ESTRO 36 Abstract Book

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S371 ESTRO 36 2017
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The ΔADC and %ADC values may be useful for predicting
the prognosis of patients with stage IIIB cervical cancer
treated with CCRT. Furthermore, the %ADC value of <30%
may be an important factor for selecting a stronger
treatment strategy in patients receiving radiotherapy
after mid-treatment MRI.
PO-0714 Toxicity and Clinical Outcome of IMRT versus
Conventional Radiation Therapy for Endometrial Cancer
L. Vaalavirta 1, S. Larjavaara1, P. Arponen-Esteves1, A.
Leminen2, J. Collan1, M. Harrela1, M. Kouri1, M.
Tenhunen1, H. Joensuu3
1 Comprehensive Cancer Center- Helsinki University
Hospital, Deparment of Radiation Oncology, Helsinki,
Finland
2 Helsinki University Hospital and University of Helsinki,
Department of Gynaecologic Oncology, Helsinki, Finland
3 Comprehensive Cancer Center- Helsinki University
Hospital, University of Helsinki, Helsinki, Finland
Purpose or Objective
To evaluate toxicity as primary objective and clinical
outcome as secondary objective in patients with
endometrial cancer (EC) treated with whole pelvic
intensity modulated radiation therapy (IMRT) versus whole
pelvic conventional radiation therapy (CRT).
Material and Methods
Between 9/2005 and 6/2008 40 eligible patients with EC
were stratified according to stage into two groups: (stage
I-II and stage III-IV) and then randomly assigned to receive
adjuvant IMRT (n=20) or CRT (n=20).The treatment
consisted of 50.4 Gy at 28 fractions. A self-administered
symptom scale questionnaire (based on the Common
Toxicity Criteria (CTC) v3.0), was being used for patient-
reported symptoms with different entities for
gastrointestinal (GI), gynecological and urological (GU)
symptoms. The questionnaire was filled by the patients
prior and after RT course, and at 3, 6, 9, 12, 16, 20, 24,
30, 36, 48 and finally at 60 months after RT. In addition,
a physician-reported toxicity questionnaire (based on
CTCv3.0) was collected in the beginning, at end of RT, as
well as at 3 and 6 months after RT. When evaluating the
differences in physician-reported toxicity between the
two arms, Fisher’s exact test was being used. Hazard
ratios (HRs) were estimated for relapse-free survival (RFS)
and EC-specific mortality for CRT arm relative to the IMRT
arm using Cox proportional hazard model. All statistical
analyses were performed using Stata software version
14.2(StataCorp).
Results
The most noticeable differences between the two study
arms were seen for urological symptoms at the end of the
given RT, for GI symptoms at 12 months and for
gynecological symptoms at 12 months, even though seen
throughout the 60-month study period. However the
differences remained moderate: patient-reported mean
score for urological symptoms at the end of RT was 4.8
(95% CI, 3.0-6.6) with CRT and 2.8 (95% CI, 1.3-4.2) for
IMRT, p=0.067; for GI symptoms 1.5 (95% CI, -0.16-3.3) for
CRT and 0.4 (95% CI, -0.0080-0.81) for IMRT, p = 0.110 at
12 months; and for gynecological symptoms 1.5 (95% CI,
0.68-2.4) for CRT and 0.2 (95% CI, -0.11-0.51) for IMRT,
p=0.0014 at 12 months.
Based on the physician-reported toxicity, grade ≥2
symptoms were further divided into urological, GI and
other symptoms. The differences between study groups
remained statistically insignificant, even after pooling all
the grade ≥2 symptoms together at each reported time.
No pelvic in-field relapses were seen in either study arms
in a median follow up of 9.1 years. At 9 years there was
no statistically significant difference in the cancer-
specific mortality between the CRT and IMRT arms. HR in
favor of the IMRT was 0.50 (95% CI, 0.14-1.70), p=0.253.
No statistically significant difference was found in RFS at
9 years between the study arms. HR in favor of the IMRT
was 0.72 (95% CI, 0.24-2.14), p=0.551.
Conclusion
IMRT reduces patient reported GI and GU toxicity. Survival
outcomes at 9 years were not statistically different
between study arms.
PO-0715 A phase II study of chemoradiation with tri-
weekly cycles of nedaplatin for uterine cervical cancer.
K. Okuma1, H. Yamashita 1, R. Kobayashi2, K. Nakagawa1
1University of Tokyo Hospital, Radiology, Tokyo, Japan
2NTT Medical Center Tokyo, Radiology, Tokyo, Japan
Purpose or Objective
Chemoradiotherapy based on cisplatin is the standard
treatment for locally advanced cervical cancer.
Nedaplatin an analog of cisplatin, has been shown to have
similar treatment effectiveness for several cancer to
cisplatin with less nephrotoxicity, myelotoxicity and
gastrointestinal toxicity. This study aimed to assess the
acute complication with the maximal dose of nedaplatin
for carcinoma of the uterine cervix when administered tri-
weekly during pelvic radiotherapy.
Material and Methods
Nedaplatin, 100mg/m2, was administered on days 1, 22,
and 43 with a concurrent external beam radiotherapy and
intracavitary or intersititial brachytherapy. External beam
radiotherapy was delivered with a fraction of 1.8-2 Gy per
day for 5 days a week during 5-5.6 weeks and
brachytherapy of 24 Gy/ 4 fractions at point A. The
efficacy and toxicity of chemoradiotherapy with
100mg/m2 nadaplatin were evaluated.
Results
Thirty-four patients with uterine cervical cancer in FIGO
stages IB1 to IVA were enrolled in this phase II trial from
April 2011 through August 2016. The median follow-up
period was 15 (range, 2-56) months. Of the 34 patients
enrolled for the trial, only 1 (3%) had grade 4 leukopenia
and neutropenia. 18 of 34 patients (53%) developed grade
3 treatment-related hematologic toxicities within 30 days.
Without one patient who had to go hospital because of
grade 3 diarrhea, there were no grade ≥3 treatment-
related non-hematologic toxicities. Complete response
was observed in 94% (32/34) of patients. The 2-year
overall survival rate and 2-year progression-free survival
rate were 96.7% (95% CI, 50-59%) and 73.5% (95% CI, 27-
45%), respectively.
Conclusion
Chemoradiotherapy with tri-weekly cycles of nedaplatin
of 100 mg/m2 was an effective and tolerable regimen in
patients for uterine cervical cancer.
PO-0716 Pelvic insufficiency fracture after IMRT for
gynecologic or anal cancer
L. Bazire1, H.P. Xu1, M. Amessis1, C. Malhaire2, K. Cao1,
A. De La Rochefordière1, Y.M. Kirova1
1Institut Curie, Radiation Oncology, Paris, France
2Institut Curie, Radiology, Paris, France
Purpose or Objective
To summarize results for pelvic insufficiency fracture (PIF)
in patients with anal or gynecological cancer treated with
pelvic intensity modulated radiation therapy (IMRT).
Material and Methods
The clinical and morphological (CT and / or pelvic MRI)
characteristics of patients treated by IMRT at the Institut
Curie, between 2007 and 2014 were analyzed. The overall
incidence of pelvic fractures occurred after external beam
radiation and the effects of localization (gynecological or
anal cancer) were calculated. A retrospective delineation
of the pelvic bones (iliac bones and sacrum) was
conducted in patients who had a fracture and in 60
patients free of fracture after radiotherapy. Dosimetric
study was then performed to compare the patients who
had a fracture in patients without fracture.