ESTRO 36 Abstract Book

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S688 ESTRO 36 2017
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simulation CT images via image registration(MIM software)
with bone matching, and by using Computational
Environment for Radiotherapy Research (CERR) program,
adequate margin covering 95% of combined vaginal cuff
volume (MARGIN95 ), rectum and bladder volume, and
vaginal cuff movement were calculated. Patients were
instructed to keep full bladder and empty rectum before
radiotherapy.
Results
Average motion change in center of vaginal cuff in 10
patients was Left-Right (L-R) 0.5mm, Anterior-posterior
(A-P) 2.2mm, and Superior-Inferior (S-I) 0.4mm,
respectively. Correlation coefficient between rectal
volume and stump Anterior movement was 0.762 (p <
0.001). Also, correlation coefficient between bladder
volume and stump posterior movement, left movement
was 0.346 (p = 0.014), 0.366 (p = 0.009), respectively.
Mean value and standard deviation of MARGIN95 was
6.7mm and 3.3mm respectively. Using T distribution,
upper 5 percentage value of Margin95 was 8.6mm
Conclusion
Although instructions were given to keep patient rectal
volume consistent, large variations in rectal volume was
observed. Also correlation between rectal volume and
vaginal stump movement was strong(p <0.001). Laxatives
and enema may be used to keep rectal volume constant to
decrease magnitude of vaginal stump. Suggestive margin
for vaginal cuff movement covering 95% of patients’
Margin95 is 8.6mm.
EP-1295 Role of postoperative adjuvant radiotherapy
in early stage cervical cancer without high risk factors
W. Jung1 , J. Kim1, Y.J. Kim1, J. Lee1, K. Kim1, S. Jeong 1
1 Ewha Womans University Medical Center, Radiation
Oncology, Yangcheon-gu, Korea Republic of
Purpose or Objective
The aim of this study was to assess and evaluate the rate
of adjuvant treatment following radical hysterectomy
with pelvic lymphadenectomy in early stage uterine
cervical cancer and to suggest the appropriate role of
adjuvant radiotherapy among the patients without
clinicopathologic high risk factors.
Material and Methods
The patients with FIGO stages IB-IIA uterine cervical
cancer who underwent radical hysterectomy with pelvic
lymphadenectomy between 2001 and 2012 were analyzed.
Outcomes and clinicopathologic adverse features of
patient groups were compared. High-risk feature was
defined as lymph node metastasis, parametrial invasion,
or resection margin status, and intermediate-risk feature
was defined as tumor size, lymphovascular invasion or
depth of invasion. Based on these factors, patients could
be divided into high risk group and non-high risk group,
and outcome according to adjuvant radiotherapy (RT) or
not (non-RT) were evaluated.
Results
Total 85 (57.0%) of 149 patients received adjuvant
radiotherapy after surgery. Five-year overall survival (OS)
and disease-free survival (DFS) rates were significantly
different between high-risk group and non-high risk group
(86.0% and 78.0% in high-risk group vs 96.5% and 93.9% in
non-high risk group). Among the non-high risk group
patients, status more than 2 intermediate-risk factors
were statistically associated with lower 5yr OS rate
(p=0.043, HR 9.219, 95% CI 1.076-78.976). In subgroup
analysis among the patients with 2 or more intermediate-
risk factors, patients who did not receive adjuvant RT
showed significantly lower 5yr OS rate compared to <2 risk
factors (97.9% vs 81.8%, p=0.023), but patients who
received adjuvant RT showed no difference (100% vs
96.8%, p=0.105).
Conclusion
This study was to re-evaluate the findings of risk factors
and appropriate role of adjuvant radiotherapy. Adjuvant
radiotherapy is not only beneficial to patients with high-
risk factors but also to patients with non-high risk factors,
especially with more than 2 intermediate-risk factors.
Therefore, adjuvant radiotherapy is still important and
appropriate modality in patients with adverse features
after radical surgery of uterine cervical cancer, despite of
potential side effect caused by radiotherapy and desirable
high rate of adjuvant treatment after radical surgery in
early stage.
EP-1296 Adjuvant radiotherapy in endometrial
cancer: Volumetric Modulated Intensity Arc Therapy vs
3DRT
C. Iftode1, A. Tozzi1, E. Clerici1, L. Di Brina1, G.R.
D'Agostino1, A.M. Ascolese1, T. Comito 1, D. Franceschini1,
C. Franzese1, F. De Rose1, S. Tomatis1, P. Mancosu1, P.
Navarria1, M. Scorsetti1
1Istituto Clinico Humanitas, Radiotherapy and
Radiosurgery, Rozzano Milan, Italy
Purpose or Objective
To appraise the role of volumetric modulated arc
(RapidArc, RA form) in the postoperative treatment
of endometrial cancer patients.
Material and Methods
A retrospective analysis has been conducted on
36 patients treated with VMAT and image-guided RT
(IGRT) since 2011 comparing treatment characteristics
and outcome against a group of 24 patients treated with
conformal therapy (CRT). Disease specific survival, local
control and acute and late toxicity were scored and
investigated as well as basic dosimetric characteristics of
the treatments.
Results
Median age of patients was 64.4 yrs for VMAT and 68 yrs
for CRT. All patients had Stage Ib-III. VMAT treatments
lead to lower incidence of higher grade of toxicity events
(all retrospectively retrieved from charts as worse
events). No patient had G3 acute toxicity in both groups
of treatment. G2 acute toxicity for patients treated with
3D versus VMAT was as follows: GU 29.17% vs 8.33%; GE
54.17% vs 25%; proctitis 25% vs 5.56%; cutaneous 25% vs
11.11%. Late toxicity in both treatment arms were
limited. In the VMAT group 1 patient (2.78%) had G2 GU
toxicity as in the 3D group; no patient treated with VMAT
had GE G2 toxicity, meanwhile 3 cases (12.5%) were in 3D
arm. No VMAT patient had proctitis, but in the 3D group
there were 2 cases with G2 (8.33%) and one case (4.17%)
of proctitis G3. No statistically significant differences
were observed concerning survival or control. With a
median FUP of 22.29 and 67.82 months for VMAT and 3D
respectively, 4 patients had metastatic progression in the
VMAT arm and in 3D arm 2 patients had loco-regional
relapse and 3 metastatic progression.
Conclusion
The present study demonstrated that VMAT for adjuvant
WPRT in endometrial cancer proved to be equally
effective as CRT while improves the OAR dose sparing. A
significant enhancement of acute toxicity support the use
of VMAT technique in this setting of patients.
EP-1297 Update: Phase III randomised trial on electro-
hyperthermia plus chemoradiation for cervical cancer
C. Minnaar1, J. Kotzen2, A. Baeyens1
1Johannesburg Hospital- Area 348, Radiobiology,
Johannesburg, South Africa
2Johannesburg Hospital- Area 348, Radiation Oncology,
Johannesburg, South Africa
Purpose or Objective
Cervical is the second most common cancer in females in
South Africa, with over 5000 new cases reported per
annum. Improving outcomes with the addition of
affordable radiosensitisers would assist in alleviating the
socio-economic burden of the disease in South