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At least 793 records · Page 44
All sourcesNASA NTRSDOE OSTI
DOE OSTI2018

A community-based evaluation of proximity to unconventional oil and gas wells, drinking water contaminants, and health symptoms in Ohio

Highlights: • We conducted a community-based study on unconventional oil and gas (UO&G) in Ohio. • We explored UO&G proximity in relation to water contamination and health symptoms. • Contaminant detection and concentrations decreased with greater distance to UO&G. • UO&G proximity was associated with increased general health symptoms (e.g. fatigue). • Communities near UO&G may be more likely to experience environmental health impacts. Over 4 million Americans live within 1.6 km of an unconventional oil and gas (UO&G) well, potentially placing them in the path of toxic releases. We evaluated relationships between residential proximity to UO&G wells and (1) water contamination and (2) health symptoms in an exploratory study. We analyzed drinking water samples from 66 Ohio households for 13 UO&G-related volatile organic compounds (VOCs) (e.g., benzene, disinfection byproducts [DBPs]), gasoline-range organics (GRO), and diesel-range organics. We interviewed participants about health symptoms and calculated metrics capturing proximity to UO&G wells. Based on multivariable logistic regression, odds of detection of bromoform and dibromochloromethane in surface water decreased significantly as distance to nearest UO&G well increased (odds ratios [OR]: 0.28–0.29 per km). Similarly, distance to nearest well was significantly negatively correlated with concentrations of GRO and toluene in ground water (r{sub Spearman}: −0.40 to −0.44) and with concentrations of bromoform and dibromochloromethane in surface water (r{sub Spearman}: −0.48 to −0.50). In our study population, those with higher inverse-distance-squared-weighted UO&G well counts within 5 km around the home were more likely to report experiencing general health symptoms (e.g. stress, fatigue) (OR: 1.52, 95%CI: 1.02–2.26). This exploratory study, though limited by small sample size and self-reported health symptoms, suggests that those in closer proximity to multiple UO&G wells may be more likely to experience environmental health impacts. Further, presence of brominated DBPs (linked to UO&G wastewater) raises the question of whether UO&G activities are impacting drinking water sources in the region. The findings from this study support expanded studies to advance knowledge of the potential for water quality and human health impacts; such studies could include a greater number of sampling sites, more detailed chemical analyses to examine source attribution, and objective health assessments.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2021

Irradiation hardening and ductility loss of Eurofer97 steel variants after neutron irradiation to ITER-TBM relevant conditions

Ten Eurofer97 steel variants, produced by non-standard fabrication-processing routes and modified alloying chemistries, were studied by neutron irradiations in the high flux isotope reactor. The irradiations were performed to ITER-TBM relevant conditions of ~255–350 °C, 2.94–3.24 dpa. We quantified the irradiation-induced degradation of the steels using mechanical property tests. All the steels suffered from irradiation hardening, where a significant increase in Vickers microhardness and yield stress (σ YS ) occurred, accompanied with severe loss of tensile elongation. The extent of hardening was material dependent. For T irr = 300±30 °C, most steels showed σ YS increase in the range of ~30% to as high as ~66%, except for a low temperature tempered steel with σYS increase below 15%. Despite large losses in elongation, most failures were ductile. Significant post-necking ductility was retained with reduction in area (RA) between 65–75%, but <50% for low temperature tempered steels. The ultimate tensile stress to yield stress (σ UTS /σ YS ) ratios decreased significantly after irradiation, highlighting irradiation-induced strain hardening capacity reduction. No major effect of irradiation on the plastic instability stress (σ PIS ) and true fracture stress of the steels was observed. By comparing the tensile stresses in true stress units and with literature, the results suggest that RAFM steel designing should target materials with a large separation between σ PIS and σ YS , to ensure the materials can maintain large work hardening and uniform deformation capability after irradiation. The tensile data of the steels additionally revealed a compelling evidence of an inverse trend between the change in RA and increase in σ YS of the neutron irradiated Eurofer97 type steels.

36 MATERIALS SCIENCE↗
DOE OSTI2017

Quantifying CO 2 storage efficiency factors in hydrocarbon reservoirs. A detailed look at CO 2 Enhanced Oil Recovery

Carbon dioxide (CO 2 ) enhanced oil recovery (EOR) will likely be the primary means of geologic CO 2 storage during the early stages of commercial-scale carbon capture and storage (CCS) because of the inherent economic incentives as well as the abundant experience and demonstrated success in the United States, where CO 2 EOR has been employed since 1974. The work presented here estimates CO 2 storage efficiency factors in CO 2 EOR operations using a unique industry database of CO 2 EOR sites and 12 different reservoir simulation models. The simulation models encompass fluvial clastic and shallow shelf carbonate depositional environments for reservoir depths of 1219 and 2438 m (4000 and 8000 feet) and 7.6-, 20-, and 64-m (25-, 66-, and 209-foot)-thick pay zones. A novel statistical modeling technique incorporating the Michaelis–Menten function is used to generate empirical percentile estimates of CO 2 storage efficiency factors. West Texas San Andres dolomite water alternating gas (WAG) CO 2 flood performance data were used to derive P10, P50, and P90 CO 2 storage efficiency factors of 0.76, 1.28, and 1.74 Mscf/STB (stock tank barrel) of original oil in place. Median CO 2 storage efficiency factors from continuous CO 2 injection following conventional waterflood varied from 15% to 61% and 8% to 40% for fluvial clastic and shallow shelf carbonate simulation models, respectively, while those from WAG injection varied from 14% to 42% and 8% to 31%, respectively. Variation in the CO 2 storage efficiency factors was largely attributable to reservoir depth (a surrogate for reservoir pressure and temperature) and lithology (clastic versus carbonate). The results of this work provide practical information that can be used to quantify CO 2 storage resource estimates in oil reservoirs during CO 2 EOR operations (as opposed to storage following depletion) and the uncertainty associated with those estimates.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2023

Enhanced internal condensation of R1233zd(E) on micro- and nanostructured copper and aluminum surfaces

In-tube condensation of refrigerants is an important process which affects thermal efficiency in many applications, ranging from refrigeration and air conditioning to electronics thermal management. In-tube heat transfer and pressure drop are important to heat exchanger sizing and design. Here, in this work, micro- and nanostructured surfaces are applied to the internal wetted areas of copper and aluminum mini-channels to enhance the condensation heat transfer coefficient of hydrofluorocarbon R1233zd(E) refrigerant. To achieve scalable nanomanufacturing, surfaces were uniformly structured by relying on hydrochloric acid etching of aluminum and chemical oxidation of copper. The etched aluminum surfaces exhibited a 150% increase in heat transfer coefficient compared to smooth aluminum channels at specific qualities, with a 66% heat transfer coefficient improvement for complete phase change from saturated vapor to saturated liquid. Copper oxide structures showed no discernable difference in thermal-hydraulic performance when compared to smooth copper channels. Critical dimensionless parameters governing the heat transfer enhancement were identified by varying the tube internal diameter (2.3 mm to 4.7 mm), refrigerant mass flux (50 to 300 kg/(m 2 ·s)), and refrigerant quality (0 to 1). The dimensionless parameters include the Bond number normalized to the condensate film thickness, and the Weber number modified by the vapor friction factor. The relatively small increase in pressure drop (< 10%) associated with these surface enhancements further supports the promise of this method. The scalable and cost-effective techniques used to create these aluminum microstructures may reduce manufacturing cost when compared with current enhancement approaches such as extrusion, drawing, and welding.

42 ENGINEERING↗
DOE OSTI2018

Supercritical cryo-compressed hydrogen storage for fuel cell electric buses

Liquid hydrogen (LH 2 ) truck delivery and storage at dispensing sites is likely to play an important role in an emerging H 2 infrastructure. Here, we analyzed the performance of single phase, supercritical, on-board cryo-compressed hydrogen storage (CcH 2 ) with commercially-available LH 2 pump enabled single-flow refueling for application to fuel cell electric buses (FCEB). We conducted finite-element stress analyses of Type 3 CcH 2 tanks using ABAQUS for carbon fiber requirement and Fe-Safe for fatigue life. The results from these analyses indicate that, from the standpoint of weight, volume and cost, 2-mm 316 stainless steel liner is preferred to aluminium 6061 alloy in meeting the required 15,000 charge-discharge cycles for 350–700 bar storage pressures. Compared to the Type 3, 350 bar, ambient-temperature H 2 storage systems in current demonstration FCEBs, 500-bar CcH 2 storage system is projected to achieve 91% improvement in gravimetric capacity, 175% improvement in volumetric capacity, 46% reduction in carbon fiber composite mass, and 21% lower system cost, while exceeding >7 day loss-free dormancy with initially 85%-full H 2 tank.

08 HYDROGEN↗
DOE OSTI2020

A Performance analysis of the Claridge-Culp-Liu dehumidification process: A novel approach for drying moist air based on membrane separation, vacuum compression and sub-atmospheric condensation

This article covers a basic model for analyzing the performance of the Claridge-Culp-Liu dehumidification process. The fundamental process efficiency limit for dehumidification is close to COP Carnot , but for the eight dehumidification cases examined, the limiting or ideal energy use required is 26% to 56% that of a Carnot condensing system as shown in an earlier paper. The model presented in this paper is used to show the membrane system performance reduction caused by finite membrane area, finite water vapor permeance, non-zero air permeance, non-zero system air pressure drop, non-ideal compressors, vacuum pumps, and condensers. The performance of a “conservative” membrane system based on the use of existing components is computed for eight specific conditions along with that of a “target” system that assumes expected component performance after additional future component development. The “conservative” membrane system would use 36% to 66% as much energy as a system with a COP=7 chiller to produce the same dehumidification for the eight cases examined while the “target” system would use 15% to 40% the energy of a system with a COP=7 chiller. In addition to the significant energy reduction over conventional technology, the membrane system offers the advantages of: 1) no HFC refrigerant use; 2) direct isothermal control over humidity ratio setpoint; 3) maximum capacity occurs at design conditions; and 4) system generates pure water extracted from air as a by-product.

42 ENGINEERING↗
DOE OSTI2010

Value of Intensity-Modulated Radiotherapy in Stage IV Head-and-Neck Squamous Cell Carcinoma

Purpose: To review outcome and toxicity of Stage IVa and IVb head-and-neck squamous cell carcinoma patients treated with concomitant chemotherapy and intensity-modulated radiotherapy (IMRT) according to a hybrid fractionation schedule. Methods and Materials: Between 2006 and 2008, 42 patients with Stage IV head-and-neck squamous cell carcinoma were irradiated according to a hybrid fractionation schedule consisting of 20 fractions of 2 Gy (once daily), followed by 20 fractions of 1.6 Gy (twice daily), to a total dose of 72 Gy. Chemotherapy (cisplatinum, 100mg/m{sup 2}) was administered at the start of Weeks 1 and 4. Treatment outcome and toxicity were retrospectively compared with a previous patient group (n = 55), treated according to the same schedule, but without intensity modulation. Results: Locoregional control (LRC) and overall survival were 81% and 56% after 2 years, respectively. In comparison with the previous cohort, no significant differences were observed regarding either LRC (66%, p = 0.38) or overall survival (73%, p = 0.29). No Grade 4 or 5 toxicity was reported in the IMRT group, either acute or chronic. The use of IMRT significantly reduced the incidence of late Grade 2 or 3 xerostomia (52.9% vs. 90.2%, p < 0.001). No difference was observed regarding late Grade 2 or 3 dysphagia (p = 0.66). Conclusions: Intensity-modulated chemoradiotherapy does not compromise LRC and significantly reduces late toxicity, especially regarding xerostomia.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

Quality of Life Assessment After Concurrent Chemoradiation for Invasive Bladder Cancer: Results of a Multicenter Prospective Study (GETUG 97-015)

Purpose: To evaluate bladder preservation and functional quality after concurrent chemoradiotherapy for muscle-invasive cancer in 53 patients included in a Phase II trial. Patient and Methods: Pelvic irradiation delivered 45Gy, followed by an 18-Gy boost. Concurrent chemotherapy with cisplatin and 5-fluorouracil by continuous infusion was performed at Weeks 1, 4, and 7 during radiotherapy. Patients initially suitable for surgery were evaluated with macroscopically complete transurethral resection after 45Gy, followed by radical cystectomy in case of incomplete response. The European Organization for Research and Treatment of Cancer quality of life questionnaire QLQ-C30, specific items on bladder function, and the Late Effects in Normal Tissues-Subjective, Objective, Management, and Analytic (LENT-SOMA) symptoms scale were used to evaluate quality of life before treatment and 6, 12, 24, and 36 months after treatment. Results: Median age was 68 years for 51 evaluable patients. Thirty-two percent of patients had T2a tumors, 46% T2b, 16% T3, and 6% T4. A visibly complete transurethral resection was possible in 66%. Median follow-up was 8 years. Bladder was preserved in 67% (95% confidence interval, 52-79%) of patients. Overall survival was 36% (95% confidence interval, 23-49%) at 8 years for all patients, and 45% (28-61%) for the 36 patients suitable for surgery. Satisfactory bladder function, according to LENT-SOMA, was reported for 100% of patients with preserved bladder and locally controlled disease 6-36 months after the beginning of treatment. Satisfactory bladder function was reported for 35% of patients before treatment and for 43%, 57%, and 29%, respectively, at 6, 18, and 36 months. Conclusions: Concurrent chemoradiation therapy allowed bladder preservation with tumor control for 67% patients at 8 years. Quality of life and quality of bladder function were satisfactory for 67% of patients.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

Combined Modality Therapy Including Intraoperative Electron Irradiation for Locally Recurrent Colorectal Cancer

Purpose: To evaluate survival, relapse patterns, and prognostic factors in patients with colorectal cancer relapse treated with curative-intent therapy, including intraoperative electron radiation therapy (IOERT). Methods and Materials: From April 1981 through January 2008, 607 patients with recurrent colorectal cancer received IOERT as a component of treatment. IOERT was preceded or followed by external radiation (median dose, 45.5 Gy) in 583 patients (96%). Resection was classified as R0 in 227 (37%), R1 in 224 (37%), and R2 in 156 (26%). The median IOERT dose was 15 Gy (range, 7.5-30 Gy). Results: Median overall survival was 36 months. Five- and 10-year survival rates were 30% and 16%, respectively. Survival estimates at 5 years were 46%, 27%, and 16% for R0, R1, and R2 resection, respectively. Multivariate analysis revealed that R0 resection, no prior chemotherapy, and more recent treatment (in the second half of the series) were associated with improved survival. The 3-year cumulative incidence of central, local, and distant relapse was 12%, 23%, and 49%, respectively. Central and local relapse were more common in previously irradiated patients and in those with subtotal resection. Toxicity Grade 3 or higher partially attributable to IOERT was observed in 66 patients (11%). Neuropathy was observed in 94 patients (15%) and was more common with IOERT doses exceeding 12.5 Gy. Conclusions: Long-term survival and disease control was achievable in patients with locally recurrent colorectal cancer. Continued evaluation of curative-intent, combined-modality therapy that includes IOERT is warranted in this high-risk population.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

Teaching the Anatomy of Oncology: Evaluating the Impact of a Dedicated Oncoanatomy Course

Purpose: Anatomic considerations are often critical in multidisciplinary cancer care. We developed an anatomy-focused educational program for radiation oncology residents integrating cadaver dissection into the didactic review of diagnostic, surgical, radiologic, and treatment planning, and herein assess its efficacy. Methods and Materials: Monthly, anatomic-site based educational modules were designed and implemented during the 2008-2009 academic year at Duke University Medical Center. Ten radiation oncology residents participated in these modules consisting of a 1-hour didactic introduction followed by a 1-hour session in the gross anatomy lab with cadavers prepared by trained anatomists. Pretests and posttests were given for six modules, and post-module feedback surveys were distributed. Additional review questions testing knowledge from prior sessions were integrated into the later testing to evaluate knowledge retention. Paired analyses of pretests and postests were performed by Wilcoxon signed-rank test. Results: Ninety tests were collected and scored with 35 evaluable pretest and posttest pairs for six site-specific sessions. Posttests had significantly higher scores (median percentage correct 66% vs. 85%, p < 0.001). Of 47 evaluable paired pretest and review questions given 1-3 months after the intervention, correct responses rates were significantly higher for the later (59% vs. 86%, p = 0.008). Resident course satisfaction was high, with a median rating of 9 of 10 (IQR 8-9); with 1 being 'less effective than most educational interventions' and 10 being 'more effective than most educational interventions.' Conclusions: An integrated oncoanatomy course is associated with improved scores on post-intervention tests, sustained knowledge retention, and high resident satisfaction.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

Weekly Dose-Volume Parameters of Mucosa and Constrictor Muscles Predict the Use of Percutaneous Endoscopic Gastrostomy During Exclusive Intensity-Modulated Radiotherapy for Oropharyngeal Cancer

Purpose: To define predictors of percutaneous endoscopic gastrostomy (PEG) use during intensity-modulated radiotherapy (IMRT) for oropharyngeal cancer. Methods and Materials: Data for 59 consecutive patients treated with exclusive IMRT at a single institution were recovered. Of 59 patients, 25 were treated with hyperfractionation (78 Gy, 1.3 Gy per fraction, twice daily; 'HYPER'); and 34 of 59 were treated with a once-daily fractionation schedule (66 Gy, 2.2 Gy per fraction, or 70 Gy, 2 Gy per fraction; 'no-HYPER'). On the basis of symptoms during treatment, a PEG tube could have been placed as appropriate. A number of clinical/dosimetric factors, including the weekly dose-volume histogram of oral mucosa (OM DVHw) and weekly mean dose to constrictors and larynx, were considered. The OM DVHw of patients with and without PEG were compared to assess the most predictive dose-volume combinations. Results: Of 59 patients, 22 needed a PEG tube during treatment (for 15 of 22, {>=}3 months). The best cutoff values for OM DVHw were V9.5 Gy/week <64 cm{sup 3} and V10 Gy/week <54 cm{sup 3}. At univariate analysis, fractionation, mean weekly dose to OM and superior and middle constrictors, and OM DVHw were strongly correlated with the risk of PEG use. In a stepwise multivariate logistic analysis, OM V9.5 Gy/week ({>=}64 vs. <64 cm{sup 3}) was the most predictive parameter (odds ratio 30.8, 95% confidence interval 3.7-254.2, p = 0.0015), confirmed even in the no-HYPER subgroup (odds ratio 21, 95% CI 2.1 confidence interval 210.1, p = 0.01). Conclusions: The risk of PEG use is drastically reduced when OM V9.5-V10 Gy/week is <50-60 cm{sup 3}. These data warrant prospective validation.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

A Comparison of the Prognostic Value of Early PSA Test-Based Variables Following External Beam Radiotherapy, With or Without Preceding Androgen Deprivation: Analysis of Data From the TROG 96.01 Randomized Trial

Purpose: We sought to compare the prognostic value of early prostate-specific antigen (PSA) test-based variables for the 802 eligible patients treated in the Trans-Tasman Radiation Oncology Group 96.01 randomized trial. Methods and Materials: Patients in this trial had T2b, T2c, T3, and T4 N0 prostate cancer and were randomized to 0, 3, or 6 months of neoadjuvant androgen deprivation therapy (NADT) prior to and during radiation treatment at 66 Gy to the prostate and seminal vesicles. The early PSA test-based variables evaluated were the pretreatment initial PSA (iPSA) value, PSA values at 2 and 4 months into NADT, the PSA nadir (nPSA) value after radiation in all patients, and PSA response signatures in men receiving radiation. Comparisons of endpoints were made using Cox models of local progression-free survival, distant failure-free survival, biochemical failure-free survival, and prostate cancer-specific survival. Results: The nPSA value was a powerful predictor of all endpoints regardless of whether NADT was given before radiation. PSA response signatures also predicted all endpoints in men treated by radiation alone. iPSA and PSA results at 2 and 4 months into NADT predicted biochemical failure-free survival but not any of the clinical endpoints. nPSA values correlated with those of iPSA, Gleason grade, and T stage and were significantly higher in men receiving radiation alone than in those receiving NADT. Conclusions: The postradiation nPSA value is the strongest prognostic indicator of all early PSA-based variables. However, its use as a surrogate endpoint needs to take into account its dependence on pretreatment variables and treatment method.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

Radiation Therapy for Pilocytic Astrocytomas of Childhood

Purpose: Though radiation therapy is generally considered the most effective treatment for unresectable pilocytic astrocytomas in children, there are few data to support this claim. To examine the efficacy of radiation therapy for pediatric pilocytic astrocytomas, we retrospectively reviewed the experience at our institution. Methods and Materials: Thirty-five patients 18 years old or younger with unresectable tumors and without evidence of neurofibromatosis have been treated since 1982. Patients were treated with local radiation fields to a median dose of 54 Gy. Six patients were treated with radiosurgery to a median dose of 15.5 Gy. Five patients were treated with initial chemotherapy and irradiated after progression. Results: All patients were alive after a median follow-up of 5.0 years. However, progression-free survival was 68.7%. None of 11 infratentorial tumors progressed compared with 6 of 20 supratentorial tumors. A trend toward improved progression-free survival was seen with radiosurgery (80%) compared with external beam alone (66%), but this difference did not reach statistical significance. Eight of the 9 patients progressing after therapy did so within the irradiated volume. Conclusions: Although the survival of these children is excellent, almost one third of patients have progressive disease after definitive radiotherapy. Improvements in tumor control are needed in this patient population, and the optimal therapy has not been fully defined. Prospective trials comparing initial chemotherapy to radiation therapy are warranted.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

Outcomes in Black Patients With Early Breast Cancer Treated With Breast Conservation Therapy

Background: The race-specific impact of prognostic variables for early breast cancer is unknown for black patients undergoing breast conservation. Methods and Materials: This was a retrospective study of 1,231 consecutive patients {>=}40 years of age with Stage I-II invasive breast cancer treated with lumpectomy and radiation therapy at the University of Chicago Hospitals and affiliates between 1986 and 2004. Patients were classified as either black or nonblack. Cox proportional hazards regression was used to model the effects of known prognostic factors and interactions with race. Results: Median follow-up for surviving patients was 82 months. Thirty-four percent of patients were black, and 66% were nonblack (Caucasian, Hispanic, and Asian). Black patients had a poorer 10-year overall survival (64.6% vs. 80.8%; adjusted hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.23-2.06) and 10-year disease-free survival (58.1% vs. 75.4%; HR 1.49; 95% CI, 1.18-1.89) compared with nonblack patients. Tumor sizes were similar between nonblack and black patients with mammographically detected tumors (1.29 cm vs. 1.20 cm, p = 0.20, respectively). Tumor size was significantly associated with overall survival (HR 1.48; 95% CI, 1.12-1.96) in black patients with mammographically detected tumors but not in nonblack patients (HR 1.09; 95% CI, 0.78-1.53), suggesting that survival in black patients depends more strongly on tumor size in this subgroup. Tests for race-size method of detection interactions were statistically significant for overall survival (p = 0.049), locoregional control (p = 0.036), and distant control (p = 0.032) and borderline significant for disease-free survival (p = 0.067). Conclusion: Despite detection at comparable sizes, the prognostic effect of tumor size in patients with mammographically detected tumors is greater for black than in nonblack patients.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

Adjuvant Chemoradiation for Gastric Cancer Using Epirubicin, Cisplatin, and 5-Fluorouracil Before and After Three-Dimensional Conformal Radiotherapy With Concurrent Infusional 5-Fluorouracil: A Multicenter Study of the Trans-Tasman Radiation Oncology Group

Purpose: The INT0116 study has established postoperative chemoradiotherapy as the standard of care for completely resected gastric adenocarcinoma. However, the optimal chemoradiation regimen remains to be defined. We conducted a prospective, multicenter study to evaluate an alternative chemoradiation regimen that combines more current systemic treatment with modern techniques of radiotherapy delivery. Methods and Materials: Patients with adenocarcinoma of the stomach who had undergone an R0 resection were eligible. Adjuvant therapy consisted of one cycle of epirubicin, cisplatin, and 5-FU (ECF), followed by radiotherapy with concurrent infusional 5-FU, and then two additional cycles of ECF. Radiotherapy was delivered using precisely defined, multiple-field, three-dimensional conformal techniques. Results: A total of 54 assessable patients were enrolled from 19 institutions. The proportion of patients commencing Cycles 1, 2, and 3 of ECF chemotherapy were 100%, 81%, and 67% respectively. In all, 94% of patients who received radiotherapy completed treatment as planned. Grade 3/4 neutropenia occurred in 66% of patients with 7.4% developing febrile neutropenia. Most neutropenic episodes (83%) occurred in the post-radiotherapy period during cycles 2 and 3 of ECF. Grade 3/4 gastrointestinal toxicity occurred in 28% of patients. In all, 35% of radiotherapy treatment plans contained protocol deviations that were satisfactorily amended before commencement of treatment. At median follow-up of 36 months, the 3-year overall survival rate was estimated at 61.6%. Conclusions: This adjuvant regimen using ECF before and after three-dimensional conformal chemoradiation is feasible and can be safely delivered in a cooperative group setting. A regimen similar to this is currently being compared with the INT0116 regimen in a National Cancer Institute-sponsored, randomized Phase III trial.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

Feasibility of Economic Analysis of Radiation Therapy Oncology Group (RTOG) 91-11 Using Medicare Data

Purpose: The specific aim of this analysis was to evaluate the feasibility of performing a cost-effectiveness analysis using Medicare data from patients treated on a randomized Phase III clinical trial. Methods and Materials: Cost data included Medicare Part A and Part B costs from all providers-inpatient, outpatient, skilled nursing facility, home health, hospice, and physicians-and were obtained from the Centers for Medicare and Medicaid Services for patients eligible for Medicare, treated on Radiation Therapy Oncology Group (RTOG) 9111 between 1992 and 1996. The 47-month expected discounted (annual discount rate of 3%) cost for each arm of the trial was calculated in 1996 dollars, with Kaplan-Meier sampling average estimates of survival probabilities for each month and mean monthly costs. Overall and disease-free survival was also discounted 3%/year. The analysis was performed from a payer's perspective. Incremental cost-effectiveness ratios were calculated comparing the chemotherapy arms to the radiation alone arm. Results: Of the 547 patients entered, Medicare cost data and clinical outcomes were available for 66 patients. Reasons for exclusion included no RTOG follow-up, Medicare HMO enrollment, no Medicare claims since trial entry, and trial entry after 1996. Differences existed between groups in tumor characteristics, toxicity, and survival, all which could affect resource utilization. Conclusions: Although we were able to test the methodology of economic analysis alongside a clinical trial using Medicare data, the results may be difficult to translate to the entire trial population because of non-random missing data. Methods to improve Medicare data capture and matching to clinical trial samples are required.

62 RADIOLOGY AND NUCLEAR MEDICINE↗