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(300 mg BID) of maximal dose (300 mg QID) for mood disorders. Weekly serum lithium concentrations were obtained. Wholebrain radiation consisted of a total of 3000 cGy over ten fractions. The feasibility of lithium treatment was measured as a functionof safety and compliance. Safety was assessed by the rate of grade 3 or worse non-hematological toxicities. Compliance wasdefined as the completion of the treatment regimen without interruption of more than two doses of radiotherapy.

Results: Five patients have been enrolled in this study. The median age at treatment was sixty. Two patients had metastatic mel-anoma, two had metastatic non-small cell lung cancer, and one had metastatic rectal cancer. Median ECOG performance status wasone. Median dose of lithium was 300 mg BID. Median lithium serum concentration was 0.6 mEq/L (ref. 0.6–1.2). Compliance was100%. No grade 3 or greater toxicities were seen with neoadjuvant and concurrent lithium treatment with whole brain radiotherapy.All patients had symptomatic improvement at the completion of radiation therapy. Serial neurological testing of patients’ globaland spatial memory revealed no decline in short term memory.

Conclusions: Lithium treatment one week prior to and during whole brain radiotherapy is well tolerated in patients treated withcranial irradiation for brain metastases. Future studies to evaluate the efficacy of lithium in the attenuation of radiation-inducedcognitive deficits are currently underway. Our long-term goal is to improve the quality of life in cancer survivors who haveundergone whole brain radiation. Phase II clinical trials are planned to study functional MRI and neurocognitive function inadult patients receiving prophylactic cranial irradiation, which was followed by studies in children treated for medulloblastoma.Cooperative group participation is encouraged.

Author Disclosure: E.S. Yang, None; B. Lu, None; D.E. Hallahan, None.

2697 Quality of Life (QOL) After Salvage Cryosurgery of the Prostate: Comparison With Outcome After

Primary Radiotherapy

M. Abdelhady1, A. M. McKenna2, A. Elamaadawi1, C. K. Ng3, J. L. Chin1, G. S. Bauman2, G. B. Rodregues2, V. Venkatesan2

1LHSC, London, ON, Canada, 2LRCP, London, ON, Canada, 3Singapore Hospital, Singapore, Singapore

Purpose/Objective(s): Currently, with modern technology and improved patient selection, cryosurgery is being used as one of thesalvage procedures for local failure after radical radiation therapy for prostate cancer with successful long-term salvage in approx-imately 35%. With the earlier concerns about the poor quality of life (QOL) in these patients, we aimed to evaluate the QOL aftercontemporary salvage cryosurgery and assess the most affected domains of a validated questionnaire in comparison to the scores ofpatients who had undergone radical radiotherapy for prostate cancer.

Materials/Methods: EPIC questionnaires were mailed to prostate cancer patients who received primary radiotherapy (n = 996) orsalvage cryosurgery (n = 155) in our center between the years 1998–2004. T test was used for statistical analysis to compare be-tween the means of scores in each group.

Results: The over all response rate was 66% (68% and 64% for cryosurgery and radiotherapy groups respectively). Patients aftersalvage cryosurgery showed statistically significant deterioration of the urinary (p \ 0.0001) and sexual (p = 0.0039) domainswhen compared to the means of radiotherapy group, while the means for the bowel and hormonal domains showed no statisticallysignificant difference (graph 1). On looking at the AUA symptom score for both groups, the cryosurgery group showed higher scorethan the radiotherapy group (11.07 vs. 8.25, p = 0.0005). Finally, there was no difference in the satisfaction mean score for bothgroups (75.27 vs. 79.02, p = 0.21).

Conclusions: Although patients after salvage cryosurgery of the prostate may experience further deterioration of their urinary andsexual function, they are usually satisfied with that modality of salvage treatment. Quality of life scores have improved since theearlier days of salvage cryoablation with improvement in patient selection, cryo-technology and operative techniques. Togetherwith acceptable rate of complications and a reasonable 8-year biochemical disease free rate of 37% in some studies, our data sup-ports the selective use of cryosurgery as a salvage treatment modality after failure of primary radiotherapy for prostate cancer.

Author Disclosure: M. Abdelhady, None; A.M. McKenna, None; A. Elamaadawi, None; C.K. Ng, None; J.L. Chin, None;G.S. Bauman, None; G.B. Rodregues, None; V. Venkatesan, None.

2698 Prospective Study on the Short-Term Adverse Effects From Gamma Knife Radiosurgery

S. T. Chao, V. V. Thakkar, B. Jamison, A. M. Reuther, G. H. Barnett, M. A. Vogelbaum, L. Angelov, S. A. Toms, G. Neyman,J. H. Suh

Cleveland Clinic, Cleveland, OH

Purpose/Objective(s): To determine the types, incidence, and severity of acute complications from Gamma Knife radiosurgery.

Materials/Methods: This prospective Institutional Review Board approved study included patients never before treated withGamma Knife (GK). The questionnaire used applicable questions modified from CTCAE (Common Terminology Criteria for Ad-verse Events) v.3.0. The Brief Pain Questionnaire (Short Form), Brief Fatigue Inventory, and the Tinnitus Handicap Inventory alsowere used to assess patients. A baseline questionnaire was administered prior to GK, and follow-up questionnaires were obtained at1 week, 1 month, and 2 months to assess complications. A total of 76 eligible patients with complete data were used for the analysis.Comparisons of baseline to each of the above time periods were analyzed using the Wilcoxon Signed Rank test. When 3 intervalswere compared, Bonferroni’s correction was implemented, resulting in a p-value \0.0166 as significant.

Results: The median age was 62 years old (range: 18–90). Twenty-six (34%) had brain metastases, 15 (20%) had trigeminal neu-ralgia, 12 (16%) had schwannoma, 10 (13%) had meningioma, 7 (9%) had arteriovenous malformation, 3 (4%) had pituitaryadenoma, and 3 (4%) had other.

One week after GK, 24% of patients reported minimal scalp numbness, not interfering with function and 1% reported mild scalpnumbness, interfering with function, but not activities of daily living (p = 0.0004 baseline compared to 1 week). At one and twomonths, 13% and 2% reported minimal scalp numbness, respectively (p = NS compared to baseline for both intervals).

Thirteen percent developed pin site pain at 1 week with a median intensity level of 2 out of 10. By one month, only 3% had pinsite pain with a median intensity level of 3 out of 10. Four percent developed pin-site infection at 1 week and none at 1 and 2 months.

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There was no significant difference in nausea from baseline at 1 week, but there was worsening nausea at 1 month (p = 0.0114),presumably due to the impact of the patients’ systemic disease or associated treatment. By 1 month, 10% reported new local hairloss. 23%, 16%, and 15% complained of new/worsening fatigue at 1 week, 1 month, and 2 months, respectively, but 40% reportedfatigue at baseline (p = NS for all 3 comparisons). Balance improved following Gamma Knife over all time periods (for all com-parisons, p\0.009). 1%, 6%, and 3% developed new tinnitus at 1 week, 1 month, and 2 months, respectively, which was signif-icant when comparing baseline to non-baseline (p = 0.0269). Thirty-two patients were employed prior to GK. Three (9%) patientsdid not return to work. Twenty-seven (84%) patients returned to work a median of 4 days after GK. Two people did not report theiremployment status after GK. There was no significant difference in scalp tingling, face swelling, headache, eye pain, vomiting,seizures, or syncopal episode at any intervals compared to baseline.

Conclusions: Overall, GK is well tolerated with few patients developing major acute effects. Many develop scalp numbness likelydue to pin placement. Fatigue from GK is being studied prospectively at our institution in a separate study. Many patients are able toreturn to work shortly after GK.

Author Disclosure: S.T. Chao, None; V.V. Thakkar, None; B. Jamison, None; A.M. Reuther, None; G.H. Barnett, None;M.A. Vogelbaum, None; L. Angelov, None; S.A. Toms, None; G. Neyman, None; J.H. Suh, None.

2699 An Analysis of Quality of Life Data in Head and Neck Cancer Patients Treated With Intensity Modulated

Radiation Therapy (IMRT)

M. J. O’Neill1, D. E. Heron2, R. S. Andrade2, J. C. Flickinger2, R. P. Smith2, S. A. Burton2, A. E. Quinn2

1University of Pittsburgh School of Medicine, Pittsburgh, PA, 2Department of Radiation Oncology, University of PittsburghCancer Institute, Pittsburgh, PA

Purpose/Objective(s): First, to evaluate patient-reported QOL domains in head and neck cancer patients treated with IMRT.Second, to evaluate time-based assessment of change in QOL as a function of baseline.

Materials/Methods: Between January 2002 and August 2006, 143 pts (105 males, 38 females) with H&N cancers were treatedwith IMRT. Beginning in Spring 2005, these pts (mean age 62.0 ± 12.77 years) were prospectively administered the University ofWashington Quality of Life-Revised (UW-QOL-R) to assess the impact of treatment on several QOL domains. Pts were treatedwith definitive primary or salvage intent for head and neck cancers. The mean total dose to the primary site was 68 Gy (range35–76). All pts completed UW-QOL-R surveys at initial and/or at each follow-up appointment. This previously validated surveyaddressed important domains related to common sequelae of head and neck radiotherapy including swallowing, xerostomia, taste,speech, and appearance amongst others.

Results: Nearly half the pts filled out a survey before IMRT (48%) with an average follow-up of 16.5 months (1.4–50.6). Tumorprimary site included hypopharynx (n = 10), larynx (n = 38), oral cavity (n = 21), oropharynx (n = 50), salivary gland (n = 10), sinus(n = 6), and thyroid (n = 8). The majority of patients were advanced as follows: stage I (n = 8), stage II (n = 25), stage III (n = 38),stage IV (n = 61), with five patients treated for recurrence and unknown stage in six patients. Ninety-seven (68%) patients receivedconcurrent chemotherapy and 20 patients were treated with surgery followed by post-op RT alone. Mean dose to the right and leftparotid averaged 28 and 27 Gy, respectively, with higher radiation dose to the parotid significantly lowering patients’ score in thedomains of saliva, chewing, taste, swallowing and pain.

Conclusions: Our data suggests that there is acute decrement in QOL in all domains except pain and anxiety, which appear toimprove over the first 3 months. Most domains return to baseline between 9 and 12 months from initiating treatment, except tasteand saliva, which continued to show slow recovery over an extended period of time (up to 3 years). The overall QOL appears tosuggest near recovery nine months from beginning treatment in the vast majority of patients.

Author Disclosure: M.J. O’Neill, None; D.E. Heron, None; R.S. Andrade, None; J.C. Flickinger, None; R.P. Smith, None;S.A. Burton, None; A.E. Quinn, None.

2700 A Pilot Study to Evaluate the Validity of Skin Care Protocols Followed by Women with Breast Cancer

Receiving External Radiation

J. Aistars, K. Vehlow

Northwest Community Hospital, Arlington Heights, IL

Purpose/Objective(s): Women with breast cancer receiving external radiation are often instructed to avoid aluminum-based de-odorant on the treated side and not to apply skin care products in the radiation field four hours prior to treatment to prevent severeskin reactions. If allowing a woman to use her deodorant and skin care products on a convenient schedule has no significant effecton skin reactions, then eliminating these instructions will be less disruptive to her normal hygiene routine.

Materials/Methods: Thirty women treated between October, 2005 and December, 2006 were given skin care instructions whichincluded using their aluminum-based deodorant and applying 100% aloe vera gel 1–3 times per day with one application of aloe