ESTRO 36 Abstract Book

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S672 ESTRO 36
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Table 1. The median follow-up time was 26.87 months.
Regional lymph node recurrence alone was only noted in
one patient who didn’t undergo RT. Distant metastases
(DM) were noted in 17 patients (with RT: 8; without RT:
9). Out of those nine patients who developed DM and
didn’t undergo RT, five had been given chemotherapy. Age
is significantly related to worse OS (Pearson correlation
coefficient=-0.248, p=.037) but not to DFS (-0.191,
p=0.111). Positive LNs number is significantly related to
both worse OS (-0.244, p=0.041) and DFS (-0.261,
p=0.028). Adjuvant RT didn’t significantly improve OS
(median: 34.3 vs. 19.7 months, p=0.123) and DFS (median:
30 vs. 17.7 months, p=0.86) (Fig. 1). The patients received
adjuvant chemotherapy were with significantly longer OS
(median: 31.9 vs. 14.7 months, p=0.007) but not DFS
(median: 28.6 vs. 14 months, p=0.42).
Conclusion
Although the patients who underwent adjuvant CRT were
significantly younger, they were also with more advanced
diseases. Most of the recurrent events were distant
metastases in our study, indicating that D2 dissection
might have largely decreased the locoregional failure
rate. Adjuvant RT didn’t show significant benefit
prolonging OS or DFS. On the other hand, the patients
received adjuvant chemotherapy were observed to have
significantly longer OS but not DFS. It is possible that the
prolonged OS is correlated to the age of patients, rather
than a result of chemotherapy. Further randomized
controlled trials are required to draw a concrete
conclusion.
EP-1249 Changes in normal liver volume after high
dose radiation in cancer of the liver
K. Rajamanickam1, S. Chopra1, R. Engineer1, V. Ostwal1,
P. Patil2, S. Mehta2, E. Dhandpani 3, K. Joshi3, S.K.
Shrivastava1
1 Tata Memorial Hospital, Radiation Oncology, Mumbai,
India
2 Tata Memorial Hospital, Digestive Diseases and Clinical
Nutrition, Mumbai, India
3 Tata Memorial Hospital, Medical Physics, Mumbai, India
Purpose or Objective
To report liver volume changes and its impact on liver
function following hepatic radiation in patients with
primary or secondary hepatic malignancies.
Material and Methods
From Jan 2015 - April 2016, consecutive patients with
unresectable hepatic lesions (hepatocellular cancer
(HCC), Cholangiocarcinoma (CCA) or liver metastasis (LM))
who received either high dose radiation (HDRT) or
stereotactic radiation (SBRT) and without disease
progression were included. All patients were required to
have Child Pugh status A-B6 prior to radiation. Total liver
volume, gross tumour volume (GTV), normal liver volume
(total liver volume- GTV) was determined. Follow up scans
were used to determine changes, if any, in normal liver
volume. As the dose prescription of each patient was
individualised, biologically equivalent dose (BED) were
calculated. Univariate analysis was perform out to
determine impact of total dose, GTV at treatment, use of
systemic chemotherapy, primary tumour type, baseline
liver function status, age and viral marker status on
normal liver volume and liver function during follow up.
Reduction in liver volume at follow-ups were analysed
with paired t-test. p value of <0.05 was considered
significant.
Results
Thirteen patients received either SBRT or HDRT. Out of
these 6/7 patients with HCC received TACE prior to RT
initiation and all received sorafenib while 3/4 with CCA
received gemcitabine and cisplatin concurrently with
radiation. Another 2 were treated for LM. The Median BED
was 59.5 Gy (48 - 85.5 Gy). The follow up scans were
performed at 1 month and 4 monthly thereafter. The
median normal liver volume at baseline, 1st, 2 nd and 3rd
follow up was 1105 (423-2100) cc, 918 (614 - 1899) cc, 778
(490 - 1746) cc and 816 (576 - 2101) cc for the entire
cohort and 1098 (423 – 2100) cc, 886 (614 – 1899) cc, 778
(490 - 1746) cc and 750 (576 – 1136) cc for patients with
primary hepatic malignancy (PHM). The reduction in liver
volume was statistically significant at 4 months (p=0.05)
in entire cohort. In PHM cohort, at 4 and 8 months
reduction in liver volume were found significant (p=0.05
and p=0.05, respectively). Deterioration of Childs score
was presented in 2/13 patients. This loss in liver function
could represent ongoing radiation effects on
compensatory liver hypertrophy or hepatocyte
regeneration. However no correlation was seen between
child score deterioration and loss of liver volume.
On univariate analysis, the higher normal liver volume at
baseline irradiated shows statistically significantly higher
loss of liver volume (p=0.005). None of other tumour or
treatment related factors had impact on liver volume
changes.
Conclusion
The reduction in liver volume at follow up does not
correlate with any tumour or treatment parameters other
than normal liver volume at baseline. This ongoing loss of
hepatic function and reduced hepatocyte regeneration
after hepatic radiation needs further investigation.
EP-1250 Prognostic impact of post-surgery and post-
adjuvant therapy in resected pancreatic
adenocarcinoma
G.C. Mattiucci1, A. Arcelli2,3 , F. Bertini2, F.A. Calvo4, M.
Falconi5, G.P. Frezza3, A. Guido2, J.M. Herman 6, R.C.
Miller7, V. Picardi8, G. Macchia8, W.F. Regine9, N.
Sharma9, M. Reni10, A. Farioli11, A.G. Morganti 2, V.
Valentini1
1Policlinico Universitario "A. Gemelli"- Università
Cattolica del Sacro Cuore, Department of Radiotherapy,
Rome, Italy
2University of Bologna, Radiation Oncology Center-
Department of Experimental Diagnostic and Speciality
Medicine - DIMES, Bologna, Italy
3Ospedale Bellaria, Radiotherapy Department, Bologna,
Italy
4Hospital General Universitario Gregorio Maranon-
Complutense University, Department of Oncology,
Madrid, Spain
5Università Politecnica delle Marche, Department of
Surgery, Ancona, Italy
6Johns Hopkins University School of Medicine,
Department of Radiation Oncology and Molecular
Radiation Sciences, Baltimore, USA
7Univeristy of Virginia, Department of Radiation
Oncology, Charlottesville, USA
8Fondazione di Ricerca e Cura "Giovanni Paolo II",
Radiotherapy Unit, Campobasso, Italy
9University of Maryland Medical Center, Department of
Radiation Oncology, Baltimore, USA
10S. Raffaele Scientific Institute, Department of
Oncology, Milan, Italy
11University of Bologna, Department of Medical and
Surgical Sciences - DIMEC, Bologna, Italy
Purpose or Objective
Prognosis of pancreatic adenocarcinoma (PAC) is so dismal
that annual mortality and incidence rates overlap. Several
studies suggested that preoperative CA19.9 (prCA19.9)
could be a useful prognostic marker in patients treated
with surgery +/- adjuvant therapies. The purpose of this
study was to determine whether post-surgical CA19.9
(poCA19.9) or post-adjuvant CA19.9 (paCA19.9) or a
change in prCA19.9 to poCA19.9 could predict pattern of