ESTRO 36 Abstract Book

745 / 1082

S729 ESTRO 36 2017
_______________________________________________________________________________________________
METHOD: From 2010 to 2016 we treated 17 pts, median
age 78 years, with diagnosis of NMSC (5/17 basal cell
carcinoma, 11/17 squamous cell carcinoma, 1/17
trichilemmal carcinoma ), ≥ 3cm (range 3-8 cm diameter),
GTV median volume was 32cc (range 5-60 cc). Only 1 pt
presented extremity disease (malleolar region) and the
others had head region disease.Total dose was 36 Gy in 6
Gy/fractions twice a week. Pts were evaluated 1 month
after the end of treatment and then every 3 months. At
the follow up pts were assessed for acute and late toxicity
according to the Radiation Therapy Oncology Group
criteria and treatment response according to Recist
criteria.
Results
Median follow up was 12 reported CR in 9/17
pts (53 %), PR in 8/17 pts (47.%) at one month after the
end of the treatment. No PD was observed. No pts had
acute side effect that required treatment interruption.
Acute toxicity was grade 1 RTOG in 3/17 pts. 1/17 had
grade 2 RTOG late skin toxicity with moderate fibrosis and
discromia.
Conclusion
The Hypofractionated schedule of 36 Gy in 6 Gy/fractions
2/week in elderly pts gave good results in term of
treatment response and of acute and late side effects
even in lesions ≥3cm.
The treatment was well tolerated in all cases and the
shorter regime facilitates compliance of elderly pts
reducing the number of Hospital visits.
Electronic Poster: Clinical track: Sarcoma
EP-1375 Volumetric-modulated-arc-therapy versus 3D-
conformal-radiotherapy for sarcoma of extremities
A.M. Ascolese1, P. Navarria1, P. Mancosu1, S. Tomatis1, A.
Fogliata 1, P. Colombo1, R. De Sanctis1, A. Marrari1, D.
Franceschini1, G.R. D'Agostino1, A. Santoro1, V.
Quagliuolo1, M. Scorsetti1
1 Istituto Clinico Humanitas, Radiotherapy and
Radiosurgery, Rozzano Milan, Italy
Purpose or Objective
To assess the impact of volumetric-modulated arc therapy
(VMAT) compared with 3D-conformal radiotherapy
(3DCRT) in patients with newly diagnosed soft tissue
sarcoma (STS) of the extremities in terms of toxicity, local
control (LC) rate and patients overall survival (OS).
Material and Methods
The present retrospective study includes patients
with newly diagnosed STS of extremities treated at our
institution. All patients underwent limb-sparing surgery
and adjuvant radiation therapy. 3DCRT was adopted
between 2006-2010 and VMAT between 2011-2015. The
median total dose prescribed was 66 Gy (range 60-70 Gy)
in 33 fractions in both groups. The clinical target volume
(CTV) corresponded to the surgical cavity and planning
tumor volume (PTV) was generated adding and isotropic
margin of 1 cm. All plans were optimized on PTV. Clinical
outcome was evaluated by physical examination, contrast-
enhanced MRI, thoracic and abdominal computed
tomography (CT) scan two months after RT and then every
3 months. The tumor progression was described as local,
if it occurred in primary site. Toxicity was evaluated with
Common Terminology Criteria for Adverse Events (CTCAE)
scale version 4.0.
Results
From January 2006 to December 2015, 147 patients were
treated. The greater number of patients had liposarcoma
and leiomyosarcoma histology (62%). Preoperative tumor
volume was > 10 cm in maximum diameter in 62 (42%) of
patients and ≤ 10 cm in 85 (58%). Radical surgery was
performed in 85 (58%) patients and marginal or closed in
62 (42%). Preoperative or postoperative chemotherapy
was administered in 73 (49.6%) patients. The median
follow up time was 45.04 months. The 5 years LC rate was
80.79% for the whole cohort, 73.98 for 3DCRT patients and
85.26% for VMAT, respectively. The 5 years OS rate was
68.85% for the entire cohort, 61.1% for 3DCRT group
and 80.64% for VMAT, respectively. All but one dosimetric
parameters were in favor of VMAT. In detail, PTV V95% was
higher for VMAT; bones volume receiving 50 Gy was
significant lower for VMAT (p<0.05). For the lower
extremities, the maximum dose (i.e. 1cm3) to the contra-
lateral leg was smaller for the 3D approach (median: 16Gy
vs 7.2Gy). Acute soft tissue G3 toxicity was observed in 10
patients underwent 3DCRT and in 2 received VMAT. G1
fibrosis was recorded in 80% of patients while
osteomyelitis conditioning pain and bone fractures in 2
patients in 3DCRT group. Factors conditioning LC and OS,
on univariate and multivariate analysis was the tumor size
(p<0.01) and the surgical radicality (p<0.01).
Conclusion
the availability of modern RT technique permit a better
conformity on the target with maximum sparing of normal
tissue and lower side effects. This matter is hopefull for
prospective study using moderate hypofractionated RT
schedule.
EP-1376 IOERT combined with EBRT in R1-resected soft
tissue sarcomas of the extremities: a pooled analysis
F. Roeder1,2, A. De Paoli3, I. Alldinger 4, G. Bertola5, G.
Boz3, J. Garcia-Sabrido6, M. Uhl7, A. Alvarez8, B. Lehner9,
F. Calvo8, R. Krempien10
1LMU Munich, Department of Radiation Oncology,
Munich, Germany
2German Cancer Research Center DKFZ, Department of
Molecular Radiation Oncology, Heidelberg, Germany
3Centro di Riferimento Oncologico, Department of
Radiation Oncology, Aviano, Italy
4University of Heidelberg, Department of Surgery,
Heidelberg, Germany
5Centro di Riferimento Oncologico, Department of
Surgery, Aviano, Italy
6University Hospital Gregorio Maranon, Department of
Surgery, Madrid, Spain
7University of Heidelberg, Department of Radiation
Oncology, Heidelberg, Germany
8University Hospital Gregorio Maranon, Department of
Radiation Oncology, Madrid, Spain
9University of Heidelberg, Department of Orthopedics,
Heidelberg, Germany
10Helios Clinic, Department of Radiation Oncology,
Berlin, Germany
Purpose or Objective
To report the results of a European pooled analysis
evaluating the use of IOERT combined with EBRT in R1-
resected patients with extremity STS.
Material and Methods
Three European expert centers participated in the current
analysis. Only patients with R1-resection of an extremity
STS who received IOERT and EBRT were included. Patient
with gross incomplete resections, primary lesions outside
the extremities, nodal or distant metastasis prior/at
IOERT or missing EBRT documentation were excluded,
leaving 68 patients for the analysis. Median age was 59
years and median tumor size 8 cm. 68% of the patients
presented in primary situation with 72% of the tumors
located in the lower limb. Stage at presentation (UICC 7th )
was I:12%, II:49%, III:40%. Most patients showed high grade
lesions (FNCLCC grade 1:12%, 2:34%, 3:54%, predominantly
liposarcoma (38%) and MFH (28%). IOERT was applied to
the tumor bed with a median dose of 12.25 Gy using a
median electron energy of 8 MeV. IOERT was preceeded
(16%) or followed (84%) by EBRT with a median dose of 46
Gy in all patients. 22% of the patients received additional
chemotherapy.
Results