ESTRO 36 Abstract Book

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S323 ESTRO 36 2017
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increased antigen load allowing for stronger immune
reaction toward mutant clones. Larger series and
translational research is needed to elucidate this finding.
PO-0625 Accelerated-hypofractionated IMRT plus
Temozolomide in Glioblastoma:a phase I dose-
escalation study
M. Ferro1 , G. Macchia1, F. Deodato1, S. Cilla2, A.C.
Melone1, P. Pagnano 1, M. Ferro 1, M. Boccardi1, A. Ianiro2,
A. Arcelli3,4, S. Cammelli3, A. Farioli5, G.P. Frezza4, M.
Ciuffreda6, G. Sallustio6, S. Chiesa7, M. Balducci7, V.
Valentini7, A.G. Morganti 3
1 Fondazione di Ricerca e Cura “Giovanni Paolo II”,
Radiotherapy Unit, Campobasso, Italy
2 Fondazione di Ricerca e Cura “Giovanni Paolo II”,
Medical Physics Unit, Campobasso, Italy
3 University of Bologna, Radiation Oncology Center-
Department of Experimental- Diagnostic and Specialty
Medicine - DIMES, Bologna, Italy
4 Ospedale Bellaria, Radiotherapy Department, Bologna,
Italy
5 University of Bologna, Department of Medical and
Surgical Sciences - DIMEC, Bologna, Italy
6 Fondazione di Ricerca e Cura “Giovanni Paolo II”,
Radiology Unit, Campobasso, Italy
7 Policlinico Universitario “A. Gemelli”- Università
Cattolica del Sacro Cuore, Department of Radiotherapy,
Rome, Italy
Purpose or Objective
We performed a dose-escalation trial to determine the
maximum tolerated dose (MTD) of Volumetric Modulated
Arc Therapy (VMAT) with standard concurrent and
sequential-dose temozolomide (TMZ) in patients with
resected glioblastoma multiforme.
Material and Methods
Histological proven glioblastoma patients underwent
VMAT dose escalation. VMAT was delivered over 5 weeks
with the simultaneous integrated boost (SIB) technique to
the two planning target volumes (PTVs) defined by adding
5-mm margin to the respective clinical target volumes
(CTVs). CTV1 was defined by adding a 10-mm isotropic
margin to the tumor bed plus any MR enhancing residual
lesion; CTV2 was defined as the CTV1 plus 20-mm isotropic
margin. Radiation dose was escalated to the PTV1 with the
SIB-VMAT strategy. Two dose levels were planned: Level 1
(PTV2: 45/1.8Gy; PTV1: 72.5/2.9Gy) and Level 2 (PTV2:
45/1.8Gy; PTV1: 75/3Gy). All treatments were delivered
in 25 fractions. Patients were treated in cohorts of
between three and six per group using a Phase I study
design. The recommended dose was exceeded if two of
the six patients in a cohort experienced dose-limiting
toxicity within 3 months from treatment. Concurrent and
sequential TMZ chemotherapy was administered according
to Stupp’s protocol.
Results
Seventeen consecutive glioblastoma patients
[male/female: 7/10; median age: 58 years) were treated.
Six patients were treated at first dose level, with one of
them experiencing a dose-limiting toxicity (DLT) (grade 3
neurological toxicity with seizures requiring
hospitalization). Being the MTD not exceeded, the PTV1
dose was escalated to the highest planned dose level (75/3
Gy) and 11 patients were treated without any further DLT.
After a median follow-up time of 7 months, no grade >2
late neurological toxicity was recorded.
Conclusion
The SIB-VMAT technique was found to be feasible and safe
at the recommended doses of 45Gy to PTV2 and 75Gy
(biological effective dose – BED - of 150 Gy, alpha/beta 3)
to PTV1 in the postoperative treatment of patients with
glioblastoma.
PO-0626 Quality of life: result from a randomized trial
that compared WBRT with radiosurgery of tumor cavity
L. Kepka 1, D. Tyc-Szczepaniak2, K. Osowiecka1, A.
Sprawka3, B. Trabska-Kluch4, B. Czeremszyńska1, M.
Olszyna-Serementa2
1Independent Public Health Care Facility of the Ministry
of the Interior and Warmian & Mazurian Oncology
Centre, Radiotherapy, Olsztyn, Poland
2Maria Sklodowska-Curie Memorial Cancer Center and
Institute of Oncology, Radiotherapy, Warsaw, Poland
3Centre of Oncological Diagnostics and Therapy,
Radiotherapy, Tomaszów Mazowiecki, Poland
4Medical University of Lodz, Radiotherapy, Lodz, Poland
Purpose or Objective
Recently published randomized trial (NCT01535209)
demonstrated no difference in neurocognitive function
between stereotactic radiotherapy of the tumor bed (SRT-
TB) (15Gy/1 fraction or 25Gy/5 fractions) and whole brain
radiotherapy (WBRT) (30Gy/10fractions) in patients with
resected single brain metastasis. Patients treated with
SRT-TB had lower overall survival compared with WBRT
arm due to the excess of neurological deaths. We
compared study arms for health-related quality of life
(HR-QoL).
Material and Methods
A self-assessed questionnaire was used to assess the QoL
(EORTC QLQ-C30 with -BN20 module) at baseline prior to
RT, 2 months after RT and every 3 months thereafter. QoL
results were presented as mean scores and compared
between arms and time points using the Wilcoxon rank
sum test.
Results
Of 59 randomized patients, 37 (64%) were eligible for QoL
analysis; 15 received SRT-TB and 22 had WBRT. There was
no difference in global health status QoL/main function
scales/symptoms (except for drowsiness which was worse
in WBRT arm 2 months after RT [p=0.048]) between arms.
Global health status QoL decreased 2 and 5 months after
RT, but significantly only for SRT-TB (p=0.025). Physical
function decreased significantly 5 months after SRT-TB
(p=0.008). Future uncertainty worsened after RT, but
significantly only for SRT-TB arm at 2 months (p=0.036).
Patients treated with WBRT had significant worsening of
appetite, drowsiness, and hair loss after treatment. Visual
disorders improved after RT, significantly for WBRT;
constipation worsened after RT, significantly for SRT-TB
arm (figures: 1 and 2).
Conclusion