763 / 1082
S747
ESTRO 36 2017
_______________________________________________________________________________________________
chemotherapy according to intradepartmental standards.
For the analysis of the QoL the EORTC QLQ-C30 and the
EORTC QLQ-LC13 were used. QoL data was collected
before radiation treatment, 6 weeks, 12 weeks, 6 month
and 12 month after RT. Additionally factors were
analyzed, including clinical outcome, survival, treatment
induced side effects.
Results
The median follow up was 34,5 weeks. In total 49,4 % of
patients had a complete or partial remission and 16,0 % a
stable local disease. Local failure occurred in 24,7 % of
patients. Distant failure occurred in 44,4 % of patients.
Severe dysphagia occurred in up to 9 % of patients, up to
50 % experienced mild dysphagia. The overall rates for RT
induced pneumonitis (RP) were low with a maximum of 8
% 12 weeks after RT. The median survival time was 34
weeks with a range from 1 to 220 weeks. All functional
scales showed a variable course but maxed or at least
showed a recovery 12 weeks after RT. Symptoms with a
high mean symptom score (> 40) were fatigue, dyspnoea
and coughing. Insomnia, peripheral neuropathia, appetite
loss, dyspnoea (from QLQ-LC13) and all parameters for
pain had an intermediate mean score (10 – 40). There were
low mean scores of fewer than 10 for nausea and vomiting,
diarrhoea, sore mouth and haemoptysis. The GLM revealed
no statistically significant difference for any QLQ-C30
parameter over time. For the QLQ-LC13 statistically
significant differences over time were found for the
peripheral neuropathy (p = 0,011) and the dysphagia (p =
0,034). There was a highly significant correlation between
the clinical dysphagia and the dysphagia scores (p <
0,005). The correlation between clinical RP and the scores
for dyspnoea and coughing was significant at some follow-
up appointments. The EORTC QLQ-C30 and QLQ-LC13
scores did not prove to have a significant influence on the
overall survival or distant and local failure.
Conclusion
12 weeks after RT the scores of the QLQ-C30 functional
scales showed the highest scores or at least a temporary
recovery. The symptom scales accurately reflected the
common symptoms and treatment related toxicities.
There was a significant correlation between clinical
dysphagia and pneumonitis and associated QoL scores. QoL
did not prove to be a significant predictor for survival or
distant and local control.
EP-1413 IORT for treatment of recurrent tumors - A
single institution analysis.
T.M. Coelho
1
, R.C. Fogaroli
1
, A.C.A. Pellizzon
1
, D.G.
Castro
1
, G.R.M. Gondim
1
, M.L.G. Silva
1
, M.J. Chen
1
, A.A.
Ambrosio
1
1
Accamargo cancer center, Radiotherapy, Sao Paulo sp,
Brazi
Purpose or Objective
The incidence of recurrent retroperitoneal or pelvic
tumors (rRPT) varies from 20% to 77% in literature and
requires a multidisciplinary approach. Local control (LC)
with isolated salvage surgical resection is dismal, and
intraoperative radiotherapy (IORT) can be considered an
adjuvant treatment option for selected cases, in special
those with previous course of radiation.
This study assessed the feasibility, efficacy and morbidity
of IORT as adjuvant treatment of rRPT who underwent to
salvage surgical resection.
Material and Methods
41 patients with non-metastatic and isolated (one
anatomic site) rRPT were treated from 2004 to 2015. All
patients were treated with intraoperative electron beam,
except one patient who was treated with intraoperative
high dose rate brachytherapy. The mean doses were 16 Gy
(range 10-21) and 14Gy (range 9-20) for patients without
and with previous external beam radiation therapy
(EBRT), respectively. The dose was delivered with a 2cm
safe margin around the tumor bed. Seventeen (39%)
patients had additional EBRT (mean dose 45 Gy) after
surgery and IORT. Median survival times were calculated
using Kaplan-Meier analysis and differences in survival
between groups were tested using log-rank test. The Cox
proportional hazards regression model was used to
estimate the hazard ratio (HR) for potential predictors of
LC, overall survival(OS) and disease-specific survival(DSS).
A difference was considered statistically significant if
p≤0,05.
Results
Twenty-two (54%) patients had pelvic lesions and 19(46%)
had retroperitoneal disease. In addition, 3 patients had a
second course of RTIO for a second recurrent tumor in
different anatomical site, 31 patients (82%) had resection
R0 and 8 patients (18%) had resection R1. The most
common recurrent tumors were colorectal cancer
(36%) and retroperitoneal sarcomas (50%). With a median
follow-up of 70 months (range 12-92), the median DSS was
54 months (range 28-80). The 5-year actuarial OS, LC and
DSS were 71%, 68% and 44%, respectively. On univariate
analysis margin status of resection significantly affected
LC. For patient with resection R0, LC was 83% whereas no
patient with R1 resection obtained local control (p<0,01).
Toxicity presented in 11(27%) patients and pain was the
most common side-effect (64%) followed by enteritis
(18%).
Conclusion
IORT is an efficient method of salvage treatment to
improve LC in selected patients with isolated locally
recurrent tumors for recurrent pelvic or retroperitoneal
tumors, with acceptable incidence of morbidity.
EP-1414 Toxicity of concurrent stereotactic
radiotherapy and targeted or immunotherapy: a
systematic review
S.G.C. Kroeze
1
, C. Fritz
1
, M. Hoyer
2
, S.S. Lo
3
, U. Ricardi
4
,
A. Sahgal
5
, R. Stahel
6
, R. Stupp
6
, M. Guckenberger
1
1
University Hospital Zürich, Department of Radiation
Oncology, Zurich, Switzerland
2
Aarhus University, Danish Center for Partical Therapy,
Aarhus, Denmark
3
University of Washington School of Medicine,
Department of Radiation Oncology, Seattle, USA
4
University of Turin, Department of Radiation Oncology,
Turin, Italy
5
University of Toronto, Department of Radiation
Oncology, Toronto, Canada
6
University Hospital Zürich, Department of Oncology,
Zurich, Switzerland
Purpose or Objective
Stereotactic radiotherapy (SRT)
and
targeted/immunotherapy play an increasingly important
role in personalized treatment of metastatic disease. The
combined application of both therapies is rapidly
expanding in daily clinical practice. Patients may benefit
from additive cytotoxic effects, but currently not much is
known regarding safety and the potential induction of
toxicity. Toxicity data from targeted/immunotherapy
combined with conventionally fractionated radiotherapy
cannot be extrapolated to SRT because of the differences
in physics and biology. The aim of our systematic review
was to summarize severe toxicity observed after
concurrent treatment.
Material and Methods
PubMed and EMBASE databases were searched for English
literature published up to april 2016 using keywords
'radiosurgery”, 'local ablative therapy”, 'gamma knife”
and 'stereotactic”, combined with 'bevacizumab”,
'cetuximab”, 'crizotinib”,
'erlotinib”,
'gefitinib”,
'ipilimumab”, 'lapatinib”, 'sorafenib”, 'sunitinib”,
'trastuzumab”, 'vemurafenib”, 'PLX4032”, 'panitumumab”,
'nivolumab”, 'pembrolizumab”, 'alectinib”, 'ceritinib”,
'dabrafenib”, 'trametinib”, 'BRAF”, 'TKI”, 'MEK”, 'PD1”,
'EGFR”, 'CTLA-4” or 'ALK”. Studies performing SRT during