ESTRO 36 Abstract Book

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S690 ESTRO 36 2017
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patient counselling and deciding on follow-up strategies
EP-1300 Stereotactic radiotherapy for oligometastatic
ovarian cancer patients: preliminary results.
S. Ronchi1, R. Lazzari 2, A. Surgo 2, S. Volpe1, S. Comi3, F.
Pansini3, E. Rondi3 , C. Fodor2, R. Orecchia4, B.A.
Jereczek-Fossa1
1 Istituto Europeo di Oncologia - IEO - University of Milan,
radiotherapy - Oncology and Hemato-oncology, MIlan,
Italy
2 Istituto Europeo di Oncologia - IEO, radiotherapy, MIlan,
Italy
3 Istituto Europeo di Oncologia - IEO, Medical Physics,
MIlan, Italy
4 Istituto Europeo di Oncologia - IEO -University of Milan,
Scientific Directorate - Oncology and Hemato-oncology,
MIlan, Italy
Purpose or Objective
To retrospectively evaluate response and toxicity of
stereotactic radiotherapy (SRT) for oligometastatic
ovarian cancer patients (pts).
Material and Methods
Between May 2012 and October 2015 we enrolled 57 adult
oligometastatic ovarian cancer pts to SRT. Indication
criteria were: 1)low tumor burden (1–5 lesions);
2)contraindication to salvage surgery; 3)localized
persistent disease after chemotherapy (CT); 4)no CT
indication due to ematological toxicity (tox); 5)no more
CT lines available or refusal of the patient. Toxicity and
tumor response were evaluated using CTCAE and RECIST
criteria. CT or PET was performed at 2-3 months (mo.).
Results
57 patients/96 lesions underwent SRT. We treated 65
nodal metastases (mets) and 31 visceral mets ¸72 and 24
lesions were treated with VERO™ and Cyberknife™
respectively. Median age was 60.3 years (range 45.7-81).
All pts had previously received CT and/or ormonotherapy
(OT). Concomitant systemic therapy was performed in 10
cases (4 CT, 6 OT). SRT consisted in re-irradiation for 8
lesions. Mean GTV was 13.2 cm3 (range 0.5 - 90.05).
Median dose was 24 Gy (range 16–45 Gy) in 3 fractions
(range 2-5). Median follow-up (FU) was 20.9 months (mo.)
(range 3.2 - 48.7). Radiological response at first FU
(evaluable for 87 lesions) was: complete response, partial
response, stabilization and progressive disease (PD) in 52
(59.8%), 18 (20.7%), 12 (13.8%) and 5 (5.7%) lesions,
respectively. At last FU (available for 55 pts), 16 pts were
alive with no evidence of disease, 26 alive with disease,
13 pts died of disease. Acute and late tox were low: 13 G1
and 12 G1-events (predominantly gastrointestinal),
respectively. Pattern of failure was mainly out field (PD
out field, in field, in and out field in 41, 3, and 1 cases
respectively). Local control at last FU was observed in
76/87 evaluable lesions (87.4%). Median local progression
free survival was 10.6 mo. (range 3.1 - 33.4). Median
progression free survival was 3.9 mo. (range 1,5 – 29).
Conclusion
In our experience, SRT in oligometastatic ovarian cancer
pts has shown excellent local control and toxicity profile.
It might be a good alternative to other more invasive local
therapies in order to delay systemic therapy especially
when temporaneously contraindicated, not tolerated, or
in chemorefractory disease. The evaluation of site and
volumes treated is ongoing. Longer FU and further studies
are needed to identify which subgroup of patients may
most benefit from this treatment.
EP-1301 Early toxicity for image guided adaptive
radiochemotherapy including brachytherapy in cervix
cancer
K. Majercakova 1, D. Najjari2, M. Buschmann1, A. Sturdza2,
E. Dörr 1, R. Pötter2, D. Georg2, Y. Seppenwoolde1
1 Medical University of Vienna, Christian Doppler
Laboratory for Medical Radiation Physics for Radiation
Oncology, Vienna, Austria
2Medical University of Vienna, Department of
Radiotherapy, Vienna, Austria
Purpose or Objective
Advanced treatment for locally advanced cervical cancer
consists of external beam radiotherapy (EBRT), concurrent
Cisplatin combined with Image Guided Adaptive
Brachytherapy (IGABT). Recently EBRT adaptive
radiotherapy (ART) based on library of plans was
implemented in our department for patients with large
cervix-uterus motion.
Acute side effects associated with chemo start usually in
the first stage of EBRT when the full dose is not yet
reached. In the last stage of treatment, combination with
IGABT may accelerate toxicity.
Material and Methods
The objective of this study was to evaluate sensitivity,
variability and dose-volume correlations of several
general, gastrointestinal (GI) and genitourinary (GU)
symptoms. These were assessed weekly during treatment
and at 3 time points after treatment. A prospective study
was performed on 21 non-adaptive EBRT (two 3D-CRT and
19 VMAT) and 5 VMAT ART patients.
GI and GU symptoms were evaluated according to CTCAE
4.03.
Results
Most parameters did not show much variation throughout
treatment and between patient groups. Weight loss
showed a slow onset in the first 3-4 treatment weeks and
increased after the first IGABT.
The most sensitive GI parameters were stool consistency
and diarrhea that were worst in the 3 rd and 4th week of
treatment for non-adaptive EBRT patients and had a little
later onset for ART patients. For patients treated with
Cisplatin, weight loss in the 3-4th week of treatment
correlated with the irradiated volume to 43Gy (±1 kg
weight loss for every 500cc irradiated to more than
1250cc) in combination with severity of vomiting and
diarrhea as secondary multivariate components.
From the GU toxicity only nighttime micturition seemed
to be less for the ART patients. This might be confounded
by the coincidence that those patients had a better
baseline function to start with and had on average 100 ml
more volume in their bladder during the treatment course.
Bladder incontinence was worst 6 weeks after treatment
and did not correlate with planned EBRT dose volumes.
Bladder volumes varied largely throughout the EBRT
treatment. The incidence of other side effects like
proctitis and cystitis was limited. More patient data is
needed to assess the time course.