238 / 1096
S225
ESTRO 36
_______________________________________________________________________________________________
Results
SMART was delivered in 45 fractions in nine pts (4F, 5M;
ages 55-87 yrs) with LAPC. Two pts had biliary stents. All
pts were able to complete the BH delivery. Median
duration of the SMART delivery was 54 min (range 42-73).
With the video-feedback method, median gated treatment
efficiency (ratio between actual beam-on time and
delivery time) was 0.66 for all fractions, ranging from
0.40-0.92 (Fig 2). Pt follow-up is still limited, but early
results show no grade ≥3 acute toxicity. Prospectively-
scored patient reported outcomes revealed maximum
Grade 2 fatigue and nausea in, respectively, 6 pts and 1
pt.
Conclusion
SMART is novel treatment approach for LAPC that requires
no placement of fiducials, and is well tolerated, even by
elderly pts and those with stents. Initial experience
revealed that delivery within a one hour time-frame per
fraction is feasible. Updated clinical follow-up data will
be presented.
OC-0426 Adjuvant chemoradiation in pancreatic
cancer: impact of radiotherapy dose on survival
A.G. Morganti
1
, M. Falconi
2
, G.C. Mattiucci
3
, A. Arcelli
1,4
,
F. Bertini
1
, A. Farioli
5
, A. Guido
1
, M.C. Di Marco
6
, L.
Fuccio
5
, S. Alfieri
7
, F.A. Calvo
8
, B.W. Maidment 3rd
9
, R.C.
Miller
10
, M. Reni
11
, G. Macchia
12
, F. Deodato
12
, S. Cilla
13
,
G. Di Gioia
12
, F. Cellini
3
, V. Valentini
3
1
University of Bologna- S. Orsola-Malpighi Hospital,
Radiation Oncology Center- Department of
Experimental- Diagnostic and Speciality Medicine- DIMES,
Bologna, Italy
2
San Raffaele Hospital, Department of Surgery-
Pancreatic Surgery Unit, Milano, Italy
3
Università Cattolica S. Cuore, Department of
Radiotherapy, Rome, Italy
4
Ospedale Bellaria, Radiotherapy Department, Bologna,
Italy
5
University of Bologna, Department of Medical and
Surgical Sciences - DIMEC, Bologna, Italy
6
University of Bologna- S. Orsola-Malpighi Hospital,
Department of Oncology, Bologna, Italy
7
Università Cattolica S. Cuore, Department of Surgery,
Rome, Italy
8
Hospital General Universitario Gregorio Marañón-
Complutense University, Department of Oncology,
Madrid, Spain
9
University of Virginia- Charlottesville, Department of
Radiation Oncology, VA, USA
10
Mayo Clinic, Department of Radiation Oncology,
Rochester, USA
11
S. Raffaele Scientific Institute, Department of
Oncology, Milano, Italy
12
Fondazione Giovanni Paolo II, Unit of Radiotherapy-
Unit of General Oncology, Campobasso, Italy
13
Fondazione Giovanni Paolo II, Unit of Medical Physics,
Campobasso, Italy
Purpose or Objective
To evaluate the impact of radiation dose on overall
survival (OS) in patients treated with adjuvant
chemoradiation (CRT) for pancreatic adenocarcinoma
(PAC).
Material and Methods
A multicenter retrospective analysis on 514 patients with
PAC (T1-3; N0-1; M0) treated with surgical resection with
macroscopically negative margins (R0-1) followed by
adjuvant CRT was performed. Exclusion criteria included
metastatic or unresectable disease at surgery,
intraoperative radiotherapy (IORT), macroscopic residual
disease (R2), postoperative death (within 60 days after
surgery) and histological diagnosis different from ductal
carcinoma. We analyzed patients stratifying them into 4
groups based on radiotherapy doses (group 1: < 45 Gy,
group 2: ≥ 45 and < 50 Gy, group 3: ≥ 50 and < 55 Gy, group
4: ≥ 55 Gy). Adjuvant chemotherapy was prescribed to 141
patients. Survival functions were plotted using the Kaplan-
Meier method
and compared through the log-rank test.
Clinical and pathological parameters associated with
significant differences in OS at the univariate analysis
were entered into a multivariable Cox model using a
forward stepwise [Wald] strategy (p removal ≥ 0.10; p
addition < 0.05) based on likelihood ratio test, in order to
obtain a final model including only the subset of variables
significant in predicting OS. All tests were two-sided and
a p value < 0.05 was considered statistically significant.
Results
Median follow-up was 20 months (3-120). At univariate
analysis a worse OS was recorded in patients with higher
Ca19.9 levels (> 90 U/ml; p < 0.001), higher tumor grade
(G3-4, p = 0.004), R1 resection (p = 0.004), higher pT stage
(pT3-4. p = 0.002) and positive nodes (p < 0.001).
Furthermore, patients receiving increasing doses of
chemoradiation showed a significantly improved OS
(Figure 1). In groups 1, 2, 3, and 4 median OS was 13.0
months, 21.0 months, 22.0 months, and 28.0 months,
respectively (p=0.004). The significant impact of higher
dose was confirmed by multivariate analysis (HR: 0.46,
95%CI: 0.27-0.78, p= 0.005).