ESTRO 36 Abstract Book

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S735 ESTRO 36 2017
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N. Bychkova1, E. Khmelevsky1
1 Gertzen Moscow Research Oncological Institute,
Radiotherapy Department, Moscow, Russian Federation
Purpose or Objective
To study the features of bone metastases according to
different primary tumors and their importance for
radiotherapy
Material and Methods
We analyzed 680 cases of symptomatic bone metastases
included in the randomized controlled trial and treated
with EBRT. The primary breast tumors were diagnosed in
426 (62,6%), prostate in 57 (8,4%), lung in 57 (8,4%), renal
in 47 (6,9%), colon in 18 (2,6%), bladder in 11 (1,6%) and
other tumors in 64 (9,5%) cases. Patient selection criteria
for radiotherapy were pain, risk of pathological
fracture/malignant spinal cord compression, increasing
neurologic dysfunction. Irradiation of one anatomical area
was applied («block concept»). Treatment schedules
included 2, 3 and 4 fractions of 6,5Gy and standard
treatment schedule with 23 fractions of 2 Gy.
Results
The average follow-up period was 70 months. Pain
intensity before treatment was significantly higher for
bone metastases of prostate and lung cancer compared to
breast cancer (p<0,01) and for the men in general
(p<0,001 for non-prostate cases). Average relative lesion
length in irradiation’s areas was significantly lower for
renal cancer – 1,8 (for the three-level scale) and
significantly higher for prostate cancer – 2,28 (p=0,017).
The risk of pathological fracture was the lowest only for
prostate cancer metastases – 0,21 compared to 0,46 for
breast cancer lesions (p=0,0002). Overall effectiveness of
EBRT was 96,1%. Complete response rate (CRR) was
observed in 59,1% of cases. CRR correlated with the level
of total dose. CRR was significantly higher for bone
metastases of breast cancer compared to lung and renal
cancer (63,6% as opposed to 40,4% and 28,3%, р<0,02) and
for melanoma metastases (75%) compared to renal cancer
(p=0,036). It is interesting, that bone metastases of
melanoma and soft-tissue sarcomas were one of the most
radiosensitive. In the multifactorial analysis MANOVA
tumor primary site and pain intensity before radiotherapy
were the only independent prognostic factors of the
effectiveness of radiotherapy.
Conclusion
Tumor primary site is a clinical predictor of
radiosensitivity of bone metastases, it significantly affect
the CRR. Revealed features of bone lesions according to
different primary tumors allow to develop individual
treatment programs with a view to high efficiency and
ease of realization.
EP-1389 Superficial hyperthermia with radiotherapy:
toxicity and outcome of 62 metastatic lesions
G. Cattari1, A.G. Di Dia2 , M. Gatti1, E. Delmastro1, E.
Garibaldi 1, G. Belli 1, A. Salatino1, P. Gabriele1
1 FPO-IRCCS Candiolo, Radiotherapy, Candiolo- Turin,
Italy
2 FPO-IRCCS Candiolo, Medical Physic, Candiolo- Turin,
Italy
Purpose or Objective
The purpose of this study is to evaluate the safety,
feasibility and toxicity of radiotherapy-hyperthermia (RT-
HT) in the treatment of superficial recurrent and
metastatic tumors in this setting of patients
Material and Methods
Thirty-nine patients (mean age 69 years; range: 49-93)
with histologically confirmed superficial
recurrent/metastatic tumours were treated: 19 breast, 10
head & neck, 2 malignant melanoma, 4 sarcomas, 1
uterine, 1 hepatocarcinoma and 2 pancreatic carcinoma.
The total number of treated lesions was 62. The mean
Karnofsky Index value is 75. Pre-treated patients (70%)
received a previous mean RT dose of 50 Gy. Patients
underwent RT treatment using 3D-conformal RT (16/39) or
Helical Tomotherapy (23/39). External beam RT was
delivered in 5-27 fractions of 1.7-5 Gy to a total dose of
20-57.5 Gy (mean external dose: 39 Gy). Hyperthermia
(HT) treatment is performed with a double
electromagnetic superficial applicators operating at the
frequency of 434 MHz. HT session was delivered
once/twice weekly during the period of RT , 1-2 hours
after RT [mean value: 5; range: 1-9 sessions]. Average,
maximum and minimum temperature parameters were
recorded during HT treatment. The treatment goal was to
reach 40- 42°C in > 90% (T90) of measured points for a
duration of 60 minutes. Acute and late toxicity was
evaluated according to the CTCAE criteria. Local control
was assessed after the end of the treatment on the basis
of the RECIST Criteria
Results
During HT treatment the median temperature [range]
reached was 40.5 °C [39 – 42.9°C]. Five patients
interrupted the treatment: 2 pts (5%) for G3 toxicity,
2 (5%) for poor compliance and 1 (2.5%) for clinical
progression disease. Two pts (5%) had acute cutaneous
toxicity ≥ G3 at 1 month. Four patients had toxicity > G2
at 3 months, three patients had > G2 at 6 months and only
one patients at 12 months. No patients showed toxicity ≥
G2 thereafter. The mean follow-up was 12 months (range
1-50 months). The Local control rate was: 87%, 72%, 65%
and 53%, 63% and 75% at 1 , 3 , 6 , 12, 24, 36 months
respectively. The time to local progression was ranged
between 1 and 12 months (mean: 6 months). The detailed
results are reported in Table 1. Five patients are dead (4
for disease and one for vascular accident). Univariate
analysis showed that Tmean, Tmax, Tmin, T90 parameters
were not associated with local control rate
follow-up (months) CR (%) PR (%) SD (%) PD (%)
1 20 48 19 13
3 22 28 22 28
6 26 4 35 35
12 20 6 27 47
24 37.5 - 25 37.5
36 25 - 50 25
TABLE 1: response rate in the time (months)
Conclusion
RT-HT is useful combined treatment with a good local
control rate and patient compliance. The clinical outcome
and the time duration of the follow-up is affected by the
advanced stage of diseases. A larger pool and a more
detailed patient stratification are needed to evaluate the
outcome data in the time
Acknowledgments
This work was supported by “5 per Mille 2009 Ministero
della Salute-FPRC Onlus”.
EP-1390 Superior target delineation of renal cell
carcinoma bone metastases on MRI vs CT
F.M. Prins 1, J.M. Van der Velden1, A.S. Gerlich1, A.N.T.J.
Kotte1, W.S.C. Eppinga1, N. Kasperts1, L.G.W. Kerkmeijer1
1UMC Utrecht, Radiation oncology, Utrecht, The
Netherlands
Purpose or Objective
In metastatic RCC (mRCC) there has been a treatment shift
towards targeted therapy, which has resulted in a 50%
increase in overall survival. Therefore, there is a need for
better local control of the tumor and its metastases.
Image-guided SBRT in bone metastases provides improved
symptom palliation and local control. After SBRT for
mRCC, local control rates have been improved from 50%
to 85% when compared to conventional fractionation