ESTRO 36 Abstract Book

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S606 ESTRO 36 2017
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5mm) and transferred into clinical routine. Patients were
matched one to one with 66 patients with HGG undergoing
conventional radiation therapy (RT) with 60.0 Gy photons
(range: 59.4 – 60.0 Gy) in 2.0 Gy fractions (range: 1.8 – 2.0
Gy)(median PTV volume: 369.4ccm). Matching criteria
were age, WHO grade, Karnofsky performance status, PTV
size, temozolomide therapy (each p>0.1). The majority of
all patients in both groups received concomitant and
adjuvant temozolomide. The study assessed overall
survival (OS) using the log-rank test, treatment-related
toxicity using the CTCAE classification (version 4.03) and
pseudoprogression according to the Response Assessment
in Neuro-Oncology (RANO) criteria for the complete study
cohort (n = 132).
Results
Median overall survival was similar in both treatment
groups (bimodality RT, 19.1 months [4 to 41 months];
photon-only RT, 20.4 months [3 to 53 months]; p = 0.306).
The median PTV volume of the proton boost was
significantly smaller compared to the median PTV volume
of the photon plans (each p<0.001). Acute toxicity was
mild in both treatment groups. Toxicity ≥ grade II was
observed in 6 patients (9.1%) receiving bimodality RT and
9 patients (13.6%) receiving photon-only RT. Two types of
severe adverse events (CTCAE grade III) occurred solely in
the photon-only group: severe increase in intracranial
pressure (3 cases; 4.5%); and generalized seizures (2
cases; 3.0%). Median PTV of these patients was 384.4ccm.
The intensity of all symptoms decreased after
corticosteroid therapy or anticonvulsant therapy.
Pseudoprogression was rare, occurring on average 6 weeks
after radiotherapy, and was balanced in both treatment
groups (n = 4 each; 7.6%).
Conclusion
Using a sequential proton boost in HGG is safe and
feasible. Delivering a proton boost to significantly smaller
target volumes when compared to photon-only plans,
yielded comparable survival rates at lower CTCAE °III
toxicity rates. Pseudoprogression occurred rarely and
evenly distributed in both treatment groups. Thus,
bimodality RT was at least equivalent regarding outcome
and potentially superior with respect to toxicity in
patients with HGG.
EP-1118 Radiotherapy-related endocrine dysfunction
in patients treated for craniopharyngioma
N. Taku1,2, A. Powlson3, M. Gurnell3, N. Burnet1
1 University of Cambridge Department of Oncology,
Addenbrooke’s Hospital, Cambridge, United Kingdom
2 Perelman School of Medicine, University of
Pennsylvania, Philadelphia, USA
3 Metabolic Research Laboratories- Wellcome Trust-MRC
Institute of Metabolic Science- University of Cambridge
and National Institute for Health Research Cambridge
Biomedical Research Centre, Addenbrooke’s Hospital,
Cambridge, United Kingdom
Purpose or Objective
Craniopharyngioma is a rare, histopathologically benign
intracranial tumor originating in the sellar
region. Neurosurgery (NS) remains the primary
management strategy. However, radiotherapy (RT) is an
important adjuvant and salvage treatment. The
probability of improved disease control with RT must
always be weighed against the risk of RT-related
morbidity, including damage to the hypothalamic-
pituitary axis (HPA). Many patients will require lifelong
treatment with hormone replacement therapies (HRTs).
Thus, the objective of minimizing RT-related HPA
dysfunction is primarily to reduce the number of required
HRTs. The current study evaluates a historical cohort of
adult patients treated with NS and RT for
craniopharyngioma and seeks to examine the development
of RT-related endocrine dysfunction using HRT as a proxy
for clinical hypopituitarism.
Material and Methods
The clinical records of 20 adult patients diagnosed with
pathologically-confirmed craniopharyngioma and treated
with both NS and RT at Addenbrooke’s Hospital
(Cambridge, United Kingdom) from 2001 to 2013 were
reviewed. All patients received either subtotal or gross
total neurosurgical resection of their craniopharyngioma.
Post –operative RT was 50 Gy in 30 fractions, in either the
adjuvant or salvage setting. Patients were assessed for
evidence of HPA dysfunction throughout the course of
diagnosis, treatment, and follow-up. Those found to have
hypopituitarism were prescribed estradiol (women),
testosterone (men), hydrocortisone, thyroxine, growth
hormone (GH), or desmopressin in accordance with the
deficient axis, and as clinically indicated. Clinical records
were reviewed for HRT both before and after
radiotherapy.
Results
Patients included 10 males and 10 females with a median
age at diagnosis of 44 years (range, 18-76 years). The
mean and median lengths of endocrine follow-up were 5.2
and 5.0 years, respectively (range, 0.5 – 9.6 years). Pre-
RT HRT data were available for 15 of the 20 patients.
Unlike other hormone axes, testing for GH deficiency was
not routinely performed prior to the delivery of RT. When
hormone supplementation excluding GH was considered,
all but one patient were taking some form of HRT prior to
RT. Before RT 53% of patients were receiving at least 3
HRT medications, compared to 73% of patients after RT
(Figure 1). The post-RT increase in the mean and median
HRT for all patients were 0.7 and 1 additional
medications, respectively (Figure 2). Eight patients (53%)
required no change in HRT following RT, and only 2
patients required an increase of more than 1 HRT from
pre- to post-RT treatment.
Conclusion
While radiotherapy may cause or exacerbate HPA
dysfunction, the actual requirement for additional
hormone replacement therapies in routine clinical
practice appears to be relatively modest, especially in
those patients with pre-existing hormone deficits.
Accordingly, the probability of increased tumor control
with adjuvant or salvage radiotherapy outweighs the risk
of increased HPA morbidity.
EP-1119 Radiosurgery for meningioma:Evaluation of
radiological outcome and factors of recurrence
S. Hassas yeganeh1, M. Tabatabiefar1, R. Sarghampour1
1Imam Hussain Hospital-, clinical oncology, tehran, Iran
Islamic Republic of
Purpose or Objective
Meningioma is one of the most common benign brain
tumors with various clinical manifestations. Since the
most common prevalence age of meningioma is forth to
fifth decades which are the active population, the
attention to optimal treatment and contributing factors
for recurrence would result in health improvement by
reduction in mortality. In this study the therapeutic
outcomes and contributing factors for recurrence were
evaluated among patients with treated meningioma by
radiosurgery.
Material and Methods
In this retrospective study 1082 consecutive meningioma
patients treated in Gamma-Knife Center since 2003 to
2011 were enrolled and the required data were collected
form existing medical documents including the
therapeutic outcomes.
Results
Totally 1082 cases including 1164 lesions were included.
The mean age was 52 years (7 to 88 years). 293 patients
(27.1%) were male and 789 subjects (72.9%) were female.
The mean follow-up time was 39.4 ± 24.9 months. In 403
cases, the follow-up was not complete and in remaining
cases, the size of lesion was reduced in 338 lesions (44%),