ESTRO 36 Abstract Book

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S692 ESTRO 36 2017
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Purpose or Objective
To determine outcomes of patients with locally advanced
cervical cancer who presented with deranged renal
functions necessitating urinary diversion
with Percutaneous Nephrostomy (PCN) before and during
course of pelvic radiation
Material and Methods
The retrospective audit was approved by institutional
review board. The hospital database from January 2010-
June 2015 was reviewed to identify patients with locally
advanced cervical cancer and deranged serum creatinine
at baseline. Patients wherein PCN was advised at baseline
or during treatment were selected for this audit.
Pretreatment patient, tumour and treatment related
factors that impacted choice of treatment and overall
survival in patients undergoing PCN were analysed using
univariate and multivariate analysis
Results
Over a 5 year study period, 128 patients with primary or
recurrent cervical cancer underwent PCN. Of these 56
(44%) underwent PCN before and during treatment and 60
patients (44%) received PCN after completion of primary
treatment within the setting of local or distant recurrence
that necessitated systemic chemotherapy. Overall 12
(9%) patients did not receive any treatment after PCN due
to anticipated poor tolerance. Median serum creatinine
before and after a week of PCN was 3.8mg/dl (0.4-7.4 )
and 1.6 mg/dl ( 0.6-1.7 ). Median hospital stay was 13
days(4-67). Overall 62.5% patients developed procedure
related urinary infection following PCN and 8% patients
died secondary to infective complications.
Of the 56 patients that received PCN before treatment,
54 received either radical (n=31) or palliative radiation
(n=23). Of those planned for radical radiation, 34 were
stage III, 15 were Stage IV with median tumour size of 4.5
cms. Only 16/54 patients could complete planned
concurrent chemoradiation (29%). Median survival for the
cohort undergoing PCN prior to treatment was 205 days
(7-369) For 16 patients that completed radical
chemoradiation the median survival was 254 days (107-
380) and 18/54 for those receiving palliative radiation was
146 days (41 - 146). On univariate analysis restricted to
cohort of patients receiving radiation Karnofsky
performance score <70 at time of PCN (p=0.005), Serum
creatinine >3mg/dl (p=0.004), post procedure infection
(p=0.002) were factors for poor outcomes of procedure.
Conclusion
Conclusion - There is significant fall in serum creatinine
and improvement in renal function occurs after
percutaneous nephrostomy. Yet the median survival was
dismal and patients had considerable procedure related
morbidity further adding to the duration of hospital stay.
Careful selection of patients to undergo percutaneous
nephrostomy is important for the success of the procedure
EP-1304 A moderate ipofractionation schedule with
IMRT in preoperative locally advanced cervical cancer
R. Autorino1, M. Campitelli1, A. Martino1, A. Nardangeli1,
G. Mattiucci1, V. Frascino1, D. Smaniotto1, A. Valentini2,
G. Ferrandina3, M. Gambacorta1
1 Polyclinic University A. Gemelli- Catholic University,
Institute of Radiotherapy, Rome, Italy
2 Polyclinic University A. Gemelli- Catholic University,
Institute of Radiology, Rome, Italy
3 Polyclinic University A. Gemelli- Catholic University,
Institute of Oncological Gynecology, Rome, Italy
Purpose or Objective
To analyze the efficacy and tolerability of intensity
modulated radiation therapy (IMRT) simultaneous
integrated boost (SIB) associated to cisplatin based
chemotherapy. in preoperative setting of patients with
locally advanced cervical cancer
Material and Methods
From September 2014 to December 2015, we analyzed
patients with locally advanced cervical cancer undergone
to neoadjuvant intensity-modulated extended-field
chemoradiation plus simultaneous integrated boost. A
radiation dose of 39.6 Gy, 1.8 Gy/fraction, was delivered
to the pelvis plus a radiation dose to the primary tumor
delivered with SIB-IMRT strategy for a total of 50.6 Gy,
2.3 Gy/fraction in 25 fractions. Cisplatin based
chemotherapy was delivered associated to radiotherapy.
Radical hysterectomy plus pelvic with or without aortic
lymphadenectomy was performed within 6 to 8 weeks
from CRT. Statistical analysis was performed using Systat
program.
Results
29 patients (median age: 52 years; The International
Federation of Gynecology and Obstetrics (FIGO) stage IB2:
1, IIB: 19, IIIA: 1; IIIB: 5; IVA: 3) were analyzed. The
treatment was well tolerated with a good compliance: no
patients had grade 3/4 gastrointestinal or genitourinary
toxicity; grade 3 leukopenia and neutropenia were
reported in only 1 case (stage FIGO IVA) without
interruption of the treatment. pCR was documented in 15
cases (51%) and 4 patients (13%) had a microscopic
residual disease (persistent tumor foci of 3 mm maximum
dimension). At median follow-up of 12.5 months (range:
7-19 months), the 1-year local control was 95%, whereas
the 1-year disease-free and overall survival rates were 95%
and 100%, respectively.
Conclusion
The treatment was globally well tolerated with a good
compliance. Results in terms of efficacy were comparable
with literature data. Local control and overall survival will
be further evaluated with a longer follow-up.
EP-1305 Hemoglobin monitoring in Endometrial
Carcinoma: how preoperative anemia impacts overall
survival.
K. Holub1, A. Biete1
1Hospital Clínic i Universitari de Barcelona, Radiation
Oncology Dpt., Barcelona, Spain
Purpose or Objective
To investigate the hematological parameters for anemia
in relation to survival in endometrial carcinoma (EC) and
to audit hemoglobin (Hb) monitoring before, during and
after radiotherapy.
Material and Methods
We retrospectively evaluated 233 patients (p) out of a
total cohort of 248p diagnosed with EC and treated with
radiotherapy (RDT) in our center between January 2011
and December 2015. We analyzed the presence of anemia
defined as Hb<12g/dL in four specific intervals: pre-
treatment (Hb), before RDT(Hb2), during (Hb3) y after
RDT (Hb4). We estimated how many patients with basal
Hb<12g/dL were monitored for anemia afterwards and if
pretreatment Hb level has prognostic value for Overall
Survival (OS). Statistics: Ch2, Kaplan-Meier test, T-test.
Results
Age at diagnosis (years): mean 64.9 (range 36-90). All
patients underwent surgery before RDT, with pelvic
lymphadenectomy in 187p (80.3%). Histology:
endometrioid 172p(73.8%), non-endometrioid 61p(26.2%).
FIGO stage (2009): IA-60p (27.8%), IB-92p(39.5%), II-
32p(13.7%), IIIA-9p(3.9%), IIIB-0, IIIC1-20(8.6%), IIIC2-
8(3.4%), IVA-9(3.9%), IVB-3(1.3%). Grade: I-50p(21.5%), II-
91p(39%), III-88p(37.8%). Majority of patients was treated
with combination of EBRT+BT (mean dose 41.2 Gy, range
5-75). Mean follow-up (months): mean 32. Progression was
observed in 40p (17.2%): only 1p developed pelvic node
recurrence, 39p developed distant recurrence (4p with
vaginal progression, 3p with regional progression and 1p
with both vaginal and regional progression, remaining 31p
presented exclusively distant progression). Mortality: 31p
(13.3%), including 28p (12%) cancer-deaths and 3deaths
(1.3%) not related with EC. Remaining 202p were alive