761 / 1082
S745
ESTRO 36 2017
_______________________________________________________________________________________________
Conclusion
Most elderly patients have a BMI at the start of treatment
not indicative of malnutrition, and hardly changes during
treatment
All patients have some degree of weight loss at the
beginning of treatment. During the treatment and at the
end, most do not progress in such loss or it is less than 5%
Patients have a progressive difficulty in feeding, mainly
due to dysphagia, but this does not translate for changing
the type of diet
It is essential to assess the nutritional status of elderly
patients with lung cancer at the start of oncological
treatment, as well as a scheduled monitoring to control
feeding problems and give adequate dietary guidelines
EP-1409 Prospective study of hypofractionated
radiotherapy for elderly patients with High Grade
Glioma
E. Clerici
1
, P. Navarria
1
, A.M. Ascolese
1
, F. Pessina
2
, S.
Tomatis
1
, L. Cozzi
1
, M. Simonelli
3
, A. Santoro
3
, C.
Franzese
1
, L. Bello
2
, M. Scorsetti
1
1
Istituto Clinico Humanitas, Radiotherapy and
Radiosurgery, Rozzano Milan, Italy
2
Istituto Clinico Humanitas, Neurosurgery Oncology
Department, Rozzano Milan, Italy
3
Istituto Clinico Humanitas, Oncology and Hematology
Department, Rozzano Milan, Italy
Purpose or Objective
Published studies showed that a short course of radiation
therapy (RT) in elderly and frail patients with diagnosed
anaplastic glioma is safe, feasible and better tolerated
compared to standard RT fractionation. Based on this
background we designed a prospective trial of
hypofractionated radiotherapy. The aim of this study was
to evaluate patients outcome in terms of progression free
survival (PFS) and Overall Survival (OS) rate, and
treatment related toxicity.
Material and Methods
Elderly patients (≥70 years old) with poor Karnofsky
performance status and histological confirmed high grade
glioma (HGG) were included in this evaluation. All patients
underwent hypofractionated radiotherapy with or without
concomitant and adjuvant chemotherapy in relation to
MGMT status, using temozolomide (TMZ). To precisely
define the target volume, computer tomography (CT) scan
with and without contrast and magnetic resonance images
(MRI) were acquired and images were coregistered. The
clinical tumor volume (CTV) corresponded to surgical
cavity or to T1 FLAIR abnormality in case of biopsy only.
Planning target volume (PTV) was generated adding an
isotropic margin of 5 mm from CTV. All plans were
optimized on PTV using volumetric modulated arc therapy
(VMAT) mode. Dose prescription was 52 Gy in 15
consecutive daily fractions (BED
10
70.88 Gy). Clinical
outcome was evaluated by neurological examination and
brain MRI performed, one month after RT and then every
3 months. Response was recorded using the Response
Assessment in Neuro-Oncology (RANO) criteria. The tumor
progression was described as local, if it occurred in/or
within 2 cm from primary site, and distant for new and
non-contiguous enhancing or non-enhancing lesions.
Hematologic and non-hematologic toxicities were graded
according to Common Terminology Criteria for Adverse
Events version 4.0.
Results
From February 2013 to February 2016, among patients
referred to our institution for anaplastic gliomas, 24
patients were included in this evaluation. Biopsy was
performed in 13 patients, complete resection in 5 and
partial resection in 6. Concomitant and/or adjuvant
chemotherapy was administrated in 7 patients.
The
median time and the 6 and 12 months progression-free
survival (PFS) rate were 4.4 months, 46% and 12%. The
median overall survival (OS) time and the 1 year OS rate
were 7.3 months, 70.8% and 16.7%. On univariate and
multivariate analysis MGMT status and administration of
adjuvant chemotherapy more than concurrent
chemotherapy significantly impacted on PFS and OS (p <
0.01). The treatment was well tolerated, no severe
toxicity was recorded.
Conclusion
In our experience, hypofractionated radiotherapy with
VMAT-RA in elderly and frail patients could be a safe and
feasible therapeutic option. Adjuvant chemotherapy, in
selected patients, can improve survival.
EP-1410 Role of PMRT in Elderly Patients with T1-2
and 1 to 3 Positive Nodes Breast Cancer
L. Cao
1
, M.Y. Kirova
2
, C. Xu
1
, K.W. Shen
3
, J.Y. Chen
1
1
Ruijin Hospital- Shanghai Jiaotong University School of
Medicine, Department of Radiation Oncology, Shanghai,
China
2
Institut Curie, Department of Radiation Oncology, Paris,
France
3
Ruijin Hospital- Shanghai Jiaotong University School of
Medicine, Comprehensive Breast Health Center,
Shanghai, China
Purpose or Objective
Even if evidence of post-mastectomy radiotherapy (PMRT)
in patients with T1-2 and 1 to 3 positive nodes breast
cancer is increasing, controversies still exist, especially in
elderly patients because the risk of treatment-related
toxicity. The aim of this study is to evaluate the efficacy
and toxicity of PMRT in elderly as well as the place and
use of systemic treatment in this population of patients.
Material and Methods
We retrospectively reviewed records of consecutive
patients with T1-2 and 1 to 3 positive nodes treated with
mastectomy at our institution between June 2009 and
June 2014. Elderly patients were defined as 65 years or
above. Patients who had received neoadjuvant treatment
were excluded from the analysis. In total, we analyzed 73
patients, of them only 23 received PMRT. Locoregional
recurrence (LRR) was defined as any recurrence within the
ipsilateral chest wall, ipsilateral axillary, internal
mammary, infraclavicular or supraclavicular lymph nodes.
All recurrences at other sites were recorded as distant
disease recurrence (DDR). Disease-free survival (DFS) was
defined as the time from start of PMRT until recurrence of
tumor or death from any cause. Overall survival (OS) is
defined as the time from start of PMRT until death from
any cause.
Results
The median age was 72 years (range, 65-91 years). There
were 10 patients with HER2 positive tumors, of them100%
(n=4) received trastuzumab in the PMRT group and 2 of 6
patients in non-PMRT group. All patients with HR positive
tumor received endocrine therapy. The patients in the
PMRT group were younger (69 years vs. 75 years, P=0.005).
Higher number of patients in the PMRT group received
adjuvant chemotherapy (82.6 % vs 48 %, P=0.006). At a
median follow-up of 48 months (range, 25-85 months),
there were 2 LRR diagnosed concurrently with distant
metastasis, one in each group respectively. We observed
six distant metastases and 5 deaths. In the whole cohort,