RTHP-31. EMERGENCY RADIOTHERAPY IN INTRACRANIAL GERM CELL TUMORS (GCTS) PATIENTS WITH KPS≤ 40: ARETROSPECTIVE ANALYSIS OF 27 CASES

OBJECTIVES To evaluate the potential role of emergency radiotherapy in intracranial germ cell tumors GCTs) patients with KPS ≤ 40. METHODS A total of 27 primary intracranial germ cell tumors (GCTs) patients with KPS ≤ 40 between Jan 2007 and Dec 2018 were retrospectively evaluated. The median age at initial diagnosis was 15 years (range, 528 years). Among those, 11 patients were germinoma and 16 patients were nonseminomatous germ-cell tumors (NGGCTs). There were 9 solitary pineal, 5 suprasellar, 3 basal ganglia and 10 multifocal and disseminated tumors. All patients received emergency radiotherapy (2 Gy/fx/d). Prior to radiotherapy, 11 patients were manifested with hydrocephalus, 10 with hypopituitarism and 5 with intracranial tumo apoplexy. RESULTS The average follow up time was 44.4 months. The 5 year progression free survival rate and overall survival rate were 29.6% and 33.3%. The median overall survival time was 38 months. In particular, the median intracranial hypertension symptoms relief time was 2 days. The median KPS following radiotherapy was 80 comparing to 30 prior to radiotherapy (P < 0.05). A significant improvement on KPS of 46.7±27.3 was observed in this study. CONCLUSION Emergency radiotherapy is implicated as a promising intervention for GCTs patients with elevated intracranial pressure (ICP). These advantages can be interpreted as direct cell killing effect and fast tumor shrinkage by ionizing radiation. However, to substantiate our findings, further investigations were highly warranted.

Acomprehensive computer database for medical physics on-call program

Purpose: A comprehensive and robust computer database was built to record and analyse the medical physics on-call data in emergency radiotherapy. The probability distributions of the on-call events varying with day and week were studied.Materials and methods: Variables of medical physics on-call events such as date and time of the event, number of event per day/week/month, treatment site of the event and identity of the on-call physicist were input to a programmed Excel file. The Excel file was linked to the MATLAB platform for data transfer and analysis. The total number of on-call events per day in a week and per month in a year were calculated based on the physics on-call data in 2010–18. In addition, probability distributions of on-call events varying with days in a week (Monday–Sunday) and months (January–December) in a year were determined.Results: For the total number of medical physics on-call events per week in 2010–18, it was found that the number was similar from Sundays to Thursdays but increased significantly on Fridays before the weekend. The total number of events in a year showed that the physics on-call events increased gradually from January up to March, then decreased in April and slowly increased until another peak in September. The number of events decreased in October from September, and increased again to reach another peak in December. It should be noted that March, September and December are months close to Easter, Labour Day and Christmas, when radiation staff usually take long holidays.Conclusions: A database to record and analyse the medical physics on-call data was created. Different variables such as the number of events per week and per year could be plotted. This roster could consider the statistical results to prepare a schedule with better balance of workload compared with scheduling it randomly. Moreover, the emergency radiotherapy team could use the analysed results to enhance their budget/resource allocation and strategic planning.

Malignant spinal cord compression secondary to testicular seminoma at the time of initial presentation and at relapse while on surveillance

We report cases of 2 pure seminoma patients who developed metastatic spinalcord compressions. One patient was diagnosed at age 33 years with stage 1seminoma and, after undergoing an orchidectomy, chose to be followed ona surveillance protocol. He was lost to follow-up and presented again 22months later with back pain, leg weakness and sensory loss when his diseaserecurred as a spinal cord compression. He was treated with urgent surgicaldecompression and subsequent standard chemotherapy. More than 2years posttreatment, he is disease-free with normal neurologic function inhis lower extremities. The second patient presented at age 44 years withback pain and rapid loss of leg strength and sensation. Investigations revealeda malignant cord compression with lymphatic and vertebral body metastases.On physical examination, the patient was found to have a 6-cm lefttesticular mass. He was treated with emergency radiotherapy to the regionof his cord compression followed by a left inguinal orchidectomy. Pathologyconfirmed a pure classic seminoma. Postoperatively, he received standardchemotherapy and eventually regained neurologic function in his legs. Althoughit is rare for malignant spinal cord compression to occur in seminoma patients—either as the initial presentation of disease or as a site of disease recurrencein stage 1 patients on surveillance—it is crucial to consider seminoma as apossible etiology in young men diagnosed with malignant spinal cord compressionbecause timely contemporary treatments for seminoma will cure mostof these patients and offer them excellent functional recovery.