ESTRO 36 Abstract Book

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S358 ESTRO 36 2017
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L. Manuzzi1,2, A. Farioli3 , G. Macchia4, F. Deodato4, S.
Cilla5, V. Picardi4 , F. Cellini6, G.C. Mattiucci6, A.D.
Andrulli7, A. Guido1 , S. Cammelli1, A. Arcelli1,8, A.
Cortesi1,9 , G. Tolento1, G. Siepe1, M. Ferioli1, M.
Buwenge1, G.P. Frezza8, L. Fuccio3, A.G. Morganti 1
1 University of Bologna, Radiation Oncology Center-
Department of Experimental- Diagnostic and Speciality
Medicine - DIMES, Bologna, Italy
2 University of Bologna, Oncology Center- Department of
Experimental- Diagnostic and Speciality Medicine -
DIMES, Bologna, Italy
3 University of Bologna, Department of Medical and
Surgical Sciences - DIMEC, Bologna, Italy
4 Fondazione di Ricerca e Cura "Giovanni Paolo II",
Radiotherapy Unit, Campobasso, Italy
5 Fondazione di Ricerca e Cura "Giovanni Paolo II",
Medical Physics Unit, Campobasso, Italy
6 Policlinico Universitario "A. Gemelli"- Università
Cattolica del Sacro Cuore, Department of Radiotherapy,
Rome, Italy
7 IRCCS- CROB, Department of Radiotherapy, Rionero in
Vulture, Italy
8 Ospedale Bellaria, Radiotherapy Department, Bologna,
Italy
9 Istituto Scientifico Romagnolo per lo Studio e la Cura
dei Tumori IRST- IRCCS, Radiotherapy Department,
Ravenna, Italy
Purpose or Objective
Hepatocellular carcinoma (HCC) is a leading cause of
cancer death. Experience with stereotactic body
radiotherapy (SBRT) for HCC is increasing due to the
possibility to deliver ablative doses in few fractions with
low rates of toxicity and excellent local control.
Furthermore, SBRT can be used in patients unsuitable for
other conventional therapies. However, the better way to
treat HCC with SBRT has not been defined. Therefore, aim
of this analysis was to systematically review the available
literature to evaluate treatment and other factors
correlated with patients outcome.
Material and Methods
Literature search was made in PubMed database. We also
checked the references list of five reviews published in
the last two year. We included randomized trials or not,
excluding case series with less than 8 patients, case
reports, and reviews. Only studies published in English
were included in this review. The primary endpoint was
duration of survival in overall population after SBRT
measured by 1-year and 2-year survival rate. Secondary
endpoint was toxicity (acute or late) reported as grade ≥
3 toxicity rate.
Results
Through the evaluation of titles and abstracts, we
selected 70 records. At the end of the screening we
included 22 papers fulfilling the inclusion criteria
amounting to 1093 patients. All selected studies were
published from 2006 to 2015. One-year OS ranged from
23% to 100% (median 75%) while 2-year OS from 23.3% to
100% (median 59%). Twenty records reported toxicity. G ≥
3 toxicity range was 0%-37% (median: 13%). We performed
a meta-regression analysis in order to explore whether 1y-
OS is correlated to the value of some explanatory variables
( Table 1). We observed a direct association between 1-y
OS and median age (p=0.004, R²=0.31) as well as the
presence of solitary lesion (p=0.033, R²=0.43), vascular
invasion (p<0.001 with R²=0.87) and median tumor size
(p<0.001 and R²=0.69). Considering the variables related
to treatment, EQD2 (α/β=10) affected 1-y OS very
significantly (p <0.001 and R²=0.72).
Conclusion
Use of higher EQD2 is correlated with improved outcome
in HCC treated with SBRT. Prognosis is worse in patients
with older age, multiple lesions, larger tumor, and
vascular invasion.
PO-0694 Post-operative Intensity-Modulated
hypofractionated Image-Guided Radiotherapy in
cholangiocarcinoma
N. Slim1, B. Noris Chiorda1, C. Gumina1, G.M. Cattaneo2,
M. Reni3, L. Aldrighetti4, A.M. Deli1, F. Zerbetto1, P.
Passoni1, N. Di Muzio1
1San Raffaele Scientific Institute- Milano- Italy,
Radiotherapy, Milan, Italy
2San Raffaele Scientific Institute- Milano- Italy, Medical
Physics, Milan, Italy
3San Raffaele Scientific Institute- Milano- Italy, Medical
Oncology, Milan, Italy
4San Raffaele Scientific Institute- Milano- Italy, Surgery,
Milan, Italy
Purpose or Objective
To evaluate feasibility of post-operative intensity
modulated hypofractionated image-guided radiotherapy
(Hypo-IGRT) in patients (pts) with extra-hepatic
cholangiocarcinoma.
Background: we previously tested Hypo- IGRT in pts with
locally advanced pancreatic cancer. The dose of 44.25 Gy
in 15 fractions to the whole tumor was feasible and safe
(Int J Radiation Oncol Biol Phys, Vol. 87, No. 5, pp. 1000-
1006, 2013).
Material and Methods
After surgery, pts with histologically proven perihilar and
distal cholangiocarcinoma were eligible for this study.
Simulation consisted in contrast-enhanced computed
tomography (c-e-CT) or 18 F-FDG CT/PET (CTPET) or when
possible four-dimensional c-e CT (4D c-e CT), Clinical
Target Volume (CTV) consisted in surgical bed and regional
lymph-nodes. In Klatskin tumor CTV was defined as the
section liver margin and hepatic hilum; the R1 site was
identified combining pathological data and surgeon
indications. In distal cholangiocarcinoma CTV consisted in
the new anastomosis between the biliary tree and the
small intestine. The planning target volume (PTV) was
defined with standard margins, except in pts who
underwent 4D c-e CT where a margin of 5 mm was added
isotropically at CTV.
Median delivered dose of RT was 44.25 Gy (40 Gy-48 Gy)
in 15 fractions on PTV and was delivered with Volumetric