ESTRO 36 Abstract Book

620 / 1082

S604 ESTRO 36 2017
_______________________________________________________________________________________________
EP-1113 Helical Tomotherapy and altered fractionation
in the treatment of Glioblastoma
C. Caruso1, R. Barbara1, S. Gomellini1, A.D. Andrulli1, A.
Caccavari2, M. Moreschi3, U. De Paula1
1 Complesso Ospedaliero San Giovanni Addolorata,
Radioterapia, Roma, Italy
2 Complesso Ospedaliero San Giovanni Addolorata, Fisica
Sanitaria, Roma, Italy
3 Complesso Ospedaliero San Giovanni Addolorata,
Oncologia Medica, Roma, Italy
Purpose or Objective
New technologies, as IMRT, VMAT and Helical
Tomotherapy (HT) is one of the most emerging aspect of
radiation therapy, especially regarding brain tumors
management; glioblastoma (GBM), for its radio-resistance
and high rate of local recurrence, is a challenging field of
application of new technologies. In this retrospective
study we evaluated the impact of altered fractionation,
administered with HT, associated with temozolomide
(TMZ) in the treatment of GBM.
Material and Methods
From 2010 to 2014, 23 patients with primary diagnosis of
GBM were treated at our Institution. Median age was 57
(range 26-75) and all patients had histologically proven
diagnosis of GBM; 15 patients (65%) had a radiological
proven residual disease after surgery. Bio-molecular
markers profiling was not routinely analyzed; molecular
genetic profile, using FISH test, was assessed in 11 (48%)
of the 23 patients; evaluation of MGMT promoter was
performed in 10 patients: 7 presented an unmethylated
profile, and 3 a methylated status. In 6 patients mutations
of IDH1 were tested and only in 2 patients they are
present. Considering extent of the disease and its
location, patients were treated with two different
radiation therapy schedules. In 16 patients (70%) two
different volumes were identified: PTV1, encompassing
surgical bed and/or residual disease (GTV1) with a margin
of 0.5 cm, treated with a total dose of 59.8 Gy in 23
fractions of 2.6 Gy, and PTV2, obtained expanding the
PTV1 of 1 cm all around, treated with a total dose of 46
Gy in 23 fractions of 2 Gy (Simultaneous Integrated Boost
SIB technique). In the remaining 7 patients (30%) it was
possible treated a single volume (PTV1) with a total dose
of 59.8 Gy in 23 fractions of 2.6 Gy. According to the
EORTC regimen, concomitant daily TMZ dose of 75 mg/mg
was administered for the entire period of radiation
therapy followed by adjuvant schedule at a dose of 150-
200 mg/mq daily for 5 consecutive days every 4 weeks.
Results
All patients completed the combined therapy without
grade ≥3 acute toxicity. Complete blood count every 2
weeks, and contrast-enhancement brain MR every 3
months were performed during follow up. At the time of
the present study, 12 patients (52%) were died, 2 patients
(9%) had disease progression, two patients (9%) had a
radiological evidence of stable disease (SD) and 7 (30%)
were free from disease. The average follow-up was 12
months (range 2-46) and median overall survival (OS) was
12 months with a progression free survival (PFS) average
time of 7.6 months.
Conclusion
Our results, in terms of OS and PFS, are similar to the
literature ones; but it is remarkable that about 65% of
patients had a subtotal resection and therefore a poor
prognosis and poor expected outcome as well documented
in large previous studies. Altered fractionation that we
used achieved similar results of standard schedule of
treatment of 60 Gy in 30 fractions, without increasing
acute and late toxicity, and reducing total time of about
25%.
EP-1114 A prospective multicenter feasibility trial of
Spine Stereotactic Body Radiation Therapy
T. Hiroshi1, T. Furuya1, K. Nihei1, Y. Kumazaki2, K.
Miyaura 2, H. Mayahara 3, H. Nishimura3, M. Nakayama3, Y.
Nomto4, N. Shikama2, K. Karasawa1
1Tokyo Metropolitan Cancer and Infectious diseases
Center Komagome Hospital, Radiation Oncology, Tokyo,
Japan
2Saitama Medical University International Medical
Center, Radiation Oncology, Hidaka, Japan
3Kobe Minimally Invasive Cancer Center, Radiation
Oncology, Kobe, Japan
4Mie University Hospital, Radiation Oncology, Tsu, Japan
Purpose or Objective
Spine Stereotactic Body Radiotherapy (Spine SBRT) is
rapidly being accepted in the clinic especially in North
America without high quality evidence. In Japan, this
treatment, however, has not been accepted widely. Since
several toxicities such as 10% to 39% of vertebral
compression fractures (VCF), high-grade toxicity of
esophagus and radiation myelopathy have been reported,
we decide to perform a small multi-center feasibility trial
to validate the safety and feasibility of Spine SBRT to
accept it in our clinic.
Material and Methods
In this prospective multi-center single arm trial, patients
from 3 centers in Japan were allocated to receive Spine
SBRT to their one or two continuous vertebral bone
metastases. Patients were eligible if ECOG performance
status 0, 1 or 2, group 1 or 2 in Recursive Partitioning
Analysis (RPA) Index, stable in Spinal Instability Neoplastic
Score, grade I or II in Bilsky grade and aged 20 to 75 years.
Rate of treatment related grade 3 or worse toxicities
during 6 months after treatment was the primary endpoint
and toxicities were evaluated with Common Terminology
Criteria for Adverse Events version 4.0 by intent-to-treat
until patients’ death or at least 6 months. Severity of pain
was scored 0 to 10 on the Brief Pain Inventory (BPI) before
and after treatment. Amounts of opioid analgesic intakes
were also recorded before and after treatment. Pain
response was evaluated according to Inter national
consensus on palliative radiotherapy endpoints. This study
is registered with University hospital Medical Information
Network, number UMIN000013428.
Results
Between March 2014 to October 2015, 20 patients are
assigned to this trial with median follow up of 330 days.
The locations of bone metastases were follows; cervical
vertebra 2 patients (10%), thoracic vertebra 7 patients
(35%), lumber vertebra 10 patients (50%), sacrum vertebra
1 patients (5%). Patient’s reported pain scores before
treatment were follows; Median over all survival time
from treatment was 330 days (ranged 35-736). Twelve
patients were group 1 and eight patients were group 2 in
RPA index. No treatment related grade 3 or worse toxicity
was observed entire the trial (0%). Rate of grade 1 or 2
toxicities were follows; grade 1 esophagitis 15%, grade 1
dermatitis 10%, grade 1 mucositis 5%, grade 1 pain flair 5%
and grade 1 dizziness 5%. Pain response rate 1 month after
treatment and 6 months after treatment was as follows,
respectively: Complete Response (CR) 15% and 12%,
Partial Response (PR) 5% and 0%, Indeterminate Response
(IR) 65% and 82%, and Pain progression (PP) 15% and 5%
(Figure). Grade 2 VCF was observed in 1 patient (5%) entire
this trial.
Conclusion
No grade 3 or worse toxicities were observed. This study
validated the safety and feasibility of Spine SBRT.
EP-1115 Linac vs viewray in brain metastases: a
dosimetric comparison of hypofractionated IMRT and
VMAT
F. Cellini1, M. Ferro1, E. Placidi 2, S. Chiesa3, B. Diletto1,
M. Massaccesi1, C. Votta4, C. Masciocchi5, V. Frascino1,