769 / 1096
S753
ESTRO 36
_______________________________________________________________________________________________
Weight loss
No loss: 12
(54%
<5%: 8 (29%)
5-10%: 2 (9%)
Diet
Standard: 19 (86.5%)
Deficient: 3 (13.5%)
Feeding problems
NO problems: 11 (50%)
Disphagia gr. 1: 11 (50%)
Nutritional supplements
NO : 18 (82%)
YES: 4 (18%)
END RADIOTHERAPY
BMI
mean: 27.6; median: 26.7 kg/m2 (20.15 37.34)
Weight loss
No loss: 14 (63.5%)
<5%: 7 (32%)
5-10%: 1 (4.5%)
Diet
Standard: 18 (82%)
Deficient: 4 (18%)
Feeding problems
NO problems: 10 (45.5%)
Disphagia: 12 (54.5%)
gr. 1: 10 (45.5%)
gr. 2: 2 (9%)
Nutritional supplements
NO: 16 (72,7%)
YES: 6 (27.3%)
Conclusion
Most elderly patients have a BMI at the start of treatment
not indicative of malnutrition, and hardly changes during
treatment
All patients have some degree of weight loss at the
beginning of treatment. During the treatment and at the
end, most do not progress in such loss or it is less than 5%
Patients have a progressive difficulty in feeding, mainly
due to dysphagia, but this does not translate for changing
the type of diet
It is essential to assess the nutritional status of elderly
patients with lung cancer at the start of oncological
treatment, as well as a scheduled monitoring to control
feeding problems and give adequate dietary guidelines
EP-1409 Prospective study of hypofractionated
radiotherapy for elderly patients with High Grade
Glioma
E. Clerici
1
, P. Navarria
1
, A.M. Ascolese
1
, F. Pessina
2
, S.
Tomatis
1
, L. Cozzi
1
, M. Simonelli
3
, A. Santoro
3
, C.
Franzese
1
, L. Bello
2
, M. Scorsetti
1
1
Istituto Clinico Humanitas, Radiotherapy and
Radiosurgery, Rozzano Milan, Italy
2
Istituto Clinico Humanitas, Neurosurgery Oncology
Department, Rozzano Milan, Italy
3
Istituto Clinico Humanitas, Oncology and Hematology
Department, Rozzano Milan, Italy
Purpose or Objective
Published studies showed that a short course of radiation
therapy (RT) in elderly and frail patients with diagnosed
anaplastic glioma is safe, feasible and better tolerated
compared to standard RT fractionation. Based on this
background we designed a prospective trial of
hypofractionated radiotherapy. The aim of this study was
to evaluate patients outcome in terms of progression free
survival (PFS) and Overall Survival (OS) rate, and
treatment related toxicity.
Material and Methods
Elderly patients (≥70 years old) with poor Karnofsky
performance status and histological confirmed high grade
glioma (HGG) were included in this evaluation. All patients
underwent hypofractionated radiotherapy with or without
concomitant and adjuvant chemotherapy in relation to
MGMT status, using temozolomide (TMZ). To precisely
define the target volume, computer tomography (CT) scan
with and without contrast and magnetic resonance images
(MRI) were acquired and images were coregistered. The
clinical tumor volume (CTV) corresponded to surgical
cavity or to T1 FLAIR abnormality in case of biopsy only.
Planning target volume (PTV) was generated adding an
isotropic margin of 5 mm from CTV. All plans were
optimized on PTV using volumetric modulated arc therapy
(VMAT) mode. Dose prescription was 52 Gy in 15
consecutive daily fractions (BED
10
70.88 Gy). Clinical
outcome was evaluated by neurological examination and
brain MRI performed, one month after RT and then every
3 months. Response was recorded using the Response
Assessment in Neuro-Oncology (RANO) criteria. The tumor
progression was described as local, if it occurred in/or
within 2 cm from primary site, and distant for new and
non-contiguous enhancing or non-enhancing lesions.
Hematologic and non-hematologic toxicities were graded
according to Common Terminology Criteria for Adverse
Events version 4.0.
Results
From February 2013 to February 2016, among patients
referred to our institution for anaplastic gliomas, 24
patients were included in this evaluation. Biopsy was
performed in 13 patients, complete resection in 5 and
partial resection in 6. Concomitant and/or adjuvant
chemotherapy was administrated in 7 patients.
The
median time and the 6 and 12 months progression-free
survival (PFS) rate were 4.4 months, 46% and 12%. The
median overall survival (OS) time and the 1 year OS rate
were 7.3 months, 70.8% and 16.7%. On univariate and
multivariate analysis MGMT status and administration of
adjuvant chemotherapy more than concurrent
chemotherapy significantly impacted on PFS and OS (p <
0.01). The treatment was well tolerated, no severe
toxicity was recorded.
Conclusion
In our experience, hypofractionated radiotherapy with
VMAT-RA in elderly and frail patients could be a safe and