ESTRO 36 Abstract Book

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S359 ESTRO 36 2017
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Modulated Arc-Therapy or Tomotherapy. Concomitant
chemotherapy (Cht) consisted in oral capecitabine at a
dose of 1250 mg/m2/day.
Results
From 11/2010 to 09/2016, 24 pts were treated.
Characteristics of pts: median age: 69 years (45-83), 12 M
and 12 F, median KPS: 90. Eighteen pts (75%) had Klatskin
disease, 6 pts (25%) had common and distal bile duct
disease (3: intra-pancreatic). Treatment: All pts
underwent surgery (19 pts R1, 5 pts R0: 3 pts were N+, 1
pt pT4 and 1 pt had hilary infiltration). Only 3 pts were
previously treated with neoadjuvant Cht (2 pts:
GEM+CDDP, 1 pt: capecitabine). Four pts received
adjuvant Cht (1 pts: PEXG, 1 pt: GEM, 1 pt: GEMOX, 1pt:
CDDP+GEM). Seventeen pts (71%) received Cht
concomitant to RT. Ten pts (42%) underwent c-e CT and
CTPET simulation, 6 pts (25%) underwent 4D c-e CT and 8
pts (33%) only c-e CT. Eight pts (50%) were PET positive.
AcuteToxicity: all pts were evaluable. Most toxicities were
G1-G2: 2 pts (8%) experienced diarrhea, 14 (58%)
nausea/vomiting, 9 (37%) abdominal pain, 3 (12%)
cholangitis, 2 (8%) gastric ulcer. Only one pt developed
gastro-duodenitis G3. Late toxicity: 20/24 pts were
evaluable, no toxicity ≥ G2 occurred. Responses: 23/25 pts
were evaluable. Nine pts (39%) had PD (3 local and distant
progression, 5 only distant and 1 only local progression).
Median TTLP and OS, evaluated using the Kaplan-Meier
method, were calculated from start of RT and resulted
31.0, 34.5 months respectively.
Conclusion
Adjuvant Hypo-IGRT delivering 44.25 Gy in 15 fractions
concomitant to oral capecitabine in patients with extra-
hepatic cholangiocarcinoma is feasible with a good
toxicity profile.
PO-0695 Neo-adjuvant chemoradiotherapy and
resection for esophageal cancer: outcomes in daily
practice.
E.S.H. Portier1, K.J. Neelis1, M. Fiocco2, W.O. De Steur3,
A.M.J. Langers4, J.J. Boonstra4, H.H. Hartgrink5, M.
Slingerland6, F.P. Peters1
1 Leiden University Medical Center, Department of
Radiation Oncology, Leiden, The Netherlands
2 Leiden University Medical Center, Department of
Medical Statistics and Bioinformatics, Leiden, The
Netherlands
3 Leiden University Medical Center, Deparment of
Surgery, Leiden, The Netherlands
4 Leiden University Medical Center, Department of
Gastroenterology, Leiden, The Netherlands
5 Leiden University Medical Center, Department of
Surgery, Leiden, The Netherlands
6 Leiden University Medical Center, Department of
Medical Oncology, Leiden, The Netherlands
Purpose or Objective
Since the first results of the Dutch randomized CROSS trial
(van Hagen et al, 2012), neo-adjuvant chemoradiotherapy
(CRT) followed by resection for primary resectable non-
metastastic esophageal cancer (EC) was implemented as
standard curative treatment in the Netherlands. We
evaluated clinical outcomes with this treatment in daily
practice.
Material and Methods
We retrospectively studied consecutive patients treated
for primary resectable non-metastatic EC between May
2010 and December 2015 at our institution. Patients were
included if they started treatment with the intention to
undergo neo-adjuvant CRT followed by resection. Patients
with neuro-endocrine histology and treatment for
recurrent EC were excluded. Treatment consisted of
external beam radiotherapy (23 fractions of 1,8 Gy), 5
weekly courses of carboplatin (AUC 2) and paclitaxel (50
mg/m2) and transthoracic or transhiatal resection. We
recorded patient and tumour characteristics, survival,
disease progression, acute and late toxicity/complications
(CTCAE version 4, Clavien-Dindo classification) and send
quality of life (QOL) questionnaires (EORTC QLQ-C30 and
QLQ-OES18, EQ-5D-5L and a self-developed questionnaire
on dumping complaints) to surviving patients.
Results
One hundred forty-five patients were included (table 1).
Median follow-up was 43 months (95% CI 32.6-53.4
months). All patients completed radiotherapy as intended
and 86.9% received the full chemotherapy regimen. One
hundred thirty-seven patients underwent surgery, with a
resection of the tumour in 130 patients (90%). One patient
had a microscopically irradical resection(<1%). Median
overall survival (OS) was 35 months (95% CI 29.8-40.2
months, fig. 1). Median progression free survival (PFS) was
30 months (95% CI 19.7-40.3 months). Three-year OS and
PFS were 49.6% (95% CI 40.4-58.8%) and 45.6% (95% CI
36.6-54.6%) respectively. Three year cumulative incidence
for locoregional progression and distant metastasis were
31% (95% CI 22.9-39.1%) and 45.3% (95% CI 36.5-54.19%).
In univariate analysis, tube feeding before start of neo-
adjuvant chemoradiotherapy, dysphagia score (0-1 versus
2-4), length of the tumour, clinical T-stage, number of
chemotherapy cycles, pathological response (pT- and pN-
stage) and extracapsular extension of lymphnode
metastases were significantly associated with OS. Tube
feeding and extracapsular extension were
significant in multivariate analysis. Toxicity and QOL are
currently analysed, results will be available at
presentation.