141Oral Presentations / Brachytherapy 8 (2009) 105e180

61-70: 14; 71-80: and 81 and above: 2. Followup data were available in 44patients and 2 patients were lost to followup. The median followup periodwas 8 months. One case of infection was noted in the lumpectomy cavitywith an incidence of 2%. No symptomatic seroma were reported afterAPBI. One case of cellulitis was seen and one patient underwent biopsyfor fat necrosis. The results of cosmesis are shown in Figure 1. Excellentand good cosmesis was seen in 90% and in 7% it was fair and 3% poor.The poor cosmetic result was due to reexcision at the time of lumpectomydue to positive margins. No relapse has been seen at a maximumfollowup of 16 months.Conclusions: Preliminary review shows excellent feasibility and initialresults show excellent local control with acceptable toxicities. While thefollowup is short, outcomes will be monitored for local relapse andtoxicities and presented.

GYN POSTERS

Saturday-Tuesday May 30, 2009eJune 2, 2009

PO15

Clinical feasibility of multiple outpatient high-dose-rate

brachytherapy insertions through a cervical sleeve and three-

dimensional dosimetry for inoperable endometrial cancer

Keyur Mehta, M.D.,1,2 Ravindra Yaparpalvi, M.S.,1,2 Alexandra J. Stewart,

DM, MRCP,4 Kunal Saigal, M.D.,3 Shalom Kalnicki, M.D., FACRO,1,2

Subhakar Mutyala, M.D.1,2 1Radiation Oncology, Montefiore Medical

Center, Bronx, NY; 2Radiation Oncology, Albert Einstein College of

Medicine, Bronx, NY; 3Radiation Oncology, University of Miami, Miami,

FL; 4Radiation Oncology, Royal Surrey County Hospital, Guildford,

United Kingdom.

Purpose: To assess the feasibility and 3-dimensional dosimetry of HDRbrachytherapy for inoperable endometrial cancer using multipleoutpatient applicator insertions through a CT/MRI compatible cervicalsleeve.Methods and Materials: Ten patients were treated with whole pelvic externalbeam radiotherapy (EBRT) followed by 5 fractions of outpatient HDRbrachytherapy. A CT/MRI compatible cervical sleeve was sutured into thecervix and the Rotte ‘Y’ applicator inserted through the sleeve, see Figure 1.CT scans were performed prior to each brachytherapy fraction fordosimetric planning. Target volume coverage was assessed using V100(percentage of target volume receiving 100% or greater of prescriptiondose) and dose to surrounding organs at risk (OAR), rectum and bladder,was assessed using D2 cc (highest dose to 2 cc of OAR).Results: All 10 patients received the full course of EBRT and brachytherapywithout complications or greater than grade 1 toxicity. All 50 insertions ofthe Rotte ‘Y’ applicator through the cervical sleeve under sedation weresuccessful. The mean CTV volume was 147.8 cc. The mean V100 was

84.4%. The mean bladder D2 cc was 4.16 Gy and the mean rectum D2 ccwas 3.87 Gy.Conclusions: Outpatient multiple insertion HDR for inoperableendometrial cancer through a cervical sleeve is feasible and well-tolerated. Three-dimensional dosimetry to OAR is acceptable. Long-termdata on disease control and toxicity are warranted.

PO16

Inoperable endometrial carcinoma treated with definitive

radiotherapy: Survival, local control, and treatment side effects

Casey Duncan, M.D., Anna Olson, M.D., Geraldine Jacobson, M.D.,

M.B.A., M.P.H. Radiation Oncology, University of Iowa Hospitals &

Clinics, Iowa City, IA.

Purpose: To assess the survival, local control, and treatment-related sideeffects in women with unstaged endometrial carcinoma treated withdefinitive radiotherapy.Methods and Materials: We performed a retrospective review of patientswith inoperable endometrial cancer treated with definitive radiotherapy atthe University of Iowa Hospitals and Clinics. Each patient’s medicalrecord was reviewed to determine age at diagnosis, stage of cancer,histology, medical comorbidities, recurrence of disease, date of death,cause of death, and treatment-related side effects. Overall survival,disease-specific survival, and treatment-related side effects were assessed.Results: Between February 2003 and April 2008 32 women with inoperableunstaged endometrial carcinoma were treated with definitive radiotherapy.Radiotherapy consisted of pelvic external beam radiation therapy withsubsequent high-dose-rate (HDR) tandem and ovoid brachytherapy orexternal beam boost. Twenty-five patients received external beamradiotherapy with an HDR boost while seven patients received externalbeam radiotherapy with a conformal or IMRT boost. The median age was67 years (range 35 to 97 years) and the median BMI was 36.8 (range 17.0to 81.2). Seven (22%) patients had normal weight. Overweight, obese,and morbidly obese patients represented 9%, 22%, and 47%, respectively.At median followup of 36 months, overall survival was 56% whiledisease-specific survival was 86%. Only one patient (3%) experiencedlocal recurrence; no patient developed metastatic disease. Acutetreatment-related side effects occurred in 6 (19%) patients: diarrhea (3),fecal urgency (1), nausea and vomiting (1), and bowel perforation (1).Three (9%) patients experienced late treatment-related side effects: colitis(2) and diarrhea (1).Conclusions: Morbid obesity complicates diagnosis, staging, treatment, andfollowup in this patient population. Significant comorbidities, not cancer,lead to poor overall survival. Definitive radiotherapy for unstagedinoperable endometrial adenocarcinoma results in excellent disease-specificsurvival and local control with minimal treatment-related side effects.

PO17

Systematic comparison of two methods of bladder contouring in

cervix cancer brachytherapy: ‘‘Direct’’ vs. ‘‘indirect’’

Carey B. Shenfield, B.Sc., M.D.,1,2 Daniel Berger, Ph.D.,1 Johannes C.A.

Dimopoulos, M.D.,1 Sunita Ghosh, Ph.D.,2 Richard Potter, M.D.1

1Radiotherapy and Radiobiology, Medical University of Vienna, Vienna,

Austria; 2Radiation Oncology, Cross Cancer Institute, Edmonton, AB,

Canada.

Purpose: The importance of accurate contouring of organs at risk includingthe bladder is critical in the setting of radical pelvic radiotherapy, and inparticular for brachytherapy due to high doses and steep dose gradientsnear organs at risk. While a dose response effect has been demonstratedfor the rectum, similar demonstration for the bladder has remainedelusive. One possible reason for this involves the accuracy of traditionalbladder contouring. We compared two methods of contouring the bladder;traditional outer bladder drawings (GEC ESTRO recommendations), witha new method using inner bladder drawings.