Volume 87 � Number 2S � Supplement 2013 Digital Poster Discussion Abstracts S177

December 31, 2010, who received definitive EBRT. We excluded patients

who received combination EBRT/Brachytherapy or stereotactic body

radiation therapy. We classified patients into NCCN risk groups. NCDB

tumor registrars extract EBRT dose data from radiation treatment record

review following recommendations of the International Commission on

Radiological Protection. We defined guideline concordant EBRT as total

prescribed dose of �75.6 Gy for low risk patients and �78 Gy for inter-

mediate and high risk patients. Using multivariable logistic regression, we

examined the association of patient, clinical, and demographic character-

istics with the use of guideline concordant EBRT dose.

Results: The median EBRT dose prescribed for all patients was 76 Gy

(IQR, 75.6-78 Gy). Of the 13,929 patients in 2010, 52.6% of patients

received guideline concordant EBRT doses. The proportions of patients in

2010 who received guideline concordant EBRT doses for low, interme-

diate, and high risk disease were 88.9%, 37.4%, and 40.7%, respectively.

After adjusting for potential confounders including the use of IMRT and

androgen suppression, use of high dose EBRT (�78 Gy) within the

intermediate and high risk groups was significantly higher in 2010

compared to 2006 (OR, 1.22; 95% CI, 1.18-1.28; p < 0.0001; OR, 1.22;

95% CI, 1.18-1.26; p < 0.0001, respectively). The presence of high grade

histology was significantly associated with use of high dose EBRT (p <

0.05), while advanced T-stage and PSA elevation were not. Patients

receiving treatment at ACS-COC community or comprehensive cancer

centers were significantly less likely to receive guideline concordant EBRT

doses compared to patients treated at high-volume ACS-COC academic

cancer centers (OR, 0.86; 95% CI, 0.75-0.97; pZ 0.02; OR, 0.87; 95% CI,

0.77-0.99; p Z 0.04, respectively).

Conclusions: In 2010, approximately 40% of men with intermediate or

high risk PCa received high dose treatment concordant with clinical

guidelines. Patients receiving treatment at high volume academic cancer

centers were more likely to receive guideline concordant EBRT doses.

Author Disclosure: S.D. Swisher-McClure: None. N. Mitra: None. K.

Woo: None. M. Smaldone: None. R. Uzzo: None. K. Armstrong: None. J.

Bekelman: None.

1075Readability Levels of Patient Education Materials in ProfessionalRadiation Oncology OrganizationsJ. Byun; University of Illinois at Chicago College of Medicine, Chicago, IL

Purpose/Objective(s): Prior studies indicate that patient education

materials are written at a level too high for the average patient to

comprehend. As lower levels of health literacy are associated with worse

clinical outcomes and increased healthcare expenditures, ensuring patient

education materials are readable is important. The purpose of the present

study is to investigate the readability of online patient education materials

related to radiation therapy from the American Society for Radiation

Oncology (ASTRO), the American Cancer Society (ACS), and the

American College of Radiology (ACR).

Materials/Methods: All radiation therapy-related articles written in

English available in 2013 and related to radiation therapy from the patient

education libraries of the web sites of the ASTRO, ACS, and ACR were

downloaded. Follow-up editing was then performed for each article to

minimize inaccurate readability scoring. Each article was assessed for

readability using the Flesch-Kincaid (FK) readability test. Mean scores

were also compared between the different patient education material

sources.

Results: A total of 100 patient education articles were reviewed (32 from

ASTRO, 50 from ACS, and 18 from ACR). The mean FK grade level of all

articles reviewed was 10.1 (range, 3.1 - 16.4). The mean FK grade level of

the articles from the ASTRO, ACS, and ACR, were 11.3 (range, 3.4 -

15.7), 8.9 (range, 3.1 - 14.3), and 12.5 (range, 11.1 - 16.4), respectively;

the difference was significant (p < .01). Only 31 articles had a readability

level at or below the eighth grade level and only 13 below the sixth grade

level. Of those below the sixth grade level, only 4 were from ASTRO,

while none were from ACR.

Conclusions: The majority of radiation therapy-related patient education

materials available online from the ASTRO, ACS, and ACR are written at

a readability level too high (greater than sixth-to-eight grade level) to be

comprehended by a substantial portion of the population. This suggests an

opportunity to improve written patient education materials through

focusing on comprehension levels.

Author Disclosure: J. Byun: None.

1076Stereotactic Radiosurgery Versus Stereotactic Radiosurgery andWhole Brain Radiation Therapy for 1-3 Brain MetastasesN. Lester-Coll, A.P. Dosoretz, and J.B. Yu; Department of Therapeutic

Radiology, Yale University School of Medicine, New Haven, CT

Purpose/Objective(s): While whole brain radiation therapy (WBRT) is

effective at controlling intracranial disease, it is also associated with side

effects including neurocognitive decline. Multiple studies have examined

whether patients with oligometastatic brain disease can be treated initially

with stereotactic radiosurgery (SRS) alone. These data demonstrate that

treating with adjuvant WBRT improves intracranial disease control but

does not result in improved overall survival. It is unclear whether a theo-

retically improved quality of life after SRS alone relative to SRS with

adjuvant WBRTwould justify the omission of WBRT given the higher risk

of intracranial failure. This study compares SRS alone with SRS and

WBRT to evaluate the theoretical benefits of intracranial tumor control

with adjuvant WBRT against its possible side effects, using Quality

Adjusted Life Expectancy (QALE) as a primary endpoint.

Materials/Methods: A Markov decision analytic model was used to

compare QALE in a hypothetical cohort of patients with 1-3 brain

metastases and a Karnofsky Performance Status �70. Patients were treated

with SRS alone or SRS with upfront WBRT. Patients treated with SRS

alone underwent surveillance MRI and could receive salvage WBRT if

they developed intracranial relapse. All patients who relapsed had neuro-

logic deaths. Probabilities of disease progression were derived from the

EORTC 22952-26001 study. Utilities were estimated from the published

literature, and were 0.80 for no evidence of disease (NED) after SRS, 0.50

for WBRT, 0.40 for failure after WBRT, and 0.15 for dying of neurologic

progression. The cycle length was one month. Sensitivity analysis was

used to examine the impact of plausible variation in key model parameters

on results.

Results: Treatment with SRS yielded 8.6 quality adjusted life years

(QALYs). The addition of upfront WBRT reduced QALE by 2.5 QALYs.

On one-way sensitivity analysis, the model was only sensitive to a single

parameter, the utility associated with the state of NED after SRS alone. At

values greater than 0.44, SRS alone was preferred.

Conclusions: Using assumptions derived from the literature, SRS alone

improved QALE in patients with 1-3 brain metastases. This model

suggests that the addition of WBRT can be reserved for patients who

would have a poor quality of life regardless of treatment. Therefore, the

decision to pursue SRS versus SRS and WBRT for brain metastases should

include consideration of the patient’s predicted quality of life.

Author Disclosure: N. Lester-Coll: None. A.P. Dosoretz: None. J.B. Yu:

None.

1077The Dissemination of New Technologies and Temporal Trends inCurative Therapy for Prostate Cancer Patients With Low Likelihoodof Clinical BenefitA. Raldow,1,2 C.J. Presley,3,2 J.B. Yu,4,2 L.D. Cramer,2 P.R. Soulos,2

J.B. Long,2 D.V. Makarov,2,5 and C.P. Gross2,6; 1Harvard Radiation

Oncology Program, Boston, MA, 2Cancer Outcomes, Public Policy, and

Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer

Center, New Haven, CT, 3Yale University School of Medicine, New Haven,

CT, 4Department of Therapeutic Radiology, Yale University School of

Medicine, New Haven, CT, 5Department of Urology, New York University

School of Medicine, New York, NY, 6Section of General Internal Medicine,

Yale University School of Medicine, New Haven, CT