Abstract Book

S61

ESTRO 37

organ sparing radiochemotherapy leading to a high toxicity burden. Head and neck oncologists are therefore actively exploring ways to limit toxicity related to treatment by reducing the number of treatment modalities and/or reducing intensity/dose of a given modality without compromising efficacy in these younger good prognostic patients. Many studies are underway to define de- escalation more precisely. Studies use either de- intensification of chemotherapy, de-intensification of radiotherapy or de-intensification of surgery/adjuvant therapy. Preliminary results of these studies are encouraging, but longer follow up is warranted. Further research improving our understanding of the underlying biology is needed and until mature results from prospective phase 3 clinical trials are available, de- intensification of therapy should not be performed outside a clinical trial. SP-0117 Strategies to minimize post-RT late effects on swallowing and QOL C. Nutting 1 1 The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Test, Sutton, United Kingdom SP-0118 Innovative strategies to monitor and manage head and neck cancer patients during radiotherapy B. Chera 1 1 The University of North Carolina, Radiation Oncology, Chapel Hill NC, USA Abstract text We will discuss the use of innovative strategies to aide in the monitoring and management of head and neck cancer patients during radiotherapy. We will discuss quality improvement strategies related to the incorporation of patient reported outcomes though the use of mobile device technology into routine clinical management, and the implementation of countermeasures to reduce unplanned hospital admissions and emergency room visits. We will also specifically discuss the use of geriatric assessments to help predict poor tolerance to therapy. The use of novel biomarkers (tumor genetics and circulating tumor DNA) pre-treatment and during treatment to improve risk-stratification and to guide treatment decisions will also be discussed. SP-0119 Personalising the management of HN cancer to minimize toxicity and maximize QOL N. Lee Memorial Sloan Kettering, New York, USA Abstract not received

Planchamp, supported by a grant of the French National Cancer Institute, INCa), starting with the building of a group of 24 European experts appointed by each Society, and a systematic literature search. Recommandations were elaborated by the group at the time of two physical meetings, then submitted to a review by 159 external reviewers. Comments of the reviewers were integrated at the time of a third physical meeting of the experts group. Final recommendations are based on scientific evidence, and/or expert consensus. Staging, management of early and advanced cases, management of clinically occult cervical cancer diagnosed after simple hysterectomy, fertility-preserving treatment, cervical cancer in pregnancy, distant metastatic disease, and recurrent disease were covered. Complementary information on principles of radiotherapy and principles of pathologic evaluation has been developed. A standardized description of the templates for radical hysterectomy (2017 update of the Querleu-Morrow classification) has been adopted. Recommendations are presented at the meetings of each participating Society, published as full papers in the Journals of each society, and are freely available as web-based documents (guidelines and complete summary reports), pocket books and in the near future smartphone apps. SP-0121 Surgical approaches in stage I B cervical cancer D. Querleu 1 1 Institut Bergonie, Surgery, BORDEAUX, France Abstract text Radical surgery by an gynaecologic oncologist is the preferred treatment modality of stage IB cervical cancer with negative nodes. However, treatment strategy should aim to avoid combining radical surgery and radiotherapy due to the highest morbidity after combined treatment. For this reason, definitive radiochemotherapy and brachytherapy without previous radical pelvic surgery is recommended in patients with unequivocally positive pelvic nodes at imaging. Debulking of suspicious nodes may be considered. Along the same line, if lymph node involvement is detected intraoperatively, further radical hysterectomy should be avoided. Patients should be referred for definitive chemoradiotherapy. In addition, nonsurgical therapy therapy can be considered when a combination of risk factors is known at diagnosis that would require an adjuvant treatment. In the above mentioned cases, pelvic lymph node dissection should be avoided. Paraaortic (at least up to the inferior mesenteric artery) lymph node dissection may be considered in patients with negative paraaortic lymph node on imaging. Minimal invasive approach is preferred for staging and surgical management. The standard lymph node staging procedure is systematic pelvic lymphadenectomy. Sentinel node biopsy before pelvic lymphadenectomy is strongly recommended. Lymph node assessment should be performed as the first step of surgical management. Intraoperative assessment of lymph node status (frozen section) is recommended. All sentinel nodes from both sides of the pelvis or any suspicious lymph nodes should be sent for frozen section. If a sentinel node is not detected, intraoperative assessment of the pelvic lymph nodes should be considered. If intraoperative lymph node assessment is negative or is not done, systematic pelvic lymph node dissection should be performed. At present, sentinel node biopsy alone cannot be recommended outside prospective clinical trials. Systematic lymph node dissection should include the removal of lymphatic tissue from regions with the most frequent occurrence of positive lymph nodes (sentinel nodes), including obturator fossa, external iliac regions, common iliac regions bilaterally, and the presacral region. Distal external iliac lymph nodes (so called circumflex iliac

Abstract not received

Joint Symposium: ESTRO-ESGO: State of the art: new ESGO-ESTRO-ESP guidelines on management of cervical cancer

SP-0120 General introduction to the recommendations D. Querleu 1 1 Institut Bergonie, Surgery, BORDEAUX, France Abstract text Guidelines for the management of usual histotypes of cervical cancer were jointly elaborated by the ESGO (European Society of Gynaecologic Oncology), ESTRO, and ESP (European Society of Pathology), under the chairmanship of Professors David Cibula, Richard Pötter, and Mariarosaria Raspollini. A strict process was followed and monitored by a professional methodologist (François