ESTRO 36 Abstract Book

S249

ESTRO 36

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international practice, allowing for further similar studies

to be performed in other countries.

Material and Methods

An evidence-based event reporting-and-learning process

map was developed from recommendations in the

literature [see Figure 1], followed by a questionnaire to

assess a radiation therapy centre’s compliance with this

map. Radiation Therapy Service Managers of Irish radiation

therapy centres (n=12) were invited to participate in the

anonymous online questionnaire. Frequency analysis of

closed-ended questions and thematic analysis of open-

ended questions was performed to assess the data.

Results

A 91.7% response rate was achieved. The

following improvements were found to be most in need of

occurring: decreased variation in event classification and

taxonomy, expanded use of external reporting systems,

and heightened dissemination of lessons-learned to wide

audiences. A recommendations table was developed to

present methods in which required standardisation and

enhancement of practice can be achieved [see Table 1].

Conclusion

This study identified aspects of Irish event reporting-and-

learning systems wherein improvements are necessary.

The recommendations made can be utilised to optimise

the national standard of incident and near-miss

management in Ireland. Due to their evidence-based

nature, they can also be applied to the field of radiation

therapy across the globe. With such developments, a

worldwide enhancement of the safety-culture in the field

of radiation therapy can occur.

Symposium: Non-rectal GI tumours: key open questions

to be answered from (and for) the radiation oncologist!

SP-0469 Radio(chemo)therapy in oesophageal cancer:

can we do better?

M. Hulshof

Academic Medical Center, Dept Radiation Oncology,

Amsterdam, The Netherlands

The indications for radiation in esophageal cancer have

increased dramatically in the last 15 years, and the

developments of chemoradiation for esophageal cancer

can be defined as a success story: Preoperative

chemoradiation became standard since phase III trials

have shown that overall survival did increase in resectable

stage of disease and the results from studies with

definitive chemoradiation for irresectable\inoperable case

has changed the treatment intent from palliative to

curative. The indications for palliative radiotherapy

remained unchanged. Thus the vast majority of

esophageal cancer patients will get radiotherapy

somewhere in their disease tract. This recent change is

the reason that improvements in radiation accuracy for

esophageal tumors are running behind compared to longer

existing indications like prostate. Improving radiation

accuracy in esophageal tumors is challenging because of

its mobility by breathing effects, the anatomical changes

that can occur during the treatment period and the

difficulties of accurate delineation of macroscopical

tumor borders on a CT scan. This challenge becomes even

larger because the impact of all these uncertainties have

shown to differ between the different levels of the

esophagus, i.e. proximal, mid versus distal. Use of

fiducials, 4 D imaging, cone beam verification, non-

uniformal margins, IMRT and adaptive radiotherapy are

tools to improve accuracy and to decrease dose to healthy

surrounding tissue, but are not yet routinely applied in

most institutes. Still, improving radiation accuracy will

probably not have a large impact on tumor control and

survival. In contrast to the preoperative treatment, in

which dose schedules are well defined and locoregional

control is good after surgery, locoregional control in

definitive chemoradiation is still disappointing and

warrants improvements. Prospective studies are needed

and currently running to analyze the effect of dose

escalation in definitive chemoradiation. If dose escalation

is effective, treatment techniques to adequately deliver

the boost dose will become more important (4 D CT scans,

fiducials, and CBCT verification). The sensitizing effect of

chemotherapy during radiotherapy is well established, but

addition of new targeted drugs are expected to increase

the treatment response during chemoradiation. The first

studies on combining monoclonal antibodies with CRT

have been executed with so far somewhat disappointing

results. But new drugs are in development and studies on

combinations with immune therapeutic agents like PD-L1

inhibition are being conducted. So yes, we can do better,

both in terms of accurate dose delivery and improving

tumor response. Efforts by radiation oncologists are

necessary to provide that the success story of

chemoradiation in esophageal cancer has not ended yet.

SP-0470 Does radiotherapy still have a role in the

management of pancreatic cancer?

E. Fokas

Goethe University Frankfurt, Department of

Radiotherapy and Oncology, Frankfurt, Germany