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S976

ESTRO 36 2017

_______________________________________________________________________________________________

50 Gy. The dose of brachytherapy was 14 Gy in 2 fractions

at intervals of one week, which was applied after 40-50

Gy EBRT

Results

Reducing dysphagia was observed in 70% of patients in the

first group, 54% - in the second group, and 23% - in the

third. Two-year overall survival was 36%, 12% and 12%

respectively. The median overall survival was 15.7; 9.7

and 6.6 months, respectively.

Conclusion

Adding intraluminal brachytherapy to EBRT can reduce

dysphagia and improve overall survival.

EP-1803 Moderate dose-escalation with perioperative

HDR brachytherapy in soft tissue sarcomas

X. Chen

1

, A. Montero

1

, E. Sanchez

1

, J. De las Heras

2

, O.

Hernando

3

, M. Lopez

1

, J. Garcia

4

, J.M. Perez

5

, R.

Ciervide

1

, J. Valero

1

, M. Garcia-Aranda

1

, R. Alonso

3

, D.

Zucca

4

, M.A. De la Casa

4

, B. Alvarez

1

, J. Marti

4

, L.

Alonso

5

, P. Fernandez-Leton

4

, C. Rubio

1

1

Hospital Universitario HM Sanchinarro, Radiation

Oncology, Madrid, Spain

2

Hospital Universitario HM Sanchinarro, Orthopaedic

Surgery, Madrid, Spain

3

Hospital Universitario HM Puerta del Sur, Radiation

Oncology, Madrid, Spain

4

Hospital Universitario HM Sanchinarro, Medical Physics,

Madrid, Spain

5

Hospital Universitario HM Puerta del Sur, Medical

Physics, Madrid, Spain

Purpose or Objective

Radiation therapy after conservative surgery improves

local control in patients with soft tissue sarcoma. A clear

relationship exists between dose and local control. We

report our experience about feasibility of perioperative

brachytherapy as a moderate dose-escalation approach in

the multidisciplinary management of soft tissue sarcoma.

Material and Methods

From May 2015 to October 2016, 9 patients (p), 5 men and

4 women, with a median age of 63 years (range 7 – 72

years) underwent perioperative brachytherapy (PoBT).

Histology: 4 p (44%) liposarcoma, 2 p (22%) desmoid and

1 p (11%) fusocellular sarcoma, 1 p (11%) pleomorphic

sarcoma and 1 p (11%) sarcoma NOS. Tumor staging: 4 p

T2aN0M0, 5 p T2bN0M0. Tumor location: thigh 5 p (56%),

trunk 2 p (22%), arm 1 p (11%), neck 1p (11%). PoBT

procedure was performed by using 6F plastic catheters

placed on the surgical bed at the time of excision. Eight

patients obtained R0 resection and 1 p R1 resection.

Catheters were placed perpendicularly to the surgical

incision at 1.5- 2 cm intervals to ensure adequate

dosimetry. CT simulation with 1.5 mm slice thickness was

done in the fourth or fifth day after surgery once the sewer

system was retired. A total 16.5 Gy was delivered to the

PTV in 3 fractions of 550 cGy separated at least 6 hours.

Catheters were retired after the last fraction.

Results

All p received external beam radiotherapy (EBRT) by using

intensity modulated radiotherapy (IMRT) at a dose of 50

Gy in 25 fractions of 2 Gy/day. Five p (56%) underwent

pre-operative radiotherapy and 4 p (44%) post-operative

radiotherapy. Four patients received chemotherapy

before or after radiotherapy. One of the biological

characteristics of sarcoma is their relatively low α-β ratio.

Assuming the alpha- beta ratio of sarcoma cells as 4 our

calculation of tumor BED is as following: (2Gy x 25fx) +

(5.5Gy x 3fx) = 114.19Gy which corresponds to an

accumulated EQD2Gy for tumor of 76.12Gy. With a median

follow-up of 7.8 months (range 3 – 17.6 months), no local

failure nor distance progression has been observed. No

grade 2 or higher toxicity was observed.

Conclusion

Peri-operative brachytherapy is feasible and well

tolerated and allows a moderate dose-escalation in

patients with soft-tissue sarcomas.

EP-1804 Laparoscopic robot-assisted brachytherapy of

muscle-invasive bladder cancer: clinical case report

F. Mascarenhas

1

, F. Marques

1

, K. Maes

2

, R. Formoso

2

, T.

Antunes

1

, S. Germano

1

, S. Faustino

1

1

Hospital da Luz, Radiation Oncology, Lisbon, Portugal

2

Hospital da Luz, Urology, Lisbon, Portugal

Purpose or Objective

The standard treatment of muscle-invasive of the bladder

cancer (MIBC) is radical cystectomy. A significant

percentage of this population is elderly, with severe co-

morbidities, or without general conditions to radical

cystectomy. Integrated brachytherapy in a multimodality

conservative approach for bladder preservation is well

established and is considered an alternative therapeutic

option in selected cases.

Material and Methods

The authors present a clinical case of an elderly patient

with a high grade stage T2aN0M0 bladder muscle-invasive

carcinoma submitted to laparoscopic robot-assisted

brachytherapy (LRAB) according the Arnhem Radiotherapy

Institute, that developed specific catheters for this

modality. The selection criteria, the clinical evaluation

and all phases of the treatment procedure will be

presented. Patient was submitted firstly to three cycles of

neoadjuvant chemotherapy with carboplatin and

gemcitabine followed by intensity modulated external

radiotherapy for the pelvis including bladder and pelvic

lymph nodes to a total dose of 40Gy in 20 fractions. After

3 weeks patient was submitted to a partial cystectomy and

internal iliac lymph nodes dissection. Three Luneray

catethers were inserted over the tumor bed in this surgical

procedure and brachytherapy was performed beginning in

the same day of surgery and completed in the following

three days delivering 25Gy in 10 fractions. Following

image represents the bladder implant.

The quality of the implant was evaluated using the

homogeneity index (HI) and the overdose index (OI),

according to the following formulas:

HI= (V

100

-V

150

)/V

100

× 100%

OI= V

200

/V

100

× 100%

The first pulse of brachytherapy was administered on the

same day of the catheters’ implant. After the last pulse,

the catheters were removed and then pulled out of the

abdomen on the other side.

Results

For the present case, HI was 62,3% and OI was 19,7%.

The excellent tolerance of the treatment and the absence

of complications allowed the patient´s hospital discharge

the day after the final of brachytherapy. The withdrawal

of Foley catheter was performed after 2 weeks. One

month after the treatment, the previous symptoms were

completely improved and the patient is actually

asymptomatic. The short follow-up ensures excellent