ESTRO 36 Abstract Book

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S745 ESTRO 36
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EP-1391 Digestive toxicity after conformal
radiotherapy for palliative cervico-thoracic spinal
metastases
G. Peyraga1, D. Caron1, Y. Metayer2, Y. Pointreau 3, F.
Denis3, G. Ganem3 , C. Lafond3, S. Roche3, O. Dupuis 3
1 Institut de Cancérologie de l'Ouest, Radiation Therapy,
Angers, France
2 Centre Jean Bernard, Medical Physics, Le Mans, France
3 Centre Jean Bernard, Radiation Therapy, Le Mans,
France
Purpose or Objective
The palliative treatment of cervico-thoracic spinal
metastases is based on a conformal radiotherapy (CRT),
delivering 30 Gy in 10 fractions (5 days a week for 2
weeks). Digestive toxicities (esophagitis, nausea and
vomiting) are common after these radiations and cause a
clinical impact probably underestimated in patients. We
performed a retrospective monocentric study of early
digestive toxicities occurred secondarily to palliative CRT
of cervico-thoracic spinal metastases.
Material and Methods
All patients receiving palliative CRT at Jean Bernard
Center from January 2013 to December 2014 of spinal
metastases (all primitive tumors were included) between
the fifth cervical vertebra (C5) and 10th thoracic vertebra
(T10) for which clinical follow-up was available beyond 3
months were included. Re-irradiations were excluded.
CRT was delivered by a linear accelerator (CLINAC,
Varian). Premedication to prevent digestive toxicities was
not recommended. Adverse events (esophagitis and
nausea/vomiting < 3 months) were evaluated according
the NCI-CTCae (version 4).
Results
From January 2013 to December 2014, 128 patients met
the study criteria. The median age was 69.6 years [31.8;
88.6]. The majority (84.4%) patients received a dose of 30
Gy in 10 fractions. The median treatment duration was 13
days [3-33]. Forty patients (31.3%) experienced grade 2 or
3 of esophagitis (35 grade 2 (27.4%) and 5 grade 3 (3.9%)),
and 8 patients (6.3%) experienced grade 2 or 3 of nausea
or vomiting (6 grade 2 (4.7%), 1 grade 3 (0.8%) and 1 grade
4 (0.8%)). The risk of digestive toxicities seems to be
related to spinal localization of metastases (38.5% of
grade 2 or 3 esophagitis if radiation from C5 to T4 versus
31.2% if radiation from T5 to T10, and 87.5% of nausea and
vomiting concerned T9 or T10) and to the number of
irradiated vertebrae (43.9% of esophagitis if more than 5
vertebrae are irradiated versus 25.3% if less than 6
vertebrae are irradiated).
Conclusion
The incidence of esophagitis after palliative CRT of
cervico-thoracic spinal metastases led to considering
static or dynamic Intensity Modulated Radiation Therapy
(IMRT) to reduce the dose to organ at risk (esophagus).
IMRT could be primarily beneficial if palliative
radiotherapy concerns vertebrae between C5 and T4 and
if it affects more than 5 vertebrae.
EP-1392 Prognostic factors for survival in patients with
bone metastases
P.M. Samper Ots1, M. Hernandez Miguel1, E. Amaya
Escobar1, M.D. De las Peñas Cabrera1
1 Hospital Rey Juan Carlos, Servicio de Oncologia
Radioterapica, Mostoles - Madrid, Spain
Purpose or Objective
To analyze the prognostic factors for survival in patients
with bone metastases.
Material and Methods
Retrospective analysis of 104 patients referred for
treatment of bone metastases, median age was 59 years,
69 males (66.3%). The most common primary tumors were:
lung 36 cases (34.6%), prostate 24 (23.1%) and breast 13
(12.6%). The means time diagnosis of bone metastases was
14.55 ± 2 months. 85 patients were treated with 3DRT
(81.7%), 9 SBRT (8.7%) and 10 no treatment (9.6%). The
study was approved by the Ethics Committee for Clinical
Research (CEIC) and meets the standards of data
protection. For statistical analysis SPSS version 22.0 was
used.
Results
70 patients (67.3%) died with a median survival of 14.4
months after the diagnosis of bone metastases. Survival
according to the treatment was: 3DRT 13.73 ± 21.3
months, SBRT 20.7 ± 12.0 months and without RT 10.48 ±
10.7 months (p <0.001). The median survival after end of
radiotherapy was 19.4 ± 5.66 months. Prognostic factors
for survival were: primary tumor controlled versus
uncontrolled 45.3 ± 15.4 versus 7.64 ± 1.09 months (p =
0.001), metastases in other organs 15.23 ± 5.2 versus not
22 ± 4.7 months (p = 0.04), lymph node metastasis 13 ±
5.06 versus not 18 ± 4.3 months (p = 0.007), liver
metastases 6.42 ± 1.52 versus not 24.44 ± 7.75 months (p
= 0.028), ECOG 0 (49.5 ± 17.1), 1 (7.49 ± 1.38), 2 (8.78 ±
1.97) and 3 (3.88 ± 1) p = 0.003. The primary diagnosis:
lung 5.68 ± 1.25 months, breast 59.81 ± 21.12 months,
prostate 18.85 ± 5.2 months (p = 0.013). In patients with
lung cáncer, the histology was a prognostic factor:
epidermoid 2.65 ± 0.9 months, adenocarcinoma 7.69 ± 1.8
months and small cell 1.92 ± 1.32 months (p = 0.009). The
time to diagnosis of bone metastases was not prognostic
factor for survival.
Conclusion
In patients with bone metastases, the best prognosis are
breast cáncer, primary controlled, no other metastases,
SBRT and ECOG 0.
EP-1393 Prognostic factors for survival in patients with
brain metastases
P.M. Samper Ots1, M. Hernandez Miguel1, E. Amaya
Escobar1, M.D. De las Peñas Cabrera1
1Hospital Rey Juan Carlos, servicio de oncologia
Radioterapia, Mostoles - Madrid, Spain
Purpose or Objective
To analyze the prognostic factors for survival in patients
with brain metastases.
Material and Methods
Retrospective analysis of 87 patients referred for
treatment of brain metastases, median age was 62.3 ± 13
years, 56 males (64.4 %). The most common primary
tumors were: lung 56 cases (64.4%), breast 12 (13.8 %) and
colorectal 9 (10.3%). The means time diagnosis of brain
metastases was 16.3 ± 35.36 months. 63 patients were
treated with holocraneal 3DRT (72.4%), 5 holocraneal and
boost (5.7%), 6 Stereotactic fracctionated radiotherapy
(SFR) (6.8%) and 13 no treatment (14.9%). The study was
approved by the Ethics Committee for Clinical Research
(CEIC) and meets the standards of data protection. For
statistical analysis SPSS version 22.0 was used.
Results
73 patients (83.9%) died with a median survival of 7.66 ±
0.96 months after the diagnosis of brain metastases.
Survival according to the treatment was: holocraneal
6.84 ± 0.97 months, holocraneal and boost 13.06 ± 6.04
months, SFR 7.38 ± 1.5 months and without RT 6.38 ± 2.6
months (p <0.519). The median survival after end of
radiotherapy was 6.47 ± 0.98 months. The time to
diagnosis of brain metastases, the situation of the
primary, metastases in other organs, number of brain
metastases, surgery of metastases, radiosurgery were not
prognostic factors for survival. Prognostic factors for
survival were: ECOG 0 (8.99 ± 1.43 months), 1 (8.05 ± 2.26
months), 2 (2.78 ± 0.64 months) and 3 (1.24 ± 0.94 months)
p = 0.000. Not completing radiotherapy 0.24 ± 0.12 versus