ESTRO 36 Abstract Book

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S755 ESTRO 36 2017
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setting, chemotherapy in outpatient setting and exclusion
criteria: combined radiochemotherapy, hospitalzation,
central venous catheter, palliative treatment. 360
patients were selected for the final analysis and were
stratified in 3 groups: group I (n=120) 3D-conformal RT for
brain tumors or brain metastasis; group II (n=120) RT for
body tumors (abdominal, retroabdominal, pelvic, chest,
breast); group III (n=120) was control –brain and body
tumors on chemotherapy. Mean fraction numbers were 25
(11 - 32), mean total dose – 52 Gy (22 - 66). VTE
assessment based on clinical data, venous ultrasound
examination (US) and chest CT. Statistical analysis was
performed by OpenEpi, Version 3 software pack.
Results
Deep vein thrombosis (DVT) was detected in 7 cases (5.8%)
in group I, 2 cases in group II and 1 case in control group.
VTE patients has a different tumors (right parietal area
astrocytoma, brain trunk tumor, skull basis cancer, rectal
cancer, breast cancer). 3 patients were available for long-
term outcomes assessment (12 months after radiation
therapy). During 1-year period we haven’t detected
thrombosis recurrence. Post thrombotic disease had
developed but without severe venous insufficiency. One
patient on 11th follow-up month was exposed with
repeated course of RT without any complications. The
difference between VTE incidence for group I and group III
characterized by statistical significance (p=0.018). Risk
difference for these groups was 5% (p<0.05).
Conclusion
Based on study results we suggest that external beam
radiation therapy is potentially an independent risk factor
for venous thromboembolism development even in
outpatient settings. High degree of clinical suspicion and
aggressive diagnostic work-up in case of suspicion is
necessary. In our opinion VTE prevention with low
molecular weight or unfractionated heparin should be
considered in selected patients at least during active
radiation therapy
EP-1431 Acute toxicity in deep loco-regional
hyperthermia
E. Burchardt1, A. Roszak2, B. Urbañski3, A. Nowak3
1 Greater Poland Cancer Centre, Department of
Oncological Gynecology and Radiotherapy, Poznan,
Poland
2 Greater Poland Cancer Centre, oncological gynecology
and radiotherapy, Poznań, Poland
3 Greater Poland Cancer Centre, Department of
Oncological Gynecology and Radiotherapy, Poznań,
Poland
Purpose or Objective
A series of phase III trials demonstrated the clinical effect
of hyperthermia. In January 2016 a new device for deep
regional hyperthermia was installed in our cancer centre.
The aim of this study was to assess tolerance and acute
toxicity of loco-regional hyperthermia given during
oncological treatment.
Material and Methods
101 patients (pts) were evaluated during treatment in the
period of time from January till September 2016. 45 pts
with cervical cancer (CC) were treated with radical
radiochemotherapy. 17 pts with CC were treated
palliative with radiotherapy, 10 pts with hepatic lesions
(1 HCC and 9 meta ad hepar) treated with chemotherapy,
7 pts with pancreatic ca treated with chemotherapy, 2
breast ca treated with chemotherapy ( 1 with RT and 1
with CT), 11pts with lung ca treated with chemotherapy ,
7 pts with rectal ca. treated with radiotherapy, 4 pts with
ca. of sigmoid colon treated with chemotherapy, 2 pts
with gastric ca. treated with chemotherapy and 1 with
radiotherapy. The Celsius TCS hyperthermia system, an
electro-hyperthermia, with a maximum output of up to
500 Watts was used. Two different electrode sizes were
applied externally by physical means to the region with
tumour in a targeted and controlled manner. The aim was
to increase the temperature to 41oC - 42oC, one session
lasted 60min. It was combined with either chemotherapy
or radiotherapy twice per week. Toxicity of the skin was
evaluated at every session with RTOG/EORTC
classification system. The tolerance of treatment was
ranged as Group 1: very good if there were 1-2 pauses
because of discomfort with no other symptoms, Group 2:
good- 3-4 pauses because of discomfort and skin toxicity
Grade 1, Group 3: poor- > 4 pauses or shortening of
hyperthermia course because of itching and skin
toxicity>=Gr 2.
Results
Local deep hyperthermia was easily tolerated. 78 pts
didn’t report any problems and were assigned to Group 1.
16 pts were assigned to Group 2 and only 2 pts to the group
“poor”. Toxicity was generally mild and never of grade 3.
1/10 pts felt pain in the last few minutes of the session.
Acute radiation toxicity was the same with or without
hyperthermia. There was a reduced tolerance of
hyperthermia in obese persons, with folds of skin on the
abdomen. This is primarily due to the fact that between
folds of skin sweat is collected what increases negative
impression from temperature. All patients with tumours
located in pelvis, reported pressure on the coccyx. We
haven’t observed any increased vaginal bleeding during
radical and palliative treatment of CC.
Conclusion
Tolerance associated with hyperthermia was very good
and most patients felt comfortable during this treatment.
Acute toxicity of the skin during the treatment was low.
EP-1432 Advantage of butterfly-vmat versus vmat in
mediastinal tumors
J. Luna1, A. Ilundain1, S. Gómez-Tejedor1, D. Esteban1,
M. Rincón1, J. Olivera1, W. Vásquez1, I. Prieto 1, L.
Guzmán1, J. Vara1
1Fundación Jiménez Díaz, Radiation Oncology, Madrid,
Spain
Purpose or Objective
There is a growing concern about the risks of late adverse
effects in young people who receive mediastinal
radiotherapy. The amazing technical advance has
achieved better planned treatments. At present, the new
focus of interest is to minimize the low doses in organs at
risks (OARs)
Material and Methods
We present our first results of a new protocol in our
Department for mediastinal radiotherapy. This protocol
includes the comparison of two treatment plannings for
every patient: volumetric modulated arc therapy (VMAT),
and Butterfly VMAT (a technique developed by the
University of Turin, Radiation Oncology Unit). VMAT was
performed with a double arc of 360º. B-VMAT consisted of
2 coplanar arcs of 60º (gantry starting angles 150º and
330º) and 1 no-coplanar arc of 60º (gantry starting angles
330º, couch angle 90º).
Until now, five patients have been included: Three
mediastinal lymphomas in young women (total dose 36 Gy
in two cases and 30 Gy in the other one), one patient
diagnosed of hemangiopericytoma located at internal
mammary chain (total dose 50 Gy) and the fifth patient
diagnosed of thymoma (54 Gy)
In the dose- volume histogram, regarding the PTV, the
parameters analyzed were V95, V98, V107, Medium dose,
Homogeneity index (HI) and conformity index (CI). For
OARS- (heart, lung and breast) and body, several
dosimetric parameters were registered.
Results
Our results show similar data in PTV coverage, IH and CI.
Regarding the OARs, dosimetric parameters were
equivalent in lung, heart and body. However, breast doses
were clearly lower with B-VMAT, mainly the lowest doses
(V4 and V10). For V4 , the medium value was 45.6% (7.8%