ESTRO 36 Abstract Book

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S661 ESTRO 36 2017
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Leuven, Belgium
7 KU Leuven - University of Leuven, Department of
Radiology, Leuven, Belgium
8 Maastricht University Medical Centre- KU Leuven -
University of Leuven, Department of Radiation Oncology
MAASTRO, Maastricht, Belgium
Purpose or Objective
The purpose of our study is to quantify the influence of
heart dose on the early and late onset of dyspnea in a
cohort of non-small cancer (NSCLC) and malignant pleural
mesothelioma (MPM) patients having multimodality
treatment including radiotherapy (RT).
Material and Methods
Patient population consisted of: a) stage I-III MPM patients
who completed trimodality treatment (induction
chemotherapy, EPP and postoperative RT [PORT]); b)
stage III (ypN2) NSCLC patients treated with induction
chemotherapy, pneumonectomy or lobectomy (+PORT); c)
stage I-III NSCLC treated with RT with curative intent (+/-
chemotherapy).
In 121 patients with multimodality-treated NSCLC and
MPM the maximal dyspnea score (CTCAE 4.0) before RT, at
an early (<6 months) and a late (7-12 months) time point
were obtained.
Included patients needed to be clinically and
radiologically progression-free 9 months after the end of
RT. The difference (Δ) between the maximal dyspnea at
<6 months and at 7-12 months with the pre-RT dyspnea
was calculated.
Results
Forty-four percent (50/113) of the patients developed an
early worsening of at least 1 point in their dyspnea score
(Δdyspnea >1) after the end of RT. Independent predictors
of an early worsening were the mean heart dose (MHD)
(for Δdyspnea >1: OR=1.032, p=0.04) and the dyspnea
score before RT (for Δdyspnea >1: OR=0.40, p=0.0001; for
Δdyspnea >2: OR=0.35, p=0.05).
At the later time point, only the dyspnea score before RT
(OR: 0.40, p=0.001) was identified as predictor of for
Δdyspnea >1.
Conclusion
Our results, albeit exploratory, suggest that heart dose
may play a role in the early worsening of the dyspnea in a
heterogeneous cohort of patients having multimodality
treatment including RT, whereas baseline dyspnea plays a
major role for both early and later worsening.
Electronic Poster: Clinical track: Upper GI (oesophagus,
stomach, pancreas, liver)
EP-1238 Patterns of recurrence in patients of pT2
esophageal squamous cell carcinoma after radical
resection
Y.X. Wang1, Y.H. Gao1,2, J. Li1, R. Qiu1, X.Y. Qiao 1
1 The Fourth Hospital of Hebei Medical University,
Department of Radiation Oncology, Shijiazhuang, China
2 the 2th Central Hospital of Baoding, department of
Medical Oncology, Zhuozhou, China
Purpose or Objective
To retrospectively investigate the patterns of recurrence
and its related factors in patients of stage pT2N0-1M0
thoracic esophageal squamous cell carcinoma(ESCC) after
radical resection.
Material and Methods
From 2008 to 2011, 222 cases of stage pT2N0-1M0 thoracic
ESCCC with R0 resection were enrolled. There were 142
males and 80 females. There were 181 in pN1 and 41 cases
in pN1. 142 patients has treated with surgery alone and 80
with adjuvant postoperative chemotherapy (POCT).
Diagnosis of recurrence was primarily based on CT images.
Results
Follow-up ended at 30, Sep, 2014. The overall recurrence
rates was 35.1%. Locoregional recurrence (LR) was found
in 25.7% of patients, distant metastasis (DM) in 5.9%, and
LR plus DM in 3.6%, respectively. The LR occupied about
83.3% of any recurrence, and 87.7% of LR has occurred in
mediastinum (91.2% of it located in upper- mediastinum).
Multivariate Cox regression analysis showed that the
danger of total recurrence, LR and DM for stage pN1
patients was about 7.1, 6.5 and 3.1 folds in comparied
with stage pN0, respectively; the danger of total
recurrence in females was about 49.1% in compared with
males. But POCT could not influence total recurrence and
LR(P>0.05).
Conclusion
The recurrence rate was very high in stage pT2N0-1M0
thoracic ESCC after radical resection, the most common
site of recurrence was mediastinum (especially upper-
mediastinum), it was probably the main target of
postoperative radiotherapy. The recurrence was more
frequently occurred in stage pN1 and males. T2N0-1M0
thoracic ESCCC with R0 resection were enrolled. There
were 142 males and 80 females. There were 181 in pN1
and 41 cases in pN1. 142 patients has treated with surgery
alone and 80 with adjuvant postoperative chemotherapy
(POCT). Diagnosis of recurrence was primarily based on CT
images.
EP-1239 SBRT in patients with HCC/CCC or
oligometastatic liver disease
S. Gerum 1, C. Heinz 1, C. Belka1, M. Niyazi1, U.
Ganswindt1, F. Roeder1,2
1LMU Munich, Department of Radiation Oncology,
Munich, Germany
2German Cancer Research Center DKFZ, Department of
Molecular Radiation Oncology, Heidelberg, Germany
Purpose or Objective
To report our experience with stereotactic body
irradiation in primary and secondary liver lesions.
Material and Methods
We retrospectively analysed 37 patients who had not been
eligible for other local treatment options (surgery, RFA)
and therefore received SBRT to 1-2 liver lesions (43 lesions
in total) in our institution from 2011-2015. Median age was
66 years (31 – 83 years) and 20 patients were male. 16
patients suffered from HCC/CCC, 21 patients had
oligometastatic liver disease, mainly originating from
colorectal cancer. The majority presented in good
performance status (median KPS 90%, range 60%-100%)
with adequate liver function (cirrhosis Child A: 13, Child
B: 2, Child C: 1, none: 21). Immobilization included a
vacuum pillow in all patients and the use of abdominal
compression since 2014. Treatment planning was based on
4D-CT (contrast-enhanced since 2014) usually after
placement of fiducial markers and rigid registration with
diagnostic MRI images. Median ITV to PTV margin was 6
mm.
Results
Mean follow-up was 14 months (range 1 - 47) Fiducials
were needed in 29 patients (78%). Placement was feasible
without any complications in all patients. Abdominal
compression was used in 12 patients since 2014 to reduce
breathing motion. Dose and fractionation varied
dependent on localisation, size, motion and liver function.
The most common schemes were 37.5 Gy/65% isodose in 3
fractions, 40 Gy/80% in 5 fx and 54Gy/80% in 9 fx. Median
GTV volume on free-breathing CT was 13 ccm (1-247) and
median PTV volume was 126 ccm (15-537). Local
recurrence (in field) was observed in 6 patients (16%)
resulting in a 1-year LC rate of 92%. New lesions in the
liver (out-field) occured in 20 patients (54%), 15 (40%)
patients developed extrahepatic progression. 5 patients
have died, resulting in a 1-year overall survival of 87% in
all patients. No significant differences in any endpoint
have been observed between HCC/CCC and