ESTRO 36 Abstract Book

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S607 ESTRO 36 2017
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not changed in 377 cases (49%), and was increased in 46
lesions (7%). Hence, totally 93% of cases were controlled
by treatment. Also 80 patients (6.8%) had recurrence.
Conclusion
Totally according to the obtained results it may be
concluded that Gamma-knife surgery is effective in more
than ninety percent of cases with cranial meningioma
leading to low recurrence rate. However further studies
should be carried out to determine the other contributing
factors for recurrence and also comparison of the results
of Gamma-knife therapy with other conventional
methods.
EP-1120 Fractionated stereotactic radiotherapy in
adult craniopharyngiomas : outcomes and
complications
R. Benlloch Rodríguez1, R. Magallón Sebastián 1, D. Rincón
Cruz1, M.I. García Berrocal 1, P. Ruiz García2, J. Romero
Fernández1, I. Zapata Paz1, M.J. Expósito Casas1, B.
Vaquero Barrón1, A. De la Torre Tomas 1
1 Hospital Universitario Puerta de Hierro, Radiation
Oncology, Majadahonda - Madrid, Spain
2 Hospital Universitario Puerta de Hierro, Radiology,
Majadahonda - Madrid, Spain
Purpose or Objective
To evaluate treatment-related complications and long
term outcomes in adult craniopharyngioma patients
treated with surgery and Fractionated Stereotactic
Radiotherapy (FSRT).
Material and Methods
Between 2002 and 2015, 30 patients (p.) with histologic
diagnosis of craniopharyngioma were treated with FSRT.
Median age: 42 years; Sex: 17 males, 13 females. FSRT was
indicated for progressive disease after surgery or
postoperatively after partial resection. FSRT was
delivered to a median dose of 50.4Gy (1.8Gy/fraction).
To evaluate tumour and treatment-related complications
and quality of life, “Craniopharyngioma Clinical Status
Scale” and “Functional Classification scale” were used.
These questionnaires were completed before and after
surgery and after FSRT. Median follow-up was 87 months.
Follow-up included neurologic, ophthalmologic,
endocrinology evaluations and MRI every 3 to 6 months.
Statistics: Kaplan-Meier method and long-rank test.
Results
Five and 10-year actuarial local control and overall
survival were 97% and 89% and 89% and 80% respectively.
Seven patients presented enlargement of cystic
component and 2 required drainage. Two patients died
due to tumour progression.
At initial diagnosis, 69% had visual field loss or decreased
of visual acuity and 6% presented others neurological
deficits Eight p. (27%) and 4 p. (13%) had partial or
complete endocrinopathy, respectively; and hypothalamic
function was deteriorated in 9 p. (31%). All p. presented
good cognitive status at initial presentation.
After surgery patients suffered a significant impairment of
their neurologic (p=0.004), endocrinologic (p<0,0001) and
hypothalamic (p=0.004) functions. Visual status worsened
in 9 p. (31%), 5 of whom presented severe deficit or
complete blindness. Other neurologic deficits were seen
in 6 p. (20%). Twenty p. (68%) had panhypopituitarism and
diabetes insipidus and 10 p. (34%) presented severe
hypothalamic dysfunction. Cognitive function worsened in
6 p.
No patient presented decrease of vision or hypothalamic
dysfunction after FSRT and only 1(3%) had neurologic and
endocrinologic deficits. Cognitive status worsened in 1 p.
after FSRT.
Improvement of visual, neurologic and hypothalamic
deficits were observed in 6 p. (20%), 3 p. (10%) and 6 p.
(20%) respectively after FSRT.
A total of 8 p. (27%) presented some grade of loss of
independence in activities of daily living after both
surgery and FSRT.
Conclusion
A high incidence of treatment-related side effects is
reported mainly after surgery. Neurologic, endocrinologic
and hypothalamic impairments after surgery were
statistically significant compared with initial
presentation. In our series FSRT is effective, well
tolerated and in some cases even improves deficits.
Further studies are needed to establish if a less aggressive
surgery combined with postoperative FSRT provides same
tumor control while diminishes complications.
EP-1121 Newly diagnoses grade III glioma patients:
evaluation of factors conditioning outcome.
P. Navarria 1, F. Pessina2, S. Tomatis1, L. Cozzi1, G.R.
D'Agostino1, A.M. Ascolese1, M. Simonelli3, A. Santoro3, E.
Clerici1, C. Franzese1, L. Bello 2, M. Scorsetti1
1Istituto Clinico Humanitas, Radiotherapy and
Radiosurgery, Rozzano Milan, Italy
2Istituto Clinico Humanitas, Neurosurgery Oncology
Department, Rozzano Milan, Italy
3Istituto Clinico Humanitas, Oncology and Hematology
Department, Rozzano Milan, Italy
Purpose or Objective
Current treatments in WHO grade III gliomas include
surgery, radiation therapy (RT) and chemotherapy (CHT),
but so far a standard of care is still lacking. The aim of this
study was to analyze the outcome of patients with newly
diagnosed WHO grade III gliomas treated with a
multimodal approach. The adjuvant treatment, after
surgery, has been chosen in relation to extent of resection
(EOR), histological subtype and molecular profile.
Material and Methods
The present retrospective study includes patients
with newly diagnosed WHO grade III gliomas treated at
our institution. All patients underwent surgery followed
by adjuvant treatment, chemotherapy only or radiation
therapy with concurrent and adjuvant chemotherapy
(TMZ) in relation to the extent of surgical resection (EOR),
histological subtype, and molecular profile. Patients with
oligodendroglial features (anaplastic oligodendroglioma or
anaplastic oligodendroglioma), complete resection (CR),
1p/19q codeletion, IDH1 mutated, and MGMT methylated
status underwent adjuvant chemotherapy alone; all the
others underwent to concomitant and adjuvant CHT. CHT
consisted of TMZ. The total RT dose prescribed was 60 Gy
in 30 fractions. Clinical outcome was evaluated by
neurological examination and brain MRI performed, one
month after RT and then every 3 months. Response was
recorded using the Response Assessment in Neuro-
Oncology (RANO) criteria. The tumor progression was
described as local, if it occurred in/or within 2 cm from
primary site, and distant for new and non-contiguous
enhancing or non-enhancing lesions. Hematologic and non-
hematologic toxicities were graded according to Common
Terminology Criteria for Adverse Events version 4.0.
Results
From January 2008 to May 2014, 123 consecutive patients
were treated. Thirty-tree (26.8%) patients had diagnosed
of anaplastic astocytoma, 36 (29.3%) patients anaplastic
oligoastrocytoma and 54 (43.9%) anaplastic
oligodendroglioma. Fifty-one (41.5%) underwent surgery
plus adjuvant chemotherapy and 72 (58.5%) surgery plus
concomitant and adjuvant chemo-radiotherapy. The
median, 1-2-3- and 5-year PFS was 27 months, 85.4%,
65.5%, 21.2% and 21.2% respectively and the 1-2-3- and 5-
year OS was 97.65%, 89.7%, 83.0%, and
58.4%, respectively. On univariate and multivariate
analysis the EOR, IDH1 mutation and 1p19q codeletion
influenced PFS while KPS, histological subtype, and
IDH1 mutation influenced OS.