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