S474 I. J. Radiation Oncology d Biology d Physics Volume 72, Number 1, Supplement, 2008

2682 Upfront Radiotherapy with Concurrent Chemotherapy for Localized Nasal NK/T-Cell Lymphoma:

Radiotherapy Quality Assurance (QA) Review in Japan Clinical Oncology Group (JCOG) Trial 0211

M. Oguchi1, Y. Kagami2, S. Ishikura3, K. Nihei4, Y. Ito2, M. Yamaguchi5, K. Tobinai2, T. Hotta6, I. Wasada7, K. Oshimi8

1The Japanese Fdn for Cancer Research, Cancer Institute Hospital, Tokyo, Japan, 2National Cancer Center, Tokyo, Japan,3Center for Cancer Control and Information Services, National Cancer Center and Radiotherapy Support Center, Tokyo, Japan,4National Cancer Center Hospital East, Kashiwa, Japan, 5Mie University, Tsu, Japan, 6Nagoya National Hospital, Nagoya,Japan, 7Tokai University, Isehara, Japan, 8Juntendo University, Tokyo, Japan

Purpose/Objective(s): It is challenging to conduct a high quality multi-institutional clinical trial for localized nasal NK/T-celllymphoma due to its rarity. JCOG 0211 is a multi-center phase I/II trial for this lymphoma to evaluate upfront radiotherapy(RT) with concurrent chemotherapy; a total RT dose of 50 Gy and 3 cycles of DeVIC (carboplatin, etoposide, ifosfamide, and dexa-methasone). The purpose of this study is to evaluate the compliance with RT protocol guidelines in concurrent chemoradiotherapyamong institutions participating in JCOG 0211.

Materials/Methods: Thirty-three patients (stage I, 23; stage II, 10) were accrued in this study from 2003 to 2006 from 18 insti-tutions. The 3-D conformal RT planning was required to cover adequately target volumes and to minimize doses to organs at risk:the eyes, the brain stem and the spinal cord. The following parameters were evaluated with RT charts and simulation/portal imagesby the RT-QA review board: prescribed dose, fractionation, overall treatment time, daily treatment, target delineation, target cov-erage, dose distributions and dose to risk organs.

Results: There was no protocol violation. All cases were compliant in fractionation, daily treatment and overall treatment time. Inevaluable 29 of 33 cases, all cases were protocol compliant in target coverage. Deviations were identified as follows: prescribeddose, 1/33; delineation of CTV (\2 cm from the edge of GTV at any direction), 2/33; and dose distribution (not covered by 90%-115% isodose line), 3/33. In 11 cases, the dose to organs at risk exceeded 40 Gy mainly due to the tumor extension close to organs atrisk such as the eyes. The individual case review and its feedback to participating institutions contributed to reduce protocoldeviations.

Conclusions: The JCOG 0211 will provide reliable results of chemoradiotherapy for localized nasal NK/T-cell lymphoma.

Author Disclosure: M. Oguchi, None; Y. Kagami, None; S. Ishikura, None; K. Nihei, None; Y. Ito, None; M. Yamaguchi, None; K.Tobinai, None; T. Hotta, None; I. Wasada, None; K. Oshimi, None.

2683 Radio-Immunotherapy (RIT): Long-term Follow-up Results with I-131 Labeled Antibody in 52 Patients

with Non-Hodgkin’s Lymphoma (NHL) Refractory to Chemotherapy and Rituxan

J. B. Colenda1, R. Mark1,2, P. Anderson1, T. Neumann1, M. Nair1, R. Akins1, D. Quick1

1Joe Arrington Cancer Center, Lubbock, TX, 2Texas Tech University, Lubbock, TX

Purpose/Objective(s): Non-Hodgkin’s Lymphoma (NHL) B-Cell subtype, is generally very sensitive to Chemotherapy and Rit-uxan. In patients who have developed refractory disease, the course of disease is usually rapidly fatal. Many NHL B-Cells expressCD-20 Antigen. Such patients may be candidates for Radioimmunotherapy (RIT) with tositumomab murine monoclonal antibodyconjugated with I-131, which can bind to CD-20 expressing cells with potentially lethal effects. We present results in 52 patientstreated according to the Bexxar CP98-020 Protocol.

Materials/Methods: Initially, candidates for Bexxar CP98-020 Protocol, were patients with NHL expressing CD-20 which hadbecome refractory to Chemotherapy and Rituxan. Since 2006, four patients have received primary treatment for NHL with RIT.Eligibility criteria included Platelet count .100,000, less than 25% involved bone marrow, and no kidney dysfunction. In addi-tion, the patients could not be pregnant or breast feeding. Between 2001 and 2008, 52 patients received I-131 labeled Antibody.The total body dose was 75 cGy for Platelet counts .150,000 and 65 cGy for Platelet 100-150,000. Activity ranged from 60 mCito 120 mCi.

Results: Median follow-up was 54 months (range, 6-84 months). The response rate was 73.0% (38/52), with complete responseachieved in 26.9% (14/52) of the patients. Median progression free survival was 14 months. All four patients treated with primaryRIT remain free of recurrence, with follow-up periods ranging from 12-38 months. Toxicity was moderate, with 9.6% (5/52) ofpatients experiencing profound (Platelets\10,000) thrombocytopenia, which was prolonged, lasting more than 20 weeks. Therewere no bleeding complications, and no patient required a transfusion. For the remaining 47 patients, Platelet counts decreasedmildly for 4-6 weeks following RIT, and then returned to normal values by 10-20 weeks.

Conclusions: RIT has yielded promising results in NHL patients’ refractory to Chemotherapy and Rituxan. Toxicity has been ac-ceptable. RIT may be considered for first line treatment in some cases of NHL.

Author Disclosure: J.B. Colenda, None; R. Mark, None; P. Anderson, None; T. Neumann, None; M. Nair, None; R. Akins, None;D. Quick, None.

2684 Palliation by Low Dose Local Radiotherapy for Indolent Non-Hodgkin’s Lymphoma

E. K. Chan1,2, R. W. Tsang Lymphoma Group1,2

1Princess Margaret Hospital, Toronto, ON, Canada, 2University of Toronto, Toronto, ON, Canada

Purpose/Objective(s): The efficacy of local palliative radiotherapy with a 2 x 2 Gy regimen (total dose: 4 Gy) in Non-Hodgkin’sLymphoma of indolent histology is assessed in a retrospective chart review.

Materials/Methods: Between 2003 and 2005, 20 patients (10 men, 10 women, median age 71.5 years at treatment date, range, 33-81) were treated with 2 x 2 Gy over two days with palliative intent. Histologies were FL in 9 patients, CLL in 9 patients, MCL in 1patient and MALT in 1 patient. Nine patients initially presented with stage 0-2 disease, ten patients with stage 3-4 disease and oneunknown. ECOG status was 0-2 in 19 patients and ECOG 3 in one patient. 17 patients had received prior chemotherapy. The

Proceedings of the 50th Annual ASTRO Meeting S475

patients were treated to a total of 37 different sites, 5 of which were extranodal. 15 disease sites were less than 5 cm in maximumdiameter, 15 sites were 5-10 cm, and 7 sites were larger than 10 cm. Clinical and radiographic data were used to assess local re-sponse. Response of less than 50% in largest tumor diameter was defined as stable disease.

Results: A response to the 2 x 2 Gy regimen was achieved in 15 patients (CR 10, PR 5, ORR 75%), 4 patients (stable 2, progression2) had stable disease or progression and one patient had a mixed response (1 site CR and a later site stable disease). Among the 37disease sites, ORR was 81% (CR 17, PR 13). Disease sites less than 5cm had an ORR of 80% (CR 9, PR 3, stable disease 3). Sitesthat were 5-10cm had an ORR of 80% (CR 5, PR 7, stable 2, progression 1). Sites larger than 10 cm had an ORR of 86% (CR 3, PR3, progression 1). Of the 11 patients who presented with symptoms (pain/discomfort, leg edema, bleeding), 9 showed improvementin their symptoms after treatment.

Among responding patients, the overall median follow-up time was 4.1 months. There was a median time between treatment anddocumented relapse of 6.1 months in patients with at least 1 site of relapse.

Conclusions: A low dose regimen of 2 x 2 Gy is an effective palliative treatment for indolent lymphomas. Patients with smallertumor bulk (.5 cm) appear more likely to respond with CR.

Author Disclosure: E.K. Chan, None; R.W. Tsang and Lymphoma Group, None.

2685 Involved Field Radiation Therapy in Limited Stage Diffuse Large B-cell Lymphoma of Head and Neck: Is it

Whole Neck Irradiation?

J. Yu, Y. Ahn, W. Park, J. Lee

Samsung Medical Center, Seoul, Republic of Korea

Purpose/Objective(s): To report the treatment outcomes after combined modality therapy (CMT) in patients with stage I/II headand neck (HN) diffuse large B-cell lymphoma (DLBL).

Materials/Methods: A retrospective review was performed on 86 patients with stage I/II DLBL of HN who received CMT from1995 till 2006 at Samsung Medical Center. The most common involved sites were oropharynx (40.7%) and cervical lymph node(38.4%). Involved field radiation therapy (IFRT) was given following median 4 cycles of CHOP or R-CHOP chemotherapy. TheRT target volume was individually determined to cover the known gross lesion with adequate margin (2-3cm), and the medianradiation dose was 39.8 Gy over 4-5 weeks.

Results: Overall survival rate (OS) and relapse-free survival rate (RFS) at 10 years were 74.0%, and 88.9%. After median follow-up of 57 months (11-131), eight treatment failures were observed: distant metastasis in eight; and loco-regional failure in four pa-tients. Among four patients with loco-regional failure, three presented with in-field failures, and one did with out-field failure atcontralateral recurrence. During and after completion of RT, there was no severe side effect except one patient with grade 3 mu-cositis. Multivariate analyses showed that B symptom (p = 0.022) and abnormal LDH (p = 0.017) were related with poor OS, ageolder than 60 (p = 0.033) was with RFS, and International prognostic index (IPI, p = 0.03) was related with OS and RFS.

Conclusions: The results of this study demonstrated that stage I, II head and neck DLBCL patients did not need ipsilateral wholeneck irradiation. Reasonable margin from tumor may reduce radiation toxicity with same treatment results.

Author Disclosure: J. Yu, None; Y. Ahn, None; W. Park, None; J. Lee, None.

2686 Incidence of Breast Cancer after Low Dose (#35 Gy) Mantle or Modified Mantle Radiation in Women

Treated for Hodgkin’s Lymphoma

L. VanderSpek, O. Vujovic, A. R. Dar, L. Stitt

London Regional Cancer Centre, London, ON, Canada

Purpose/Objective(s): To determine the incidence of breast cancer and other secondary cancers in women treated for Hodgkin’sLymphoma with low dose (#35 Gy) mantle or modified mantle field radiation.

Materials/Methods: Eighty female patients with histologically confirmed Hodgkin’s Lymphoma were treated with mantle ormodified mantle radiation between 1980 and 1990 at the London Regional Cancer Centre. Information was gathered from patients’charts and included age, clinical presentation, stage, B symptoms, bulk, histology, chemotherapy use, radiation dose and technique,smoking history and development of breast cancer or other secondary cancer. A descriptive analysis was obtained for patients de-veloping a secondary cancer. Kaplan-Meier estimates of survival were calculated.

Results: Median follow-up was 15.5 years. Patients (pts) who did not die from Hodgkin’s Lymphoma had a median follow-up of 17years (range, 2.9 - 27.7). Median age was 25 years (range, 12 - 72). Most common presentation was cervical or supraclavicular in 46pts (65%) and mediastinal in 21 pts (26.3%). Most common histology was nodular sclerosing in 53 pts (66.3%) and mixed cellularityin 17 pts (21.3%). B symptoms occurred in 13 pts (16.3%) and bulky disease in 21 pts (26.3%). The distribution for stage of diseasewas, Stage I; 16 pts (20%), Stage II; 43 pts (53.7%), Stage III; 17 pts (21.3%) and Stage IV; 4 pts (5%). A mantle field was used in 71pts (88.8%) and a modified mantle in 9 pts (11.2%). Fifteen pts (18.8%) also had radiation to a para-aortic and spleen field. RT dose tothe mantle or modified mantle field was #35 Gy in 79 pts (98.8%) and .35 Gy in 1 pt (1.2%). 35 Gy was used in 66 pts (88.5%). Aboost dose was used to the region of involvement in 52 pts (65%) of #5 Gy in 41 pts (51%) and .5 Gy in 11 pts (14%). Chemotherapywas given to 30 pts (37.5%) either as MOPP or MOPP/ABVD. Overall disease free survival was 73.8% (59 patients). Overall inci-dence of secondary cancers was 17.5% (14 pts). The most common secondary cancer was breast cancer in 5% (4 pts) and lung cancerin 5% (4 pts). Median time to diagnosis of breast cancer was 19 years. Death secondary to Hodgkin’s Lymphoma was 13.8% (11 pts).Death due to a secondary cancer was 7.5% (6 pts). No patient died from breast cancer, which presented as Stage 0-Stage II disease.

Conclusions: In this retrospective review, Hodgkin’s Lymphoma patients treated with doses of #35 Gy to a mantle or modifiedmantle field had a low incidence (5%) of developing breast cancer. This would imply that with the current practice of involved fieldRT with doses of 30 Gy, the incidence of breast cancer should be very low.

Author Disclosure: L. VanderSpek, None; O. Vujovic, None; A.R. Dar, None; L. Stitt, None.