763 / 1096
S747
ESTRO 36
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EP-1396 Versatis® and focal neuropathic pain in
cancer patients (screening tool)
C. Prieto Prieto
1
, E. López Ramirez
2
1
Hospital Universitario Virgen de las Nieves, Radiation
Oncology, Granada, Spain
2
Oncosur, Oncología Radioterápica, Granada, Spain
Purpose or Objective
Lidocaine 5% patch (L5%P) = (Versatis®) represents a novel
therapeutic approach to neuropathic pain in cancer
patients. The objective of this study is to evaluate its role
in treating acute or chronic focal neuropathic pain (FNP)
in cancer patients, regardless of its causal relationship
with the tumour.
Material and Methods
We collected information from 33 cancer patients with
focal neuropathic pain (FNP) treated with L5%P. Some
interesting data related to L5%P use were analyzed: NP
nature, body areas affected, previous and concomitant
analgesic treatment, time from patch application to
analgesic effect, duration of therapy with L5%P, analgesic
efficacy and adverse reactions. Therapeutic indication
with L5%P was established in all patients using a validated
FNP screening tool (ST) consisting in 4 simple questions.
Results
All patients underwent radiotherapy in our Departments.
66.7% of them (n=22) suffered from FNP related with
cancer and its therapies. In the other 33.3% of cases
(n=11), FNP was not considered related. Potent analgesic
effect of L5%P was observed in 23 cases (69.7%), and
partial effect in 5 cases (15,2%). It represents an 84.9% of
efficacy in our sample. 81.3% of patients did not report
adverse reactions at all. 45.5% of patients achieved pain
control within one week after starting L5%P treatment.
39.4% of patients did not need concomitant analgesic
treatment.
Conclusion
Our data support that L5%P (alone or in association with
other drugs) may be an effective and safe approach for
FNP in cancer patients.
EP-1397 Dose painting guided by diffusion-weighted
MRI applied to recurrent glioblastoma: a phase I
protocol
M. Iori
1
, M. Galeandro
2
, A. Botti
1
, R. Sghedoni
1
, P.
Ciammella
2
, M. Orlandi
1
, M. Napoli
3
, S. Tanzi
4
, R.
Pascarella
3
, S. Cavuto
5
, A. Pisanello
6
, M. Russo
6
, E.
Cagni
1
, D.E. Chiari
7
, M. Campioli
8
, C. Iotti
2
1
Arcispedale S. Maria Nuova - IRCCS, Medical Physics
Unit, Reggio Emilia, Italy
2
Arcispedale S. Maria Nuova - IRCCS, Radiation Oncology
Unit, Reggio Emilia, Italy
3
Arcispedale S. Maria Nuova - IRCCS, Neuroradiology
Unit, Reggio Emilia, Italy
4
Arcispedale S. Maria Nuova - IRCCS, Palliative Care
Unit, Reggio Emilia, Italy
5
Arcispedale S. Maria Nuova - IRCCS, Infrastructure
Research and Statistic, Reggio Emilia, Italy
6
Arcispedale S. Maria Nuova - IRCCS, Neurology Unit,
Reggio Emilia, Italy
7
UNITN, Dipartimento di Fisica, Trento, Italy
8
UNIMORE, Dipartimento di Scienze e Metodi
dell’Ingegneria, Reggio Emilia, Italy
Purpose or Objective
Standard treatment for glioblastoma (GBM) is surgery,
followed by radio- & chemo-therapy. However, disease
recurs in almost all patients and re-irradiation is an option
to be considered. Although the topic of re-irradiation is
generally controversial because of the toxicity risk,
literature provides consistent data supporting both the
feasibility and the survival-strengthening capability of
radiation, compared to supportive care only. In the
present study, voxel-based re-irradiations guided by
magnetic resonance imaging (MRI) were simulated and
planned with apparent diffusion coefficient (ADC) used as
biomarker for tumor cellularity.
Material and Methods
The relapse areas of 6 selected GBM patients treated with
STUPP protocol were monitored with MRI. The ADC
patterns, considered in the literature as a surrogate
biomarker of cellularity was analyzed and chosen to define
a signal-to-dose transfer function. This decision, coupled
with our clinical data in re-treating GBM with moderate
hypo-fractionation regime (Ciammella et al, Clin Neurol
Neurosurg, 2013, 115: 1609-14), have formed the basis of
a phase I study undertaken on 12 GBM relapse patients,
simulated with multi-parametric MRI and re-treated with
a dose-painted hypo-fractionated regime. The study
foresees dose levels of 30-50Gy/5fr with a cumulative
BED
10
>120Gy in an attempt to achieve some changes in the
recurrence pattern, without causing excessive radiation
necrosis (<12 Gy/fr) inside the irradiated area and
respecting the previously irradiated healthy tissue (EQD
2
<
100Gy). To realise the ADC data extraction and DPBN
(Dose Painting By Numbers) planning procedure with
RapidArc technique, home-made MATLAB software and
automatic scripting procedure on a commercial treatment
planning system (TPS) were realised. Nine target sub-
volumes were used for the volume-based TPS plan
optimisation. Phantom (PTW, Octavius 4D) and portal
dosimetry (EPID) based on g-index (2%, 2mm) were applied
for the pre-treatment plan evaluation.
Results
Considering follow-up data that correlates patient
outcomes with histogram changes in the tumour
recurrence ADC values of the 6 relapsed patients, a double
threshold transfer function was defined. The first patient
was enrolled in the study and treated. To a first control to
three months after treatment, the first patient has not
had acute toxicity, has a performance status of 100%, and
has a radiological picture of stable disease albeit
associated with signs of pseudo-progression. The pre-
clinical check of the delivered treatment, verified with
portal and phantom dosimetry, has provided a minimum
g-index of 90.7%. The total beam-on time with 4 non-
coplanar 6MV FFF arcs was less than 5 min.
Conclusion
The phase I protocol, approved by Ethical Committee, has
enrolled its first patient. Data on planning, dosimetric and
patient follow-up aspects will be presented and discussed.
EP-1398 Application of radiosurgery in treatment of
oligometastases
T. Chebotarova
1
, N. Spizhenko
1
, N. Lisovzka
1
, O. Yarmak
1
1
Cyber Clinic of Spizhenko, Radiation therapy,
Kapitanivka -Kyiv region, Ukraine
Purpose or Objective
Development of genetic researches in the field of oncology
found out proofs of genomic instability in solid tumors
which results in their clonal heterogeneity.
Oligometastatic disease considered as an intermediate
biological state with limited ability of tumor to promote
numerous metastases. In this transition stage of growth
tumor could gave oligometastatic clones expressed with
single metastatic lesions. Now it’s known, that the cells of
oligometastatic tumors expressed specific microRNAs able
to block tumor-promoting genes, and as a result make the
spread of tumors slower. We are focusing on the group
patients with metastatic lesion aiming to detect clinical
application for local ablative radiosurgery treatment.
Material and Methods
The results of treatment of 335 patients with metastases
of brain, lung, liver, renal and epinephrine were analyzed.
The localization of primary tumors in this group of patients