Proceedings of the 50th Annual ASTRO Meeting S503

Conclusions: Information quality of prostate cancer websites in English, German, Arabic, and Hebrew languages is uneven andreflects the different cultural backgrounds. Internet information deficits should be corrected in a culturally-appropriate way to im-prove the potential impact of Internet use for patient education.

Author Disclosure: C. Weissenberger, None; S. Jonassen, None; W. Schultze-Seemann, None; S. Schulz, None; H. Matar, None;C. Fischer, None; J. Fogel, None.

2747 Early Intervention with PDE-5 Inhibitors Following Prostate Brachytherapy Improves Subsequent

Erectile Function

G. Pahlajani, R. Raina, A. Phillippi, R. Ochoa, C. Zippe

Cleveland Clinic Foundation, Garfield Heights, OH

Purpose/Objective(s): Prostate mono brachytherapy (PMB) is an accepted option for Gleason 6, low-volume Gleason 7 prostatecancers, and is being offered more frequently in younger patients. Unfortunately, erectile dysfunction can be a side effect fromPMB, occurring frequently in the first 12 months following treatment. This study examines the use of early PDE-5 inhibitors (sil-denafil citrate) in preventing subsequent erectile dysfunction following prostate brachytherapy.

Materials/Methods: We examined a single surgeon series of 69 patients that had undergone prostate mono brachytherapy from2002-2005. All patients had a minimum 1-year follow-up. Prospectively, patients had baseline, 6 and 12 month SHIM and IIEF-6scores recorded. The 69 patients were divided into early sildenafil (31) and non sildenafil groups (38) and their SHIM and IIEF-6scores were compared at 6 and 12 months. Daily sildenafil (25-50 mg) was given immediately in the perioperative period for a du-ration of 12 months. Overall, for the entire group, the mean PSA was 6.8; 78% had Gleason 6 cancer; 20% had Gleason 7 (3+4)cancer. The mean age in the early PDE-5 group was 62.8 years; in the non PDE-5 group, 66.0 years. The mean radiation units in theearly PDE-5 group was 50.2; in the non PDE-5 group, 43.9U (p = 0.08).

Results: In the non PDE-5 group, the mean baseline SHIM score of 17.1 dropped quickly to 9.1 at 6 months and stayed at 9.3 at 12months. In the early PDE-5 group, the mean baseline SHIM score of 21.8 decreased slightly to 17.6 at 6 months, and was main-tained at 17.9 at 12 months (p . 0.01 vs. baseline). Using the Wilcoxon Rank Sum Test, the 6 and 12 month SHIM scores in theearly PDE-5 group differed from the non PDE-5 group (p \ 0.001). The IIEF-6 questionnaire confirmed the SHIM analysis.

Conclusions: Following prostate mono brachytherapy, patients experience a significant decline in SHIM / IIEF-6 scores at 6 and12 months. Our data indicates a 50% decrease in the quality of their erections. This gives us a window of opportunity to initiate anearly intervention program with PDE-5 inhibitors, vacuum constriction devices or intraurethral alprostadil. In this study, the earlyuse of sildenafil citrate following PMB maintained erectile function at both 6 and 12 months.

Author Disclosure: G. Pahlajani, None; R. Raina, None; A. Phillippi, None; R. Ochoa, None; C. Zippe, None.

2748 A Feasibility Study of Acupuncture for Radiation Therapy Related Fatigue

T. J. Styles1, J. J. Mao1, A. Cheville2, J. Wolf1, S. Fernandes1, J. T. Farrar1

1Hospital of the University of Pennsylvania, Philadelphia, PA, 2The Mayo Clinic, Rochester, MN

Purpose/Objective(s): Fatigue is one of the most common symptoms seen by cancer patients undergoing radiation therapy (RT)and existing therapies are very limited. Fatigue is also a common symptom that is treated by acupuncture with reported empiricalsuccess. The goal of this study is to establish the feasibility of recruitment and retention, as well as the preliminary effect for anacupuncture clinical trial to prevent RT-induced fatigue.

Materials/Methods: Phase I: A cross-sectional survey study among patients undergoing RT; Phase II: a single arm acupunctureclinical trial among consented participants. Patients with a Karnofsky score of less than 60, severe anemia, or substantial psycholog-ical diagnoses were excluded. Patients received up to 12 treatments of acupuncture over the entire course of their RT. Lee FatigueScale (LFS) was administered at baseline, in middle and at the end of RT, along with the Patient Global Impression of Change (PGIC).

Results: Phase I: Among the 48/53 (91% response rate) participants, 20 (42%) reported they would participate if the study wereavailable, 13 (27%) would not participate and 15 (31%) were unsure. Of the 28 that refused or were unsure, 11/28 (39%) reportednot having the extra time as the major impediment and 5/28 (18%) did not like needles. Phase II: Among the 16 trial participants,average fatigue and energy domains of the LFS remained stable during and after RT without any expected statistical decline due toRT. Based on PGIC at the end of RT, two subjects (13%) reported fatigue being worse, 8 (50%) stable and 6 (37%) better.

Conclusions: Compared to the historical data which suggested up to 40% worsening of fatigue among cancer patients undergoingRT, this study suggests acupuncture may be helpful to prevent RT-related fatigue. Effective recruitment strategy, staffing, andspace issues need to be addressed to enhance patient recruitment and retention to the study so that a rigorous randomized controlledtrial can be conducted.

Author Disclosure: T.J. Styles, None; J.J. Mao, None; A. Cheville, None; J. Wolf, None; S. Fernandes, None; J.T. Farrar, None.

2749 Combination Short-course, Preoperative Irradiation, Surgical Resection and Reduced-field, High-dose,

Postoperative Irradiation in the Treatment of Tumors Involving the Bone

T. D. Wagner1, W. Kobayashi2, S. Dean2, S. I. Goldberg2, D. G. Kirsch3, H. D. Suit2, F. J. Hornicek2, D. S. Springfield2,S. S. Yoon2, T. F. DeLaney2

1Brooke Army Medical Center, San Antonio, TX, 2Massachusetts General Hospital, Boston, MA, 3Duke University School ofMedicine, Durham, NC

Purpose/Objective(s): To assess the feasibility and outcomes of combination short-course, preoperative (pre-op) radiation, fol-lowed by resection, and reduced-field (tumor bed without operative field coverage), high-dose, postoperative (post-op) radiationfor solid tumors involving the spine, pelvis, and long bones.

S504 I. J. Radiation Oncology d Biology d Physics Volume 72, Number 1, Supplement, 2008

Materials/Methods: Between 1982 and 2006, 48 patients were treated with this strategy for solid tumors involving bone. Radi-ation treatments (RT) utilized both photons and protons. The preoperative field covered pre-op ‘‘Clinical Target Volume’’ (CTV1)which included gross disease and tissue at risk for microscopic spread to 19.8 Gy. The patient then underwent maximal surgicalresection. Post-op RT was by shrinking field technique to maximize dose to regions of highest risk. Post-op CTV1 was continuedfor an additional 30.6 Gy (50.4 Gy total). The initial postoperative field was not intended to cover all of the surgically manipulatedregions and scars, but a continuation of treatment of those tissues at high risk preoperatively. CTV2 which represented the originalgross tumor volume (GTV) was boosted to an additional 19.8 Gy (70.2 Gy total). CTV3 (if necessary) represented gross residualdisease after surgery was boosted to an additional 7.2 Gy (77.4 Gy total).

Results: Of those treated, 52% had chordoma, 31% chondrosarcoma, 8% osteosarcoma, and 4% Ewing’s sarcoma, with 71% in-volving the pelvis/sacrum and 21% elsewhere in the spine. Median pre-op dose was 20 Gray (Gy) with median 50.4 Gy post-op.With 31.8 month median follow-up, 5-year overall survival (OS) is 65%, 5-year disease-free survival (DFS) is 53.8%, and 5-yearlocal control (LC) is 72%. There is no significant difference in OS, DFS and LC according to histology. Between primary and re-current disease, there is no significant difference at 5 years in OS, 74.4% versus 51.4% (p = 0.128), respectively, in contrast to DFS,71.5% versus 18.3% (p = 0.0014), and LC, 88.9% versus 30.9% (p = 0.0011) favoring primary disease. Following resection, 10patients experienced delayed wound healing which did not significantly impact OS, DFS, or LC.

Conclusions: This approach is promising for bone sarcomas where resection is likely to have close/positive margins. It appears toinhibit tumor seeding with an acceptable rate of wound healing complications. Dose escalation is accomplished without high-dosepre-op radiation (which would likely be associated with higher rates of acute wound healing delays) or large-field, post-op radiationonly (likely to be associated with late normal tissue toxicity). Outcomes are substantially better for primary than recurrent sarcomas,with an LC approaching 90% in patients with primary disease.

Author Disclosure: T.D. Wagner, None; W. Kobayashi, None; S. Dean, None; S.I. Goldberg, None; D.G. Kirsch, None; H.D. Suit,None; F.J. Hornicek, None; D.S. Springfield, None; S.S. Yoon, None; T.F. DeLaney, None.

2750 Retrospective Study of Volume Changes in Two Pathological Subtypes of Sarcomas using Deformation

Image Registration

K. Magierowski1, J. Moseley1, G. Lockwood1, A. Parent1, C. Euler1, M. Sharpe1, A. Griffin2, K. Brock1, C. Catton1,B. O’Sullivan1

1Princess Margaret Hospital, Toronto, ON, Canada, 2Mount Sinai Hospital, Toronto, ON, Canada

Purpose/Objective(s): Radiotherapy (RT) and limb salvage surgery are important in the management of extremity soft tissue sar-comas (STS). Clinical evidence suggests varied radiation responses for different pathologic subtypes of sarcomas. Quantitativeanalysis of data is necessary to support these findings. The study objective is to perform deformation image registration to quantifytumor volume changes in Myxoid Liposarcomas (MLS) and Malignant Fibrous Histiocytomas (MFH) for patients receiving pre-operative RT.

Materials/Methods: Our unit’s surgical sarcoma database was searched for all lower extremity MLS or MFH STS patients treatedwith pre-operative intensity modulated RT to 50 Gy in 25 fractions. The gross tumor volume (GTV) and bone were contoured onpre and post RT computed tomography (CT) or magnetic resonance image (MRI) data sets using a 3D Pinnacle planning system. Asenior radiation oncologist reviewed all GTV contours. Mean tumor volumes pre and post RT were calculated in Pinnacle based onthe contours. MORFEUS, a finite element model-based multi-organ deformable registration platform resolved the geometric dis-crepancies between the pre and post RT images and subsequently measured the response of the tumor in the left/right (LR), anterior/posterior (AP) and superior/inferior (SI) directions.

Results: Preliminary results of twenty patients were analyzed, ten MLS and ten MFH. The median (inter-quartile range) pre andpost RT volume for MLS tumors was 98 cm3 (62 to 146) and 62 cm3 (23 to 90) respectively (p = 0.11). For MFH the median volumewas 338 cm3 (140 to 580) and 378 cm3 (152 to 886) respectively (p = 1.0). In the LR, AP and SI dimensions, MLS patients hadmedian volume changes of -0.40 cm (-0.81 to 0.25), 0.09 cm (-0.44 to 0.23) and 0.35 cm (-0.90 to 0.66) respectively. For MFHpatients the volume change was 0.11cm (-0.21 to 0.31), 0.25 cm (0.04 to 0.45) and 1.10 cm (-0.02 to 1.63) in the LR, AP and SI,respectively. When the two subtypes were compared, MLS had greater changes in all directions however these results were notstatistically significant.

Conclusions: Deformation image registration was valuable in the assessment of sarcoma GTV changes. The greatest change oc-curred in the SI direction for both MLS and MFH patients. When the two subtypes were compared no significant difference wasfound in the three directions. Overall, MFH tumors grew and MLS tumors shrunk however these changes were not statisticallysignificant. Additional factors, which require further investigation, are changes in edema surrounding the GTV and changes in tu-mor volume during the course of treatment.

Author Disclosure: K. Magierowski, None; J. Moseley, None; G. Lockwood, None; A. Parent, None; C. Euler, None; M. Sharpe,None; A. Griffin, None; K. Brock, None; C. Catton, None; B. O’Sullivan, None.

2751 Spot Scanning Proton Radiation Therapy for Extra-cranial Chordomas: Five-year Outcomes in Patients

Treated at PSI

H. P. Rutz1, A. Staab1, A. J. Lomax1, C. Ares1, B. Timmermann1, D. C. Weber2, A. Bolsi1, C. Negreanu1, E. B. Hug1, G. Goitein1

1Center for Proton Radiation Therapy, Paul Scherrer Institute, Villigen PSI, Switzerland, 2Radiation Oncology, GenevaUniversity Hospital, Geneva, Switzerland

Purpose/Objective(s): To evaluate feasibility and safety of post-operative spot-scanning based proton radiation therapy (PT) forextracranial chordoma (EC).

Materials/Methods: Forty patients were treated between 1999 and 2005. Gross total resection was achieved in 21 patients(GTV=0 ml; CT, MRI since 2004). Sixteen patients had cervical, 4 thoracic, 9 lumbar, and 11 sacrococcygeal chordomas (epicenterof disease). Twenty-one patients had implants for post-operative stabilization. Twenty-seven patients had intra-spinal tumor before