irradiating young patients, patient with a long life expectancy or patients with renal dysfunction. The clinical advantage is to preserve renal function and to not.
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EP-1403 A comparison between 3D and volumetric technique in lumbar vertebral palliative irradiation N. Ricottone1, N. Cavalli2, E. Bonanno2, C. Marino2, G. Pisasale1, A. D'Agostino1, A. Girlando1 1 HUMANITAS CCO, Radiation Oncology, Catania, Italy 2 HUMANITAS CCO, Medical Physics, Catania, Italy Purpose or Objective Lumbar rachis radiation treatment requires to take into account dose to kidneys. Aim of this paper is to evaluate if volumetric techniques can give an advantage when irradiating young patients, patient with a long life expectancy or patients with renal dysfunction. The clinical advantage is to preserve renal function and to not interfere with previous or further medical treatments that make use of renal toxic drugs, as for instance: cisplatin, carboplatin, ifosfamide. Material and Methods A comparison between four plans were performed: a two fields three dimensional (3D) anterior-posterior plan (3D2F); a three fields (0°-150°-210°) 3D plan (3D-3F); a VMAT plan and a second VMAT plan spine sparing (VMAT-SS). Dose prescription was 30 Gy in 10 fractions. All plans were calculated with Eclipse 13.6 using AAA algorithm. 3D plans were calculated using MLC shielding and different weighted fields; regarding VMAT plans dose constraints according to QUANTEC were used. Results Even if dose delivered to kidneys do not exceed QUANTEC dose constraints, VMAT plans achieve better results in term of dose reduction to OARs particularly for kidneys (as showed in the table 1) thus without affecting PTV coverage (figure 1).
Purpose or Objective To evaluate the overall survival times of patients with brain metastases who were treated in our institution with WBRT, comparing patients over and under 70 years old, and between fractionation schedules. Material and Methods A retrospective review was carried out of patients treated with WBRT over a two year period (2013-2014). Data was collected with regards to the time of initial histological diagnosis, dose delivered, age, in-or outpatient basis, extracranial disease status, and time to death, or last known follow up. Results 101 patients were identified for analysis. The median age was 64 years (range 32-88). The radiotherapy was delivered as two opposed 6MV-10MV photon beams, with shielding to the lenses. 50.5% of patients were prescribed 30Gy in 10 fractions, 33.7% 20Gy in 5 fractions and 15.8% patients were prescribed other fractionation schemes. 29.7% were treated as inpatients, and 70.3% as outpatients. The 4 most common histological subtypes were NSCLC 42.6%, small cell lung carcinomas 19.8%, breast adenocarcinoma 14.9%, and malignant melanoma 12.9%. 17.8% of patients had a biopsy or resection of the brain metastases. 11.9% of patients received stereotactic radiotherapy and 2% had already received prophylactic cranial irradiation. The median follow-up was 2.5 months (range: 2 days–30.5 months) from the end of RT. Median overall survival was 2.6 months (95% CI: 1.1 to 4.0). Overall survival at 1 year was 24%. All of those aged >70 years died. Overall survival differed significantly between those < 70 years of age and those > 70 (p< .0005). Median overall survival at 12 months was 5.5% for those 70 years. The hazard (risk of death) is higher and thus the prognosis worse, for older patients controlling for RT dose and Brain surgery or biopsy (p= .011). Univariate analysis revealed that higher RT doses were significantly associated with longer survival (p< .0005), although this may be due to patients with better performance status receiving 30Gy in 10 fractions as opposed to 20Gy in 5 fractions.
Figure1: DVH comparison between the two plans that gives the best PTV coverage Conclusion Both 3D plans do not exceed kidneys QUANTEC reference dose constraints. Doses under QUANTEC constraints can cause renal dysfunction in long survivors, young patients and oligometastatic patients. In these situations it is important to consider VMAT planning that gives the opportunity to reduce dose delivered to kidneys decreasing the probability to develop a late renal dysfunction and giving the opportunity for further toxic renal drugs treatments. EP-1404 Survival time following palliative whole brain radiotherapy to treat brain metastases A. Billfalk Kelly1, M. Dunne1, C. Faul1, O. McArdle1, I. Fraser1, J. Coffey1, A. Boychak1, B.D. O'Neill1, D. Fitzpatrick1 1 St. Lukes Radiation Oncology Network, Radiation Oncology, Dublin 6, Ireland
Conclusion Our review shows that survival for most patients is poor in patients who have brain metastases treated with WBRT, which is consistent with international data. 6.9% of patients did not complete the prescribed course of radiotherapy due to clinical deterioration, therefore some patients may be better served with shorter courses of radiotherapy, or treatment with steroids alone, in order to minimise their time in hospital and to ensure maximum quality of life.
