ESTRO 36 Abstract Book

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S667 ESTRO 36 2017
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Research Ministry of Educati Peking University Cancer
Hospital & Institute, Department of Radiation Oncology,
Beijing, China
2 Key laboratory of Carcinogenesis and Translational
Research Ministry of Educati Peking University Cancer
Hospital & Institute, Gastrointestinal Cancer Center,
Beijing, China
3 Peking Union Medical College Hospital-Chinese Academy
of Medical Sciences and Peking Union Medical College,
Department of Radiation Oncology, Beijing, China
4 Peking Union Medical College Hospital-Chinese Academy
of Medical Sciences and Peking Union Medical College,
Department of General Surgery, Beijing, China
5 Cancer Hospital-Chinese Academy of Medical Sciences,
Department of Radiation Oncology, Beijing, China
6 Cancer Hospital-Chinese Academy of Medical Sciences,
Department of Pancrea-gastric Surgery, Beijing, China
7 Chinese People's Liberation Army General Hospital,
Department of Radiation Oncology, Beijing, China
8 Chinese People's Liberation Army General Hospital,
Department of General Surgery, Beijing, China
Purpose or Objective
To evaluate the safety and efficacy of preoperative
chemoradiotherapy and D2 radical resection in patients
with locally advanced gastroesophageal junction
carcinoma
Material and Methods
Gastroesophageal junction carcinomapatients
withadenocarcinoma, clinical stage T3-4N0 or any TN1-
3M0, Siewert type II and III were enrolled. After exclusion
of peritoneal metastasis with laparoscopic exploration,
patients were randomly assigned into surgery group and
preoperative chemoradiotherapy plus surgery group. The
preoperative chemoradiotherapy group received intensity
modulated radiation therapy (IMRT) and concurrent
chemotherapyS-1 combined with oxaliplatin weekly plan.
The prescription dose was GTV 50Gy/CTV 45Gy/25f/35d
with concomitant boost. For the concurrent
chemotherapy, S-1 was 30mg/m2 bid, five days a week;
oxaliplatin was 40mg/m2 per week, with a total of 5
weeks.Laparoscopic exploration was needed 6 weeks after
the end of the preoperative chemoradiotherapy. Patients
with no peritoneal metastasis underwent D2 radical
resection.Postoperative patients received SOX
chemotherapy for 6-8 cycles. This trial (PAPER) is a
multicenter randomized controlled studyin Beijing,
Tianjin and Hebei Province. Primary endpoint is 3-year
DFS, the secondary endpointsare safety and effectivity
Results
From Sep. 2014 to Jul. 2016,40 cases of 4 centers were
enrolled. There were 20 patients in surgery group and 15
cases in the preoperative chemoradiotherapy group. The
median age was 61 years (range 33-73).28 were male and
7 were female. Clinical staging were as follows: 20 cT3,
15 cT4; 4 cN0, 8 cN1, 19 cN2, 13 cN3. In the preoperative
chemoradiotherapy group ,All patients completed
radiotherapy. Six patients cannot tolerate concurrent
chemotherapy due to toxicity.There was no grade 4
toxicity.The incidence of grade 3 toxicities were 13.3%:
neutropenia. The incidence of grade 2 toxicities were 80%,
including: thrombocytopenia (26.7%), neutropenia (6.7%)
,esophagitis and nausea(13.3%). All patients underwent
radical D2 resection. Pathological complete response
occurred in 13.3% (2/15) of patients. The T and N
downstaging rate were 86.7% (13/15) and 100% (11/11).
respectively.
The tumor regression grade (TRG) were1 case of Grade 0,
2cases of Grade 1 and 3 cases of Grade 2, respectively.
Surgery-related complications consisted of anastomotic
leakage in 2 (13.3%), infection in 1 (6.7%) and hemorrhage
in 1 (6.7%) patients. The perioperative mortality was nil.
In the surgery group, Surgery-related complications
consisted of anastomotic leakage in1 (6.7%), infection in 1
(6.7%) and hemorrhage in 1 (6.7%) patients. The
perioperative mortality was nil
Postoperative complications had no significant differences
between two groupsConclusion
Preoperative Chemoradiotherapy for patients with locally
advanced gastroesophageal junction adenocarcinoma
showed an acceptable toxicity, promising efficacy and
safety for D2 resection. Further conclusions need to be
verified by the mid-term results after the completion of
enrollment
EP-1252 Update of Stereotactic body radiation
therapy for pancreatic adenocarcinoma: efficacy and
safety
X. Chen1, E. Sanchez1, A. Montero1, O. Hernando2, M.
Lopez1, J. Garcia3, J.M. Perez4, R. Ciervide1, J. Valero1,
M. Garcia-Aranda1, R. Alonso2, D. Zucca3, M.A. De la
Casa3, B. Alvarez1, J. Marti3, L. Alonso4, P. Fernandez-
Leton3, C. Rubio1
1Hospital Universitario HM Sanchinarro, Radiation
Oncology, Madrid, Spain
2Hospital Universitario HM Puerta del Sur, Radiation
Oncology, Madrid, Spain
3Hospital Universitario HM Sanchinarro, Medical Physics,
Madrid, Spain
4Hospital Universitario HM Puerta del Sur, Medical
Physics, Madrid, Spain
Purpose or Objective
To review feasibility and single center experience with
stereotactic body radiation therapy (SBRT) in pancreatic
adenocarcinoma.
Material and Methods
Since February 2014, 15 (p) patients with a median age of
69.8 years (range 53-86) with histologically proven
adenocarcinoma of the pancreas were enrolled on this
protocol. Six p (40%) were treated with a radical intent, 5
p (33%) as a part of a neoadjuvant treatment and 4 p (27%)
under a palliative intention. Prior to radiation, at least 2
gold fiducials markers were located into the tumor guided
by endoscopic ultrasound. All the SBRT treatments
included CT or PET-CT for GTV delineation, treatment
technique was intensity-modulated radiation therapy
(IMRT) and daily image-guided radiation therapy (IGRT)
with intrafraction control of tumor motion with a Novalis
Exactrac Adaptive Gating System. Total dose: 50 Gy in 10
fractions were prescribed in 13 p (87%), 1 p was treated
with 35 Gy in 5 fractions and 1 p was treated with 40Gy in
10 fractions.
Results
With a median follow-up of 8 months (range 3 - 24
months), 2 p (13%) are alive without tumor, 4 p (26%) are
alive with tumor and 9 p (61%) have died; median overall
survival (OS) was 13.4 months (range 8.6 – 30.4 months)
and the actuarial 12 and 24 months OS was 79% and 22%
respectively. Eleven p (73%) remain locally controlled and
median time to local progression (PFS) was 11.4 (range 4.5
– 30.4 months). The actuarial PFS at 12 and 24 months
were 85% and 56% respectively. Pancreatic SBRT was well
tolerated in our cohort of patients. No grade 3 or higher
toxicity was observed. Six p (40%) developed grade 2
epigastric pain and/or grade 2 nausea/vomiting.
Conclusion
In our experience, gating SBRT for pancreatic tumor is a
feasible and well-tolerated treatment. Most patients are
free from local progression, but overall survival remains
poor. Prospective studies are needed to define the role of
SBRT for pancreatic tumors.
EP-1253 Interobserver variability in the target
delineation of hepatocellular carcinoma.
E. Gkika1, S. Tandini-Lang2, S. Kirste1, P. Holzner3, H.P.
Neeff3, H.C. Rischke4, T. Reese 5, F. Lohaus6, M.N. Duma7,
K. Dieckmann 8, R. Semrau9, M. Stockinger 10, D. Imhoff11,
N. Kremers 12, M. Häfner13, N. Andratschke2, U. Nestle1,14,