737 / 1082
S721
ESTRO 36 2017
_______________________________________________________________________________________________
No 52% 48%
Linfovascular invasion:
-Yes -No 22%
78%
Results
All patients received complete treatment. There were no
complications during marker placement. With a median
follow-up of 3.7 months (range 1-13 months ), the
RTOG/EORTC acute urinary toxicities were grade 1 in 34,7
% and grade 2 in 21,7 %. Neither urinary stress nor
incontinence was influenced by radiation therapy.
Maximal acute gastrointestinal toxicities were grade 1 in
13%. There was no adverse events ≥ grade 3.
Conclusion
Present Hypo-IMRT with IGRT schedule for irradiation of
prostate bed after radical prostatectomy reduces the
length of treatment by 2 week as compared to other
treatment regimens commonly used, is feasible and well
tolerated with no severe acute effects side. Longer follow-
up is needed to determine late impact of if this low rate
of acute toxicity and the biochemical control
EP-1358 Prostate postoperative hypofractionated
radiotherapy: a single institution experience with Tomo
S. Gomellini
1
, B. Shima
1
, R. Barbara
1
, C. Caruso
1
, A.D.
Andrulli
1
, U. De Pula
1
1
azienda ospedaliera san giovanni addolorata, specialità-
radioterapia, roma, Italy
Purpose or Objective
During the last decades, many studies of hypofractionated
radiotherapy have been published in the prostate cancer
field, due to the stronger radiobiological evidences of a
low alpha/beta ratio for the prostate cancer ranging
around 1.5 , demonstrating a trend in improvement in the
hypofractionated groups in terms of Local Control and
Biochemical Control if compared to the standard
fractionation, with a substantial equivalence of acute and
late toxicities. Very few publications are at the moment
available in the postoperative setting. This is a single
institution
experience
with
Tomotherapy
of
hypofractionated radiotherapy in adjuvant and salvage
treatmens. We report the preliminary results of acute and
late toxicities.
Material and Methods
Between February 2012 and October 2015 27 patients
underwent an hypofractionated radiotherapy with
Tomotherapy in our Institute. Seven pts received adjuvant
treatment for the presence of risk factors for local relapse
at hystological examination at the surgery, while 20 pts
underwent a salvage radiotherapy for biochemical relapse
after prostatectomy. All patients did a regimen in 23
fractions for a total dose of 57.5 Gy and 59.8 Gy. Patients
characteristics are reported in table 1
Results
The acute and late urinary and rectal toxicities have been
evaluated by the use of the C.T.C.A.E. 4.02 and the SOMA-
LENT modified Scales. We lost 2 patients during the follow
up period (1 patients died for other cause and 1 patients
was not found anymore).The acute and late toxicities are
reported below.
The acute GU-G2 and GI-G2 toxicities were 18.5% and
14.8% respectively. One patient (3.7%) experimented a
subacute rectal toxicitiy ≥ G3, (dilatation for rectal
substenosis within 6 months from the end of RT). The late
GU-G2 and GI-G2 toxicities were 8% and 0% respectively.
Only 1 patient (4%) had a urinary late G3 toxicity (urethral
dilations for substenosis) while none patients had a rectal
late toxicity ≥ G3.
Conclusion
Many of the randomized and not randomized trials
regarding hypofractionation have been published in the
elective treatment setting with very few datas available
in the postoperative group with the alert for the acute and
late toxicities reported in the different published series.
Even if this is a very small experience with a limited
number of patients, we had very few toxicities but future
and larger series are necessary to better understand the
real impact of hypofractionated radiotherapy in
postoperative prostate cancer setting.
EP-1359 Pain response in a Population-based study of
Radium-223 for Metastatic Prostate Cancer
S. Tyldesley
1
, S. Parimi
2
, E. Tsang
3
, F. Bachand
4
, M.
Aparicio
5
, G. Duncan
5
, K. Sunderland
6
, R. Olson
7
, H. Pai
8
,
A. Alexander
8
, V. Lapointe
5
, K. Chi
9
1
BC Cancer Agency - Vancouver, Radiation Oncology,
Vancouver, Canada
2
BC Cancer Agency, Medical Oncology, Victoria, Canada
3
BC Cancer Agency, Medical Oncology, Vancouver,
Canada
4
BC Cancer Agency, Radiation Oncology, Kelowna,
Canada
5
BC Cancer Agency, Radiation Oncology, Vancouver,
Canada
6
BC Cancer Agency, Genitourinary Cancer Outcomes Unit,
Vancouver, Canada
7
BC Cancer Agency, Radiation Oncology, Prince George,
Canada
8
BC Cancer Agency, Radiation Oncology, Victoria, Canada
9
BC Cancer Agency, Medical Oncology, Viancouver,
Canada
Purpose or Objective
Randomized trials have demonstrated the survival and
quality of life benefit of Radium (Ra 223) for pts with
Castration Resistant Prostate Cancer (CRPC) with
symptomatic bone metastases. Alkaline Phosphatase (ALP)
level and response is correlated with survival after Ra 223.
The British Columbia Cancer Agency (BCCA) is the single
provider of Ra223 in BC since 2013. The BCCA also has a
provincial Prospective Outcomes and Support Initiative
(POSI) using the Brief Pain Inventory (BPI).
Objective: To assess the baseline pain, pain response, and
relationship of pain response to ALP response in patients
treated with Ra 223 at a population based level.
Material and Methods
All patients that started radium 223 between Sep 2013 and
Feb 2016 had the required minimum potential to complete
6 cycles at time of analysis. Since June 2015, all patients
treated with radium 223 completed POSI questionnaires
including BPI at each visit. Pain medication was group as
none, non, weak, or strong opiod; a change between
groups was categorized as an increase or decrease. ALP
and PSA were recorded at consult and prior to each Ra223
dose. A worst pain improvement of at least 2 units on the
10 point scale was considered a pain response. ALP
response was defined as a >30% decrease from baseline.
Correlation between pain and ALP response was assessed
using a Phi statistic.
Results
91 patients started Ra223 during the entire study period.
34 patients completed at least baseline BPI , and had at
least one follow-up BPI. Of these cases, 90% had pain, 80%
had a pain score of at least 3, and 26% scored at least 7 at
baseline. Of those with baseline pain of 3 or higher,
37% had a pain improvement of at least 2 units during the
course of Ra 223. Of these responding patients, 30% had
also received EBRT during Ra223 course, and 90% had
stable or improved pain medication group. The ALP
response rate was the same in those with and without a
pain response (Phi -0.12, p=0.96). Comparing participants
with pain response <2 versus at least 2 units, the ALP
response (>30%) was similar (58% vs 57%) (0.96). Of note,
the median number of prior treatments for CRPCs
(abiraterone,
enzalutamide,
chemotherapy
or
investigational agents) was 2 (with a range 0-5), reflecting
a heavily pretreated cohort.
Conclusion
In this population based study of Ra 223, the vast majority
of patients have pain at baseline. 37 % of patients had
improvement of pain during Ra 223 treatment, although
analysis was confounded by use of EBRT. No correlation