ESTRO 36 Abstract Book

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S668 ESTRO 36
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1 LMU Munich, Department of Radiation Oncology,
Munich, Germany
2 German Cancer Research Center DKFZ, Department of
Molecular Radiation Oncology, Heidelberg, Germany
Purpose or Objective
To report our experience with stereotactic body
irradiation in primary and secondary liver lesions.
Material and Methods
We retrospectively analysed 37 patients who had not been
eligible for other local treatment options (surgery, RFA)
and therefore received SBRT to 1-2 liver lesions (43 lesions
in total) in our institution from 2011-2015. Median age was
66 years (31 – 83 years) and 20 patients were male. 16
patients suffered from HCC/CCC, 21 patients had
oligometastatic liver disease, mainly originating from
colorectal cancer. The majority presented in good
performance status (median KPS 90%, range 60%-100%)
with adequate liver function (cirrhosis Child A: 13, Child
B: 2, Child C: 1, none: 21). Immobilization included a
vacuum pillow in all patients and the use of abdominal
compression since 2014. Treatment planning was based on
4D-CT (contrast-enhanced since 2014) usually after
placement of fiducial markers and rigid registration with
diagnostic MRI images. Median ITV to PTV margin was 6
mm.
Results
Mean follow-up was 14 months (range 1 - 47) Fiducials
were needed in 29 patients (78%). Placement was feasible
without any complications in all patients. Abdominal
compression was used in 12 patients since 2014 to reduce
breathing motion. Dose and fractionation varied
dependent on localisation, size, motion and liver function.
The most common schemes were 37.5 Gy/65% isodose in 3
fractions, 40 Gy/80% in 5 fx and 54Gy/80% in 9 fx. Median
GTV volume on free-breathing CT was 13 ccm (1-247) and
median PTV volume was 126 ccm (15-537). Local
recurrence (in field) was observed in 6 patients (16%)
resulting in a 1-year LC rate of 92%. New lesions in the
liver (out-field) occured in 20 patients (54%), 15 (40%)
patients developed extrahepatic progression. 5 patients
have died, resulting in a 1-year overall survival of 87% in
all patients. No significant differences in any endpoint
have been observed between HCC/CCC and
oligometastatic patients, although the latter ones had a
higher absolute 1-year OS rate (73% vs 87%). Toxicity was
generally mild (grade 1: 8 pts., grade 2: 2 pts.), except
one patient with Child C cirrhosis who developed hepatic
failure shortly after SBRT which was successfully treated
by liver transplantation.
Conclusion
SBRT is a locally effective and well tolerated treatment
method for primary and secondary liver lesions. Given the
high rates of intrahepatic outfield failures, careful
pretreatment evaluation and patient selection seems
mandatory.
EP-1240 Stereotactic radiotherapy in pancreatic
cancer: a systematic review on pain relief
M. Buwenge1, G. Macchia2, F. Deodato2, S. Cilla3, L.
Caravatta4, A. Farioli5, A. Guido1, A. Arcelli1,6, F. Bertini1,
F. Cellini 7, G.C. Mattiucci7, M.C. Di Marco8, S. Cammelli1,
G. Tolento1, V. Valentini7, L. Fuccio5, A.G. Morganti 1
1 University of Bologna, Radiation Oncology Center-
Department of Experimental- Diagnostic and Specialty
Medicine - DIMES, Bologna, Italy
2 Fondazione di ricerca e cura "Giovanni Paolo II",
Radiotherapy unit, Campobasso, Italy
3 Fondazione di ricerca e cura "Giovanni Paolo II", Medical
Physics Unit, Campobasso, Italy
4 Centro di Radioterapia e Medicina Nucleare- P.O.
Businco, Radiotherapy Unit, Cagliari, Italy
5 University of Bologna, Department of Medical and
Surgical Sciences - DIMEC, Bologna, Italy
6Ospedale Bellaria, Radiotherapy Department, Bologna,
Italy
7Policlinico Universitario "A. Gemelli"- Università
Cattolica del Sacro Cuore, Department of Radiotherapy,
Roma, Italy
8University of Bologna, Oncology Center- Department of
Experimental- Diagnostic and Specialty Medicine - DIMES,
Bologna, Italy
Purpose or Objective
In locally advanced pancreatic carcinoma (LAPC) standard
radiotherapy and concurrent chemoradiation are able to
reduce pain. Stereotactic radiotherapy (SBRT) is an
emerging treatment technique but its role in pain
palliation is not well known. Therefore, aim of this
analysis was to systematically review the palliative effect
of SBRT in LAPC.
Material and Methods
A systematic review based on PRISMA methodology of
papers reporting pain control after SBRT in LAPC patients
was performed using PubMed database. Combination with
chemotherapy was allowed. Only article published in
English were considered.
Results
A total of 11 studies reporting data on pain control after
SRT in LAPC patients met the inclusion criteria. SBRT was
performed using both standard and robotic Linacs. The
prescribed SBRT median total dose 24 Gy (range: 14-45
Gy), and the median number of fraction was 3 (range: 1-
6). Median EQD2 using α/β: 10 and α/β: 3 were 65.5 Gy
(range 31.3-93.8) and 95.0 Gy (range 40.0-162.0),
respectively. Nine of the 11 studies reported different
rates pain reduction. Particularly, median pain ORR was
57.0% (range: 44.0-100.0%) with 2 studies reporting pain
CR in 48.4% and 81.3% of patients. Reduction of analgesic
consumption was recorded in 65.0-100.0% of patients. One
study reported no significant pain reduction, while
another study reported a significant worsening of pain 2
weeks after SBRT. Acute and late toxicity (grade ≥ 3)
ranged between 3.3-18.0% and 6.0-8.2%, respectively. All
recorded toxicity were GI complications.
Conclusion
SBRT was able to achieve pain reduction in most studies
with a reasonable rate of side effects. Therefore, further
prospective studies on palliative role of SBRT in LAPC
seems to be justified. Aim of these trials should be the
definition of the optimal dose/fractionation and the best
way to combine SBRT with systemic therapies. Finally,
being treatment of LAPC patients mainly palliative,
quality of life and particularly pain control should be
considered as an end point in future SBRT trials.
EP-1241 Successful pain relief after a short course of
palliative radiotherapy in painful pancreatic cancer.
G. Ebrahimi1, C.R.N. Rasch1, G. Van Tienhoven 1
1Academic Medical Center, Radiation oncology,
Amsterdam, The Netherlands
Purpose or Objective
Patients with pancreatic cancer have a high burden of
symptoms. At time of diagnosis 30-40% of the patients
report pain as a dominant symptom, which rises up to 90%
shortly before death. Because of a poor overall survival,
the burden of a palliative treatment should be balanced
against the expected effect. This study was conducted to
assess the effect of a short course of palliative
radiotherapy on pain symptoms.
Material and Methods
All patients who were treated with palliative radiotherapy
because of painful pancreatic cancer between 1998 and
2015 were retrospectively analyzed. Primary endpoint was
pain relief and secondary endpoint was overall survival.