Non-coplanar conformal radiotherapy has recently been considered promising for the treatment of stage I non-small cell lung cancer (NSCLC). Usually, it is performed with some kind of fixation or gating and with relatively high fraction doses of 10 to 20 Gy. However, this treatment method has contraindications for so-called centrally located tumors because of its high fraction dose. We have been treating these tumors with relatively low fraction dose (3∼4 Gy) without fixation. The tolerance dose of the critical organs might be increased and tumors located nearby could be treated safely. Furthermore, as our method does not need fixation nor breath-holding, it can be widely applied for elderly or compromised patients. Formerly, we presented our preliminary data at this meeting. This year we will report our updated results with longer follow-up period and larger number of cases. Eligibility criteria were as follows: maximum tumor diameter not greater than 5 cm, PS between 0 and 2, and no limitation concerning age and respiratory function. Radiotherapy is given with 6MV photon beam by fixed 10 non-coplanar conformal beams. Irradiation is aiming at the internal target volume with proper margins. No elective nodal irradiation is performed. Between September 1999 and March 2006, 64 eligible patients were treated with this method. Age ranged from 53 to 91 (average 76). The male/female ratio was 44/20. There were 37 patients with T1 tumors and 27 patients with T2 tumors. Fourteen tumors were sqcca, 44 were adenoca, 1 was large cell ca and 5 were NSCLC NOS. There were 55 inoperable patients (86%) the reasons for which were pulmonary in 34 patients, old age in 8, cardiac in 5 and so on. Remaining 9 patients were operable but refused operation. The average size of the tumor was 3.1 cm (range; 1.0 to 5.0 cm). As for PS, there were 59 PS 1 and 5 PS 2 patient. Total radiation dose ranged from 59.5 Gy to 76.5 Gy with a median of 75 Gy. Overall treatment time ranged from 26 to 42 days (median 35 days). Median follow-up period was 28 months (range: 12∼88 months). Average V20 of the normal lung was 11.5% (range; 2%–21%). Overall 1-, 3-, and 5-year survival rates (SR) were 94%, 74%, and 62%, respectively. Local control rates (LCR) at 1, 3, and 5 years were 98%, 85%, 76%, respectively. Cause-specific survival rates at 1, 3, and 5 years were 100%, 85%, 71%, respectively. Relapse-free survival rates at 1, 3, and 5 years were 91%, 58%, 47%, respectively. There was no difference in SR nor LCR between T1 and T2 tumors. Seventeen patients developed recurrence; 7 in local, 3 in mediastinal, 2 in pleura and 5 in distant organs. Fourteen patients have died. Among them 7 patients died of the disease, 1 died of other cancer, 3 died of intercurrent diseases, and the other 3 died of pneumonia. Five patients (8%) developed grade 3 or higher pulmonary complications according to NCI-CTCAEv3.0, all of whom had had pulmonary comorbidities. No life-threatening complications regarding heart, large vessels, esophagus, spinal cord, etc. have been observed. Considering the status of our patients, our method might be promising with favorable survival and local control results and with acceptable toxicity, and not worse compared with the published results of SBRT for the treatment of stage I NSCLC and might have broader indications. Longer follow-up with larger number of patients is still necessary.

20515 Background: Metastatic spinal tumors often cause spinal cord compression and jeopardize the quality of life of the patients much. To decrease the local symptomatic recurrence rate, we have been adding IORT to decompression surgery. Methods: For those patients whose life expectancy was more than 6 months were eligible for this treatment. Posterior decompression by laminectomy of the involved vertebrae was performed. Following decompression, the patient was irradiated the lesions intraoperatively with electrons generated from Microtron by shielding the spinal cord with lead plate. The central aspects of the vertebrae were irradiated by scattered electrons detouring from the edge of the lead shield up to 40% of the administered dose. Following IORT, posterior instrumentation was performed. External beam radiotherapy might be added pre- and/or postoperatively when considered necessary. Results: 108 patients were treated between 1992–2005. There were 58 males and 50 females. Age ranged from 26 to 85 with a median of 62.5. By primary sites, 26 breast, 24 kidney, 18 colorectum, 17 lung 12 prostate and 11 thyroid cases were included. Irradiated spines were cervical in 6, thoracic in 76, and lumbar/sacral in 27. Overall median follow-up period was 12.7months. Median IORT dose was 20Gy (range 15–26Gy) and median electron energy was 16MeV (range 11–22MeV). There were 37 cases with preoperative RT and 41 cases with postoperative RT. Overall median survival time was 14.5months (breast 15.3, kidney 22.6, colorectum 5.7, lung 6.2, prostate 31.6, thyroid 60.6months). Neurological response rate was 73.1%. Ambulatory rates were 87.0% for success and 80.6% for rescue by Klimo's definition(2005). There were only 8 symptomatic relapses (7%). As for major complications, only one myelopathy has been observed. Conclusions: Decompression surgery and IORT for metastatic spinal tumors with impending spinal cord compression was a promising treatment modality with excellent local control and neurological response rate and with minimal toxicity especially for those patients with long-term prognosis. No significant financial relationships to disclose.

Évaluation prospective de la préservation des glandes salivaires, des survies globales et sans récidive locale après traitement de cancers ORL par tomothérapie hélicoïdale (TH).De mars 2007 à février 2009, 30 patients atteints de cancers ORL ont été traités par TH. La fraction d’excrétion salivaire (FES) a été évaluée par scintigraphie au technétium avant, 6, 12 et 18 mois après la TH, permettant de définir le taux de préservation glandulaire. Parallèlement, les patients ont été examinés tous les 3 mois pour évaluer les toxicités cliniques.Le suivi médian a été de 4,3 ans. La dose moyenne reçue aux glandes parotides homolatérales (GPH) a été de 25,4 Gy. Dix-neuf patients ont pu être évalués à 18 mois par scintigraphie, et ils ont eu une bonne préservation des GP (84 %). Parmi les 6 patients ayant reçu plus de 26 Gy dans la parotide, la survie sans récidive locale (SSRL) était de 100 % à 5 ans. La SSRL à 28 mois était de 33 % dans le groupe ayant reçu moins de 20 Gy versus 91 % dans le groupe ayant reçu plus de 20 Gy à la GPH.La tomothérapie hélicoïdale nous a permis de réduire l’incidence et la sévérité de la xérostomie. Nous avons montré qu’une dose moyenne délivrée aux parotides entre 20 et 26 Gy préservait la fonction salivaire sans compromettre l’efficacité du traitement. Par contre, la préservation parotidienne limitant la dose moyenne en dessous de 20 Gy augmente le risque de récidive locale.

Purpose/Objective: The standard treatment for locally advanced (stage III) non-small cell lung cancer (NSCLC) is concurrent use of chemoradiotherapy containing cisplatinum (CDDP). To enhance the local control and to reduce the systemic adverse effects, we have been performing intraarterial infusion of CDDP from the bronchial arteries (BAI of CDDP) instead of intravenous administration. We presented the preliminary results in the past ASTRO Annual Meetings. This year we analyzed the long-term results of our method. Materials/Methods: In principle, we administered 80mg/m2 of CDDP intraarterially twice during the conventionally fractionated radiation therapy of 60 to 70Gy. The dose of CDDP was changed according to patient's renal function. We did not administer any adjuvant chemotherapy until the disease recurrence was observed. Between 1996 and 2001 40 cases with stage III NSCLC were treated definitively. Age ranged from 43 to 85 with a median of 75. There were 32 males and 8 females. There performance status was 0–1 in 35 cases, 2 in 3 cases, and 3 in 2 cases. There were 28 squamous cell carcinomas, 9 adenocarcinomas, 1 large cell carcinoma, and 2 others. There were 7 stage IIIA cases and 33 stage IIIB cases (20 T4 tumors and 17 N3 tumors). Total radiation dose (TRD) ranged from 50.4Gy to 73.2Gy with an average of 63.4Gy. In 35 cases (87.5%), TRD was between 60 and 70Gy. In 10 cases (25%), hyperfractionated radiotherapy of 1.2Gy/fr, twice a day was used. Single dose of CDDP ranged from ranged from 50mg to 140mg with a median of 120mg. Fifteen cases received BAI once, 23 cases twice, and 2 cases 3 times. Total amount of CDDP ranged from 50mg to 360mg with a median of 220mg. Median follow-up period of alive patients exceeded 5 years (63.2 months (Range 32 - 99 months)). Results: Overall survival rates at 1, 2, 3, 4, and 5 years were 72.5%, 55%, 44.9%, 44.9%, and 41.1%, respectively. Median survival time was 27 months. Relapse-free survival rates at 1, 2, 3, 4, and 5 years were 55%, 45%, 42.5%, 39.8%, and 32.7%, respectively. Yearly hazard rates for death of the 1st, 2nd, 3rd, 4th, and 5th year were 0.275, 0.241, 0.183, 0, and 0.085, respectively. Eleven patients (27.5%) survived longer than 5 years. Fifteen patients (37.5%) were still alive at the time of the analysis, among them 14 cases (35%) were disease-free. As for acute complications, we had 6 (15%) grade 3 hematological complications and 2 (5%) grade 3 pulmonary complications, but we had no severe esophageal complications. Concerning the causes of deaths, there were 16 cases (40%) who died of disease, 2 who died of second malignancy, and 7 (17.5%) who died of pneumonia possibly complicated by interstitial pneumonitis and/or fibrosis. Conclusions: Our survival results of concurrent radiotherapy and BAI of CDDP for the treatment of stage III NSCLC have been promising. After 2 years following treatment, hazard rate for death decreases and the slope of survival curve becomes gentle. Judging from the high rate of long-term disease-free survivors, disease clearance by the initial chemoradiotherapy might be quite essential to improve the treatment results. Any measures to avoid pulmonary complications might be necessary to further improve the treatment results. Prospective trials are worthwhile.

5554 Background: Altered fractionation radiation therapy has been thought to improve the local control and survival of the patients with head and neck cancer. Since 1996, we have been conducting a clinical trial of hyperfractionated radiation therapy (HFRT) for the treatment of squamous cell carcinoma of the head and neck (SCCHN). METHODS Between 1996 and 2002 88 cases with SCCHN were treated and analyzed. Average age was 64.7 (39-91), M/F=77/11. Primary site: Larynx 34 cases, hypopharynx 27 cases, oropharynx 17 cases, oral cavity 5 cases, nasopharynx 4 cases, and maxillary sinus 2 cases. Stage I/II/III/IV(M0) = 11/32/15/31. Radiotherapy was administered with 4MVXrays. Fraction dose was 1.2Gy twice a day more than 6 hours apart, to the average total dose of 71.7Gy (range 60∼81.6Gy). Chemotherapy was combined in 22 cases. Median follow-up period was 37 months. RESULTS Five-year overall survival rate (OS) and local control rate (LC) of overall cases were 67.6% and 73.8%, respectively. OS and LC of stage I-II and III-IV were, 82.7%, 95.2%, and 54.5%, 53.5%, respectively. As for larynx, OS and LC of overall, stage I-II, and stage III-IV were, 91.2%, 84.2%, 100%, 93.8%, and 50% (2y), 67% (1y), respectively. As for oropharynx, OS and LC of overall, stage I-II, and stage III-IV were, 71.1%, 83.9%, 100% (2y), 100% (2y), and 73.8%, 80%, respectively. As for hypopharynx, OS and LC of overall, stage I-II, and stage III-IV were, 49.9%, 65.3%, 53.6%, 100%, and 48.2%, 42.9%, respectively. Disease-specific survival of stage I-II hypopharyngeal cancer was 100%. Acute toxicities of grade 3 or greater were observed in 17 cases (19%). No severe late toxicity has been observed. CONCLUSIONS HFRT for SCCHN was promising not only for stage III and IV(advanced) cases but also for stage I and II (early) cases. No significant financial relationships to disclose.

Purpose/ObjectiveNoyn-coplanar conformal radiotherapy has recently been considered promising for the treatment of stage I non-small cell lung cancer (NSCLC). Usually, it is performed with some kind of fixation or gating and with relatively high fraction doses of 10 to 20Gy. However, this treatment method has contraindications if the tumor locates in the vicinity of such critical organs as esophagus, large vessels, spinal cord, and so on, because of its high fraction dose. We have been treating these tumors with relatively low fraction dose (3-4Gy) without fixation. The tolerance dose of the above mentioned critical organs might be increased and tumors located near such critical organs could be treated safely. Furthermore, as our method does not need fixation nor breath-holding, it can be widely applied for elderly or compromised patients. In this presentation, we will present the safety and efficacy of our method for the treatment of stage I NSCLC.Materials/MethodsEligibility criteria were as follows: maximum tumor diameter not greater than 5cm, V20 not exceeding 20%, performance status (PS) between 0 and 3, and no limitation concerning age and respiratory function. Radiotherapy is given with 6MV photon beam by fixed 6 to 10 non-co-planar conformal beam. Total dose was escalated from 60Gy to 75Gy and has been fixed at 75Gy with a fraction dose of 3Gy at the present time. Fraction dose was also escalated from 3Gy to 4Gy and has been fixed at 3Gy. This would make biological equivalent dose at 10Gy (BED10) 97.5Gy. In order to dispense with fixation, we set the planning target volume by taking CT scans taken both at inhaled and exhaled position into account. Between September 1999 and August 2003, 28 patients with stage I NSCLC were treated with this method. Age ranged from 56 to 87 with an average of 77.1. The male to female ratio was 21 to 7. There were 12 patients (13 sites) with T1 tumors and 17 patients (17 sites) with T2 tumors. Five tumors were squamous cell carcinoma, 19 were adenocarcinoma, 1 was large cell carcinoma and 5 were others. There were 25 inoperable patients (89%), the reasons of which were pulmonary in 10 patients, old age in 8, cardiac in 6, and cerebro-vascular in 1. The other 3 patients refused operation. The size of the tumor ranged from 1.2cm to 5 cm with an average of 3.2cm. As for PS, there were 26 PS 1 patients and 2 PS 2 patients. Total dose ranged from 59.5Gy to 75Gy with an average of 68.1Gy. Overall treatment time ranged from 26 to 38 days with an average of 32.1 days. Median follow-up period was 28 months (range: 6-54 months).ResultsV20 ranged from 6% to 20% with an average of 12.2%. Overall 1-year and 3-year survival and local control rates were 92%, 81%, 100% and 75% respectively. In patients with T1 tumors, 1-year and 3-year survival and local control rates were 83%, 66%, 100% and 90% respectively. In patients with T2 tumors, 1-year and 3-year survival and local control rates were 100%, 82%, 100% and 69% respectively. Five patients have died. Among them 3 patients died of the disease, and the other 2 died of other cancers. Only 2 patients (7%) had grade 2 lung toxicity according to NCI-CTCv2.0. No life-threatening complications regarding heart, large vessels, esophagus, spinal cord, etc. have been observed.ConclusionsConsidering the status of our patients, our method might be promising with favorable survival results and with acceptable toxicity compared with conventional radiotherapy and not worse compared with the published results of stereotactic hypofractionated radiotherapy for the treatment of stage I NSCLC. Longer follow-up with larger number of patients is necessary Purpose/ObjectiveNoyn-coplanar conformal radiotherapy has recently been considered promising for the treatment of stage I non-small cell lung cancer (NSCLC). Usually, it is performed with some kind of fixation or gating and with relatively high fraction doses of 10 to 20Gy. However, this treatment method has contraindications if the tumor locates in the vicinity of such critical organs as esophagus, large vessels, spinal cord, and so on, because of its high fraction dose. We have been treating these tumors with relatively low fraction dose (3-4Gy) without fixation. The tolerance dose of the above mentioned critical organs might be increased and tumors located near such critical organs could be treated safely. Furthermore, as our method does not need fixation nor breath-holding, it can be widely applied for elderly or compromised patients. In this presentation, we will present the safety and efficacy of our method for the treatment of stage I NSCLC. Noyn-coplanar conformal radiotherapy has recently been considered promising for the treatment of stage I non-small cell lung cancer (NSCLC). Usually, it is performed with some kind of fixation or gating and with relatively high fraction doses of 10 to 20Gy. However, this treatment method has contraindications if the tumor locates in the vicinity of such critical organs as esophagus, large vessels, spinal cord, and so on, because of its high fraction dose. We have been treating these tumors with relatively low fraction dose (3-4Gy) without fixation. The tolerance dose of the above mentioned critical organs might be increased and tumors located near such critical organs could be treated safely. Furthermore, as our method does not need fixation nor breath-holding, it can be widely applied for elderly or compromised patients. In this presentation, we will present the safety and efficacy of our method for the treatment of stage I NSCLC. Materials/MethodsEligibility criteria were as follows: maximum tumor diameter not greater than 5cm, V20 not exceeding 20%, performance status (PS) between 0 and 3, and no limitation concerning age and respiratory function. Radiotherapy is given with 6MV photon beam by fixed 6 to 10 non-co-planar conformal beam. Total dose was escalated from 60Gy to 75Gy and has been fixed at 75Gy with a fraction dose of 3Gy at the present time. Fraction dose was also escalated from 3Gy to 4Gy and has been fixed at 3Gy. This would make biological equivalent dose at 10Gy (BED10) 97.5Gy. In order to dispense with fixation, we set the planning target volume by taking CT scans taken both at inhaled and exhaled position into account. Between September 1999 and August 2003, 28 patients with stage I NSCLC were treated with this method. Age ranged from 56 to 87 with an average of 77.1. The male to female ratio was 21 to 7. There were 12 patients (13 sites) with T1 tumors and 17 patients (17 sites) with T2 tumors. Five tumors were squamous cell carcinoma, 19 were adenocarcinoma, 1 was large cell carcinoma and 5 were others. There were 25 inoperable patients (89%), the reasons of which were pulmonary in 10 patients, old age in 8, cardiac in 6, and cerebro-vascular in 1. The other 3 patients refused operation. The size of the tumor ranged from 1.2cm to 5 cm with an average of 3.2cm. As for PS, there were 26 PS 1 patients and 2 PS 2 patients. Total dose ranged from 59.5Gy to 75Gy with an average of 68.1Gy. Overall treatment time ranged from 26 to 38 days with an average of 32.1 days. Median follow-up period was 28 months (range: 6-54 months). Eligibility criteria were as follows: maximum tumor diameter not greater than 5cm, V20 not exceeding 20%, performance status (PS) between 0 and 3, and no limitation concerning age and respiratory function. Radiotherapy is given with 6MV photon beam by fixed 6 to 10 non-co-planar conformal beam. Total dose was escalated from 60Gy to 75Gy and has been fixed at 75Gy with a fraction dose of 3Gy at the present time. Fraction dose was also escalated from 3Gy to 4Gy and has been fixed at 3Gy. This would make biological equivalent dose at 10Gy (BED10) 97.5Gy. In order to dispense with fixation, we set the planning target volume by taking CT scans taken both at inhaled and exhaled position into account. Between September 1999 and August 2003, 28 patients with stage I NSCLC were treated with this method. Age ranged from 56 to 87 with an average of 77.1. The male to female ratio was 21 to 7. There were 12 patients (13 sites) with T1 tumors and 17 patients (17 sites) with T2 tumors. Five tumors were squamous cell carcinoma, 19 were adenocarcinoma, 1 was large cell carcinoma and 5 were others. There were 25 inoperable patients (89%), the reasons of which were pulmonary in 10 patients, old age in 8, cardiac in 6, and cerebro-vascular in 1. The other 3 patients refused operation. The size of the tumor ranged from 1.2cm to 5 cm with an average of 3.2cm. As for PS, there were 26 PS 1 patients and 2 PS 2 patients. Total dose ranged from 59.5Gy to 75Gy with an average of 68.1Gy. Overall treatment time ranged from 26 to 38 days with an average of 32.1 days. Median follow-up period was 28 months (range: 6-54 months). ResultsV20 ranged from 6% to 20% with an average of 12.2%. Overall 1-year and 3-year survival and local control rates were 92%, 81%, 100% and 75% respectively. In patients with T1 tumors, 1-year and 3-year survival and local control rates were 83%, 66%, 100% and 90% respectively. In patients with T2 tumors, 1-year and 3-year survival and local control rates were 100%, 82%, 100% and 69% respectively. Five patients have died. Among them 3 patients died of the disease, and the other 2 died of other cancers. Only 2 patients (7%) had grade 2 lung toxicity according to NCI-CTCv2.0. No life-threatening complications regarding heart, large vessels, esophagus, spinal cord, etc. have been observed. V20 ranged from 6% to 20% with an average of 12.2%. Overall 1-year and 3-year survival and local control rates were 92%, 81%, 100% and 75% respectively. In patients with T1 tumors, 1-year and 3-year survival and local control rates were 83%, 66%, 100% and 90% respectively. In patients with T2 tumors, 1-year and 3-year survival and local control rates were 100%, 82%, 100% and 69% respectively. Five patients have died. Among them 3 patients died of the disease, and the other 2 died of other cancers. Only 2 patients (7%) had grade 2 lung toxicity according to NCI-CTCv2.0. No life-threatening complications regarding heart, large vessels, esophagus, spinal cord, etc. have been observed. ConclusionsConsidering the status of our patients, our method might be promising with favorable survival results and with acceptable toxicity compared with conventional radiotherapy and not worse compared with the published results of stereotactic hypofractionated radiotherapy for the treatment of stage I NSCLC. Longer follow-up with larger number of patients is necessary Considering the status of our patients, our method might be promising with favorable survival results and with acceptable toxicity compared with conventional radiotherapy and not worse compared with the published results of stereotactic hypofractionated radiotherapy for the treatment of stage I NSCLC. Longer follow-up with larger number of patients is necessary