ESTRO 36 Abstract Book

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S563 ESTRO 36
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app are available at aftercare check-ups, while 22.2%
(24/108) are not convinced of a benefit of app-based
patient documentation. Favorable of an alert function due
to data input by patients with the need for further
clarification are 64.8% (versus 35.2%), 94.3% are willing to
contact the patient after notification. Of all, 93.5%
support the idea to use collected data for scientific
research and 75.0% believe it could be beneficial for the
providing hospital.
Conclusion
The present work shows a great approval for telemedicine,
mHealth and apps in oncology amongst HCPs. Assessing
side effects can lead to quicker response and thus lower
inconvenience of patients. Clinical data as life quality and
treatment satisfaction could be used to evaluate and
improve the therapy workflow. Regular input of patient-
reported outcome or side effects can be used to early
detect and document the disease progression. Overall,
this patient data can be used for scientific evaluations.
Eventually, a mobile app would enhance the patient
relation to his treating department as he has permanent
contact using the mobile app - a trend also evolving in the
medical field.
PO-1020 Re-irradiation of Head and Neck Sarcomas:
initial results of Protontherapy Center of Trento, Italy
I. Giacomelli 1, D. Scartoni1, M. Cianchetti1, F. Dionisi1, B.
Rombi1, M. Amichetti1
1 Azienda Provinciale per i Servizi Sanitari APSS Trento,
U.O. di Protonterapia, Trento, Italy
Purpose or Objective
Radiotherapy for head and neck (H&N) recurrent sarcomas
is usually limited by the dose tolerance of critical
structures mainly in the skull base. Re-irradiation of such
cases is rarely performed in clinical practice. Numerous
dosimetric studies have shown that proton therapy (PT)
can spare more healthy tissue than conventional X-ray
therapy and it can result in fewer side effects. We report
the preliminary results in terms of feasibility and
tolerance of re-irradiation with PT for recurrent previously
irradiated H&N sarcomas .
Material and Methods
Between November 2015 and September 2016 four
patients (pts) with five recurrent H&N Sarcomas were re-
irradiated with PT. Histology of the primary lesions were:
pleomorphic sarcoma (1), alveolar rhabdomyosarcoma (2),
sclerosing rhabdomyosarcoma (1), radiation-induced
spindle cell sarcoma (1). Median age at re-irradiation was
30.0 years (range, 29.0-50.0 years). Karnofsky
performance status was 90-100. Median interval time
between previous radiotherapy and PT was 55.4 months;
the median total dose received at the first radiotherapy
course was 54.7 Gy (range, 50.4 – 60.0 Gy). Target
definition was based on CT and MR imaging. Median CTV
volume was 45.36 cc (range, 10.48-132.2 cc) and median
PTV volume was 126.4 cc (range, 35.87-277.8 cc). Patients
received a median total dose of 60.0 GyRBE (range, 50.0-
60.0 GyRBE), 1.8–2.0 GyRBE per fraction; two pts received
also sequential and one concomitant chemotherapy. All
pts were treated with active beam scanning PT using 2-3
fields with single field optimization (SFO) technique.
Acute and late toxicities were registered according to
Common Terminology Criteria for Adverse Events version
4.0. Patients’ quality of life was assessed using the
EORTCEORTC QLQ-C30 questionnaire.
Results
Treatment was well tolerated: all patients completed PT
without breaks. Acute Grade 3 cutaneous erythema
occurred in four pts . Registered G2 toxicities were fatigue
(1) and soft tissue edema (1). Concerning late toxicities,
one patient had persistent G1 pain at the site of previous
irradiation and in one pt acute G3 skin erythema became
G1 chronic dyschromia. At a median follow-up of 7.4
months (range, 1.4-12.7 months), all pts are alive with
controlled local and distant disease
Conclusion
Our preliminary experience shows that PT re-irradiation of
recurrent H&N sarcoma is feasible and safe. Longer follow-
up and a larger number of patients are needed to
definitively assess efficacy and late toxicity.
Poster: RTT track: Risk management / quality
management
PO-1021 An electronically configurable checklist
program for quality control of RT treatment planning
K.H. Grosser 1, A.C. Schulte1, W. Harms1
1St. Claraspital, Radiooncology, Basel, Switzerland
Purpose or Objective
To asses efficacy of an adaptive checklist program to
facilitate plan review for physicists.
Material and Methods
Pre-treatment plan review is fundamentally important to
patient safety and treatment plan quality. A critical
control point in this process is the ‘Planning Approval‘
process. To reduce the error rate we developed an
adaptive electronical planning approval checklist as part
of our quality assurance. We applied this program to more
than 600 treatment plans produced with the Eclipse
treatment planning system (VARIAN). Because we wanted
to optimize the checklist continuously the program was set
up to be adaptive with respect to the plan type and to
allow the addition of new checklist items. All evaluated
cases were documented in a database. The incidence rates
of errors and their types are reported.
Results
The checklist program was introduced into clinical routine
in October 2012 and was used in this version until the end
of 2015.
In total 638 plans were checked. With the help of this
checklist program 303 errors in 190 treatment planes
were detected. Most errors were classified as minor errors
(i.e. incorrect target volume nomenclature). However, 29
dose-related errors have also been found.
13 new checklist items have been gradually added to the
existing checklist to account for newly detected error
possibilities.
The average time to complete the checklist was
approximately 3 minutes. The compliance rate was very
high. As expected, the acceptance of the “Do-Confirm”
strategy was higher than for the “Read-Do” practice.
Conclusion
A planning approval checklist is a valuable tool to reduce
the error rate of treatment plan validation to almost zero.
An automated or semi-automated checklist tool with
direct access to the database of the treatment planning
system would be desirable.
PO-1022 Implementation of a paperless workflow in
radiotherapy; Reducing transcription
O. Shoffren 1, Y. Tsang1, J. Kudhail1
1Mount Vernon Cancer Centre, Radiotherapy
Department, borehamwood, United Kingdom
Purpose or Objective
It is well recognised that due to the complexities of the
radiotherapy pathway transcription errors are common. As
such robust processes are in place throughout the
treatment pathway to ensure checking processes are fit
for purpose.
With the importance on using source data to eliminate this
potential for transcription errors to arise, our centre has
adopted a paperless workflow allowing access to source
data ; from referral to the last fraction of radiotherapy.