ESTRO 36 Abstract Book

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S725 ESTRO 36 2017
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pelvis, and it was shrunk to the bladder or tumor as a
boost. Systemic chemotherapy combined with
radiotherapy was performed in 10 of the 15 cases. The 1-
year and 3-year overall survival rates were 66.7% and
40.0%, respectively, and the 1-year and 3-year local
control rates were 70.0% and 60.0%, respectively.
Chemotherapy contributed to improvement of overall
survival and relapse-free survival (p = 0.001). There were
no serious adverse events in the observation period. The
bladder was maintained in all cases.
Conclusion
Radiotherapy has an important role from the point of view
of the patient’s QOL and is likely to become an option for
local treatment. Chemotherapy combined with
radiotherapy is considered to be essential for systemic
tumor control.
EP-1367 Conservation treatment of Carcinoma Penis
with surface mould brachytherapy
M. Anjanappa1, A. Kumar1, P. Raghukumar2, F. James1
1 Regional Cancer Center, Radiation Oncology,
Trivandrum, India
2 Regional Cancer Center, Radiation Physics, Trivandrum,
India
Purpose or Objective
To assess the rate of organ preservation and to identify
factors related to local control in patients treated with
surface mould brachytherapy for carcinoma penis.
Material and Methods
A retrospective analysis of patients treated with surface
mould brachytherapy for carcinoma penis at our
institution during the period 2000 to 2011 was carried out.
The details of age and date of diagnosis of these patients,
tumour size, histology, stage, size of residual disease after
biopsy were collected. Further, the treatment details
regarding the type of brachytherapy treatment, dose
prescribed, response to treatment and recurrences were
documented. Local control was calculated from the date
of diagnosis to documented date of local recurrence or
residual disease. In addition, nodal and systemic relapses
were documented separately.
Results
A total of seventeen patients were identified from
database and the records of sixteen patients were
available for the analysis. The mean age was 47.3 years
(range 31-73). All patients had histologically verified
squamous cell carcinoma. Nine patients had lesion on the
glans, six on the prepuce and one on the shaft. Three
patients did not have any disease palpable after biopsy
and the rest had a tumor size of less than 2cm. Three
fourths of the total number had T1 disease. Majority of the
patients (fourteen) were treated with pre-loaded LDR
source brachytherapy and the rest with remote after
loading HDR source. The dose prescribed ranged from
55Gy to 65 Gy at surface for LDR and the HDR dose was
50Gy in 15 fractions and 30Gy in 10 fractions treated twice
daily. At a median follow up of 37.5 months (range 9-167),
the local control was 75%. Among the twelve patients with
T1 disease, one patient had residual disease after
brachytherapy and the other had a local recurrence after
seven months resulting in local control rate of 83.3%.
Three out of sixteen patients had partial response after
brachytherapy for which they underwent salvage surgery.
The local control with salvage surgery after residual
disease or recurrence was 100%. Furthermore, among the
patients with residual disease following brachytherapy,
two were having T2 disease. Among them, one patient
subsequently developed systemic recurrence (lung and
bone) and succumbed to disease. Regional nodal relapse
was documented in one patient for whom inguinal block
dissection was performed. The nodal and systemic
relapses were in T2 patients.
Conclusion
Three fourth of patients had local control with organ
preservation by mould brachytherapy for Penile squamous
cell carcinoma and the rest had surgical salvage to achieve
local control . It appeared that the control was better for
T1 disease than T2. Mould brachytherapy may be
considered as a safe alternative to surgical treatment in
patients with early stage penile carcinoma who wish to
retain entire penis.
EP-1368 Impact of post-operative Radiotherapy in
bladder cancer after loco-regional relapse.
M.J. Mañas1, X. Maldonado1, F. Lozano2, C. Raventós2, R.
Morales3, V. Reyes1, S. Micó1, D. SantaMaria1, J. Carles3,
J. Morote2, J. Giralt1
1Radiation Oncology. H.U. Vall d’Hebrón, Barcelona,
Spain
2Urology. H.U. Vall d’Hebrón. Barcelona, Spain,
3Medical Oncology. H.U. Vall d’Hebrón. Barcelona, Spain,
Purpose or Objective
To assess the role of radiotherapy in bladder carcinoma
after loco-regional relapse or pathologic adverse factors
in patients previously treated with or without cystectomy
after chemotherapy. To evaluate the toxicity of these
treatments.
Material and Methods
Since September 1998 to September 2016, seventy-eight
patients with bladder cancer (68 men, 10 women, median
age 53 years, range 37-87 years) have been
postoperatively treated with radiation therapy in our
department. 63 patients had transitional carcinoma, 7
squamous cell carcinoma and 8 sarcomatoid carcinoma.
The aim of the treatment was adjuvant in 27 patients
(34.6%), consolidative after nodal relapse post-
chemotherapy 19 patients (24.3%) and for local tumor
persistence in 32 patients (41.0%).
Mean radiotherapy dose was 50.4 Gy (range 37.5 Gy - 64,8
Gy) 1,8 Gy/fraction, 5 fraction/week (40 Gy to the pelvis
and a boost to the GTV up to 55,8 Gy if cystectomy or 64,8
if the bladder was present). RTOG Late Toxicity scale and
CTCAEv3.0 were used. Survival was calculated by means
the Kaplan-Meier method.
Results
Cystectomy was previously performed in 42 patients
(53.8%). Clinical prognostic factor were: pT1, 5 (6%); pT2,
29 (37.1%); pT3, 30 (38.4%); pT4 14 (18%); N+, 53 (67.9%);
N0 25 (32%).
With a median follow-up of 30.6 months (m). Median time
between infiltrative bladder tumor diagnoses and local
relapse was 13m (3-77 m), nodal relapse, 11 m (3-39 m).
Actuarial survival at 16 m and 36 m were 68% and 51%
respectively. At 60 m, actuarial survival post-
radiotherapy was 34%.
Median survival after treatment for nodal relapse, local
relapse and adjuvant Radiotherapy were 15.5 m(11-92 m),
22.5 m (9-180 m) and 18.5 m (15-84 m) respectively.
Failures after consolidative radiotherapy were: bone
metastases (7.7%), nodal relapse (25.6%), local relapse
(20.5%), soft tissues metastases (12.8%).
No grade 4 late toxicity has been reported. 8 patients
(10%) presented late GI toxicity grade 2 and in 2 was
grade 3. In 4 patients (5.1%) grade 2 GU toxicity was
reported and grade 3 in 2.
Conclusion
Post-operative radiotherapy in bladder cancer with loco-
regional relapse or with pathological adverse factors is
feasible with a low late toxicity profile. Half of our
patients are alive at 3 years.
In these patients with loco-regional relapses after radical
cystectomy or with macroscopic residual tumor after
maximal surgical effort with curative intent, loco-regional
control rate is improved with respect to the chemotherapy
alone standard treatment.