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S977
ESTRO 36
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EP-1777 Cervical cancer outcomes in the high-dose-
rate brachytherapy era: A single institution experience
N. Alyamani
1
, G. Bhattacharya
1
, R. Samant
1
, C. E
1
, T.
Le
1
, K. Lupe
1
1
The Ottawa Hospital Regional Cancer Centre, Radiation
Oncology, Ottawa, Canada¨
Purpose or Objective
Since 2008, the management of cervix cancer with primary
radiotherapy at our institution has included the use of HDR
(high-dose-rate) brachytherapy; prior to this, LDR (low-
dose-rate) brachytherapy was used. The aim of this study
is to review our experience with HDR brachytherapy and
to evaluate patient outcomes.
Material and Methods
A retrospective review of cervical cancer patients treated
with curative intent using radical external beam
radiotherapy and HDR brachytherapy, from 2008 to 2014
inclusive was performed. Overall survival (OS) and
progression-free survival (PFS) were analyzed using the
Kaplan-Meier method.
Results
A total of 76 patients were treated with radical
radiotherapy incorporating HDR brachytherapy during this
time period. The median age was 47 years with a median
follow-up of 38 months. The histology was squamous cell
carcinoma in 88% and adenocarcinoma in 11%. The
distribution according to stage was as follows: stage I 16%,
stage II 38%, stage III 40% and stage IV 5%. All patients
received weekly Cisplatin chemotherapy with a median of
5 cycles delivered. The median dose of external beam
radiotherapy was 45Gy delivered in 25 fractions over 5
weeks. The median brachytherapy dose was a total of
24Gy in 3 weekly fractions of 8Gy. The 5-year OS and PFS
rates were 74% and 63% respectively. The 5-year
locoregional control rate was 82%. There were a total of
25 failure and 12 of these had a component of local
failure. However, only 3 of these had exclusively local
failure. Of note is that the majority of patients with
recurrences had a component of distant failure (19/25;
representing 77% of relapses). Using the Common
Terminology Criteria for Adverse Events version 4.0
(CTCAE v.4.0), it appears as though severe acute (Grade
3/4) Gastrointestinal (GI) and Genitourinary (GU) toxicity
was present in approximately 21% of patients, along with
Grade 3/4 Hematologic toxicity seen in 34%. These results
are similar to the published literature and compare
favorably with our previous LDR brachytherapy
experience.
Conclusion
There has been a shift towards incorporation of HDR
brachytherapy world-wide in the management of cervix
cancer and our institutional experience indicates that
long-term outcomes for patients remain good, with
generally high rates of local control.
EP-1778 Combined intracavitary-interstitial IGABT of
cervical cancer –First dosimetric experience in
Hungary
G. Fröhlich
1
, J. Vízkeleti
1
, N.N. Anhhong
1
, N. Mészáros
1
,
T. Major
1
, C. Polgár
1
1
National Institute of Oncology, Centre of Radiotherapy,
Budapest, Hungary
Purpose or Objective
Dosimetric evaluation of combined intracavitary-
interstitial high-dose-rate image-guided adaptive
brachytherapy (IGABT) of cervical cancer, implemented in
Hungary.
Material and Methods
Since April 2016, 9 patients with cervical cancer were
treated with overall 22 fractions of combined
intracavitary-interstitial IGABT. After transrectal US-
guided implantation of Utrecht or Fletcher applicator and
needles, High-Risk-CTV (HR-CTV), bladder (b), rectum (r)
and sigmoid (s) were contoured on CT, based on the post-
teletherapy MRI of the patients. Dose-volume criterions of
treatment plans were based on the recommendations of
GEC-ESTRO Gyn WG. Treatment plans were compared to
the conventional intracavitary 2D plans (the dose was
prescribed to point A) and to CT-based 3D optimized plans
(without needles) with Friedman and Kruskal-Wallis
ANOVA and Spearman rank correlation tests.
Results
Median number of implanted needles was 3 (range: 2-4),
mean volume of HR-CTV was 39.8 cm
3
(8.3-100.2 cm
3
). For
intracavitary-interstitial IGABT, intracavitary 2D and
intracavitary 3D optimized plans, difference was found
almost in all dose-volume parameters: V100 were 90.4%,
83% and 87.1% (p=0.043), DHI were 0.34, 0.30 and 0.27
(p=0.0137), D2(b) were 4.8 Gy, 6.9 Gy and 5.9 Gy (p<001),
D2(r) were 3.3 Gy, 6.6 Gy and 3.5 Gy (p<0.001), D2(s) were
3.6 Gy, 5.3 Gy and 4.6 Gy (p=0.045), respectively. Needle
number showed inverse correlation with D2(r) (p=0.0264)
and D1(r) (p=0.0433) parameters. Volume of HR-CTV
correlated with D2(r) (r
2
=0.58) and D2(s) (r
2
=0.71).
Conclusion
Dosimetric results of combined intracavitary-interstitial
IGABT were comparable to international literature.
Dosimetric quality of these plans was significantly higher
than intracavitary 2D and 3D optimized plans. Although 3D
optimisation improved the quality of conventional 2D
plans, IGABT plans resulted in even more homogeneous
dose distribution and significantly lower doses to organs at
risks.
EP-1779 High-dose rate brachytherapy for inoperable
endometrial cancer: definitive results
L. Draghini
1
, F. Trippa
2
, M. Casale
2
, P. Anselmo
1
, F.
Arcidiacono
1
, S. Fabiani
1
, M. Italiani
1
, E. Maranzano
1
1
Radiation Oncology Centre "S.Maria" Hospital Terni,
Oncology Departement, Terni, Italy
2
Radiation Oncology Centre- “S.Maria” Hospital Terni,
Oncology Department, Terni, Italy
Purpose or Objective
Purpose/Objective:
To report our experience on three
dimensional (3D) high-dose rate brachytherapy (HDR-BRT)
in patients with stage I-III inoperable endometrial cancer.
Material and Methods
Material/Methods:
Between March 2005 and April 2016 17
patients underwent HDR-BRT or HDR-BRT after external
beam radiotherapy (EBRT) as definitive treatment. Median
age was 79 years (range, 60-95), median KPS 90% (range,
60-100). Histology was endometrial adenocarcinoma in 14
(82%) and non-endometrial in 3 (18%) patients. In 15 (88%)
patients FIGO clinical stage was I and in remaining 2 (12%)
III. All patients were evaluated with computed
tomography (CT) and endometrial biopsy, in 2 cases also
magnetic resonance imaging (MRI) was done. Using the
Fletcher applicator, a CT-based planning HDR-BRT was
delivered. Follow-up was performed with physical
examination, cervical cytology and CT or MRI. Local
control (LC) was obtained when there was an interruption
of vaginal bleeding.
Results
Results:
All patients had a clinical LC, table 1 shows dose
schedules used. After a median follow-up of 36 months
(range, 6-131), 3 and 6 years LC rates were 86% and 69%,
respectively. Cancer specific survival (CSS) at 1, 2 and 6
years was 93%, 85%, 85%, respectively. Age, stage, dose
and type of radiotherapy did not result significant
prognostic factors for LC and CSS. Only histology
significantly influenced LC: for high risk histology (i.e.,
non-endometrial carcinoma or grade (G)3 endometrial
adenocarcinoma) LC was 73% at 1 year and 36% at 6 years,