Shoko Takano

Radiation therapy for lymph node metastasis from extramammary Paget's disease

Inoperable patients with lymph node metastasis from extramammary Pagets disease (EMPD) have limited curative treatment options.

Clinical and dosimetric predictors of late rectal bleeding of prostate cancer after TomoTherapy intensity modulated radiation therapy

Rectal bleeding after radiotherapy impacts the quality of life of long‐term surviving prostate cancer patients. We sought to identify factors associated with late rectal bleeding following intensity modulated radiation therapy (IMRT) using TomoTherapy for prostate cancer.

Clinical Usefulness of Somatostatin Receptor Scintigraphy in Japanese Patients with Gastroenteropancreatic Neuroendocrine Tumors.

Background/Aims: Somatostatin receptor (SSTR) scintigraphy (SRS) is the standard imaging modality for evaluation of gastroenteropancreatic neuroendocrine tumor (GEP-NET) in Western countries. However, this modality was not approved in Japan until recently. The purpose of this study was to evaluate the clinical efficacy of SRS for detecting GEP-NET in Japanese patients. Methods: Japanese patients with advanced GEP-NET were enrolled and evaluated by the SRS and CT. We also compared SRS and immunohistochemical expression of SSTR type 2a (SSTR2a). Results: We enrolled 16 patients and the primary sites were the pancreas in 9, the stomach in 1, the small intestine in 2, the colon in 3, and unknown in 1. SRS showed positive findings in 3 (100%) of grade 1 (G1) and in 12 (92.3%) of grade 2 (G2) lesions. In the liver, SRS and CT detected lesions in 13 and 14 cases, respectively. The concordance rate of SSTR2a expression with SRS findings was 93.8% in the whole body and 92.9% in the liver. Conclusions: SRS could detect almost all of G1 and G2. SRS could be useful to detect lesions, with a high concordance rate with CT and pathological findings. We confirmed that SRS is a useful and reliable modality for Japanese patients.

Abstract 3134: Pilot study of immune status of GEP-NETs in tumor microenvironment

Introduction: Neuroendocrine tumor (NET) is a rare cancer, however, morbidity rate is increasing every year. Recently, effective molecular targeting drugs for NET were developed and leading acceptable results, however, it is still not enough. Immune checkpoint inhibitor is becoming a very effective drug in malignant melanoma, lung cancer, and some kind of cancer showing microsatellite instability (MSI). Aim: Aim of this study is to investigate NET about MSI status and immune status of microenvironment using NET patients9 operative or biopsy samples. Method: Patients were 20 NETs, male: 11, female: 9, G1: 6, G2: 8, G3: 6, pancreas: 11, duodenum: 4, colon: 2, liver: 1, unknown: 2. Using patients9 samples by operative resection or biopsy, examinations by immunohistochemistry were performed to confirm MSI status using MSH2, MSH6, PMS2 and MLH1 antibody and count the cell number expressing PD-L1, PD-1, CD8 or Foxp3. Expression of MSH2, MSH6, PMS2, MLH1 and PD-L1 was evaluated on tumor cells. Specimens were categorized as IHC negative or positive if 1% of cells were stained by each monoclonal antibody. Expression of PD-1, CD8, Foxp3 was evaluated on the infiltrating lymphocyte of intratumor and peritumor respectively. Positive cells absolute number of each staining were counted in the 3 hot spot field (X400) and then the average of the 3 field of each specimen was utilized. Results: MSI: Expression of the 4 mismatch repair protein could be detected in the all 20 NETs tumor, then there was no case showing MSI. PD-L1 was detected in the 15 cases (75%). PD-L1 was expressed in the surface of tumors. PD-1 was also detected 15 cases (75%). PD-1 was expressed in the surface of infiltrative intratumoral and peritumoral lymphocyte. Both of PD-L1 in the tumor and PD-1 in the lymphocyte were detected in the 12 cases (60%). PD-L1 was detected in 72.7% of pancreatic NET, 72% of gastroenteral NET. PD-L1 was detected in 100% of NET-G1, 75% of G2 and 50% of G3. The absolute number of intratumoral PD-1+ lymphocyte, CD8+ lymphocyte or Foxp3+ lymphocyte was higher in the PD-L1+ tumor than in the PD-L1- tumor. In peritumor, there was not a similar tendency. In the PD-L1 positive NET, the absolute number of intratumoral PD-1+ lymphocyte or CD8+ lymphocyte increased according to NET grade. Conclusion: Seventy-five% of GEP-NET expressed PD-L1. It might be higher rate of PD-L1 expression compared with other cancers. The absolute number of Intratumoral infiltrating lymphocyte expressing PD-1 or CD8 was also high. There might be a fraction of a good target for immune check point therapy in NETs. Citation Format: Yasushi Ichikawa, Noritoshi Kobayashi, Ayumu Goto, Motohiko Tokuhisa, Yukihiko Hiroshima, Takashi Ishikawa, Shoko Takano, Tomio Inoue, Itaru Endo. Pilot study of immune status of GEP-NETs in tumor microenvironment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3134.

MP05-19 OUTCOMES OF TREATMENT FOR LOCALIZED PROSTATE CANCER IN A SINGLE INSTITUTION; COMPARISON OF RADICAL PROSTATECTOMY VS RADIATION THERAPY ~PROPENSITY SCORE MATCHING ANALYSIS~

Effient (1,) All patients received 4 fiducial markers placed under Transrectal ultrasound guidance (TRUS.) EMLA Cream and lidocaine gel were used to numb the perineum and rectum. 2 needles each double loaded with 2 gold fiducial markers with a spacer in between were placed transperineally into the prostate. 2 fiducial markers were placed at the right and left base and 2 fiducial markers were placed at the right and left apex. Patients had a CT scan after procedure to confirm ideal geometry of the marker placement. The needles were withdrawn as was the ultrasound transducer. Gentle pressure was applied by the nursing staff. All patients were monitored for bleeding afterwards by a registered nurse. RESULTS: All 23 patients who were on anticoagulation and underwent fiducial marker placement were discharged home the same day of the procedure. No patient experienced significant bleeding in the peri-procedural window and no patient had any untoward cardiovascular event. CONCLUSIONS: This series suggests active anticoagulation is not an absolute contraindication to fiducial marker placement in patients undergoing SBRT or IGRT for prostate cancer. Transperineal fiducial marker placement appears to be safe in patients on active anticoagulation medication. These patients should be closely monitored after the procedure for bleeding complications.

Radiation therapy for stage IVA uterine cervical cancer: treatment outcomes including prognostic factors and risk of vesicovaginal and rectovaginal fistulas

Purpose To evaluate the safety and efficacy of radiation therapy for stage IVA uterine cervical cancer and to identify an optimal radiation regimen. Results Seventeen of the 28 patients developed recurrence after radiation therapy (local recurrence in 10 and distant metastasis in 12). The local control and distant metastasis-free rates at 3 years in all patients were 61% and 49%, respectively. Fourteen patients died after radiation therapy, and all but 2 died of tumor progression. The disease-free, cause-specific, and overall survival rates at 3 years in all patients were 32%, 49%, and 45%, respectively, and the estimated median survival time was 32 months. Tumor size (P = 0.007) and involvement in the lower third of vagina (P = 0.006) were significant prognostic factors for local control. Older age (P = 0.018) and performance status (P = 0.020) were significant prognostic factors for distant metastasis. The presence of hydronephrosis was the sole significant prognostic factor for survival (P = 0.026). Only 2 patients developed grade 3 late toxicities (vesicovaginal fistula and radiation proctitis, respectively). Materials and Methods Twenty-eight patients with stage IVA uterine cervical cancer received radiation therapy. All patients initially received external pelvic irradiation at a median dose of 50.4 Gy in 28 fractions. Twenty patients also received high-dose-rate intracavitary brachytherapy at a median dose of 22 Gy in 4 fractions. These fraction sizes were lower than conventional sizes. The total median dose for all 28 patients was 68.7 Gy. Conclusions Radiation therapy is safe and effective for treatment of stage IVA uterine cervical cancer. The reduced radiation dose per fraction may contribute to the prevention of vesicovaginal fistula formation.