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S381
ESTRO 36 2017
_______________________________________________________________________________________________
Surgery, Milan, Italy
5
European Institute of Oncology - University of Milan,
Department of Urologic Surgery, Milan, Italy
6
European Institute of Oncology - University of Milan,
Department of Medical Imaging and Radiation Sciences-
Department of Oncology and Hemato-oncology, Milan,
Italy
Purpose or Objective
To report toxicity and efficacy of moderately
hypofractionated external-beam radiotherapy in a large
series of patients treated for prostate cancer in a 9-year
period.
Material and Methods
Between January 2007 and December 2015, 590 T1-
T3N0M0 prostate cancer patients received 70.2 Gy in 26
fractions at 2.7 Gy/fraction (equivalent to 84 Gy in 42 2-
Gy fractions, considering α/β of 1.5 Gy) using image-
guided three-dimensional conformal radiotherapy (3D-
CRT) and intensity modulated radiotherapy (IMRT).
Radiation Therapy Oncology Group/European Organization
for Research and Treatment of Cancer criteria
(RTOG/EORTC) and Houston definition (nadir + 2) were
used for toxicity and biochemical failure evaluation,
respectively.
Results
All patients completed radiotherapy. Mean age was 72.6
years (6.5 standard deviation). Fourteen patients were
lost to follow-up. Information on gastrointestinal (GI)
toxicity was available for 306 (54.4%) patients. Of these,
287 patients (93.7%) reported G0-G1 GI toxicity, with
prevalence of G0 (84.6%), 13 (4.3%) G2 toxicity, 6 (2.0%)
G3-G4 toxicity (table 2a). Information on genito-urinary
(GU) toxicity was available for 306 (54.4%) patients. Of
these, 277 patients (91.2%) reported G0-G1 GU toxicity,
with prevalence of G0 (68.8%), 26 (8.6%) G2 toxicity, 1
(0.3%) G3-G4 toxicity (table 2b). At univariate analysis,
age>80 years, increasing initial risk category, increasing
Gleason score, increasing prostate-specific antigen (PSA)
and the seminal vesicle involvement were associated with
increased mortality. At multivariate analysis, Gleason
score was the only predictor of mortality, even after
adjustment for age. At univariate analysis, increasing risk,
increasing Gleason score, increasing PSA and seminal
vesicle involvement were associated with disease
progression. At multivariate analysis, Gleason score was
the stronger predictor of disease progression, even after
adjustment for age.
Conclusion
The present study confirms that hypofractionated
radiotherapy is a viable treatment option for localized
prostate cancer in terms of toxicity and clinical outcome.
PO-0733 Radium 223: Difference in clinical outcomes
between young and old
Y.P. Song
1
, T. Ellis
2
, R. Walshaw
1
, J. Logue
1
, O. Parikh
2
,
A. Choudhury
1
1
The Christie NHS Foundation Trust, Clinical Oncology,
Manchester, United Kingdom
2
Lancashire Teaching Hospitals NHS Foundation Trust,
Clinical Oncology, Preston, United Kingdom
Purpose or Objective
The commonest metastatic site for prostate cancer is the
bone. The alpha-emitting radioisotope, Radium 223
(Ra223) has been shown to be effective in symptom
management and improving overall survival in patients
with metastatic castrate resistant prostate cancer
(mCRPC). The balance between clinical benefit and
impact of treatment in older patients is important to
consider as over 50% of newly diagnosed patients in the UK
are over the age of 70. We hypothesized that there would
be no difference in outcome between the two groups. The
aim of this clinical study is to examine the toxicities and
clinical benefits of Ra223 between older and younger
patients.
Material and Methods
Data from all patients treated with Ra223 in two tertiary
cancer centres from December 2013 to February 2016 was
collected retrospectively. Patients were divided into two
groups – those 72 years and above at the time of
commencing treatment, and those below 72, as the
median age of patients treated in the landmark ALSYMPCA
trial was 71. Toxicities were graded with CTCAE version 4.
Statistical analysis was carried out using SPSS version 24.
Results
A total of 129 patients were treated during this period.
The median age was 71 (range: 55-89). 65 (50.4%) were
below 72 years while 64 (49.6%) were 72 and above.
Patients received a median of 5 cycles (range: 1-6) of
Ra223 at a dose of 50kBq/kg.
41 (63%) younger patients and 38 (59%) from the older
group had had previous abiraterone while 20 (31%) and 15
(23%) respectively had had previous enzalutamide. 41
(63%) from the younger group were previously treated with
docetaxel compared to 24 (38%) older patients (p=0.004).
11 (16.9%) of the younger patients and 4 (6.3%) of the
older patients had had previous carbazitaxel.
51% of those below 72 and 59% of those 72 and above
reported an improvement in symptoms (p=0.326). The
median overall survival from starting Ra223 was 8.2
months (0.7-22.4) in the younger group and 8.6 (0.9-23.7)
in the older group.
Ra223 was well tolerated with 13 of 129 (10%) patients
developing grade 3 (G3) anaemia. This included 11 (17%)
from the younger group compared to 2 (3%) from the older
group (p=0.009). There was one patient in each group with
G3 neutropenia, but no neutropenic sepsis or G3
thrombocytopaenia. During the course of treatment, 11
(9%) patients developed a skeletal-related event. This
included 3(5%) older patients and 8 (12%) younger patients
(p=0.123).
Conclusion
Ra223 was well tolerated with minimal toxicities.
However, a higher percentage of the young patients
reported toxicities, with a statistically significant higher
incidence of G3 anaemia. This may be associated with
previous lines of treatment, since a larger proportion of
patients below the age of 72 had had docetaxel in the
past. There was no statistical difference between the
younger and older patients with respect to symptomatic
relief and median overall survival. Older patients had
similar clinical benefit with Ra223 and should be
considered in appropriate patients.
PO-0734 The effect of TAB duration and pelvic RT in
prostate cancers with gleason score 8-10: TROG study