ESTRO 36 Abstract Book

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S686 ESTRO 36 2017
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5 Saitama Medical University International Medical
Center, Radiation Oncology, Saitama, Japan
Purpose or Objective
Elderly patients with cervical cancer (CC) are commonly
treated with radiation therapy (RT) alone because age-
related physiologic changes can increase the toxicity of
chemotherapy. Thus, brachytherapy (BT) assumes more
crucial role for elderly patients with CC. In our institution,
treatment technique of BT has moved from 2D-based to
CT-based image guided BT (IGBT) in a phased manner. The
purpose of this study is to analyze the impact of fraction
of IGBT on the clinical outcome for elderly patients with
CC.
Material and Methods
Between January 2001 and September 2014, 104 patients
aged≧70 years with CC received external beam RT (EBRT)
and high-dose rate BT with curative intent in our
institution. EBRT (38.0-56.8 Gy) with central shielding
after 20-40 Gy was performed for each patient. We
compared clinical results of two groups; the patients
treated with IGBT only once (single-IGBT group, n=74) or
at least twice (multiple-IGBT group, n=30) out of all
sessions of BT. Four fractions of BT were administered
once a week with a fraction dose of 6 Gy to Point
A,basically. Dose adaptation was initially based on dose
changes at Point A in IGBT session. If dose adaptation to
Point A could not be achieved as intended, manual
optimization of dwell positions and dwell weights was
performed to improve dosimetry. We predicted that a 6
Gy isodose line would cover the high-risk clinical target
volume (HR CTV) in order to achieve a HR CTV D90 (the
minimum dose delivered to 90% of the HR CTV) of >6 Gy.
The local control (LC) rate, overall survival (OS) rates, and
late toxicities were compared in the 2 groups. Late
toxicity was defined using the Radiation Therapy Oncology
Group late radiation morbidity scoring system as any
toxicity occurring 6 months after the initiation of RT.
Results
The median follow-up period was 59 months in all
patients. Twenty-seven patients had stage IB, 45 had stage
II, 29 had stage III, and 3 had stage IVA in FIGO staging.
The median dose of all BT sessions in total was 24 (7.8-31)
Gy at Point A. There was no statistical difference between
the two groups in age, FIGO stage, tumor size, Point A
dose, and the number of BT. The 4-year LC and OS rates
were 89.5% and 70.2% in single-IGBT group, 87.5% and
59.0% in multiple-IGBT group, respectively. There were no
statistical differences in survivals between the 2 groups.
In regard to late toxicities ( ≧grade 1), 18 patients
developed lower gastrointestinal (GI) toxicity and 19
patients developed genitourinary (GU) toxicity in single-
IGBT group, whereas 4 patients developed GI toxicity and
no GU toxicity were found in multiple-IGBT group.
Multiple-IGBT had tendency to reduce GI toxicity and
significantly reduced GU toxicity (p < 0.05).
Conclusion
IGBT for elderly patients were performed safely and
effectively. Multiple-IGBT, acquiring CT images more than
twice, contributes to reduce late toxicity, compared to
single-IGBT for elderly patients with CC.
EP-1290 Helical Tomotherapy plus Brachytherapy
boost in cervical cancer: a double dose escalation
G. Cattari1, E. Delmastro1, A. Mranti2, S. Bresciani2, S.
Squintu1, E. Garibaldi1, P. Gabriele 1
1 FPO-IRCCS Candiolo, Radiotherapy, Candiolo- Turin,
Italy
2 FPO-IRCCS Candiolo, Medical Physic, Candiolo- Turin,
Italy
Purpose or Objective
Traditionally, curative radiation treatment for squamous
cervical cancer (SCC) is associated to concomitant
chemotherapy platinum based. Doses on the pelvic volume
and on the present disease were limited by tolerance of
health tissues, especially by small bowel. The possibility
of dose escalation (DE) was achieved by intracavitary
brachytherapy (BRT) boost, the most classical and proven
hypofractionation technique. More modern technologies
and techniques, like Helical Thomoterapy (HT), allowed a
safe and concomitant dose escalation in this setting of
patients (pts) and we need to show our experience in
terms of outcome, tolerance and feasibility
Material and Methods
From 2011 to 2015 we treated 34 pts affected by SCC, 22
with curative intent (4 recurrences). The mean age was 58
years (range 32-88). Grading was: G2 in 10 pts and G3 in
12pts. Stage was: IIA in 4 pts, IIB in 14 pts, IIIA in pt, IIIB I
in 2 pts and IV in 1 pt. All pts received concurrent
chemotherapy (CHT) with cisplatin and/or taxanes. All
patients were treated with Intensity Modulated Radiation
Therapy with Simultaneous Integrated Boost Image Guided
Radiation Therapy (IMRT-SIB-IGRT) using @Helical
Tomotherapy (HT). External beam radiotherapy (EBRT)
was planned on PET-CT images acquired in treatment
position. Tumor doses ranged from 60 to 70.4 Gy in 30
fractions (fr) with a moderate hypofractionation; dose to
the pelvis ranged from 50.4 to 54 Gy. Lumbar-aortic chain
was treated In 4 pts (51 Gy); 13 pts received a boost on
PET positive lymph nodes with dose ranging from 60 to 66
Gy. All pts were treated with high dose rate BRT boost
with dose/fraction of 6-15 Gy in 1-3 fr
Results
All pts completed the treatment. Mean follow up was 13,6
months (range 1-26). Three pts recurred: 1 pt in lumbar-
aortic chain, 2 pts in pelvic region. Mean time to
progression was 3,3 months. Overall survival was 82% with
a mean time of 10 months. Two pts died for distant
metastases, two for peritoneal progression. No acute or
late gastro-intestinal (GI) toxicity > G2 were observed;
only one pt developed a G3 acute and late genitourinary
toxicity. No severe late hematological toxicity was
observed; only one pt developed a G4 acute neutropenia
requiring medical therapy
Conclusion
Our experience of double DE by HDR+ EBRT with
concurrent chemotherapy, showed to be effective and
safe and well tolerate with a low rate of complications
EP-1291 Does concomitant boost using conformal
therapy maximize local control in Stage III.B cervical
cancer
R. Santosham1
1Cancer Institute WIA, radiation oncology, Chennai, India
Purpose or Objective
BACKGROUND : This is a prospective study to assess the
local control and toxicity profile of concomitant boost
using conformal therapy. The role of IMRT to
simultaneously boost the primary is unquestionable when
small volumes are considered and where more organs are
at risk around our target. But in an advanced pelvic
malignancy where the target volume is large and where
completely avoiding the bladder base or the recto-sigmoid
septum are not recommended, 3D CRT may be tried.
AIM : To compare the local control and acute toxicity
profile of patients treated with concomitant boost and
conventional fractionated radiotherapy.
Material and Methods
29 patients with locally advanced FIGO stage III.B received
concomitant boost(Arm A) (190cGy to the pelvis along with
210cGy to the boost volume) using conformal therapy
between Sept 2015 and June 2016 of whom 18 patients
received chemotherapy. In the same period, an age
matched control group(Arm B) of 29 patients were
managed with conventional fractionated radiotherapy of
whom 11 patients received chemotherapy. All patients in
the concomitant boost arm underwent repeat CT and
replan at 36Gy when the response was assessed based on