ESTRO 36 Abstract Book

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S618 ESTRO 36
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1 Barretos Cancer Hospital, Radiation Oncology, Barretos,
Brazil
2 UCLA, Radiation Oncology, Los Angeles, USA
Purpose or Objective
To evaluate the clinical outcomes with linear accelerator-
based multifraction stereotactic radiosurgery (mSRS), 3
fractions, to treatment of the large Brain Metastasis in
Brazilian Population.
Material and Methods
Patients with brain metastases were included with 30 days
or more of the end of the mSRS, between May 2015 to
August 2016.
The primary endpoint was acute toxicity and the
secondary endpoints were overall survival, local control
(in field) and Regional recurrence free survival. Prognostic
factors were analyzed, as Ds-GPA, RPA, the number of
treated lesions, the major lesion, time between the last
chemotherapy and procedure, fractionation (7, 8 or 9 Gy
/ fraction). The acute toxicity scale used was the RTOG /
EORTC. For the survival curve calculations were used
Kaplan- Mayer and Log-Rank test. To compare different
categories of the same variable was used chi-square test.
The significance level was 0.05.
Results
Were treated 51 patients, corresponding 110 lesions, 49%
patients had one lesion. The study showed median follow-
up of 8.00 months (2.42– 13.57). The overall survival (OS)
estimated at 6 and 12 months were 58% and 43%
respectively, with 84% non-neurologic deaths at 12
months. The primary sites were lung (39.2%), breast
(29.4%) and colon/rectum (15.7%). The 9 Gy/fractions was
the most used in 84.3% patients, 5.9% were treated with 8
Gy/fraction and 9.8% with 7 Gy/fraction. The median KPS
was 80% (50-100%). Of the DS-GPA found, 31.9% had 0 – 1,
38.3% was 1.5 - 2.5 and 3 – 4 in 29.8%. The most of the RPA
was 2 (45.1%). There were influence of the RPA and Ds-
GPA in overall survival. The local control estimated at 12
months was 81%. There wasn’t statistical significance
between local control with fraction, GTV and PTV volume,
WBRT and Primary tumor. Toxicity Grade 2 was 31 % (most
common was seizure, 16%). The regional recurrence free
survival were 69.2% and 43% in 6 and 12 months. There
were 3 patients with acute grade 3 CNS toxicity.
Radionecrosis was observed in 6% of patients until this
moment, and we had 2 “radiation Recall” episodes, after
FOLFOX chemotherapy. There weren’t relation between
toxicity and Radionecrosis with dosimetric and clinical
variables, as Conformity Index, Brain Volume receiving 24
Gy, number of lesions, fractionation, etc.
Conclusion
Until this moment, our trial showed that mSRS is safe and
feasibility, with excellent local control rates and low
toxicity. Despite the most patients showed regional
failure, out of field, death by neurologic causes was very
low, just 15%. More patients included and longer follow-
up must be help in improve and confirm the efficiency of
this strategy.
Electronic Poster: Clinical track: Haematology
EP-1134 Head and neck DLBCL in HIV-positive
patients: long-term results in the HAART era
F. De Felice1, L. Grapulin1, A. Di Mino1, J. Dognini 1, D.
Musio1, V. Tombolini1
1 Policlinico Umberto I- Sapienza Università Roma,
Radiotherapy, Rome, Italy
Purpose or Objective
To report long-term outcomes and toxicity rates after
chemotherapy (CHT) followed by radiotherapy (RT) in the
highly active antiretroviral therapy (HAART) era in human
immunodeficiency virus (HIV) positive patients with head
and neck diffuse large B-cell lymphomas (HN-DLBCL).
Material and Methods
Clinical data concerning consecutive HIV patients treated
for DLBCL located in head and neck region with CHT and
RT between January 1995 and August 2010 were
retrospectively reviewed. Systemic treatment consisted of
combination CHT agents given with concomitant HAART
and regimen was left to oncologists’ discretion. Involved
field RT was delivered with a 3D-conformational technique
at a total dose of 30/36 Gy (2 Gy per fraction). Survival
rates were estimated using the Kaplan–Meier method.
Toxicity was evaluated using National Cancer Institute’s
Common Terminology Criteria for Adverse Events.
Results
Overall, 13 patients were included. There were no missing
data. Seven patients had limited disease (stage I = 3; stage
II = 4) and 6 patients had stage IV disease. Primary tumour
location was sinus (n = 4), oral cavity (n = 7), nasopharynx
(n = 1) and larynx (n = 1). All patients completed the
programmed treatment.
Overall, 4 patients had died. No treatment-related deaths
were recorded. The 10-year, 15-year and 20-year overall
survival (OS) rates were 87.5% (95% confidence interval
[CI] 0.387 – 0.981), 62.5% (95% CI 0.229 – 0.861) and 50%
(95% CI 0.152 – 0.775), respectively. Median OS was 168
months. Details are shown in Figure 1. In total, only 1
patient had local relapse, 10 years after the end of RT.
The patient received CHT and is still alive without
evidence of disease. No patients had developed distant
metastasis.
Globally, there were no RT-related late complications.
One patient had a second cancer arising from cervix, 5
years after the end of treatment.
Conclusion
This data analysis suggested that CHT followed by RT can
be safety proposed in the management of patients with
HIV-related HN-DLBCL in the HAART era. Combined
modality therapy reduced local recurrence rates and
achieved a high response rate, without chronic toxicity.
EP-1135 Radiotherapy in primary CNS lymphoma
R. Muni1, G. Grittii2, L. Feltre 1, F. Filippone1, E.
Iannacone1, M. Kalli1, L. Maffioletti1, F. Piccoli1, S.
Takanen1, L. Cazzaniga1
1ASST Papa Giovanni XXIII, Radiation Oncology, Bergamo,
Italy
2ASST Papa Giovanni XXIII, Haematology, Bergamo, Italy
Purpose or Objective
Primary CNS lymphoma(PCNSL) is a rare and aggressive
brain tumor with poor prognosis. Patients are primarily
treated with high dose chemotherapy while radiotherapy
plays a role as consolidation after chemotherapy. Total
dose and fractionation are not well established.
In patients older than 60 years the incidence is higher with
a worse outcome. The management of these patients is