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Conclusion
A spectacular reduction in mean heart dose of 8,2Gy can
be obtained by deep inspiration breath-hold, with similar
or even lower mean lung dose, compared to the current
standard partial VMAT/IMRT. This may decrease the risk
of radiation induced cardiac toxicity.
PO-0701 Discrepancies between pathologi
cal data on nodal spread and the CTVs in RT for biliary
tract cancer
J. Socha
1
, M. Michalak
2
, G. Wołąkiewicz
3
, L. Kępka
3
1
Regional Oncology Centre Czêstochowa, Radiotherapy,
Czestochowa, Poland
2
Independent Public Care Facility of the Ministry of the
Interior and Warmian & Mazurian Oncology Center,
Diagnostic imaging, Olsztyn, Poland
3
Independent Public Care Facility of the Ministry of the
Interior and Warmian & Mazurian Oncology Center,
Radiation Oncology, Olsztyn, Poland
Purpose or Objective
To compare pathological-surgical data on the pattern of
nodal spread in biliary tract cancer (BTC) with nodal CTVs
commonly used in adjuvant radiotherapy (RT) for BTC.
Material and Methods
A comprehensive literature search was performed, using
the ‘‘PubMed’’ and ‘‘Google Scholar’’ databases, to select
articles on adjuvant RT for BTC, that provided information
on the lymph node stations (LNS) included into CTV.
Another search was done to extract the surgical and
pathological data on the patterns of nodal recurrence and
lymph node involvement in BTC. The risk of nodal
involvement and the degree of concordance between
different RT studies on including each of the LNS into CTV
were established with numerical scales presented in Table
1, and compared to show the nodal areas of potential
geographical misses as well as unnecessarily irradiated
nodal
areas,
separately
for
intrahepatic
cholangiocarcinoma
(IHC),
extrahepatic
cholangiocarcinoma (EHC) and gall bladder cancer (GBC).
Results
Out of 59 studies on the use of adjuvant RT in BTC, 19
were finally included: 1 prospective, 15 retrospective and
3 reviews; 14 pathological and/or surgical studies that
reported on the lymph node positivity rates in BTC were
included. Nodal areas of potential geographical misses
include: for right IHC - paraaortic LNS [risk level (R): 3,
degree of concordance (C): 1]; for left or hilar IHC - left
gastric LNS [R: 3, C: 0] and paraaortic LNS [R: 3, C: 1]; for
proximal EHC - paraaortic LNS [R: 3, C: 1]; for middle EHC
- paraaortic LNS [R: 3, C: 1] and superior mesenteric artery
(SMA) LNS [R: 2, C: 0]; for distal EHC - paraaortic LNS [R:
3, C: 1], SMA LNS [R: 4, C: 1] and anterior pancreatico-
duodenal LNS [R: 3, C: 1]; for GBC - paraaortic LNS [R: 4,
C: 1] and SMA LNS [R: 2, C: 1]. Nodal areas that seem to
be unnecessarily irradiated include celiac lymph nodes for
middle and distal EHC [R: 0, C: 3]. Moreover, the
interaorto-caval LNS seems to be the only subsite of the
paraaortic LNS that should be included into CTV, which
can limit the increase of overall treatment volume caused
by inclusion of paraaortic LNS. Similarly, only the posterior
group of pancreatico-duodenal LNS should be included
into CTV, except for distal EHC - where both posterior and
anterior pancreatico-duodenal LNS are at high risk of
involvement.
Conclusion
This is the first study that reports on the nodal areas of
potential geographical misses and the unnecessarily
irradiated nodal areas in adjuvant RT for BTC. Paraaortic
LNS are at very high risk of involvement in all BTC
locations - but are almost uniformly omitted, as well as
the SMA LNS for middle and distal EHC. Contrarily, celiac
LNS are always included into CTV, which seems
unnecessary for distal and middle EHC, at least in less
advanced stages. In view of some considerable
discrepancies between pathological-surgical data and the
elective nodal CTVs used in common practice, there is an
obvious need for the international consensus guidelines.
Poster: Clinical track: Lower GI (colon, rectum, anus)
PO-0702 Phase I trial evaluating panitumumab in
combination with chemoradiotherapy for anal cancers
V. Vendrely
1
, C. Lemanski
2
, E. Le Prise
3
, E. Maillard
4
, X.
Mirabel
5
, G. Lledo
6
, L. Dahan
7
, A. Adenis
5
, G. Paintaud
8
,
T. Lecomte
9
, C. Levy-Piedbois
10
, E. Terrebonne
1
, V.
Mammar
6
, S. Manfredi
11
, T. Aparicio
12
1
CHU de Bordeaux, Gironde, Pessac, France
2
Institut Regional du Cancer Montpellier, Herault,
Montpellier, France
3
Centre Eugene Marquis, Ille-et-Villaine, Rennes, France
4
Federation Francophone de Cancerologie Digestive,
Cote-d'Or, Dijon, France
5
Centre Oscar Lambret, Nord, Lille, France
6
Hopital prive Jean Mermoz, Rhone, Lyon, France
7
CHU La Timone, Bouches-du-Rhone, Marseille, France
8
CHU Bretonneau, Indre-et-Loire, Tours, France
9
CHU Trousseau, Indre-et-Loire, Tours, France
10
Institut de Radiotherapie, Seine-Saint-Denis, Bobigny,
France
11
EPICAD INSERM U866- Universite de Bourgogne Franche
Comte, Cotes-d'Or, Dijon, France
12
CHU APHP- Hopital Avicenne, Seine-Saint-Denis,
Bobigny, France
Purpose or Objective
To assess the safety and determine the recommended
Phase II dose of anti-EGFR Panitumumab combined with
Mitomycin, 5FU and radiotherapy in patients (pts) with
locally advanced epidermoid anal cancers.
Material and Methods
This open prospective, multicentric, single-arm phase I
study included patients (OMS: 0 or 1) with histologically
proven epidermoid anal cancers T2> 3 cm, T3, T4 or every
T-N+, M0. Phase I study was done to determine the Dose
Limiting Toxicity (DLT) and the Maximum Tolerated Dose
(MTD) of chemotherapy with a conventional 3+3 design.
Radiotherapy (conformational 3D or IMRT) was delivered
over 5 weeks at 1.8 Gy/fraction to reach a total dose of
45 Gy to the pelvis. After a 2 week break a boost of 20
Gy/2 Gy was delivered to the tumor. Mitomycin was
administered on day 1, 29 and 50 at 10 mg/m², 5FU on