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S977

ESTRO 36 2017

_______________________________________________________________________________________________

acute tolerance and can predict the absence or minimal

risk of late toxicity to treatment.

Conclusion

This clinical case and the previously reported studies of

LRAB revealing

similar rates of tumor control and survival

to radical cystectomy constitute a hope in terms of quality

of life for the most minimally invasive conservative

treatment in a selected group of patients with localized

MIBC.

EP-1805 Interstitial and superficial brachytherapy for

skin cancer

S. Brovchuk

1

, S. Romanenko

1

, N. Ratushnia

1

, O.

Vaskevych

1

1

Kyiv Regional Oncology Dispensary, Radiotherapy

department, Kyiv, Ukraine

Purpose or Objective

The main purpose of this work was to demonstrate the

capabilities of brachytherapy in skin cancer treatment.

Malignant skin lesions are highly frequent type of cancer.

Between two main non-melanoma forms, basal cell

carcinoma (BCC) and squamous cell carcinoma (SCC), BCC

accounts for about 70%, and SCC of about 30%. And while,

in our practice, for treatment of SCC in some cases

external beam radiotherapy (EBRT) was required to

irradiate regional lymph nodes, BCC, which is almost

always local, is perfectly suitable for monobrachytherapy

treatment.

Material and Methods

In 70% of cases (in our practice more than that) skin

tumors are located on head and neck, where high

conformity is extremely important. If invasion of a tumor

was less than 5 mm deep, accommodated to the surface

mold applications were used, if invasion of a tumor 5 mm

or more, interstitial implants were used (the examples are

presented on Image

1).

Radiation dose was delivered using high dose rate (HDR)

afterloader with Ir192 radioactive source and was

prescribed in case of BCC at 0.5 cm from visible lesion

(growth tumor volume GTV), the enclosed volume

corresponds to clinical tumor volume (CTV), in case of SCC

at 1-1.5 cm from GTV the enclosed volume corresponds to

CTV (planning tumor volume PTV=CTV).

Dose fractionation (every day treatment, 5 days per

week):

for BCC cases - dose per fraction (fr) 4Gy in 2 cases and

the total dose (TD) of 48Gy (12fr), 5.2Gy per fraction in 39

cases and TD=41.6Gy (8fr), 6Gy per fraction in 5 cases and

TD=42Gy(7fr);

for SCC cases - dose per fraction 5.2Gy in 5 cases and

TD=46.8Gy (9fr), dose per fraction in 6.3Gy 2 cases and

TD=44.1Gy(7fr).

Equivalent dose to standard fractionation was about 58-

60 Gy (a/b ratio was taken 6-7Gy (BCC) and 10Gy

(SCC)). Treatment planning was performed on CT images,

the ratio of CTV that received 150% of the prescribed dose

(CTV

150

) to CTV

100

was kept below 0.45 (CTV

150

/ CTV

100

-

<0.45), that constrain in interstitial technique, where

radiation source is inside the tissue, is achieved when

spacing between implants is about 1-1.2 cm.

Results

Totally 53 patients (46 – BCC cases, 7 – CSS cases) were

treated acording to the described method during clinical

work in 2013 (clinical example is presented on Image 2);

median follow-up 2.5 years (range from 2 to 3 years); 4

patients had local recurance and one lymph node failure

(3-BCC cases and 2 (1 local+1 lymph node) – CSS cases).

Conclusion

Brachytherapy method of delivering radiation dose is

naturally the most conformal, which also is challenging,

but using interstitial implants or, accommodated to the

skin surface, mold applications, gives good results. Dose

per fraction of 6Gy and more lead to higher late

complications (fibrosis in our experience).

EP-1806 HDR brachytherapy for superficial non-

melanoma skin cancers.

C. De la Pinta

1

, T. Muñoz

1

, J. Dominguez

1

, A. Montero

2

1

Hospital Ramon y Cajal, Radiation Oncology, Madrid,

Spain

2

Radiation Oncology, Madrid, Spain

Purpose or Objective

The aim of this study was to evaluate the clinical and

cosmetic outcomes in patients treated with high-dose-rate

brachytherapy for non-melanoma skin cancer and disease-

specific and overall survival.

Material and Methods

All patients referred for interstitial brachytherapy in our

centre from 2007 to 2016 with non-melanoma skin cancer

without distant metastases were retrospectively analysed

(n=13). Median age was 7 years (range 54-88). Treatment

consisted of brachytherapy alone (10p) or after surgery

(3p). Patients with histologically confirmed squamous

carcinoma (4p), and basal cell carcinoma (9p). All lesions

were macroscopic. Lesions were located on the head and

neck: nasal skin (5p), periocular skin (4p) and ear skin

(4p). All patients were treated with interstitial

brachytherapy median implant dose 53 Gy (range 45-

66Gy).

Inclusion criteria were as follows: head and neck location

and malignant tumors.

Results

From January 2007, 13 patients were treated. Median

follow-up was 36 months (range 6-68 months), local

control was achieved on clinical examination.

Acute toxicities (8/13p) consisted of ephitelitis grade 1

(2p) and grade 2 (6p). Cosmesis was good or excellent in

12p. Late skin hypopigmentation were observed in 7

patients. Not acute toxicities grades 3 or 4 were reported.

Grade 4 complication rate for all patients was 7,6% (one

patient presented skin necrosis)

Among 13 patients studied, 4 lost follow-up and they were

excluded from the survival analysis.

Preservation of organ functions were in all patients.

Using Kaplan-Meier analysis overall survival after minimum

follow-up of 36 months was 93% and disease-free survival

was 75%. One patient had a locoregional recurrence.

Conclusion

Interstitial brachytherapy is a good choice to deliver high-

dose radiation in tumor after surgery or as an exclusive

treatment in non-melanoma skin cancers. This treatment

offers adequate locoregional control with acceptable

range of

complications.

EP-1765 Volume delineation based on 18FDG-PET and

MRI in head and neck cancer treated with IG-VMAT

L. Méndez Blanco

1

, C. Herrero

2

, M. Fueyo

1

, A. Martos

1

, D.

Abad

2

, P. Santin

1

, S. Palizas

1

, D. Alonso

1

, A. Rios

1

, M.

Vilches

2

, R. Cabanillas

1

1

Institute of Molecular and Oncological Medicine of

Asturias, Radiation Oncology, Oviedo, Spain

2

Institute of Molecular and Oncological Medicine of

Asturias, Medical Physics, Oviedo, Spain

Purpose or Objective

Image Guided-Volumetric Modulated Arc Therapy (IG-

VMAT) is being increasingly used to treat locally advanced

head and neck cancers. In this context 18-FDG-PET and

MRI are becoming especially useful for accurate target

volume delineation.

Material and Methods

Between November 2012 and October 2015, 38 patients

with head and neck carcinomas were treated at our

institution with IG-VMAT. Sites included were the

nasopharynx (14), oropharynx (5), hypopharynx (4), larynx

(6), paranasal sinuses and nasal cavity (3), thyroid (1),

parotid (1) and metastatic neck nodes from an unknown

primary (4). Each patient underwent endoscopy, contrast

enhanced CT, MRI and 18-FDG PET scans. Plans were