ESTRO 36 Abstract Book

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S665 ESTRO 36 2017
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exclusive EBRT with Carboplatin-Taxol compared to
FOLFOX-4 regimen.
Material and Methods
Patients were matched 1:1 with respect to age at
diagnosis (±5 years), stage (I-II vs III-IV), biopsy proven
histology (squamous vs adeno) and topography (upper,
middle or lower third or cardia). 46 patients followed the
above criteria and remained for the final analysis : 23
patients were treated with FOLFOX-4 regimen (group A)
and 23 patients with Carboplatin AUC2 mg/mL per min and
Taxol 50mg/m2, weekly (group B). Comparison between
the 2 groups was performed using Mac Nemar test for
paired data. Statistical analyses were performed using SAS
9.3 software. All tests were two sided and P values were
considered significant when less than 0.05.
Results
The mean age in group A was 69.4 years (12.5) and 72.4
years (12.6) in group B (p=ns). In each group, 11 patients
had a stage III disease at diagnosis (47.8%) with only 2
stage IV in group A (8.7%) vs none in group B.
The median delivered RT doses were 50Gy [14-60] in group
A while it was 50Gy [20-70] in group B. We found no
difference in the compliance with chemotherapy in each
group : 6 courses were delivered in 12 patients in group A
(52.2%) and 14 patients in group B (60.9%) (p=0.51). No
difference in dose reduction was observed between each
group for each course of chemotherapy.
After chemoradiation, G1 or higher esophagitis was
observed in 5 patients (26.3%) in group A and 3 patients
(13.0%) in group B of whom 0 vs 2 G3 were observed in
group A and B, respectively. Four patients (21.1%) had a
pulmonary infection in group A and 3 in group B (13.0%).
Looking at haematological toxicity, 2 patients (8.7%) vs 4
patients (17.4%) had G3 neutropenia, with only 0 and 2
neutropenic fever in group A and B, respectively. No
patient had G-CSF. Neither G3 anemia, nor G3
thrombopenia occured.
After a median follow-up of 17.7 months [0.0-46.9], 25
patients had died, 14 in group A (60.9%) and 11 in group B
(47.8%).
The median PFS rates were 14 months in group A [7.7-NR]
vs 12.1 months [4.4-NR] in group B (p=0.32).
The median OS rates were 20.3 months in group A [6.2-
39.3] vs 17.0 months [4.8-NR] in group B (p=0.82).
Conclusion
Exclusive chemoradiation with Carboplatin and Taxol
seems feasible with similar toxicity and survival outcomes
than FOLFOX-4. The safety and efficacy of the CROSS
regimen needs to be tested prospectively with EBRT doses
>41.4Gy in a phase II or III trial.
EP-1248 Adjuvant radiotherapy for gastric cancer
patients underwent gastrectomy and D2 lymph node
dissection
Y. Wang1, J.M. Hwang1 , Y.K. Chang1, W.Y. Kao2, H.L.
Wan2, S.Y. Chang2, C.C. Wu3
1 Taipei Tzu Chi Hospital, Radiation Oncology, New Taipei
City, Taiwan
2 Taipei Tzu Chi Hospital, Medical Oncology, New Taipei
City, Taiwan
3 Taipei Tzu Chi Hospital, General Surgery, New Taipei
City, Taiwan
Purpose or Objective
The benefit of adjuvant chemoradiation (CRT) has been
confirmed by the Intergroup 0116 (INT-0116) study.
However, as D2 lymph node dissection has been linked to
lower recurrence rate, the role of adjuvant radiotherapy
(RT), whether with or without concurrent chemotherapy,
following D2 dissection is controversial. The goal of this
study is to review the clinical outcome of patients with
locally advanced gastric adenocarcinoma underwent
gastrectomy and D2 lymph node dissection with or without
adjuvant RT.
Material and Methods
We reviewed 420 patients who were diagnosed with
gastric cancer at Taipei TzuChi Hospital during Jan, 2008
to Sep, 2015, while excluding the following patients: those
a) >80 years old, b) didn’t undergo gastrectomy and D2
dissection, c) with distant metastases at diagnosis, d)
stage IA or IB without nodal metastases, or e) patients who
had never been disease-free. The overall survival (OS) and
disease-free survival (DFS) rates were compared between
patients treated with or without adjuvant RT. Chi-square
test or unpaired t-test were used to compare the age,
gender, positive lymph nodes (LN) numbers, stage, and
chemotherapy status distribution between these two
groups.
Results
Of those selected patients, thirty-one underwent adjuvant
RT and 40 didn’t. The characteristics were described in
Table 1. The median follow-up time was 26.87 months.
Regional lymph node recurrence alone was only noted in
one patient who didn’t undergo RT. Distant metastases
(DM) were noted in 17 patients (with RT: 8; without RT:
9). Out of those nine patients who developed DM and
didn’t undergo RT, five had been given chemotherapy. Age
is significantly related to worse OS (Pearson correlation
coefficient=-0.248, p=.037) but not to DFS (-0.191,
p=0.111). Positive LNs number is significantly related to
both worse OS (-0.244, p=0.041) and DFS (-0.261,
p=0.028). Adjuvant RT didn’t significantly improve OS
(median: 34.3 vs. 19.7 months, p=0.123) and DFS (median:
30 vs. 17.7 months, p=0.86) (Fig. 1). The patients received
adjuvant chemotherapy were with significantly longer OS
(median: 31.9 vs. 14.7 months, p=0.007) but not DFS
(median: 28.6 vs. 14 months, p=0.42).
Conclusion
Although the patients who underwent adjuvant CRT were
significantly younger, they were also with more advanced
diseases. Most of the recurrent events were distant
metastases in our study, indicating that D2 dissection
might have largely decreased the locoregional failure
rate. Adjuvant RT didn’t show significant benefit
prolonging OS or DFS. On the other hand, the patients
received adjuvant chemotherapy were observed to have
significantly longer OS but not DFS. It is possible that the
prolonged OS is correlated to the age of patients, rather
than a result of chemotherapy. Further randomized
controlled trials are required to draw a concrete
conclusion.
EP-1249 Changes in normal liver volume after high
dose radiation in cancer of the liver
K. Rajamanickam1, S. Chopra1, R. Engineer1, V. Ostwal1,
P. Patil2, S. Mehta2, E. Dhandpani3, K. Joshi3, S.K.
Shrivastava1
1Tata Memorial Hospital, Radiation Oncology, Mumbai,
India
2Tata Memorial Hospital, Digestive Diseases and Clinical
Nutrition, Mumbai, India
3Tata Memorial Hospital, Medical Physics, Mumbai, India
Purpose or Objective
To report liver volume changes and its impact on liver
function following hepatic radiation in patients with
primary or secondary hepatic malignancies.
Material and Methods
From Jan 2015 - April 2016, consecutive patients with
unresectable hepatic lesions (hepatocellular cancer
(HCC), Cholangiocarcinoma (CCA) or liver metastasis (LM))
who received either high dose radiation (HDRT) or
stereotactic radiation (SBRT) and without disease
progression were included. All patients were required to
have Child Pugh status A-B6 prior to radiation. Total liver
volume, gross tumour volume (GTV), normal liver volume
(total liver volume- GTV) was determined. Follow up scans
were used to determine changes, if any, in normal liver
volume. As the dose prescription of each patient was
individualised, biologically equivalent dose (BED) were