ESTRO 36 Abstract Book

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S43 ESTRO 36 2017
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2 and 3 respectively). Before treatment symptoms of itch
(80% and 69%) and pain (67% and 58%) were present in a
majority of cases in center 1 and 2, after treatment
complaints were relieved completely or less severe in
most patients (no or less itch 95%, no or less pain 95%).
The scheme of 2x9Gy resulted in more and more severe
complications, with 3x6Gy less complications were found,
and using 2x6Gy even fewer and less severe complications
were reported (major complication 24%, 16%, 6% p=0.046,
minor complication 56%, 39%, 17% p<0.001 for center 1, 2
and 3 respectively).
Conclusion
We conclude that the scheme using the lowest dose of
radiation seems to have a similar good outcome on
recurrences as well as a lower risk on mild as well as more
severe side effects, like infections, chronic wounds and
apparent pigmentation differences. Our results show that
when using brachytherapy a BED of 30Gy is not needed and
19Gy can be sufficient. We recommend using a lower
radiation scheme, i.e. 2x6Gy, to reduce adverse events
and minimize stochastic effect of this treatment.
OC-0086 Perioperative interstitial high-dose-rate
(HDR) brachytherapy for the treatment of recurrent
keloids
P. Jiang1, M. Geenen 2, F.A. Siebert1, R. Baumann1, P.
Niehoff3, D. Druecke4, J. Dunst1
1 UKSH- Campus Kiel, Department of Radiation Oncology,
Kiel, Germany
2 Lubinus Clinic, Department of Reconstructive Surgery,
Kiel, Germany
3 University Witten-Herdecke, Department of Radiation
Oncology, kiel, Germany
4 UKSH- Campus Kiel, Department of Reconstructive
Surgery, Kiel, Germany
Purpose or Objective
Perioperative radiotherapy of keloids can reduce the risk
of recurrence. Due to the wide variety of concepts the
optimal treatment regime remains unclear. We
established in our clinic a protocol of perioperative
interstitial HDR-Brachytherapy with 3 fractions of 6 Gy and
achieved an excellent local control rate of 94%. (Jiang. et.
al. 2015 IJROBP). We report now an update of our long-
term results of this prospective study of perioperative
interstitial brachytherapy. Here we include 29 patients
with a median follow-up of 5 years.
Material and Methods
From 2009 to 2015, 29 patients with 37 recurrent keloids
were treated with perioperative interstitial HDR-
brachytherapy; 3 patients had been previously treated
with adjuvant external beam radiotherapy and presented
with recurrences in the pretreated area. After (re-)
excision the keloids, a single plastic flexible
brachytherapy tube for irradiation was placed
subcutaneously before closing the wound. The target
volume covered the scar in total length. CT-based
treatment planning was used in selected cases, e.g. if two
lesions in close proximity were to be treated or for lesions
in difficult anatomic locations (e.g. helix of the ear).
Brachytherapy was given in three fractions with a single
dose of 6 Gy in 5mm tissue depth, with the exception of
one patient with a keloid on the helix who received a
single dose of 6 Gy to the whole tissue. The first fraction
was given within 6 hours after surgery, the other two
fractions on the first postoperative day. Follow-up visits
were scheduled at 6 weeks, 3 months, 6 months, 1 year,
and every year thereafter.
Results
No procedure-related complications (e.g. secondary
infections) occurred. 23 patients had keloid-related
symptoms prior to treatment like pain and pruritus;
disappearance of symptoms was noticed in all patients
after treatment. After a median follow-up of 49,7 months
(range: 7,9 to 92,7 months), 3 keloid recurrences and 2
hypertrophied scars were observed. Pigmentary
abnormalities were detected in 3 patients and additional
7 patients had a mild delay in the wound healing process.
Conclusion
Interstitial brachytherapy is able to deliver conformal
radiation exactly in the scar with extremely low exposure
of other normal tissues. It is suitable to most shapes and
irregular surfaces. Brachytherapy is cost-effective und can
be offered in the majority of radiotherapy centers. Our
three-fraction treatment schedule reduces the treatment
period to two days and is therefore convenient for the
patients. A radiobiological analysis of more than 2500
patients from multiple centers found a low α/β-value for
local control of keloids (Flickinger et. al. 2011 IJROBP).
The analysis recommended a treatment concept with few
fractions and high doses per fraction delivered in a short
period of time as early as possible after resection. Our
results confirm it and suggest that brachytherapy may be
advantageous in the management of high-risk keloids,
even after failure of external beam radiotherapy.
Poster Viewing : Session 2: Palliative and health services
research
PV-0087 Improvement of models for survival prediction
through inclusion of patient-reported symptoms
C. Nieder1, T. Kämpe1, B. Mannsåker1, A. Dalhaug1, E.
Haukland1
1Nordlandssykehuset HF, Dept. of Oncology and Palliative
Medicine, Bodoe, Norway
Purpose or Objective
Widely used prognostic scores, e.g., for brain metastases
and incurable lung cancer are based on disease- and
patient-related factors such as extent of metastases, age
and performance status (PS), which were available in the
databases used to develop the scores. Few groups were
able to include prospectively recorded patient-reported
symptoms. In our department, all patients were assessed
with the Edmonton Symptom Assessment System (ESAS, a
questionnaire addressing 11 major symptoms and
wellbeing on a numeric scale of 0-10) at the time of
treatment planning since 2012. Therefore, we analyzed
whether or not baseline symptom severity provides
relevant prognostic information, which should be included
during development of prognostic scores.
Material and Methods
A retrospective review of 112 patients treated with
palliative radiotherapy (PRT) between 2012 and 2015 was
performed. The patients scored their symptoms before
PRT. ESAS items were dichotomized (below/above
median). Uni- and multivariate analyses were performed
to identify prognostic factors for survival, and from these
a predictive model was developed.
Results
The most common tumor types were pro state (30%),
breast (12%) and non-small cell lung c ancer (26%),
predominantly with distant metastases. M edian survival
was 8 months. Univariate analyses identified 12 factors
that were associated with survival, including several ESAS
items. Multivariate analysis confirmed the significance of
6 factors, from which a predictive model was developed.
These were ESAS pain while not moving (median 3), ESAS
appetite (median 5), ECOG PS, pleural effusion/pleural
metastases, iv antibiotics during or within 2 weeks before
PRT and no systemic cancer treatment. The table shows
the prognostic score resulting from the multivariate
model. One or two points were assigned, depending on the
hazard ratio of each factor. Patients with a point sum of
0-1 had an estimated median survival of 23 months, a
point sum of 2-3 8.4 months, a point sum of 4-5 4.2 months
and a point sum of 6 or more 1.8 months (p=0.001).