Cs-131 stranded seeds were placed as a permanent volume implant. Prescription dose was 80 Gy at 5mm depth from the resection cavity surface. Patients.
Volume 96 Number 2S Supplement 2016
2151 Intraoperative Cesium-131 Brachytherapy as Salvage Therapy for Recurrent Brain Metastases A.W. Smith,1 S. Taube,2 B. Parashar,2 S. Trichter,2 L. Nedialkova,2 A.M. Sabbas,2 S. Pannullo,2 P. Stieg,2 T. Schwartz,2 and A.G. Wernicke2; 1 University of Rochester School of Medicine and Dentistry, Rochester, NY, 2 Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY Purpose/Objective(s): Managing patients whose intraparenchymal brain metastases fail prior radiation therapy remains a challenge. Intra-operative Cesium-131 (Cs-131) brachytherapy performed at the time of neurosurgical resection may represent an excellent salvage treatment option. We evaluated the safety, feasibility, and efficacy of a novel treatment with permanent intra-operative Cs-131 brachytherapy. Materials/Methods: After IRB approval, 13 patients with 15 recurrent metastasis to the brain after failing prior stereotactic radiosurgery and/or whole brain radiation therapy were accrued between 2010 and 2015. Cs-131 stranded seeds were placed as a permanent volume implant. Prescription dose was 80 Gy at 5mm depth from the resection cavity surface. Patients received follow-up MRI every 2 months to evaluate for disease progression and toxicity. Primary endpoint was resection cavity freedom from progression (FFP), defined as absence of new nodular enhancement 5 mm from the resection cavity. Secondary endpoints included regional FFP defined as new or increased contrast enhancement > 5 mm from the resection cavity, distant FFP defined as new or increased contrast enhancement elsewhere in the brain, median survival, overall survival (OS), and toxicity. Results: Median follow-up from salvage treatment was 5 months (range, 0.5e18 months). Median age was 64 years (range, 51-74 years). Median resected tumor diameter was 2.9 cm (range, 1.0e5.6cm). Median number of seeds deployed was 19 (range, 10-40) with median activity per seed of 2.25 U (range, 1.98-3.01 U) and total activity of 39.6 U (range, 20.0-95.2 U). 1 year Local FFP was 83.3% (95% CI 27.3%, 97.5%), 1 year Regional FFP was 55.6% (95% CI 7.3%, 87.6%), and 1 year Distant FFP was 46.7% (95% CI 7.1%, 80.3%). Median OS was 7 months (95% CI 4 months, 14.8 months) and 1-year OS was 24.7% (95% CI 4.2%, 54.0%). Complications included infection (3), pseudomeningocele (1), seizure (1), and asymptomatic radionecrosis (1). Conclusion: After failed prior irradiation of brain metastases, re-irradiation with intra-operative Cs-131 brachytherapy implants provides durable local control and limits the risk of radionecrosis. Our initial experience demonstrates that this treatment approach is well tolerated and safe for patients with previously irradiated tumors that failed more than one radiation therapy regimen, resulting in excellent response rates and minimal toxicity. Author Disclosure: A.W. Smith: Research Grant; University of Rochester School of Medicine and Dentistry. S. Taube: None. B. Parashar: None. S. Trichter: None. L. Nedialkova: None. A.M. Sabbas: None. S. Pannullo: None. P. Stieg: Chairman; Weill Cornell Medical College. T. Schwartz: None. A. Wernicke: Employee; New York University Langone Medical Center.
2152 Hypofractionated Short-Course Radiation Therapy Associated With Worse Survival in Elderly Patients With Glioblastoma Multiforme: An Analysis of the National Cancer Data Base K.S. Mak,1,2 M.M. Qureshi,2,3 and M.T. Truong1,2; 1Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA, 2Boston University School of Medicine, Boston, MA, 3Department of Radiation Oncology, Boston Medical Center, Boston, MA Purpose/Objective(s): For elderly patients with glioblastoma multiforme (GBM), randomized trials have shown similar survival with adjuvant hypofractionated short-course radiation therapy (SCRT) in 2-3 weeks compared to standard long-course radiation therapy (LCRT) with conventional fractionation over 6 weeks. The purpose of this study was to evaluate these findings in a national patient registry.
Poster Viewing
E63
Materials/Methods: Using the National Cancer Data Base (NCDB), we identified patients aged 60 years or older with GBM, diagnosed between 1998-2011, who underwent surgery and either SCRT (defined as 34-42 Gy in 2.5-3.4 Gy fractions), or LCRT (58-63 Gy in 1.8-2.0 Gy fractions). Survival rates were estimated using the Kaplan-Meier method. Crude and adjusted hazard ratios (HR) were calculated using Cox regression modeling. P-values of
