Volume 87 � Number 2S � Supplement 2013 Digital Poster Discussion Abstracts S179

to undergo salvage WBRT, craniotomy, a longer hospital stay and have

increased need for rehabilitation. As symptomatic brain metastases clearly

do worse clinically, a prospective trial assessing the value of surveillance

brain imaging may be useful before adopting guidelines mandating that

clinicians wait until metastases become symptomatic before allowing for

surveillance imaging in high-risk populations.

Author Disclosure: J.G. Kuremsky: None. S.C. Lester: None. J.T. Lucas:

None. D.M. Randolph: None. S.B. Tatter: None. M.D. Chan: None.

1080Trends in Intensity Modulated Radiation Therapy Use for Locally-Advanced Rectal Cancer at National Comprehensive Cancer Network(NCCN) CentersM. Laufer,1 A. ter Veer,2 T. Bekaii-Saab,3 P.F. Engstrom,4 L. Lai,2

D. Schrag,5 J.M. Skibber,6 W. Small,7 N. Wilkinson,8 and K.A. Goodman1;1Memorial Sloan-Kettering Cancer Center, New York, NY, 2City of Hope

Cancer Center, Duarte, CA, 3The Ohio State University Comprehensive

Cancer Center e James Cancer Hospital and Solove Research Institute,

Cleveland, OH, 4Fox Chase Cancer Center, Philadelphia, PA, 5Dana-

Farber Cancer Institute, Boston, MA, 6University of Texas MD Anderson

Cancer Center, Houston, TX, 7Robert H. Lurie Comprehensive Cancer

Center of Chicago, IL, 8Roswell Park Cancer Institute, Buffalo, NY

Purpose/Objective(s): Despite limited evidence on the benefits of

intensity modulated radiation therapy (IMRT) for rectal cancer, it is being

increasingly used in clinical practice. A pattern-of-care study of radiation

therapy (RT) in stage II and III rectal cancer was performed using the

NCCN outcomes database to characterize trends in the use of IMRT during

2005-2011 at dedicated cancer centers.

Materials/Methods: Prospective NCCN Colorectal Cancer Database was

queried for patients with stage II-III rectal cancer diagnosed between April

2005 and May 2011, who received RT to the pelvis at eight NCCN centers.

Patient, tumor, and treatment characteristics were abstracted. We used

a multivariable logistic regression to identify factors associated with IMRT

use.

Results: Among 971 identified patients, 778 patients (80%) received

3-dimensional conformal RT (3D-CRT), 169 patients (17%) received

IMRT, 16 patients (2%) received 2-dimensional RT, 6 patients (<1%)

received a combination of techniques, and 2 patients (<1%) received

proton therapy. Among 947 patients treated with 3D-CRT or IMRT

(median age 57, 58% male, 29% stage II), 865 (81%) underwent a defin-

itive resection. RT was delivered pre-operatively to 849 (98%) post-oper-

atively to 11 (1%), and pre-operatively followed by intra-operative external

beam RT (EBRT), brachytherapy or post-operative EBRT boost in 5

(<1%). The median RT dose was 5040 cGy (range, 1080-6660 cGy).

Twenty one patients (2%) received <4500 cGy, including 9 in whom RT

discontinuation was due to toxicity. Use of IMRT increased over time from

under 13% in 2005-2008, to 23% in 2009, 32% in 2010, and 38% in 2011.

Use of IMRT varied significantly between centers, with 4 of 8 participating

NCCN centers using IMRT for 26%-43% of all advanced rectal cancers,

and <9% rate at others. On multivariable analysis, factors associated with

IMRT vs 3D-CRT use included diagnosis year 2009-2011 (OR Z 3.4, 4.7,

4.6; p < 0.001), age at diagnosis 65-74 and �75 (OR Z 1.9, 2.4, p Z0.008), and African American race (OR Z 2.3; p Z 0.01). There was no

association with IMRT use for gender, stage, BMI, ECOG performance

Digital Poster Abstract 1081; Table

Potential factors influencingtreatment selection

% of patients reporting thisfactor is “very important” Perceptions a

Impact on ability to performusual daily activities

62% Will significantlusual daily a

Recovery time after treatment 57% Worried about rBurden on family 74% Concerned abouPreserving quality of life 85% Concerned abouCure 92% Will cure my pr

Travel distanceLike this treatm

status, comorbidity burden, tumor fixation, tumor level from anal verge,

presence of connective tissue disease, or history of IBD. Surrogate

measures of toxicity were similar between 3D-CRT and IMRT (2% vs 3%

RT dose <4500 cGy, and 10% vs 9% RT >6 weeks).

Conclusions: From 2005 to 2011, most stage II-III rectal cancer patients

received 3D-CRT, but a significant and rising number are being treated

with IMRT. The observed trend in RT modality choice generally reflects

growing acceptance of IMRT for many disease sites; however, modality

choice is highly variable among institutions and not uniform among

different age and racial groups.

Author Disclosure: M. Laufer: None. A. ter Veer: None. T. Bekaii-Saab:

E. Research Grant; Oncolytics and Pfizer. G. Consultant; BMS, Amgen,

Genentech, Onyx. P.F. Engstrom: None. L. Lai: None. D. Schrag: None.

J.M. Skibber: None. W. Small: None. N. Wilkinson: None. K.A. Goodman:

None.

1081Barriers to Receiving Radiation Therapy for Localized ProstateCancer (CaP), Results From the North Carolina Prostate CancerComparative Effectiveness and Survivorship Study (NC ProCESS)R.C. Chen, W.R. Carpenter, B.B. Reeve, L.H. Hendrix, A.M. Meyer,

D.S. Usinger, T.S. Strigo, A.M. Jackman, and P.A. Godley; University of

North Carolina at Chapel Hill, Chapel Hill, NC

Purpose/Objective(s): Comparative effectiveness of CaP treatment

options is a “highest priority” research topic according to the Institute of

Medicine. From 2011-2013, we assembled a population-based prospective

cohort of 1,500 patients enrolled at diagnosis and followed longitudinally

for factors associated with treatment selection, quality of life, cancer

control and survival. Here, we report cohort characteristics and patient-

reported potential barriers to radiation therapy.

Materials/Methods: Through the NC Cancer Registry’s Rapid Case

Ascertainment system, newly diagnosed men across NC are offered

participation; 59% enrolled. After a waiting period allowing physicians to

opt-out a patient from participation, baseline (pre-treatment) survey is

completed at a median of 6 weeks after diagnosis. Follow-up surveys occur

at 6 weeks after baseline, 3 months, 1 year, and then annually.

Results: Median age was 65. The cohort is sociodemographically diverse:

28% non-White, 33% high school education or less (27% some college,

40% college graduates), 36% household income $40K or less (26% $40-

70K; 38% more than $70K). Most had comorbidities at baseline: 22%

diabetes, 61% hypertension, 10% history of myocardial infarction, 39%

arthritis, and 11% depression. While 98% reported discussing treatment

options with a urologist, only 50% discussed with a primary care physician

and 42% with a radiation oncologist. Most patients indicated the physician

had the biggest impact on treatment selection (64%), with 15% reporting

family/friends. Overall, 46% knew someone who had external beam

radiation: 46% had a good experience, 44% mixed good/bad, and 10% bad.

Further, 27% knew someone who had brachytherapy: 67% good experi-

ence, 27% mixed good/bad, and 7% bad. Patients expressed many

concerns about radiation and all were “very important” factors for treat-

ment selection (Table). Other important factors included cost (73%) and

treatment duration (81%). Regarding the treatment option with fewest side

effects overall, 24% said robotic prostatectomy, 18% external beam radi-

ation, and 20% brachytherapy.

bout radiation treatments External beam radiation Brachytherapy

y impact ability to performctivities

45% 13%

ecovery time after treatment 41% 15%t being a burden on family 64% 34%t side effects 82% 46%ostate cancer 52% 32%is prohibitive 10% 3%ent option 41% 29%

Digital Poster Abstract 1083; Table LDCT Cost-effectiveness

Patient subsetLife expectancybenefit (yr)

QALYbenefit

Incrementalcost per QALY

Smoker with HL at age 25:Male, mantle RT 35 Gy 0.70 0.25 $7,026Male, IFRT 20 Gy 0.57 0.17 $16,101Female, mantle RT 35 Gy 0.84 0.30 $4,941Female, IFRT 20 Gy 0.70 0.22 $12,309

Non-smoker with HL at age 25:Male, mantle RT 35 Gy 0.38 0.09 $43,008Male, IFRT 20 Gy 0.21 0.03 $138,636Female, mantle RT 35 Gy 0.47 0.12 $33,772Female, IFRT 20 Gy 0.27 0.05 $104,430

International Journal of Radiation Oncology � Biology � PhysicsS180

Conclusions: In this unique and diverse population-based cohort of CaP

patients, misperceptions about radiation therapy, lack of multidisciplinary

consultation, travel distance, treatment duration, and cost are important

barriers to the use of radiation.

Author Disclosure: R.C. Chen: None. W.R. Carpenter: None. B.B. Reeve:

None. L.H. Hendrix: None. A.M. Meyer: None. D.S. Usinger: None. T.S.

Strigo: None. A.M. Jackman: None. P.A. Godley: None.

1082Patient and Institutional Predictors of Trimodality Therapy forStage III Non-Small Cell Lung Cancer (NSCLC) in the NationalCancer DatabaseD.J. Sher, M.J. Liptay, and M.J. Fidler; Rush University Medical Center,

Chicago, IL

Purpose/Objective(s): The optimal locoregional therapy for stage III non-

small cell lung cancer is controversial, with definitive chemoradiation

therapy (CRT) and trimodality therapy (chemoradiation therapy followed

by surgery, TMT) serving as competing strategies. Randomized data

suggest a progression-free but no overall survival benefit from surgical

resection, an ambiguous result that has led to varying practice patterns.

Indeed, the implementation of TMT in the United States has not been

closely examined. In this study, we used the National Cancer Database

(NCDB) to determine predictors of TMT among a large cohort of patients,

focusing on the importance of demographic and institutional parameters.

Materials/Methods: Patients with stage III NSCLC treated between 1998

and 2010 at Commission on Cancer-accredited programs were included in

this study. Patients must have received concurrent CRT with or without

subsequent surgical resection. Demographic, clinical and non-clinical

parameters were extracted from the NCDB, and the patient volume of

stage III NSCLC (patients treated per site per year) was determined; high-

volume center was defined as the upper decile. Per NCDB coding, the type

of treatment center was stratified into academic, comprehensive commu-

nity cancer center (CCC), and non-comprehensive CCC. Logistic regres-

sion was used for univariable analyses, and a multivariable model was

prepared using stepwise selection.

Results: A total of 49,534 patients were included in this cohort, 3,843

(7.8%) of whom underwent TMT. Out of stage 19,002 IIIA patients, 10.3%

underwent TMT. Multivariable predictors of TMT included demographic,

clinical and non-clinical factors. Demographic factors were: white race

(odds ratio [OR] 1.36), younger age (lowest [LQ] vs highest [HQ] quartile,

OR 4.31), percent of adults per zip code with at least high school education

(HQ vs LQ, OR 1.37). Clinical factors were: stage (IIIA vs IIIB, OR 3.02)

and squamous histology (OR 1.26). Non-clinical factors were: early

treatment era (first vs last 3 years, OR 1.30), private insurance (OR 1.53),

increasing distance from the treatment center (HQ vs LQ, OR 1.81),

geographic region (Northeast vs other, OR 1.35), type of center (academic

program vs comprehensive CCC or non-comprehensive CCC, OR 1.53 and

2.01, respectively), and treatment at high-volume institutions (OR 1.26).

Conclusions: TMT was not commonly implemented across Commission

on Cancer accredited programs. White race, level of education and private

health insurance e measures often associated with higher socioeconomic

status e were statistically significant predictors of TMT. The academic

nature and volume of the facility strongly influenced TMT, suggesting

more aggressive practice patterns in university-based, high-volume

institutions.

Author Disclosure: D.J. Sher: None. M.J. Liptay: None. M.J. Fidler: None.

1083Low-Dose Chest CT for Lung Cancer Screening Among HodgkinLymphoma Survivors: A Cost-Effectiveness AnalysisD.A. Wattson,1 P.J. DiPiro,2 P. Das,3 D.C. Hodgson,4 P.M. Mauch,5

and A.K. Ng5; 1Harvard Radiation Oncology Program, Boston, MA,2Department of Imaging, Dana-Farber Cancer Institute, Boston, MA,3Department of Radiation Oncology, University of Texas MD Anderson

Cancer Center, Houston, TX, 4Department of Radiation Oncology,

University of Toronto, Toronto, ON, Canada, 5Department of Radiation

Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer

Institute, Boston, MA

Purpose/Objective(s): Survivors of Hodgkin lymphoma (HL) face an

increased risk of treatment-related lung cancer (LC), which predominantly

presents at an advanced stage and has a very poor prognosis. The use of

low-radiation-dose computed tomography (LDCT) for LC screening may

allow detection of early, resectable lesions, thereby improving outcomes.

We developed a Markov decision-analytic and cost-effectiveness model to

estimate the merits of annual LDCT screening among HL survivors.

Materials/Methods: Population databases and HL-specific literature

informed key model parameters, including LC rates and stage distribution,

cause-specific survival estimates, and utilities. Relative risks accounted for

radiation therapy (RT) technique, smoking status, sex, age at HL diagnosis,

time from HL treatment, and excess radiation from LDCTs. LDCT

assumptions, including expected stage shift, false-positive rates, and likely

additional workup (including diagnostic CT, followed by PET/CT and

possible biopsy for suspicious lesions) were derived from the National

Lung Screening Trial and preliminary results from an internal Phase II

protocol that performed annual LDCTs on 53 HL survivors. Costs of LC

care and diagnostic procedures were determined from the literature and

CMS/Medicare data. We assumed a 3% discount rate and a willingness-to-

pay threshold (WTPT) of $50,000 per quality-adjusted life year (QALY).

Deterministic and probabilistic sensitivity analyses (SA) were used to

examine uncertainty in these parameters.

Results: In the model, annual LDCT screening initiated 5 years after HL

treatment was cost-effective for all current or past smokers, regardless of

RT field, age at HL treatment, or sex. Among non-smokers, annual

screening produced a QALY benefit, but the incremental cost was below

the WTPT only for pts treated with mantle RT, but not involved-field RT

(IFRT). The Table contains results for select patient subsets. One-way SA

revealed that the model was most sensitive to expected stage shift from

LDCT, cost of LDCT, and risk of developing LC. Probabilistic SA

confirmed these results.

Conclusions: HL survivors are an important high-risk population in which

to consider LDCT screening. Screening appears to be cost-effective for all

current or past smokers regardless of RT fields, and for non-smokers

treated with mantle RT.

Author Disclosure: D.A. Wattson: None. P.J. DiPiro: None. P. Das: None.

D.C. Hodgson: None. P.M. Mauch: None. A.K. Ng: None.

1084The Role of Shared Decision Making in Patient Experiences inRadiation OncologyJ.E. Shabason,1 J.J. Mao,2,3 E. Frankel,2 and N. Vapiwala1; 1Department of

Radiation Oncology, University of Pennsylvania Health System,

Philadelphia, PA, 2Abramson Comprehensive Cancer Center, University of

Pennsylvania Health System, Philadelphia, PA, 3Department of Family

Medicine and Community Health, University of Pennsylvania Health

System, Philadelphia, PA

Purpose/Objective(s): Shared decision making (SDM) has been linked to

important healthcare quality outcomes, such as patient well-being and