ESTRO 36 Abstract Book

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S619 ESTRO 36
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critical because a standard is lacking and treatments are
associated with a higher toxicity.
We evaluated efficacy and tolerance in patients with
PCNSL treated with whole brain radiotherapy because
unfit for chemotherapy or with recurrence/ no response
after chemotherapy treatment.
Material and Methods
From April 2010 to December 2014, fifteen consecutive
patients with hystologically proven PCNSL underwent
whole brain 3-dimensional conformal radiotherapy at our
institution. One patients was excluded because lost to
follow-up. Mean age was 59.7 and median age was
70(range 30-77). Median KPS was 60(range 50-90).
Two patients had a recurrence after a complete response
to upfront chemotherapy. The other 12 patients were
unfit for chemotherapy or had chemotherapy suspended
for toxicity or underwent chemotherapy with no response.
Median radiotherapy dose was 38,5 Gy(range 24-45),
median fraction dose was 2 (range 1,8-3 Gy) and median
number of fractions was 19(range 10-23).
Data were retrospectively analyzed. Survival was
calculated from the diagnosis to the death date or last
follow-up.
Results
Median follow-up was 28.5 months(range 23-76) . Eleven
patients (79%) completed radiotherapy without breaks.
One patient died during radiotherapy, one stops the
treatment because of neurological deterioration and one
for lack of compliance.
Median survival from first diagnosis was 8.5 months (range
1-70). Median survival from the end of radiotherapy was 4
months(range 1-34).
In patients older than 60 years (64%) median survival from
diagnosis was 14 months and in patients younger than 60
years(36%) was 4 months. One of these patients, HIV-
positive, died one month after the completion of
radiotherapy.
One-year survival rates from diagnosis was 46%, 2 years
survival rate was 30% and 5 years survival rate was 7%.
Fifty percent of patients had a radiologic or clinical
progression. In 5 patients radiologic response was not
assessed because of poor clinical conditions. Five/9
patients (55%) who underwent imaging evaluation had a
response (33% complete and 22% partial).
In 25% of patients an early improvement of neurological
status during radiotherapy was reported.
Conclusion
Despite limitations due to the small number of patients,
radiotherapy may represent a feasible option in patients
with diagnosis of PCNSL that are unfit for chemotherapy
or had recurrence or no response, with a quite good
tolerance and survival in same cases. We have not
observed worse tolerance or survival in older patients.
EP-1136 Technical results of total skin irradiation
using helical TomoTherapy.
K. Okuma1, A. Haga1, Y. Imae1, W. Takahashi1, K.
Nakagawa1
1 University of Tokyo Hospital, Radiology, Tokyo, Japan
Purpose or Objective
The purpose of this study was to report results of dose
distributions of total skin irradiation (TSI) for cutaneous T-
cell lymphoma using helical TomoTherapy (Accuray,
Sunnyvale, CA).
Material and Methods
In our institution, six patients with refractory T-cell
lymphoma were tried to treat of TSI using TomoTherapy.
Treatments were delivered to three parts of the body
(legs, head and neck, and trunk). Patients were received
a prescription dose of 10-20 Gy in 10 fractions over 14 days
in each part.
Results
Five out of six patients, TomoTherapy technique was able
to achieve good coverage of the planning target volume
(PTV) and good sparing of organ at risk. In one patient who
was a 25-year-old big man diagnosed mycosis fungoides,
dose distribution of trunk, especially abdominal skin, were
not able to achieve good coverage of PTV. The body mass
index (BMI) of the patient was 30.6 while the mean BMI of
other patients were 22 (18-25). However, a trial planning
using another big patients’ CT (BMI=38) showed good dose
distribution.
Conclusion
Using helical TomoTherapy was a good new treatment
technique for TSI. It was not able to get good coverage of
PTV for all patients. This treatment method will be
needed further research to get good dose distribution for
all patients.
EP-1137 Meningeal localisation in Sezary Syndrome
patient treated with VMAT craniospinal irradiation
R. MuniI1, M. Fortunato2, 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, Medical Physics, Bergamo,
Italy
Purpose or Objective
Sezary syndrome(SS) is a rare erythrodermic and leukemic
variant of cutaneous T cell lymphomas(CTCL) that belongs
to extranodal non-Hodgkin’s lymphomas. SS together with
mycosis fungoides (MF) are the most common forms of
has an aggressive behavior with a median survival
of 1–5 CTCL nervous system involvement has been
reported in 1.6% of patients. Most patients had a MF with
malignant transformation and usually it is associated with
late stage disease and very poor prognosis. Individual case
reports of patients with large cell trasformation of MF but
not of SS, were report a case of
histologically proven meningeal involvement in a patient
with early stage SS treated with craniospinal irradiation
with Volumetric Modulated Arc Therapy(VMAT) technique
with long term radiologic complete response, alive 5 years
after diagnosis.
Material and Methods
Case report. A 67-year-old woman with a Sezary Syndrome
diagnosed 3 years before, with a 3 months history of
headache, underwent a cranial magnetic resonance
imaging (MRI) showing diffuse meningeal contrast
enhancement with thickening, especially in frontal
meninx. A biopsy was performed with diagnosis of
meningeal localisation of T cell lymphoma.She underwent
intratechal chemotherapy with radiologic stable disease,
so a craniospinal irradiation with VMAT technique was
performed. Prescription dose was 18 Gy on entire neuraxis
in 10 fractions (1.8 Gy per fraction) and a 6 Gy sequential
boost in 3 fractions on the brain(total dose 24 Gy).
Treatment was performed in supine position with a head
long mask and a vacuum pillow including body till pelvis.
PTV length was 70 cm. Three isocenters were used.
Distance between cranial and thoracic isocenters and
between thoracic and abdominal isocenters was 23 cm.
Plan was optimised defining an overlapping region
between arcs of different isocenters so that no field
matching was necessary. Set-up position verification by
daily CBCT was performed.
Results
Headache resolution was observed before the end of
radiation treatment. No toxicity was reported.The first
MRI performed 1 month after the completion of
radiotherapy showed a partial response and after 6
months, a complete radiologic response was achieved. At