ESTRO 36 Abstract Book

707 / 1082

S691 ESTRO 36 2017
_______________________________________________________________________________________________
Conclusion
Interference of the three different treatment modalities
makes it very difficult to unravel dose-effect relations for
this patient group. Internal motion of the organs could
have induced mismatches between planned and irradiated
EBRT dose.
Despite interplay effects of Cisplatin and IGABT, we found
some trends i.e. correlation of early weight loss with body
V43Gy, severity of vomiting and diarrhea. Consequently,
rescanning for the ART patient group is now rescheduled
to week 4, to adapt EBRT to reduced body volume if
necessary.
For GU toxicity, we recommend the combination of daily
bladder volume during EBRT and IGABT to be assessed with
non-rigid analyses in a larger patient group.
EP-1302 Acute toxicity of prophylactic para-aortic
chemoradiation for cervical cancer treated in IMAT era
N. Ballari1 , B. Rai1, R. Miriyala1, A. Bahl1, B.R. Mittal2, S.
Ghoshal 1
1 Post Graduate Institute of Medical Education and
Research, Radiotherapy and Oncology, Chandigarh, India
2 Post Graduate Institute of Medical Education and
Research, Nuclear Medicine, Chandigarh, India
Purpose or Objective
Prophylactic paraaortic irradiation is being increasingly
advocated for patients of locally advanced cervical
cancer. Up to 25% of patients with FDG avid pelvic lymph
nodes harbor micro-metastases in paraaortic lymph nodes,
corroborating the postulated benefit of prophylactic para-
aortic irradiation. However, acute toxicity was a major
limiting factor when 2-dimensional extended field
radiotherapy planning was used with concurrent cisplatin.
With the use of intensity modulated radiotherapy (IMRT)
in the form of intensity modulated arc therapy (IMAT),
doses to organs at risk could be successfully reduced,
limiting the treatment related toxicities. The purpose of
our study was to prospectively evaluate the tolerance and
acute toxicity in patients of locally advanced cervical
cancer undergoing prophylactic extended field paraaortic
irradiation by IMAT, with concurrent cisplatin.
Material and Methods
Patients of FIGO stage IIB-IIIB cervical cancer with FDG
avid pelvic lymph nodes,were prospectively accrued
between 2014 and 2016. All patients received 45 Gy in 5
weeks to pelvic and paraaortic target volumes, with
simultaneous integrated boost (SIB) of 55 Gy in 5 weeks to
gross nodal disease by IMAT (Rapidarc TM), with weekly
concurrent cisplatin of 40 mg/m2, followed by
intracavitary brachytherapy. Acute toxicity was monitored
twice a week, using CTCAE v 4.03 for gastrointestinal (GI)
and genitourinary (GU) toxicity, and RTOG criteria for
hematological toxicity. Treatment interruptions were
taken as a surrogate for tolerance. Descriptive statistics
were used to evaluate acute toxicities; multivariate
analysis was used to correlate the toxicities with doses to
organs at risk.
Results
Out of the 15 patients recruited, treatment interruptions
due to acute toxicity were observed in none. No grade 3
or 4 acute toxicity was reported in GI, GU or hematological
domains.
Among GI toxicities, vomiting and diarrhea of ≥ grade 2
were observed in 13.3%, while nausea, anorexia and
dyspepsia of ≥ grade 2 were observed in 6%. Grade 1
proctitis was reported in 26%, while none had ≥ grade 2
proctitis.
Only 6% of patients experienced grade 1 GU toxicity in the
form of increased frequency and cystitis, while none had
≥ grade 2 toxicity. Hematological toxicity in the form of ≥
grade 2 anemia was observed in 46%, while 13.3% of
patients had ≥ grade 2 leucopenia and 6% had ≥ grade 2
thrombocytopenia.
On multivariate analysis, significant correlation was
observed between volume of bowel bag receiving 45 Gy
(median, 142 cc) and ≥ grade 2 vomiting (p=0.003). Other
dosimetric correlates of toxicity were statistically
insignificant.
Conclusion
Extended field prophylactic para-aortic irradiation with
concurrent cisplatin is well tolerated in patients of locally
advanced cervical cancer with FDG avid pelvic
lymphnodes, treated with IMAT. While none of our
patients experienced grade 3 or grade 4 toxicities in GI,
GU or hematological domains, proportion of ≥ grade 2
toxicities was within acceptable levels.
EP-1303 Clinical outcomes of patients with advanced
cervical cancer and percutaneous nephrostomy : An
audit
R. Salunkhe1, S. Chopra 1, S. Kulkarni2, R. Engineer1, U.
Mahantshetty1, N. Shetty2, J. Ghosh3, S. Gupta3, S.K.
Shrivastava1
1Tata Memorial Hospital, Radiation Oncology, Mumbai,
India
2Tata Memorial Hospital, Interventional Radiology,
Mumbai, India
3Tata Memorial Hospital, Medical Oncology, Mumbai,
India