ESTRO 36 Abstract Book

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S756 ESTRO 36
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(36%) and retroperitoneal sarcomas (50%). With a median
follow-up of 70 months (range 12-92), the median DSS was
54 months (range 28-80). The 5-year actuarial OS, LC and
DSS were 71%, 68% and 44%, respectively. On univariate
analysis margin status of resection significantly affected
LC. For patient with resection R0, LC was 83% whereas no
patient with R1 resection obtained local control (p<0,01).
Toxicity presented in 11(27%) patients and pain was the
most common side-effect (64%) followed by enteritis
(18%).
Conclusion
IORT is an efficient method of salvage treatment to
improve LC in selected patients with isolated locally
recurrent tumors for recurrent pelvic or retroperitoneal
tumors, with acceptable incidence of morbidity.
EP-1414 Toxicity of concurrent stereotactic
radiotherapy and targeted or immunotherapy: a
systematic review
S.G.C. Kroeze1, C. Fritz1, M. Hoyer2, S.S. Lo3, U. Ricardi 4,
A. Sahgal 5, R. Stahel6, R. Stupp 6, M. Guckenberger1
1 University Hospital Zürich, Department of Radiation
Oncology, Zurich, Switzerland
2 Aarhus University, Danish Center for Partical Therapy,
Aarhus, Denmark
3 University of Washington School of Medicine,
Department of Radiation Oncology, Seattle, USA
4 University of Turin, Department of Radiation Oncology,
Turin, Italy
5 University of Toronto, Department of Radiation
Oncology, Toronto, Canada
6 University Hospital Zürich, Department of Oncology,
Zurich, Switzerland
Purpose or Objective
Stereotactic radiotherapy (SRT) and
targeted/immunotherapy play an increasingly important
role in personalized treatment of metastatic disease. The
combined application of both therapies is rapidly
expanding in daily clinical practice. Patients may benefit
from additive cytotoxic effects, but currently not much is
known regarding safety and the potential induction of
toxicity. Toxicity data from targeted/immunotherapy
combined with conventionally fractionated radiotherapy
cannot be extrapolated to SRT because of the differences
in physics and biology. The aim of our systematic review
was to summarize severe toxicity observed after
concurrent treatment.
Material and Methods
PubMed and EMBASE databases were searched for English
literature published up to april 2016 using keywords
'radiosurgery”, 'local ablative therapy”, 'gamma knife”
and 'stereotactic”, combined with 'bevacizumab”,
'cetuximab”, 'crizotinib”, 'erlotinib”, 'gefitinib”,
'ipilimumab”, 'lapatinib”, 'sorafenib”, 'sunitinib”,
'trastuzumab”, 'vemurafenib”, 'PLX4032”, 'panitumumab”,
'nivolumab”, 'pembrolizumab”, 'alectinib”, 'ceritinib”,
'dabrafenib”, 'trametinib”, 'BRAF”, 'TKI”, 'MEK”, 'PD1”,
'EGFR”, 'CTLA-4” or 'ALK”. Studies performing SRT during
or within 30 days of targeted/immunotherapy, reporting
severe (≥Grade 3) toxicity were included.
Results
A total of 49 studies were included. Of these, 13 (321
patients) were prospective studies, 27 (653 patients)
retrospective studies and 9 (16 patients) case reports. The
number of patients per study ranged from 1 to 106
(median 15). Targeted agents concurrent with cranial SRT
were tested in 34 studies and with extra-cranial SRT in 19
studies. For cranial SRT, severe toxicity was observed in
14% (89/644) of patients, for extra-cranial SRT in 16%
(84/524). Severe toxicity possibly related to cranial SRT or
extra-cranial SRT was observed in 6% (5.4% Gr3; 0.6% Gr4;
0% Gr5) and 9% (7.6% Gr3; 0.8% Gr4; 0.6% Gr5),
respectively. Overall, concurrent cranial SRT was well
tolerated, except when combined with BRAF-inhibitors
(severe toxicity in 20/75 patients (27%)). Furthermore,
there is a high risk of morbidity when extra-cranial SRT is
combined with EGFR-targeting tyrosine kinase inhibitors
and bevacizumab, which was not observed after cranial
SRT.
Conclusion
The currently available information concerning toxicity
after concurrent SRT and targeted/immunotherapy is
limited. The focus of published studies lies mainly on
concurrent cranial SRT, where the combination generally
is well tolerated. For extra-cranial SRT, no definitive
conclusions can be drawn. This review underlines the need
for clinical studies testing the combination of SRT and
targeted drugs/immune check point Inhibitors.
EP-1415 Interventions to Address Sexual Problems in
People with Cancer
L. Barbera1, C. Zwaal2, D. Elterman3, W. Wolfman4, A.
Katz5, K. McPherson6, A. Matthew7
1Odette Cancer Centre - Sunnybrook Health Sciences
Centre, Radiation Oncology, North York- Toronto,
Canada
2McMaster University, Oncology, Hamilton, Canada
3University Health Network, Urology, Toronto, Canada
4Mount Sinai Hospital, Obstetrics and Gynecology,
Toronto, Canada
5CancerCare Manitoba, Cancer and Sexuality Counselling,
Winnipeg, Canada
6Cancer Care Ontario, Patient and Familty Advisory
Council, Toronto, Canada
7University Health Network, Surgical Oncology, Toronto,
Canada
Purpose or Objective
Objective: Sexual dysfunction in people with cancer is a
significant problem. This guideline aimed to address the
following question: “What is the effectiveness of
pharmacologic interventions, psychosocial counselling or
devices to manage sexual problems after cancer
treatment?”
Material and Methods
Methods: This guideline was created with the support of
the Program in Evidence-Based Care. We searched for
existing systematic reviews, guidelines and relevant
primary literature from 2003-2015. Men and women were
evaluated separately. No restrictions were made on
cancer type or study design. When first approaching the
guideline the working group chose to focus on sexual
disorders commonly known to arise in people with cancer.
These included decreased desire, arousal disorders, pain
(in women) and erectile dysfunction (in men). Only studies
that evaluated the impact of an intervention on a sexual
function outcome were included.
Results
Results: The panel made one overarching recommendation
that there be a discussion with the patient, initiated by a
member of the health care team, regarding sexual health
and dysfunction resulting from the cancer or its
treatment. The Expert Panel felt that this is vital since the
additional recommendations cannot be used unless
someone has taken the initiative to ask. There were
numerous limitations of the existing literature. However,
we made additional recommendations on 11 outcomes: 6
for women (sexual response, body image,
intimacy/relationships, overall sexual
function/satisfaction, vasomotor symptoms, genital
symptoms) and 5 for men (sexual response, genital
changes, intimacy/relationships, overall sexual
function/satisfaction, vasomotor symptoms). There is a
role for medication or devices in particular