S120 I. J. Radiation Oncology d Biology d Physics Volume 69, Number 3, Supplement, 2007

215 Prognostic Factors and Adjuvant Therapy in Patients With Uterine Carcinosarcoma

D. Nemani, W. Yang, N. Mitra, L. L. Lin

University of Pennsylvania, Philadelphia, PA

Purpose/Objective(s): Uterine carcinosarcoma are rare neoplasms and generally associated with a dismal prognosis. The optimalmanagement of patients after total abdominal hysterectomy remains controversial. The purpose of this retrospective analysis is todetermine the pathologic prognostic factors and treatment outcome of patients with carcinosarcoma of the uterus.

Materials/Methods: A retrospective analysis of data from the Surveillance, Epidemiology, and End Results program of the Na-tional Cancer Institute from January 1, 1988 and November 1, 30, 2003 was conducted. A total of 1855 with AJCC stage I-IIIdisease were identified who received primary surgical treatment. Overall survival curves were constructed using Kaplan-Meiercurves. Factors such as age, race, use of adjuvant radiotherapy, lymph node dissection, number of lymph nodes removed, grade,and stage were examined to determine if they were predictors of survival using the Cox proportional hazard model.

Results: The median age of all patients was 69 years (range 19–96). AJCC Stage of all patients was I (1202 (64.8%)), II (268(14.5%)), III (385 (20.7%)). 1116 (60.3%) patients underwent lymph node dissection. Of these, the median (standard deviation)number of lymph nodes was 10 (10.2); 135 (12.1%) patients had positive lymph nodes. 795 (43.1%) patients received adjuvantradiotherapy. Median follow-up for all alive patients was 42 months. 5 yr overall survival for patients receiving any radiotherapyvs without radiotherapy was 45.5% and 42.6%, respectively (p = 0.21). 5 yr overall survival for Stage I patients with and withoutradiotherapy was 54.5% and 49.7%, respectively (p = 0.10). 5 yr overall survival for patients with a lymph node dissection andwithout lymph node dissection was 51.3% and 32.7%, respectively (p \ .0001). Other factors such as grade, age, race, lymphnode dissection and stage were also predictive of survival on multivariate analysis. In a subanalysis of patients with lymphnode dissection, the number of lymph nodes removed on dissection was not predictive of survival (HR = 1.00, 95% CI [0.99,1.01]).

Conclusions: Cox regression demonstrated that lymphadenectomy significantly improved overall survival in patients with StageI-III uterine carcinosarcoma compared to no lymphadenectomy, however use of radiotherapy did not.

Author Disclosure: D. Nemani, None; W. Yang, None; N. Mitra, None; L.L. Lin, None.

216 Gamma Knife Radiosurgery (GKRS) in the Management of Trigeminal Neuralgia: Long-Term Follow-up

Report of 441 Cases

D. B. Jacques1, R. F. Young2, B. G. Copcutt1, C. Chen1, R. J. Mark3

1Good Samaritan Hospital, Los Angeles, CA, 2Northwest Hospital, Seattle, WA, 3Joe Arrington Cancer Center, Lubbock, TX

Purpose/Objective(s): Gamma Knife Radiosurgery (GKRS) has been used successfully in the treatment of Trigeminal Neuralgia(TN). Results have compared favorably to surgical procedures with respect to pain relief and complications. We report our updatedlong-term results with GKRS in the treatment of TN.

Materials/Methods: Between 1991 and 2002, 441 patients with medically refractory typical TN were treated with GKRS, andhave not been lost to follow-up. Prior neurosurgical intervention had been performed in 29% of the patients (128/441), with a totalof 307 procedures. All patients had typical TN. GKRS was given to the cranial nerve V entry root zone into the brainstem. Targetingwas defined by CT and MRI Scans, and inversion recovery MRI, utilizing axial, coronal and sagittal images. Treatment planningwas accomplished thru the Leksell Treatment Planning System. The prescribed doses ranged from 70 to 90 Gy prescribed to Dm, inone shot using the 4 mm collimator, with the 20% Isodose line just touching the brainstem. Response to treatment was defined asexcellent (no pain, off analgesics), good (no pain, with analgesics), and poor (continued pain despite analgesics). Response to treat-ment was recorded in interviews conducted by a Gamma Knife Nurse.

Results: With a median follow-up of 10 years (range 5–15 years), 54.2% (239/441) of patients reported an excellent result, and23.1% (102/441) a good result after GKRS. There was a dose response, with 56.6% (69/122) of patients reporting an excellent orgood response after 70 Gy, compared to 83.5% (127/152) at 80 Gy, and 86.8% (145/167) at 90 Gy (p\0.01). Temporary ipsilateralfacial numbness occurred in 18.8% (83/441), and permanent facial numbness in 5.2% (23/441). Loss of corneal reflex occurred in1.4% (6/441), and painful dysesthesias in 2.7% (12/441). There have been no cases of anesthesia dolorosa. There was a dose re-sponse in facial numbness, with temporary numbness occurring in 6.5% (8/122) at 70 Gy, 17.1% (26/152) at 80 Gy, and 29.3% (49/167) at 90 Gy (p\0.01). Permanent numbness occurred in 2.5% (3/122) at 70 Gy, 3.3% (5/152) at 80 Gy, and 9.0% (15/167) at 90Gy (p \ 0.01).

Conclusions: GKRS offers favorable results, both in pain relief and complications, compared to surgery in the management ofmedically refractory TN. In view of these long-term good pain relief and low complication risks, GKRS should be consideredas a primary initial treatment option in patients with medically refractory TN. The optimal dose with maximum pain relief andminimal complications, appears to be 80 Gy.

Author Disclosure: D.B. Jacques, None; R.F. Young, None; B.G. Copcutt, None; C. Chen, None; R.J. Mark, None.

217 Immortalizing Renal Allografts With Stem Cell Transplantation Using Low Dose Irradiation as an Adjuvant

to Non-myeloablative Conditioning

V. Shankar1, H. L. Trivedi2, A. V. Vanikar2, P. R. Shah2, P. R. Modi2, V. R. Shah2, C. Haritha1, J. Prajapathi1, A. Shanubhogue3

1M.S. Patel Cancer Center, Karamsad, Gujarat, India, 2Institute of Kidney Diseases & Research Center and Institute ofTransplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India, 3Dept of Statistics, S.P. University,Vallabh Vidyanagar, Gujarat, India

Purpose/Objective(s): Donor specific immunologic tolerance protects an allograft from chronic rejection & allows discontinua-tion of chronic immunosuppressive therapy. Studies suggest that mixed lymphohematopoietic chimerism (MLHC) leads to toler-ance. We designed a prospective, open label, randomized, parallel control, single center clinical trial to evaluate the efficacy oftolerance induction protocol (TIP) incorporating radiation therapy in achieving MLHC in living related donor (LRD) renal allograftrecipients.

Proceedings of the 49th Annual ASTRO Meeting S121

Materials/Methods: 412 patients with End stage renal disease (ESRD) treated between May 2003 & Mar.2006 were randomizedinto 2 groups: Stem cell (SC) group [n = 206] & control (CON) group [n = 206]. Patients in both groups were comparable for de-mographic features, ESRD etiology & donor-recipient HLA match profiles.

SC group underwent renal transplantation (RTx) following TIP and negative Lymphocytotoxicity cross match (LCM). TIP forSC group patients included (a) 2 donor leucocyte transfusions (b) low intensity conditioning & (c) Hematopoietic stem cell trans-plantation (HSCT). The conditioning regimen included fractionated low dose target specific irradiation (delivered by 6MV photonsto spleen, Abdominal & inguinal Lymph nodes, Bone marrow of thoracolumbar vertebra and part of the pelvis on alternate days @125 cGy/#� 4), Cyclosporine (CyA), Cyclophosphamide, anti T-cell antibody & Treosulfan. Unfractionated HSC procured fromdonor bone marrow was administered into the BM, portal & peripheral circulation, within 24 hours of achieving CD4+/CD8+ T cellcount\10% of normal. This infusion was supplemented with a dose of peripherally mobilized stem cells (mean total dose of 20�108cell/kg recipient BW). Donor specific cytotoxic antibodies were eliminated with iv immunoglobulins & plasmapharesis beforeRTx. Immunosuppression was withdrawn 6 months after RTx for patients with consistently positive chimerism. Robust clinicaltolerance was defined as stable allograft function for more than 100 days without immunosupression. Prope tolerance is definedas early adequate, stable graft function with no rejection episodes on minimum immunosupression. Metastable tolerance is ade-quate graft function on immunosupression with single episode of steroid responsive acute rejection.

CON group underwent RTx directly after negative LCM followed by triple drug immunosuppression with CyA, Prednisolone &mycophenolate mofetil/azathioprine. Equality of proportions test is used for statistical analysis.

Results: In SC group pts, at mean follow-up of 19.8 months 12.5%, 85.5% & 2% had robust, prope & metastable tolerance re-spectively. Graft rejection was observed in 8.7% of which 3.8% had graft loss. Mortality rate was 3% (7 pts–4 nonrenal + 3 renalcauses). Mean S.creatinine was 1.3 mg%. None of the pts had GVHD. In the CON group, at the mean follow-up of 19.7 months,59.2% had rejection of which 30% had graft loss. Mortality rate was 18.4% (34 pts–21 nonrenal + 13 renal causes). Mean S.creatinine was 2.7 mg%. SC group had statistically significant reduction in rejection, graft loss & mortality (p = 0.0001).

Conclusions: Ahmedabad Tolerance Induction Protocol, the largest series reported so far, is safe, effective & reproducible ininducing robust & prope tolerance across MHC barriers in LRD renal transplantation.

Author Disclosure: V. Shankar, None; H.L. Trivedi, None; A.V. Vanikar, None; P.R. Shah, None; P.R. Modi, None; V.R. Shah,None; C. Haritha, None; J. Prajapathi, None; A. Shanubhogue, None.

218 Single Institution Experience Treating 100 Vestibular Schwannomas With Fractionated Stereotactic

Radiation Therapy or Stereotactic Radiosurgery

B. M. Anderson, D. Khuntia, W. A. Toma, S. Bentzen, L. Hayes, M. P. Mehta

UW Radiation Oncology Clinic, Madison, WI

Purpose/Objective(s): To assess the long-term outcome and toxicity of fractionated stereotactic radiation therapy (FSRT) andstereotactic radiosurgery (SRS) for vestibular schwannomas in 99 patients treated at a single institution.

Materials/Methods: From 1990–2006, 49 patients underwent SRS for vestibular schwannoma. From 2000–2006, 51 patients un-derwent FSRT for 52 vestibular schwannomas. One patient was initially treated with SRS, then received FSRT for the same tumorafter progression. The mean prescription dose was 12.9 Gy for SRS (range 9.7–18 Gy). For FSRT two different fraction scheduleswere employed: a conventional schedule of 1.8 Gy per fraction (Gy/F) times 25 or 28 fractions to a total dose of 45 Gy or 50.4 Gy;and a once weekly hypofractionated course consisting of 4 Gy/F times 5 fractions to a total dose of 20 Gy. Amongst FSRT patients,31 tumors received 20 Gy in 5 fractions and 20 tumors received either 45 Gy (75%) or 50.4 Gy (25%). The mean tumor volume was1.42 cm3 for SRS and 2.63 cm3 for FSRT.

Results: The median follow-up time was 28 months after SRS, 16 months for FSRT in the 1.8 Gy/F group, and 13 months forFSRT in the 4 Gy/F group. The Kaplan-Meier estimate of the overall 5-year progression free rate (PFR) was 91% ±5%. Patientswho underwent SRS had 5-year PFR of 92% ± 6%. After FSRT to 20 Gy in 4 Gy/F, 5-year PFR was 88% ± 7%. After FSRT toeither 45 Gy or 50.4 Gy in 1.8 Gy/F, 5-year PFS was 100%.

Conclusions: For larger vestibular schwannomas, FSRT offers equivalent or superior 5-year PFR compared with single fractionSRS. No differences in treatment-related toxicities were observed between the various treatment regimens.

Author Disclosure: B.M. Anderson, None; D. Khuntia, None; W.A. Toma, None; S. Bentzen, None; L. Hayes, None; M.P. Mehta,None.

219 Radiation is Superior Over Control for Early-Stage Morbus Dupuytren to Prevent Progression: Long-Term

Data of a Randomized Prospective Trial

H. M. Seegenschmiedt1, C. Schubert1, M. Wielputz1, F. Guntrum1, A. Hinke2

1Alfried-Krupp Krankenhaus, Essen, Germany, 2Scientific Service Pharma Ltd., Langenfeld, Germany

Purpose/Objective(s): Long-term analysis to compare observation versus radiotherapy (RT) for early-stage Morbus Dupuytren(MD) to prevent disease progression and analyze patient, disease or treatment factors for failure.

Materials/Methods: Since 1997 over 500 pts with MD were referred for RT to prevent disease progression. At 12/2006, 273 pts(161 M; 112 F) were evaluated for at least 5 and a median follow-up of 7 years. Due to bilateral disease, 419 hands were included inthe analysis. After informed consent pts chose between observation (n = 90) versus RT randomized between 10 � 3 Gy (30 Gy; 2RT series of 5� 3 Gy within 12 weeks (arm A: n = 163) and 7� 3 Gy (21 Gy) in 1 RT series within 2 weeks (arm B: n = 166). RTwas applied with orthovoltage 125 kV X-rays, lead rubber shielding and superflab bolus for individual RT-portal set-up. Possiblyconfounding factors were almost equally distributed in all groups. MD was classified according to Tubiana: 264 hands had initialMD stage N (no deficit), 73 stage N/I (extension deficit £ 10�); and 82 stage I–IV (11–180� extension deficit); possibly confoundingpatient, treatment and disease factors were equally distributed between all three groups except of slightly more cords in group A.Clinical evaluation (toxicity, efficacy) was performed at 3 and 12 months after RT and thereafter yearly.