No abstract

Ten-year metastasis-free survival is significantly improved with ART compared with WS. Biochemical progression-free, clinical progression-free, and hormone-free survival were also improved with ART. Grade 2 or higher GI and GU toxicities were greater in ART. Therefore, ART should be offered to patients with these high-risk features.

19 Background: Optimal management after radical prostatectomy (RP) remains controversial in patients with pathologic T3 or margin-positive prostate cancer with the options being early adjuvant radiotherapy (ART) versus wait-and-see (WS). Methods: A comprehensive Medline search to identify randomized controlled trial (RCT) of ART vs WS was done. Synthesized results from the included studies show Metastasis-Free Survival (MFS) and overall survival (OS) rates at 10 years as well as Grade 2 or greater GI and GU toxicities in the studies. Results were based on the random-effect (RE) model if there was evidence of between-trial heterogeneity, otherwise the fixed-effect (FE) model was used. Results: A total of 3 RCTs (ARO9602/AUO AP09/95, EORTC22911, SWOG8794) were identified with 1,737 patients (ART: n=864, WS: n=873). 10-year estimates of MFS and OS rates were reported for SWOG and EORTC studies, and estimated for ARO 96-02/AUO AP09/95 study from their Kaplan-Meier curves (Table). Pooled 10-year MFS data showed a significant improvement with ART vs WS (OR= 0.77; 95% CI 0.62–0.96, p=0.02, FE). However, pooled 10-year OS was not significantly different (OR= 0.98; 95% CI 0.64–1.49, p=0.91, RE). Grade 2 or greater GI toxicity was reported by all three studies and was significantly higher in ART (2.5%) compared with WS (1.1%), p=0.04. Grade 2 or greater GU toxicity was reported by ARO9602 and EORTC studies and was significantly higher in ART (17.1%) compared with WS (10.3%), p=0.0004. Conclusions: 10-year MFS is significantly improved with ART compared with WS. No benefit in 10-year OS was found. Grade 2 or greater GI and GU toxicities where greater in ART compared with WS. [Table: see text]

Method and Materials:Eight packets of films were exposed to 13.5cm ×13.5cm, 6MV radiation fields in a solid water phantom. Dose levels of 1.1, 3.2, 5.3, 7.4, and 9.5 Gy were delivered to five films in each packet. Films were scanned both before and after irradiation using an Epson flat‐bed scanner (24hr wait‐time for post‐irradiation coloration). Corresponding 2D dose distributions were measured with a detector‐array (MatriXX). Point dose comparisons were performed with an ion chamber. Digitized film images were registered to the 2D dose distribution to generate a correction map that compensated the scanner non‐uniform response as a function of dose. Optical density (OD) and net optical density (NetOD) values were calculated for all images. Dose response curves were established using mean values of a central 0.5cm × 0.5cm region‐of‐interest (ROI). Images were converted to dose, and error uncertainties (1SD) were measured in the central 8cm × 8cm ROI. Results: The overall dosimetric uncertainties (1SD) of the NetOD approach were 2.2%, 1.9%, and 3.5% for red, green, and blue channels, respectively. The corresponding uncertainties of OD were 2.7%, 3.1%, and 8.3%, respectively. For low dose range (<3 Gy), the green channel revealed higher uncertainty (SDgreen= 3.3%) than the red channel (SDred=2.6%). However, for high doses (3∼9 Gy), the green channel showed less variability (SDgreen=1.6%, SDred=2.9%). Minimum SDred and SDgreen were 1.6% at 5.3Gy and 1.3% at 7.4 Gy, respectively. Scanner non‐uniformity correction mitigated the irregular response of scanner detector elements observed initially. Conclusion: NetOD may be a more useful metric for benchmarking EBT2 than OD. We demonstrated that the lowest dose uncertainties were achieved using the red channel for low dose range, while the green channel was preferred for higher doses. Scanner non‐uniformity correction is necessary for higher precision dosimetry.

To identify which type of implant based reconstruction has the most favorable outcome in the setting of post mastectomy radiation (PMRT). Materials/Methods: We conducted a retrospective cohort study of 1179 breast cancer patients who underwent a total of 1729 mastectomies of which 76% (1329) underwent implant based reconstruction; 56% (739) involved tissue expander/implant (TE/I) exchange and 44% (590) were single-stage permanent implants (PI); 23% (400) had autologous tissue reconstruction (ATR), all treated at one institution from 1997-2014. Of the total breasts undergoing mastectomy, 29% (507) received PMRT and 71% (1222) did not. Median prescribed PMRT dose to the chest wall was 50 Gy (range 45-50.4 Gy); of which 61% (311) received a chest wall boost (10-16 Gy). Forty percent (495) of mastectomies were performed prophylactically in an uninvolved breast. Primary outcome was defined as implant removal (IR) due to complications requiring surgical intervention, with or without re-reconstruction. The association of clinical and pathologic parameters with IR was evaluated using logistic regression models, and the cumulative incidence of outcome was estimated using the Kaplan-Meier method. Results: The median follow-up was 64 months. In patients who received PMRT, the 5-year risk of IR was 33.8% vs 16.4% for TE/I and PI; respectively (P Z 0.0007). Similarly, patients with TE/I had a higher risk for IR with failed implant replacement compared to patients with PI (18.6% vs 9.3%; respectively; P Z 0.0098); as well as a higher 5 yr predicted IR with successful re-reconstruction (18.7%, vs 7.8%; respectively; P Z 0.025). In the absence of PMRT, 5-year predicted incidence of IR did not differ between TE/I and PI (13.9% vs 8.4%; respectively; P Z 0.074). Neither did the 5-yr IR with failed implant replacement (3.9% vs 2.3% respectively; P Z 0.31); nor 5-yr IR with successful re-reconstruction (10.4% vs 6.3%; respectively; P Z 0.14). The 5-yr complication rate among patients with ATR was not significantly different with and without PMRT (18.2% vs 16.6%; respectively; P Z 0.97). The 5-yr complication rate was not significantly different between irradiated ATR and irradiated single stage (PI) (18.2% vs 16.4%; respectively; P Z 0.99); while this was significantly lower compared to irradiated TE/I (18.2% vs 33.8%; respectively; P Z 0.015). In multivariate analysis, PMRT, tissue expander/implant (TE/I) reconstruction and active smoking were significant predictors for implant removal (Odds Ratio [OR] Z 7.2, P < 0.001; OR Z 5.8, P Z 0.001 and OR Z 3.5, P Z 0.02; respectively). Neoadjuvant chemotherapy, surgery related parameters as reconstruction timing, and implant size were not predictive of IR. Conclusion: These data suggest that in the setting of PMRT, two stage tissue expander/implant (TE/I) has significantly higher rate of implant removal compared to Single Stage PI and ATR. PI could be considered a preferable alternative to TE/I when PMRT is indicated.