ESTRO 36 Abstract Book

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S21 ESTRO 36 2017
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3 University of Bologna, Department of Medical and
Surgical Sciences - DIMEC, Bologna, Italy
4 Rizzoli Institute, Department of Oncology, Bologna,
Italy
5 Fondazione di Ricerca e Cura “Giovanni Paolo II”,
Radiotherapy Unit, Campobasso, Italy
6 Fondazione di Ricerca e Cura “Giovanni Paolo II”,
Medical Physics Unit, Campobasso, Italy
Purpose or Objective
Whole Lung Irradiation (WLI) represents a treatment
option in patients with lung metastases from Ewing
Sarcoma. However, prospective trials reporting impact of
WLI on outcome and toxicity are few and discordant. Aim
of our analysis was to systematically review the available
literature to better define toxicity of WLI in patients with
Ewing Sarcoma and Osteosarcoma. Secondary endpoints
were overall survival (OS) and disease-free survival (DFS)
analysis.
Material and Methods
A systematic review based on PRISMA methodology of
papers reporting studies on prophylactic or curative
bilateral WLI was performed using PubMed, Cochrane
Library and Scopus. Combination with other treatment as
chemotherapy and surgery was allowed. Only article
published in English were considered.
Results
According to title and abstract 115 studies were screened
and 12 of them met the inclusion criteria (4/12 were
randomized controlled trials), reporting results on 649
patients. Clinical mild and moderate impairment as
dyspnea and cough was reported in 49 patients (7.6%).
Severe pneumonitis occurred in 13 patients (2.0%).
Smoking significantly increased WLI toxicity and toxicity
rates were higher in WLI combined with chemotherapy,
surgery or radiotherapy boost. No impact of WLI on OS was
described.
Conclusion
WLI produce a relatively low rate of radiation-induced
severe effects. However, a positive impact on patients
outcome was not demonstrated. New strategies to prevent
or treat lung metastases have to be tested in these
patients.
PV-0048 Prognostic impact of tumor size and response
in neoadjuvant radiotherapy of soft tissue sarcoma
A. Cortesi1,2, A. Arcelli1,3, R. Frakulli1, L. Giaccherini1, S.
Bisello 1, G. Bianchi4, D.M. Donati 4, M. Gambarotti5, S.
Ferrari 6, A. Farioli7, R. Vanini8, G. Macchia9, F. Deodato9,
S. Cilla10, V. Picardi9 , G. Torre9, G. Ghigi2, A. Romeo11,
G.P. Frezza3, A.G. Morganti 1, S. Cammelli1
1 University of Bologna, Radiation Oncology Unit-
Department of Experimental Diagnostic and Speciality
Medicine - DIMES, Bologna, Italy
2 Istituto Scientifico Romagnolo per lo Studio e la Cura
dei Tumori IRST- IRCCS, Radiotherapy Department,
Ravenna, Italy
3 Ospedale Bellaria, Radiotherapy Department, Bologna,
Italy
4 Istituto Ortopedico Rizzoli, III Clinica Ortopedica,
Bologna, Italy
5 Istituto Ortopedico Rizzoli, Department of Pathology,
Bologna, Italy
6 Istituto Ortopedico Rizzoli, Department of Oncology,
Bologna, Italy
7 University of Bologna, Department of Medical and
Surgical Sciences - DIMEC, Bologna, Italy
8 University of Bologna, Medical Physic Unit, Bologna,
Italy
9 Fondazione di Ricerca e Cura "Giovanni Paolo II",
Radiotherapy Unit, Campobasso, Italy
10 Fondazione di Ricerca e Cura "Giovanni Paolo II",
Medical Physics Unit, Campobasso, Italy
11 Istituto Scientifico Romagnolo per lo Studio e la Cura
dei Tumori IRST- IRCCS, Radiotherapy Department,
Meldola, Italy
Purpose or Objective
To evaluate clinical-radiological response and outcome in
patients with primary or recurrent soft tissue sarcomas
(STS) of extremities treated with neoadjuvant
chemoradiation.
Material and Methods
Sixty patients (median age 52 years, range: 23-87) with
primary (54 patients, 90%) or recurrent (6 patients, 10%)
STS, were treated with neoadjuvant chemotherapy (CHT)
and pre-operative external beam radiotherapy (RT: 50 Gy
in 25 daily fractions). Selection criteria were diseases of
large dimension (> 5 cm) or in close proximity of critical
structures such as nerves or vessels. The Gross Tumor
Volume (GTV), defined as macroscopic disease visible in
the T1-weighted sequences, was delineated based on MRI
images. MRI images were merged with CT-simulation
scans. For CTV definition we added a 4 cm margin in
cranio-caudal direction and a 1 cm radial margin (except
where anatomical barriers were present) to GTV. CTV to
PTV margin was 1 cm added isotropically. All patients
underwent CT scan and MRI of the interested anatomical
region plus chest TC before and after RT (before surgery).
For the aims of this analysis the tumor volume before and
after RT was divided into quartiles.
Results
With a median FU of 58.5 months (range 12-116), only one
patient had local relapse 24 months after surgery and was
treated with surgical re-resection, with local control of
the disease in the following radiological-clinical
investigations. Fifteen patients (25%) developed
metastases. Six out of 60 patients died (10%). Only 20
patients (33.3%) received postoperative RT-boost for
marginal or intralesional margins. At preoperative MRI
tumor volume showed an average reduction of 18% (range
-90% to +191%). Patients with smaller tumors at diagnosis
(volume < median) showed a trend for improved 5-year
disease-free survival (DFS) (81.3% vs 64.3%; p=0.075). In
patients with very large tumors at diagnosis (4th quartile),
a significant volume reduction after RT was correlated
with very high 5-year DFS (100%) and 5-year OS (100%).
Patients presenting with smaller but volumetrically
enlarged lesions showed worse 5-year DFS (50%) and 5-
year OS (50%). Five-year DFS and OS of patients with
volume of larger dimensions before and after RT (4th
quartile) were 46.2% and 72.7%, respectively. Tumor
reduction after neoadjuvant therapy was significantly
correlated with DFS (p:0.002) and OS (p:0.027).
Conclusion
In this series of patients treated with preoperative RT a
high LC rate was recorded. Pre-treatment and volumetric
changes of tumor size significantly predicted patients
outcome. Prospective studies on neoadjuvant setting of
STS are necessary to improve outcome in high-risk groups.
PV-0049 Recurrent skull base and extra-cranial
chordoma following proton therapy: clinical outcomes.
M. Kountouri1, M. Walser1, R. Schneider 1, A. Bolsi 1, A.
Lomax1, D. Weber1
1Paul Scherrer Institute PSI, CPT, Villigen PSI, Switzerland
Purpose or Objective
The aim of this study was to evaluate the clinical outcomes
in patients diagnosed with a recurrence of a skull base or
extra-cranial chordoma following treatment with pencil
beam scanning (PBS) proton radiation therapy.
Material and Methods
Between November 1997 and December 2015, 77 patients
with a mean age of 51.3 years (range 22.3 – 79.6 years)
were treated for a skull base (N=38) or extra-cranial
(N=39) chordoma with PBS proton therapy and later
presented with a recurrence. Of those patients treated for
an extra-cranial chordoma, proton therapy was delivered