ESTRO 36 Abstract Book

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S990 ESTRO 36
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EBRT 60-70 Gy, in 3 group -22 patients received EBRT 40-
50 Gy. The dose of brachytherapy was 14 Gy in 2 fractions
at intervals of one week, which was applied after 40-50
Gy EBRT
Results
Reducing dysphagia was observed in 70% of patients in the
first group, 54% - in the second group, and 23% - in the
third. Two-year overall survival was 36%, 12% and 12%
respectively. The median overall survival was 15.7; 9.7
and 6.6 months, respectively.
Conclusion
Adding intraluminal brachytherapy to EBRT can reduce
dysphagia and improve overall survival.
EP-1803 Moderate dose-escalation with perioperative
HDR brachytherapy in soft tissue sarcomas
X. Chen1, A. Montero1 , E. Sanchez1, J. De las Heras2, O.
Hernando3, M. Lopez1, J. Garcia4, J.M. Perez5, R.
Ciervide1 , J. Valero1, M. Garcia-Aranda1, R. Alonso3, D.
Zucca4, M.A. De la Casa4, B. Alvarez1, J. Marti 4, L.
Alonso 5, P. Fernandez-Leton 4, C. Rubio1
1 Hospital Universitario HM Sanchinarro, Radiation
Oncology, Madrid, Spain
2 Hospital Universitario HM Sanchinarro, Orthopaedic
Surgery, Madrid, Spain
3 Hospital Universitario HM Puerta del Sur, Radiation
Oncology, Madrid, Spain
4 Hospital Universitario HM Sanchinarro, Medical Physics,
Madrid, Spain
5 Hospital Universitario HM Puerta del Sur, Medical
Physics, Madrid, Spain
Purpose or Objective
Radiation therapy after conservative surgery improves
local control in patients with soft tissue sarcoma. A clear
relationship exists between dose and local control. We
report our experience about feasibility of perioperative
brachytherapy as a moderate dose-escalation approach in
the multidisciplinary management of soft tissue sarcoma.
Material and Methods
From May 2015 to October 2016, 9 patients (p), 5 men and
4 women, with a median age of 63 years (range 7 – 72
years) underwent perioperative brachytherapy (PoBT).
Histology: 4 p (44%) liposarcoma, 2 p (22%) desmoid and
1 p (11%) fusocellular sarcoma, 1 p (11%) pleomorphic
sarcoma and 1 p (11%) sarcoma NOS. Tumor staging: 4 p
T2aN0M0, 5 p T2bN0M0. Tumor location: thigh 5 p (56%),
trunk 2 p (22%), arm 1 p (11%), neck 1p (11%). PoBT
procedure was performed by using 6F plastic catheters
placed on the surgical bed at the time of excision. Eight
patients obtained R0 resection and 1 p R1 resection.
Catheters were placed perpendicularly to the surgical
incision at 1.5- 2 cm intervals to ensure adequate
dosimetry. CT simulation with 1.5 mm slice thickness was
done in the fourth or fifth day after surgery once the sewer
system was retired. A total 16.5 Gy was delivered to the
PTV in 3 fractions of 550 cGy separated at least 6 hours.
Catheters were retired after the last fraction.
Results
All p received external beam radiotherapy (EBRT) by using
intensity modulated radiotherapy (IMRT) at a dose of 50
Gy in 25 fractions of 2 Gy/day. Five p (56%) underwent
pre-operative radiotherapy and 4 p (44%) post-operative
radiotherapy. Four patients received chemotherapy
before or after radiotherapy. One of the biological
characteristics of sarcoma is their relatively low α-β ratio.
Assuming the alpha- beta ratio of sarcoma cells as 4 our
calculation of tumor BED is as following: (2Gy x 25fx) +
(5.5Gy x 3fx) = 114.19Gy which corresponds to an
accumulated EQD2Gy for tumor of 76.12Gy. With a median
follow-up of 7.8 months (range 3 – 17.6 months), no local
failure nor distance progression has been observed. No
grade 2 or higher toxicity was observed.
Conclusion
Peri-operative brachytherapy is feasible and well
tolerated and allows a moderate dose-escalation in
patients with soft-tissue sarcomas.
EP-1804 Laparoscopic robot-assisted brachytherapy of
muscle-invasive bladder cancer: clinical case report
F. Mascarenhas1, F. Marques1, K. Maes 2, R. Formoso2, T.
Antunes1, S. Germano1, S. Faustino1
1Hospital da Luz, Radiation Oncology, Lisbon, Portugal
2Hospital da Luz, Urology, Lisbon, Portugal
Purpose or Objective
The standard treatment of muscle-invasive of the bladder
cancer (MIBC) is radical cystectomy. A significant
percentage of this population is elderly, with severe co-
morbidities, or without general conditions to radical
cystectomy. Integrated brachytherapy in a multimodality
conservative approach for bladder preservation is well
established and is considered an alternative therapeutic
option in selected cases.
Material and Methods
The authors present a clinical case of an elderly patient
with a high grade stage T2aN0M0 bladder muscle-invasive
carcinoma submitted to laparoscopic robot-assisted
brachytherapy (LRAB) according the Arnhem Radiotherapy
Institute, that developed specific catheters for this
modality. The selection criteria, the clinical evaluation
and all phases of the treatment procedure will be
presented. Patient was submitted firstly to three cycles of
neoadjuvant chemotherapy with carboplatin and
gemcitabine followed by intensity modulated external
radiotherapy for the pelvis including bladder and pelvic
lymph nodes to a total dose of 40Gy in 20 fractions. After
3 weeks patient was submitted to a partial cystectomy and
internal iliac lymph nodes dissection. Three Luneray
catethers were inserted over the tumor bed in this surgical
procedure and brachytherapy was performed beginning in
the same day of surgery and completed in the following
three days delivering 25Gy in 10 fractions. Following
image represents the bladder implant.
The quality of the implant was evaluated using the
homogeneity index (HI) and the overdose index (OI),
according to the following formulas:
HI= (V100-V150)/V100 × 100%
OI= V 200/V100 × 100%
The first pulse of brachytherapy was administered on the
same day of the catheters’ implant. After the last pulse,
the catheters were removed and then pulled out of the
abdomen on the other side.
Results
For the present case, HI was 62,3% and OI was 19,7%.
The excellent tolerance of the treatment and the absence
of complications allowed the patient´s hospital discharge
the day after the final of brachytherapy. The withdrawal
of Foley catheter was performed after 2 weeks. One
month after the treatment, the previous symptoms were