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treatment MRI was checked in all patients 3 months after
CCRT completion. Out of the 545 patients, 53 with residual
cervical cancer based on MRI following definitive CCRT
were included in this analysis.
Results
Thirty-two patients were disease-free at the last follow-
up. Of them, 31 had a residual tumor size of ≤ 2 cm. Of
these 32 women, 30 showed spontaneous regression of
residual tumor during follow-up without salvage
treatments, whereas the remaining two were alive with no
evidence of disease after salvage surgery and
chemotherapy. Disease progression was observed in 21
patients, including 7 local, 8 distant and 6 local and
distant failures. Of these 21 women, 13 died of disease, 6
were alive with disease, and 2 remained disease-free after
salvage treatments. Initial and residual tumor sizes were
significant prognostic factors for overall survival; only
residual tumor size was significant for local progression-
free survival.
Conclusion
About 60% of patients with residual disease detected on
post-treatment MRI remained disease-free without further
disease progression. Careful observation without
immediate salvage treatments might be feasible in
selected patients with a residual tumor size ≤ 2 cm.
PO-0710 Concurrent chemoradiotherapy in locally
advanced cancer cervix: Systematic review and meta-
analysis
N.R. Datta
1
, E. Stutz
1
, M. Liu
1
, S. Rogers
1
, A.
Siebenhüner
2
, D. Klingbiel
3
, S. Singh
4
, S. Bodis
1
1
Kantonsspital Aarau, Radio-Onkologie, Aarau,
Switzerland
2
University Hospital Zurich, Oncology, Zurich,
Switzerland
3
Swiss Group of Clinical Cancer Research SAKK
Coordinating Centre, Biostatistics, Bern, Switzerland
4
Sanjay Gandhi Postgraduate Institute of Medical
Sciences, Radiotherapy, Lucknow, India
Purpose or Objective
Concurrent chemoradiotherapy
(CTRT) is one of the
preferred management strategies in cancer cervix.
However, unlike early stage cancer cervix, the efficacy of
CTRT in locally advanced cancer cervix (LACC) (stages IIB-
IVA) has been contentious as the therapeutic benefit has
not been consistently shown in various randomized clinical
trials. A systematic review and meta-analysis was
therefore conducted exclusively in LACC to explore the
therapeutic efficacy of concurrent CTRT vs. radiotherapy
(RT) for the endpoints - complete response (CR), long-
term loco-regional control (LRC), overall survival (OS),
grade III/IV acute and late toxicities.
Material and Methods
Six databases - Cochrane Library, PubMed, EMBASE,
SCOPUS, Google Scholar and Web of Science were
searched as per the PRISMA guidelines using MeSH words,
'Uterine cervical neoplasms” AND 'Radiotherapy” AND
'Drug Therapy”. This was supplemented by hand-searching
and last updated on 29.8.16. The selection criteria
included (a) patients exclusively/predominantly in LACC
(b) no surgical intervention (c) randomized trials with
CTRT vs. RT and (d) full length publications in English.
Odds ratio (OR), risk ratio (RR) and risk difference (RD) for
each of the above endpoints were estimated along with
their test for heterogeneity (I
2
). Subgroup analysis (Q
values) and meta-regression (using CT regimes as
covariates) were performed for each endpoint to explore
the differences in outcomes with different CTRT
approaches.
Results
14 articles from a pool of 1788 citations were considered
for the final analysis. A total of 2445 patients (CTRT:
n=1217; RT: n=1228) were included in these trials. 96.6%
of these patients were LACC. A mean teletherapy dose of
48.2Gy (SD:±2.9) was delivered along with brachytherapy.
The brachytherapy doses were variable and depended on
the high, medium or low dose-rates of the units as
available in each institution. Eight studies used CDDP
alone, 4 had multiple agents CT with CDDP
(5FU/Taxanes/BLM/VCR) and 2 were based on MMC. The
OR, RR and RD for each endpoint is summarized in the
Table. CTRT improved the CR (+10.2%, p=0.027, I
2
=8.72),
LRC (+8.4%, p<0.001, I
2
=0.0) and OS (+7.5%, p<0.001,
I
2
=0.0, Fig.) over RT alone. However, a 10.4% higher
incidence of acute toxicities (p<0.001, I
2
=77.8) was
evident with CTRT. Late toxicities in both groups were
equivocal. Subgroup analysis and meta-regression for each
of the 5 endpoints did not reveal any significant difference
in outcomes with the 3 different CTRT regimes.
Conclusion
In LACC, although CTRT offers a significant benefit over
RT alone, it also results in significantly higher grade III/IV
acute toxicities. As no specific CT regime was found to be
specifically advantageous, the choice of CT agents could
be presently based on cost considerations both for primary
treatment and management of acute toxicities. This
assumes importance especially in most resource
constrained developing countries with limited
infrastructure and resources but faced with the highest
burden of LACC.
PO-0711 Risk factors for insufficiency fractures in
cervix cancer following intensity modulated
radiotherapy
A. Ramlov
1
, E. Pedersen
2
, L. Røhl
2
, E. Worm
3
, L. Fokdal
1
,
J. Lindegaard
1
, K. Tanderup
4
1
Aarhus University Hospital, Department of Oncology,
Aarhus C, Denmark
2
Aarhus University Hospital, Department of Radiology,
Aarhus C, Denmark
3
Aarhus University Hospital, Department of Medical
Physics, Aarhus C, Denmark
4
Aarhus University Hospital, Department of Oncology and
Department of Medical Physics, Aarhus C, Denmark
Purpose or Objective
To investigate incidence and risk factors of pelvic
insufficiency fracture (PIF) after definitive chemo-
radiotherapy for locally advanced cervical cancer (LACC).
Material and Methods
101 patients with LACC treated from 2008-2014 were
analysed. Patients received weekly Cisplatin, external
beam radiotherapy with 45Gy/25fx (node-negative