ESTRO 36 Abstract Book

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S291 ESTRO 36
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GA has multiple drawbacks for the young patient, his
relatives and the RTTs. VLADI (Video Launching Applied
during Irradiation) project’s aim is to replace the use of
anesthesia with the projection of videos during treatment
in order to reassure and distract the patient throughout
the treatment procedure.
Material and Methods
Finding alternatives to general anesthesia in the
treatment of children is of great interest.
Hypnosis has been known to replace anesthesia during
interventions in some hospitals. This technique is very
interesting but it varies from patient to patient and it’s
somewhat difficult to apply in children undergoing RT
treatments.
As a possible alternative, VLADI project was created. It
consists of a small projector which projects multimedia
content in the field of view of the child throughout the
treatment procedure. At this stage, this device has been
specifically designed for Tomotherapy® treatment units.
This project was started in late 2014 in our RT
department, and we have evaluated the impact of the
project on the potential reduction of the use of GA for
children between the ages of 1.5 and 6 years old).
Results
VLADI’s impact on the use of GA was evaluated by
comparing 2 groups of children aged between 1.5-6 years
old (n= 12): Group 1 (n=6) composed of pediatric patient
treated in our RT department before the implementation
of VLADI project and Group2 (n=6) composed of pediatric
patient treated in our RT department after the
implementation of VLADI project.
Since we implemented the VLADI project, we’ve
diminished the use of GA from 83.3% (Group1) to 33.3%
(group 2) and we’ve reduced the number of anxiolytics
given to patients.
In total, 72.2% of the children benefited of this system
instead of GA.
Also before VLADI each RT treatment with GA took at least
1h, after its implementation this has been reduced to 15-
20min.
Conclusion
The use of VLADI as an alternative to anesthesia
represents a gain both at the level of patient care (less
medication) but also on a workflow level.
In our department, VLADI has almost completely replaced
anesthesia resulting in reduced treatment times and
reduction of stress for the young patients and their family.
These first results on our pediatric patients underline the
efficiency of the system and can even be extended to
claustrophobic or stressed adult patients who would –
without VLADI- require anxiolytics to undergo their
treatment.
OC-0547 Acute and late morbidity in a Phase II trial of
adaptive radiotherapy for urinary bladder cancer
A. Vestergaard1, L. Muren1, H. Lindberg2, L. Dysager3, K.
Jakobsen 2, H. Jensen3, J. Petersen1, U. Elstrøm1, A. Als4,
M. Høyer4
1Aarhus University Hospital, Department of Medical
Physics, Aarhus C, Denmark
2Copenhagen University Hospital- Herlev, Department of
Oncology, Herlev, Denmark
3Odense University Hospital, Department of Oncology,
Odense, Denmark
4Aarhus University Hospital, Department of Oncology,
Aarhus C, Denmark
Purpose or Objective
Large changes in bladder shape and size during a course of
radiotherapy (RT) make adaptive RT (ART) appealing in
the treatment of this tumour site. Patients with bladder
cancer unfit for surgery and chemotherapy were treated
in a multicentre phase II trial of daily plan selection with
the primary aim of reducing gastro-intestinal (GI)
morbidity. Acute and late morbidity is reported from the
trial and the frequency of acute diarrhoea is compared to
a previous cohort of similar patients treated with non-
adaptive RT (non-ART).
Material and Methods
All 54 patients (median age 80 years) received 60 Gy in 30
fractions to the bladder; in 41 of the patients the pelvic
lymph nodes were simultaneously treated to 48 Gy. Cone-
beam CT (CBCT) image guidance was used for daily set-up
and treatment was delivered by volumetric modulated arc
therapy (VMAT). The first five fractions were delivered
using large, population-based margins(non-ART: 20 mm
sup and ant; 15 mm post; 10 mm lat and inf); the bladder
contours from the CBCTs acquired during the first four
daily treatment sessions were used to create a library of
three plans, corresponding to a small, medium and large
size bladder. From fraction six all patients were treated
using daily online plan selection, where the smallest plan
covering the bladder was selected prior to each treatment
delivery. Morbidity scoring was performed at baseline,
every second week during RT and two weeks as well as 3,
12 and 24 month after RT using CTCAE v. 4.0. The
frequency of any grade 2 or higher GI morbidity was
evaluated at treatment completion. Peak acute morbidity
was assessed using the scorings until 3 months after RT
and peak late morbidity was evaluated after 12 months of
follow up. The frequency of peak acute diarrhoea was
compared to the cohort treated with non-ART. Acute and
late genito-urinary (GU) morbidity was also recorded.
Median follow-up was 12 months.
Results
Frequency of use of small size plans was 46%, medium 25%
and large 31%. The median volume ratio of PTV-ART vs.
non-ART across the treatment course was 0.68 (range:
0.46-0.93 for individual patients). Any GI morbidity grade
2 or higher was reported by 11 patients (20%) at treatment
completion and returned to baseline level at the 3 months
follow-up. Peak acute grade 2 or higher diarrhoea was
reported by 12 patients (22%). In the previous cohort of
patients treated with non-ART, 15 (30%) reported grade 2
or higher diarrhoea. An expected increase in acute GU
morbidity during RT was observed compared to baseline
scoring, but primarily grade 1. Late GU morbidity was
comparable to baseline.
Conclusion
Daily adaptive plan selection in RT of bladder cancer
results in a considerable dose sparing of normal tissue.
This phase II trial indicates that adaptive RT can be
delivered with low risk of morbidity.