ESTRO 36 Abstract Book

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S662 ESTRO 36 2017
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oligometastatic patients, although the latter ones had a
higher absolute 1-year OS rate (73% vs 87%). Toxicity was
generally mild (grade 1: 8 pts., grade 2: 2 pts.), except
one patient with Child C cirrhosis who developed hepatic
failure shortly after SBRT which was successfully treated
by liver transplantation.
Conclusion
SBRT is a locally effective and well tolerated treatment
method for primary and secondary liver lesions. Given the
high rates of intrahepatic outfield failures, careful
pretreatment evaluation and patient selection seems
mandatory.
EP-1240 Stereotactic radiotherapy in pancreatic
cancer: a systematic review on pain relief
M. Buwenge1, G. Macchia2, F. Deodato2, S. Cilla3, L.
Caravatta4, A. Farioli5, A. Guido1, A. Arcelli1,6, F. Bertini1,
F. Cellini 7, G.C. Mattiucci7, M.C. Di Marco8, S. Cammelli1,
G. Tolento1, V. Valentini7, L. Fuccio5, A.G. Morganti 1
1 University of Bologna, Radiation Oncology Center-
Department of Experimental- Diagnostic and Specialty
Medicine - DIMES, Bologna, Italy
2 Fondazione di ricerca e cura "Giovanni Paolo II",
Radiotherapy unit, Campobasso, Italy
3 Fondazione di ricerca e cura "Giovanni Paolo II", Medical
Physics Unit, Campobasso, Italy
4 Centro di Radioterapia e Medicina Nucleare- P.O.
Businco, Radiotherapy Unit, Cagliari, Italy
5 University of Bologna, Department of Medical and
Surgical Sciences - DIMEC, Bologna, Italy
6 Ospedale Bellaria, Radiotherapy Department, Bologna,
Italy
7 Policlinico Universitario "A. Gemelli"- Università
Cattolica del Sacro Cuore, Department of Radiotherapy,
Roma, Italy
8 University of Bologna, Oncology Center- Department of
Experimental- Diagnostic and Specialty Medicine - DIMES,
Bologna, Italy
Purpose or Objective
In locally advanced pancreatic carcinoma (LAPC) standard
radiotherapy and concurrent chemoradiation are able to
reduce pain. Stereotactic radiotherapy (SBRT) is an
emerging treatment technique but its role in pain
palliation is not well known. Therefore, aim of this
analysis was to systematically review the palliative effect
of SBRT in LAPC.
Material and Methods
A systematic review based on PRISMA methodology of
papers reporting pain control after SBRT in LAPC patients
was performed using PubMed database. Combination with
chemotherapy was allowed. Only article published in
English were considered.
Results
A total of 11 studies reporting data on pain control after
SRT in LAPC patients met the inclusion criteria. SBRT was
performed using both standard and robotic Linacs. The
prescribed SBRT median total dose 24 Gy (range: 14-45
Gy), and the median number of fraction was 3 (range: 1-
6). Median EQD2 using α/β: 10 and α/β: 3 were 65.5 Gy
(range 31.3-93.8) and 95.0 Gy (range 40.0-162.0),
respectively. Nine of the 11 studies reported different
rates pain reduction. Particularly, median pain ORR was
57.0% (range: 44.0-100.0%) with 2 studies reporting pain
CR in 48.4% and 81.3% of patients. Reduction of analgesic
consumption was recorded in 65.0-100.0% of patients. One
study reported no significant pain reduction, while
another study reported a significant worsening of pain 2
weeks after SBRT. Acute and late toxicity (grade ≥ 3)
ranged between 3.3-18.0% and 6.0-8.2%, respectively. All
recorded toxicity were GI complications.
Conclusion
SBRT was able to achieve pain reduction in most studies
with a reasonable rate of side effects. Therefore, further
prospective studies on palliative role of SBRT in LAPC
seems to be justified. Aim of these trials should be the
definition of the optimal dose/fractionation and the best
way to combine SBRT with systemic therapies. Finally,
being treatment of LAPC patients mainly palliative,
quality of life and particularly pain control should be
considered as an end point in future SBRT trials.
EP-1241 Successful pain relief after a short course of
palliative radiotherapy in painful pancreatic cancer.
G. Ebrahimi1, C.R.N. Rasch1, G. Van Tienhoven 1
1Academic Medical Center, Radiation oncology,
Amsterdam, The Netherlands
Purpose or Objective
Patients with pancreatic cancer have a high burden of
symptoms. At time of diagnosis 30-40% of the patients
report pain as a dominant symptom, which rises up to 90%
shortly before death. Because of a poor overall survival,
the burden of a palliative treatment should be balanced
against the expected effect. This study was conducted to
assess the effect of a short course of palliative
radiotherapy on pain symptoms.
Material and Methods
All patients who were treated with palliative radiotherapy
because of painful pancreatic cancer between 1998 and
2015 were retrospectively analyzed. Primary endpoint was
pain relief and secondary endpoint was overall survival.
Results
61 patients were treated with a short course of palliative
radiotherapy at the Academic Medical Center. A majority
had stage four disease (69%) and a minority had local
recurrence after surgery (10%). Median age was 62 years,
51% of the patients were male and mean Karnofsky
performance score (KPS) was 79%. Median pain score
before treatment was 8 on an 11-point numeric pain rating
scale. Eighty-five percent of the patients used strong
opioids with a mean equivalent oral morphine dose of 147
mg a day. Four radiotherapy dose schedules were given: 3
x 8 Gy (46%), 2 x 8 Gy (39%), both once per week, 1 x 8 Gy
(13%) and 1 x 6 Gy (2%). Pain relief after radiotherapy was
experienced by 66% of patients. Median time to reduction
in pain was 1 week after end of radiotherapy, although
this time interval could only be assessed in 25 patients.
Information on use of pain medication after treatment was
not clearly documented. Four patients had complete pain
relief and in 4 patients pain medication was reduced or
even stopped. Nausea was a common reported side effect
in 51% and vomiting was reported in 21%. Median overall
survival was 3.5 months. Patients who had pain relief after
treatment had a better overall survival (p<0,0001)
compared to non responders.
Conclusion
A short course of palliative radiotherapy was effective in
66% of the patients with the most frequent given
radiotherapy dose schedule of 3 x 8 Gy. Radiotherapy was
fairly well tolerated. These results were the basis for a
prospective phase-2 study at our institute named
PAINPANC (NTR5143). Thirty patients with painful
unresectable pancreatic cancer will receive 3 x 8 Gy, one
fraction a week, and are prospectively followed with
EORTC-QLQ-C15-PAL and Brief Pain inventory
questionnaires during and after treatment.
EP-1242 Palliative EBRT for incurable esophageal
cancer and symptomatic dysphagia-single center
results
K. Yordanov1, A. Richetti1, S. Cima1, G. Pesce1, C.
Azinwi1, F. Martucci1, B. Muoio1, P. Fanti1, M.C. Valli1
1Oncology Institute of Southern Switzerland,
Radiotherapy, Bellinzona, Switzerland
Purpose or Objective
Purpose: to assess the effectiveness and safety of external
beam radiation therapy (EBRT ) to palliate dysphagia in