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ESTRO 36 2017
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PO-0682 Re-irradiation for oligo-recurrence from
esophageal cancer with radiotherapy history
K. Jingu
1
, Y. Niibe
2
, H. Yamashita
3
, K. Katsui
4
, T.
Matsumoto
5
, T. Nishina
5
, A. Terahara
2
1
Tohoku University Graduate School of Medicine,
Department of Radiation Oncology, Sendai, Japan
2
Toho University Omori Medical Center, Department of
Radiology, Tokyo, Japan
3
the University of Tokyo, Department of Radiology,
Tokyo, Japan
4
Okayama University Graduate School of Medicine-
Dentistry and Pharmaceutical Sciences, Department of
Proton Beam Therapy, Okayama, Japan
5
Shikoku Cancer Center, Department of Gastrointestinal
Medicine, Ehime, Japan
Purpose or Objective
to reveal the effectiveness and toxicity of re-irradiation
for oligo-recurrence in lymph nodes from esophageal
cancer treated by definitive radiotherapy or by surgery
with additional radiotherapy
Material and Methods
We reviewed retrospectively 248 patients treated with
(chemo)radiotherapy for oligo-recurrence in lymph nodes
from esophageal cancer in 5 Japanese high-volume centers
between 2000 and 2015. Of those 248 patients, 33 patients
in whom re-irradiation was performed were enrolled in
this study, and the results for patients in whom re-
irradiation was performed were compared with the results
for other patients. Survival estimates were calculated
using the Kaplan-Meier method from the first date of
radiotherapy for oligo-recurrence. Toxicity was graded
according to the Common Terminology Criteria for Adverse
Events (CTCAE v4.0).
Results
Median maximum lymph node diameter (MLD) was 22 mm
(range, 5-106 mm). Median total radiation dose was 60 Gy
(range, 18-70 Gy). Eleven of the 33 patients with a past
irradiation history underwent re-irradiation by a
hyperfractionation method. Therefore, the median
calculated biological effective dose using the LQ model
with α/β = 10 Gy (BED10) in patients in whom re-
irradiation was performed was significantly lower than the
median BED10 in others (Mann-Whitney U test, p<0.001).
There were no other significant differences than BED10 in
patients’ characteristics between the group with past
irradiation history and the group without past irradiation
history. Twenty-nine in the 33 patients performed
concurrent chemotherapy with re-irradiation. The median
observation period in patients in whom re-irradiation was
performed was 14.9 months. The 3-year and 5-year overall
survival rates in the 33 patients with a past irradiation
history were 17.8% and 0%, respectively, with a median
survival period of 16.0 months (95% C.I.= 7.0-17.6). The 3-
year and 5-year overall survival rates in 215 patients
without past irradiation history were 36.1% and 27.0%,
respectively, with a median survival period of 21.5 months
(95% C.I.= 16.4-26.6). There was a significant difference
between the survival rates in the two groups (log-rank
test, p=0.016). The 3-year irradiated field control rates in
the 33 patients with a past irradiation history and in 215
patients without past irradiation history were 21.0% and
58.9%, respectively. There was a significant difference
between irradiated field control rates in the two groups
(log-rank test, p=0.001). Grade 5 toxicity occurred in 4 of
248 patients. Treatment related death, which was gastric
hemorrhage, occurred in a patient in whom re-irradiation
was performed.
Conclusion
Results of
radiotherapy with or without chemotherapy for
oligo-recurrence in lymph nodes from esophageal cancer
in patients with a past irradiation history were insufficient
compared with results for patients without a past
irradiation history.
PO-0683 Impact of the radiation dose on hepatic
perfusion evaluated using mebrofenin liver scintigraphy
B. De Bari
1
, T. Breuneval
2
, M. Zeverino
3
, S. Godin
2
, L.
Deantonio
4
, J. Prior
5
, J. Bourhis
2
, R. Moeckli
3
, M.
Ozsahin
2
1
Hôpital Univ. Jean Minjoz, Radiation Oncology,
Besançon, France
2
Centre Hospitalier Universitaire Vaudois, Radiation
Oncology, Lausanne, Switzerland
3
Centre Hospitalier Universitaire Vaudois, Medical
Physics, Lausanne, Switzerland
4
University Hospital "Maggiore della Carità", Radiation
Oncology, Novara, Italy
5
Centre Hospitalier Universitaire Vaudois, Nuclear
Medicine, Lausanne, Switzerland
Purpose or Objective
We aimed at evaluating the impact of the dose of
radiotherapy (RT) on hepatic function (HF). HF variations
were evaluated by integrating mebrofenin liver
scintigraphy (HBS) before and after RT in patients treated
with stereotactic body RT (SBRT) on liver.
Material and Methods
Between 04/2015 and 09/2015, 6 patients with primary (3
patients) or secondary liver cancers (3 patients) were
treated with SBRT (3x15 Gy: 4 pts, 5x8 Gy: 1 pt or 6x5 Gy
1 pt). All patients received an HBS to assess HF before and
three months after RT. HBS was co-registered with the
planning phase of the simulation CT-scanner. The
biological equivalent dose of 2 Gy per fraction (EQD2) was
calculated for each patient with an alpha / beta = 10 Gy
(acute toxicity). Isodoses (5, 10, 20, 30, 40, 50, 60, 70, 80,
and 90 Gy) were drawn. Then, we calculated the activity
(MBq) in these volumes before and after treatment.
Results
Linear regression analysis showed a significant reduction
in HF at three months, which was proportional to the
increase of the radiation dose (p = 0.0009, Figure 1). Our
analysis showed a reduction of 0.78% of the HF for each
delivered gray. Even with the limits of the small
population of this study, the linear equation showed a
predictive value in predicting the loss of HF/Gy of 96% (R
2
= 0.9605).
Conclusion
To the best of our knowledge, this is the first evidence
available in the literature showing the utility of HBS in
evaluating the variation of HF after SBRT. This analysis
shows a functional decrease, which is proportional to the
delivered dose, thus predicting the resulting acute
toxicity. These functional based approaches could
improve our knowledge about the response of the OARs to
the radiation, and should be prospectively evaluated.
PO-0684 Opposite pharmacokinetics of sorafenib
modulates by liver irradiation – concurrent versus
sequential
C.H. Hsieh
1
, L.Y. Wang
2
, T.H. Tsai
3
, Y.J. Chen
4
1
Far Eastern Memorial Hospital, Radiation Oncology,
Taipei, Taiwan
2
National Taiwan University, School and Graduate
Institute of Physical Therapy, Taipei, Taiwan
3
National Yang-Ming University, Institute of Traditional
Medicine, Taipei, Taiwan
4
Mackay Memorial Hospital, Radiation Oncology, Taipei,
Taiwan
Purpose or Objective
Sorafenib is a multi-kinase inhibitor that demonstrated a
significant improved survival of patients with
hepatocellular carcinoma (HCC). The efficacy of
radiotherapy (RT) concurrent or sequential with sorafenib
in unresectable HCC patients has better effects than single
agent. However, the effects of local RT on sorafenib in the
plasma system remain unclear. Here, we evaluate the