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castration resistant and >3 +LN pts (worse prognosis). Pts
characteristics were: median age 67(53-78) yrs; median
PSA post-surgery/at relapse: 2.74(0.66-23.52) ng/ml;
median Gleason score 8(6-10). Five pts underwent RP; 33
RP+LND. Twelve pts were pT2, 22 pT3, 1 pT4, 11 pN1, 1
M1a, 11 R1. Twenty one pts had androgen deprivation(AD)
prescription after surgery, 5 were hormonal resistant; 1
patient was treated with chemotherapy(Docetaxel and
Estramustine). The interval between surgery and PET was
19.3(3.1-170.2) mts, the median number of PET +LN was
3(1-20). In 23 pts AD was prescribed for a median of 19(0-
57) mts. Patients were treated with daily image-guided TT
on pelvic/LA LN (51.8 Gy/28 fr), with simultaneous
integrated boost (SIB) on prostatic bed (71.4 Gy), and on
PET+ LN (65.5 Gy).
Results
With a median follow up of 38.1(14.4-82) mts, acute
toxicity was low (1 G3 GU acute toxicity;2 G2 bowel, 2 G2
rectal and 2 G2 GU acute toxicities). Late toxicities were:
rectal ³ G2 13.9% (1 pt G3), lymphedema ³ G2 13.9% (1 pt
needing surgery), and GU ³ G2: 33.4% (1 pt with salvage
cystectomy). At the last control, late toxicities were mild,
showing that most events were transitory with no rectal
G2, 1 rectal G3; 2 GU G2, 3 GU G3 and 2 Lymphedema G2.
A summary of outcome is shown in Table I and Figure I:
Median biochemical relapse free survival (BRFS) was 51.2
months; 3 and 5-year biochemical relapse-free survival
(bRFS) was 65.5% and 43% respectively; distant progression
free survival (DPFS) was 88% and 70% and Cancer Specific
Survival was 92 and 83%.
Conclusion
Our excellent outcome results suggest that PET-guided
prophylactic treatment of LN chains together with SIB to
PET+ LN may translate in a substantial increase of bRFS
and DPFS compared to reported results after SBRT. A
phase III trial comparing these approaches would be
suitable. Because of high GU toxicity caused by
hypofractionation on post-operative settings the protocol
for prostate bed irradiation was modified since 2014 to
deliver 70-74 Gy with conventional fractionation.
EP-1316 Moderate Hypofractionation RT in post-
prostatectomy setting:report on feasibility and acute
toxicity
S. Fersino
1
, U. Tebano
1
, R. Mazzola
1
, F. Ricchetti
1
, N.
Giaj Levra
1
, A. Fiorentino
1
, G. Sicignano
1
, S. Naccarato
1
,
R. Ruggeri
1
, F. Alongi
1
1
Sacro Cuore Don Calabria Cancer Care Center, Radiation
Oncology, Negrar, Italy
Purpose or Objective
to evaluate the acute toxicity profiles of a moderate hypo-
fractionated regimen with volumetric modulated arcs
therapy (VMAT) in prostate cancer (PC) patients
underwent to radical prostatectomy (RP).
Material and Methods
From December 2012 to February 2016, 125 patients,
previously submitted to RP, received adjuvant (64
patients) or salvage (61 patients) radiotherapy (RT) inside
an institutional protocol of moderate hypofractionation
schedule using VMAT technique (Varian RapidArc, Palo
Alto, CA, USA).Eligible patients were < 85 years old, with
an ECOG performance status of 0–2, histologically proven
adenocarcinoma of the prostate without distant
metastases, and pathological stage pT2–4 N0-1, with at
least one of the following risk factors: capsular
perforation, positive surgical margins, seminal vesicle
invasion and/or postoperative PSA > 0,2 ng/ml.Patients
were stratified into low (1%), intermediate (9%), and high-
risk (90%) groups.The median age was 68 years. The
median doses were 66 Gy (range 65.5-71.4) to the
prostatic bed and 52.5 Gy (range 50.4-54) to the pelvic
lymph nodes, in 28 or 30 fractions. The acute
genitourinary (GU) and gastrointestinal (GI) toxicities
were scored according to the Common Terminology
Criteria for Adverse Events CTCAE v4
Results