ESTRO 36 Abstract Book

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S683 ESTRO 36 2017
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this approach in published international guidelines.
Intervals from 1 to 4 weeks are associated with higher
rates of postoperative complications.
In this study we aim to evaluate toxicity, response to
treatment and survival in patients with LARC treated with
SC-RT in the neoadjuvant setting.
Material and Methods
Prospective inclusion of patients with LARC treated by SC-
RT between 2002 and 2015. Response was assessed by
pathological stage and Ryan modified tumor regression
grade (TRG); toxicity was evaluated using CTCAE 4.0 scale.
Survival curves were estimated using Kaplan-Meier’s
method. A type I error of 0.05 was considered.
Results
73 patients included, 63.0% male. Median age was 80
years, 31.5% with Karnofsky index lesser or equal to 80%.
Tumor stage was cT3 in 80.9% and cT4 in 15% of patients;
58.9% were cN+. Perineal acute toxicity grade 2 was
described in 2.7%, with no other toxicities. 68 patients
underwent surgery with a median RT-surgery interval of 7
weeks (1-22 weeks). Conservative surgery was performed
in 79.4% and postoperative complications observed in
33.8%. Complete pathological response (cPR) achieved in
7.4% of patients with TRG 0-1 in 8.9%. Lymphovascular
invasion was observed in 23.5% of surgical specimens and
R0 resections in 83.8%. 42 patients underwent surgery
more than four weeks after the end of RT (61.7%), with a
higher percentage of cPR than those submitted to surgery
before, although not statistically significant (3.8% vs.
9,5%). This group also achieved TRG 0-1 more often (3.8%
vs. 12.2%). Postoperative complications were higher in the
group that underwent surgery up to 4 weeks (42.3% vs.
28.6%), without statistical differences. With a median
follow-up of 27 months, at 5 years, locoregional-disease-
free survival (LRDFS) was 88.7%, disease-free survival
(DFS) was 68.1%, cancer-specific survival (CSS) was 60.8%
and overall survival (OS) was 37.0%. Although not
statistically significant, cPR showed better outcome at 5
years on LRDFS (100% vs. 87.7%), DFS (100% vs. 65.3%) and
CSS (100% vs. 57.5%).
Conclusion
In this set of patients, SC-RT was a good option for LARC
neoadjuvant treatment, particularly given patient’s age
and co-morbidities. Although not statistically significant,
delayed surgery (over 4 weeks) was associated with a
higher cPR rate. In the group of patients with cPR, no local
recurrence or distant metastasis were registered. In
patients undergoing surgery up to 4 weeks, the higher rate
of surgery-related complications may be explained by the
existence of surgeries performed in the second and third
weeks after RT.
EP-1284 Impact of surgical delay after long-course
radiochemotherapy in rectal cancer
T.M. Dos Santos Teixeira1, A. Ponte1, J. Casalta.Lopes1, I.
Nobre-Góis1, M.R. Silva2 , R. Lebre3, A. Barros3, M.
Borrego1
1 Hospitais da Universidade de Coimbra, Serviço de
Radioterapia, Coimbra, Portugal
2 Hospitais da Universidade de Coimbra, Serviço de
Anatomia Patológica, Coimbra, Portugal
3 Hospitais da Universidade de Coimbra, Serviço de
Oncologia Médica, Coimbra, Portugal
Purpose or Objective
One of the possible treatments for locally advanced rectal
carcinoma (LARC) in the neoadjuvant setting is long course
radiotherapy, associated to concomitant chemotherapy
(LC-RCT). There is growing evidence that a longer interval
between radiation therapy and surgery improves tumor
response to LC-RCT. Randomized studies have shown that
the achievement of a complete pathological response
provides a decrease in local recurrence and an
improvement in overall survival.
In this study we aim to evaluate the impact of delayed
surgery in pathologic complete response rate after
neoadjuvant therapy with LC-RCT.
Material and Methods
Prospective inclusion of patients with LARC, clinically
staged as cT3 or cT4, treated with LC-RCT between 2002
and 2015, with a dose of
50.4Gy / 28 fractions / 5.5 weeks and undergoing surgery
afterwards. The response to neoadjuvant therapy was
assessed by pathological stage and toxicity was evaluated
by using CTCAE 4.0. Survival curves were estimated using
Kaplan-Meier’s method. A type I error of 0.05 was
considered.
Results
249 patients included, 64.7% male. Median age was 64
years, 95.2% of patients with Karnofsky index greater than
or equal to 90%. Tumor stage was cT3 in 83.9% of patients
and cT4 in 16.1%; 90.4% had lymph nodes with criteria for
tumor infiltration. During the treatment acute toxicity
was observed in 75.1% patients, with 10.0% corresponding
to grade 3 or 4. Concomitant chemotherapy was mainly
administered using oral fluoropyrimidines (84.7%). 73
patients (29.3%) underwent surgery over 8 weeks after the
end of LC-RCT. 67.1% of patients underwent conservative
surgery; there were no differences in postoperative
complications regarding time to surgery. Patients
undergoing surgery over 8 weeks after the end of LC-RCT
showed higher T downstaging (65.8% vs. 56.8%) and
pathological complete response (pCR) rate (16.4% vs.
13.1%), although no statistically significant differences
were observed. With a median follow-up of 57 months, at
5-years, locoregional-disease-free survival (LRDFS) was
93.4%, disease-free survival (DFS) was 69.5%, cancer-
specific survival (CSS) was 77.5% and overall survival (OS)
was 70.6%. Patients achieving pCR had better DFS (5-year:
93.3% vs. 65.3%, p=0.003), CSS (5-year: 96.7% vs. 74.5%,
p=0.006) and OS (5-year: 88.9% vs. 67.8%, p=0.010).
Although not statistically significant, LRDFS was also
higher in this group (5-year 100% vs. 92.3%, p=0.100).
Conclusion
Although not significantly, delaying surgery over 8 weeks
provided greater T downstaging rate and pCR, with no
differences regarding postoperative complications. pCR
showed significant impact on the DFS, CSS and OS.
Electronic Poster: Clinical track: Gynaecological
(endometrium, cervix, vagina, vulva)
EP-1285 Neutrophilia in locally advanced cervical
cancer: biomarker for image-guided adaptive
brachytherapy?
C. Chargari1, A. Escande1, C. Haie-Meder 1, P. Maroun1, S.
Gouy 2, R. Mazeron1, T. Leroy3, E. Bentivegna2, P. Morice2,
E. Deutsch1
1Gustave Roussy, Radiotherapy department-
Brachytherapy unit, Villejuif, France
2Gustave Roussy, Department of surgery, Villejuif,
France
3Oscar Lambret Cancer Center, Radiotherapy
department, Lille, France
Purpose or Objective
To study the prognostic value of leucocyte disorders in a
prospective cohort of cervical cancer patients receiving
definitive chemoradiation plus image— guided adaptive
brachytherapy (IGABT).
Material and Methods
We examined patients treated in our Institution between
April 2009 and July 2015 by concurrent chemoradiation (45
Gy in 25 fractions +/– lymph node boosts) followed by a
magnetic resonance imaging (MRI)-guided adaptive pulse-
dose rate brachytherapy (15 Gy to the intermediate-risk
clinical target volume). The prognostic value of
pretreatment leucocyte disorders was examined.