ESTRO 36 Abstract Book

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S728 ESTRO 36 2017
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A. Bresolin1, L.C. Bianchi1, G. Staurenghi2
1 Centro Diagnostico Italiano, Cyberknife, Milano, Italy
2 Luigi Sacco Hospital - University of Milan, Eye Clinic,
Milan, Italy
Purpose or Objective
We report our clinical experience of a Hypofractionated
Cyberknife Stereotactic Radiotherapy schedule for uveal
melanoma treatment.
Material and Methods
Between April 2014 and October 2015 12 patients (pts),
mean age 65 years (range 36 – 82 years) suffering from
uveal melanoma (11 choroidal melanoma and 1 ciliary
body melanoma) were treated at Cyberknife Center,
Centro Diagnostico Italiano, Milan. All of the pts had
received a diagnosis and referral from an ophthalmologist.
Cyberknife robot-controlled LINAC radiotherapy was
performed delivering a total dose of 54 - 60 Gy (mean 60
Gy) given in 3 or 4 fractions (mean 3) of 15 - 20 Gy (mean
20 Gy) prescribed to the 79 - 82% (mean 80%) isodose
surface. All pts underwent orbit MRI with gadolinium for
coregistration with the planning CT scans. The planning
target volume (PTV) included the contrast-enhancing
lesion on MRI plus a 2.5 mm margins in all directions. All
pts were irradiated eyelids closed, without peribulbar
anesthesia, using a contention with a thermoplastic mask.
At presentation the mean PTV volume was 2148 mm³
(range 701.82 – 5792 mm³), mean tumor base measured
ultrasonographically 11.75 mm (range 7-15 mm), mean
thickness 4.6 mm (range 2.5 - 7.1 mm), with a mean
distance of 5.7 mm (range 0 – 15 mm) from fovea and 6.1
mm (range 0 – 13 mm) from optic nerve.
Results
After a mean follow-up of 11.5 months (range 3 – 24) local
control was achieved in 100% of pts. No patient underwent
enucleation and none developed distant metastases (all
pts underwent abdomen ultrasound and liver blood
examination once every six months and chest CT once a
year). We observed a reduction of 17% in median base and
of 40% in median thickness that were respectively 10 mm
(range 4.8 – 13 mm) and 2.75 mm (range 0.5 – 5 mm) at
last follow-up. Visual acuity was reduced in 58% of pts,
while in the others no change was found. Three pts
suffered of radiation maculopathy, associated in one case
with atrophy and in two cases with cystoids macular
edema. Moreover radiation-induced optic neuropathy and
radiation vasculopathy occurred respectively in 2 and 4
cases. 5 pts developed choroidal ischemia and 3 retinal
detachment. At the last follow-up none had corneal
anomalies and only one cilia loss.
Conclusion
These initial results of our Cyberknife schedule are
consistent with data in literature and show a safe,
minimally invasive and well tolerated method for treating
uveal melanoma. Further follow-up is necessary.
EP-1373 Will appropriate TSEI timing help to find
effective dose for patients with mycosis fungoides?
A. Chourova1, M. Doleckova1, D. Kralova1, P. Berkovsky1,
T. Juraskova 1
1 Hospital Ceske Budejovice, Oncology, Ceske Budejovice,
Czech Republic
Purpose or Objective
Mycosis fungoides (MF) is the common type of cutaneous T
cell lymphoma, CD4+, with great heterogeneity, but
incidence is low. TSEI is the most effective single agent
for the treatment MF. It is a complex method for
delivering superficial irradiation to entire skin surface.
Recommended doses are in range 8-36Gy (The
International Lymphoma Radiation Oncology Group, 2015).
Presently, the attention is focused on low dose (10-12Gy)
TSEI, the complete response rate is lower, but lower are
also the complications. Now is the opportunity for
retreatment TSEI.
Material and Methods
In Department of Oncology, Hospital Ceske Budejovice,
Czech Republic, from 1993 to October 2016, 65 patients,
who had cutaneous T cell lymphoma, mostly MF, received
TSEI.
Different treatment modalities (chemotherapy, PUVA,
Interferon, Targretin, local irradiation, ...) have been
used prior TSEI for majority of patients.
We have modified TSEI technique developed at McGill
University, Montreal (Freeman C.R., 1992) for our
condition. The patient is in „ballet dancer“ position and
rotates on the carrousel, two arc fields produce an
uniform treatment field over the total patient height, with
SSD 355 cm, 6 MeV electron beam.
The oblique fields achieve with rotational radiotherapy
technique maximal dose on the surface of the skin,
with stationary radiotherapy technique there is 88% of
max. dose on the surface (max. dose in 9 mm) with PLEXI
glass in front of patient, without PLEXI 77% (max. dose in
14 mm). A total dose 18- 40 Gy (10 Gy/week). Dose
distribution was monitored by thermoluminescent
dosimeters (TLD) with subsequent “patch treatments“ and
“boost treatments“.
In the last 2 years (December 2013- June 2016) we used
time for complication decreasing in TSEI and better
evaluation of MF response to treatment (n=9). TSEI week
timing: first week TSEI, second week break, third week
TSEI... Fractionation: 2Gy/fraction, 5 fraction/week.
Total dose 18-36Gy., median dose 26Gy. Applied dose
depended on MF response to TSEI. Median age: 75 years
(42-80), T2N0M0B0 (n= 2), T3N0M0B0 (n=3), T3N1M0B0
(n=2), T3N2M0 B0 (n=1), T4N0M0B0 (n=1).
Results
• ·Complete response: in 100%
• Relapse: 4 patients in 4, 6, 7 and 12 month
-2 patients with relapse - solved by retreatment TSEI (8 a
10 Gy) and Roferon A application, both patients are
without MF
1 patient with relapse (4 months) - treated by local
irradiation, relapse repeated, become worse, died of
reaction GVH.
1 patient relapse (in 6 months) - treated by Targretin
• · Follow-up: 4 – 20 months, median 14 months
• · 5 alive without MF
• ·1 alive with MF
• ·3 died
- 1 patient died of IM without MF
- 1 patient (non mycosis fungoides) died of GVH reaction,
with MF
-1 patient died of IM with MF
• All patients without acute complications of TSEI
(erythema, dry desquamation)
Conclusion
• · For all of TSEI patients week timing improves quality of
life.
• · Protraction of the whole time TSEI with week timing
allows to get time for treatment effect evaluation.
EP-1374 Hypofractionated radiotherapy in non-
melanoma skin cancer ≥ 3 cm in elderly PTS .
L. Ferella1, S. Parente1, G.L. Gravina1, P. Bonfili2, M. Di
Staso2, P. Franzese2, M.E. La Verghetta1, M. Cerasani1, D.
Di Genova1, E. Di Cesare1
1Università degli studi de L'Aquila, Divisione radioterapia
e radiobiologia, L'aquila, Italy
2ospedale San salvatore L'Aquila, Uo Radioterapia,
L'aquila, Italy
Purpose or Objective
To evaluate clinical outcome of an Hypofractionated
schedule in elderly pts with NMSC ≥3cm.
Material and Methods