from first day of chemotherapy to death of any cause) were
evaluated.
Results: A total of 43 patients were included. The median
follow-up was 45 months (range 6-105 months). Five year
DFS, PFS and OS were 90%, 76% and 86% respectively. On
post-chemotherapy PET, CR was seen in 35 patients (81%),
partial response in three patients (7%) and progression in five
patients (12%).
Of the patients with CR, three patients (9%) relapsed, all in
initial sites of disease with one patient also relapsing in new
sites. Three of four patients with bulky disease (defined as a
single nodal mass of 10cm or greater) received consolidative
RT and none of these patients relapsed. Five year OS for
patients with PET CR was 94%. Two patients died, one from
progressive disease and one from bleomycin-related lung
toxicity.
Conclusions: Advanced stage HL with PET CR following ABVD
chemotherapy is associated with an excellent prognosis.
Relapses were low and occurred in both initial and new sites.
The use of consolidative RT for bulky disease provided good
disease control, with no relapses observed.
EP-1342
Risk of local failure with Cyberknife radiosurgery to the
resection bed for large intracranial metastases
J. Vogel
1
, A. Hollander
1
, E. Ojerholm
1
, C. Briola
2
, R. Mooij
2
,
M. Bieda
2
, J.D. Kolker
2
, S. Nagda
2
, G.A. Geiger
2
, J.F. Dorsey
1
,
R.A. Lustig
1
, D.M. O'Rourke
3
, S. Brem
3
, J.Y.K. Lee
3
, M. Alonso-
Basanta
1
1
University of Pennsylvania, Department of Radiation
Oncology, Philadelphia PA, USA
2
Pennsylvania Hospital, Department of Radiation Oncology,
Philadelphia PA, USA
3
University of Pennsylvania, Department of Neurosurgery,
Philadelphia PA, USA
Purpose/Objective: Stereotactic radiosurgery (SRS) is an
alternative to post-operative whole brain radiation therapy
(WBRT) following resection of brain metastases. At our
institution, CyberKnife (CK) is generally used for local
treatment of larger cavities. In this study, we aimed to
evaluate patterns of failure with this approach and assess
whether size of lesion correlated with local failure.
Materials and Methods: We retrospectively reviewed 30
patients treated with CK to 33 lesions between 2011-2014.
Both the cavity resection volume (GTV) and CK treatment
volume (PTV) were analyzed on treatment planning MRI for
all cases. Patterns of intracranial control were analyzed in 26
patients with post-treatment imaging. Survival was estimated
by the Kaplan Meier method and prognostic factors for local
and distant control were examined with Fisher’s exact test.
Results: The most common histologies were lung (42%),
breast (21%), and melanoma (15%). The cohort was evenly
split by gender and generally RPA I (33%) and RPA II (57%).
Median preoperative diameter was 3.3cm and 57% of patients
underwent gross total resection. Median cavity volume was
17.5cm
3
(range 2.4-69.8 cm
3
) and median treatment volume
was 25.11cm
3
(range 4.7-90.9cm
3
). Treatments were
delivered to a median 30 Gy in 5 fractions to the 75% isodose
line. Synchronous metastases were treated at the time of CK
in 33% of cases. The median clinical follow up for the 13
living patients was 16.9 months (range 4.4-35.2) and for the
entire cohort of 30 patients was 9.5 months (range 1.0-34.3).
Local failure developed in 7 treated cavities (23%) and
median time to local failure was not reached. Patients with
lung primaries were found to fail locally in five of twelve
cases (42%) compared to two of 17 (12%) non lung histologies
(p=0.092). Evaluation of both cavity volume and CK
treatment volume at a variety of cut-off points showed no
association with local failure and size (p>0.61 and 0.64,
respectively). Distant brain failure occurred in 20 cases (63%)
at a median of 4.6 months. Distant failure developed in eight
of nine patients with synchronous metastases (89%) compared
to 11 of 20 without synchronous metastases (56%) (p=0.107).
Salvage therapies included WBRT (23%) performed at a
median of 5.1 months from treatment and additional SRS
(40%) at a median of 4.9 months from treatment.
Leptomeningeal carcinomatosis developed in 12 cases (40%).
Patients survived a median of 10.1 months from the time of
treatment.
Conclusions: This study suggests that large resection cavities
are likely to achieve equivalent local control as smaller
resection beds using adjuvant CK strategy. However, patients
with lung primaries appear more likely to fail within this
cohort. Most patients do develop intracranial failure which
was correlated with synchronous metastases at the time of
CK. The majority of patients with large cavity volumes were
spared or delayed WBRT with the use of local CK therapy.
EP-1343
Stereotactic radiotherapy (SBRT)in the treatment of lung
metastases from bone and soft tissue sarcomas
F. Salvi
1
, R. Frakulli
2
, A. Longhi
3
, S. Ferrari
3
, S. Cammelli
2
, D.
Balestrini
1
, M. Palombarini
4
, S. Magi
4
, A.G. Morganti
2
, G.
Frezza
1
1
Ospedale Bellaria, Radiation, Bologna, Italy
2
Policlinico Universitario S. Orsola-Malpighi, Radiation,
Bologna, Italy
3
Istituto Ortopedico Rizzoli, Musculoskeletal Oncology
Department, Bologna, Italy
4
Ospedale Bellaria, Medical Physics Unit, Bologna, Italy
Purpose/Objective: The most common site of relapse in
muscoloskeletal sarcomas is lung. Metastasectomy is
considered the standard of care in these patients (pts). In
those unfit for surgery SBRT might represent however an
alternative approach. The purpose of this study is to evaluate
local control and toxicity of SBRT in a group of pts treated for
lung metastases (LM) from bone and soft tissue sarcomas.
Materials and Methods: From October 2010 to July 2014, 24
pts with LM from sarcomas not amenable to surgery were
treated with daily cone beam CT guided SBRT. 22 of them
had already been submitted at least once to thoracic surgery
procedures, and 16 pts had been treated with several lines of
chemotherapy. In 50% of pts the primary tumor was a soft
tissue sarcoma and in 50% a bone sarcoma (Ewing sarcoma: 5
pts; osteosarcoma: 3 pts; chondrosarcoma: 4 pts). 21% of pts
had LM at diagnosis whereas 79% developed LM at a mean of
39,9 months after initial diagnosis. 71 lesions were treated
with SBRT. All patients underwent computed tomography
simulation. Active breath control (ABC©) was employed to
reduce internal margin in lesions located in the lower lobes.
Dose was prescribed to 80% isodose. Administered dose
ranged from 30 to 60 Gy in 3-8 fractions. Follow-up (fu)
included physical examination and a chest CT scan +/- FDG
PET/CT every 3 months after treatment. Response rates were