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EP-1063 PREOPERATIVE HYPERFRACTIONATED RADIOTHERAPY WITH ORAL FLUOROPYRIMIDINES IN LOCALLY ADVANCED RECTAL CANCER
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Materials and Methods: Retrospective cohort study of 110 pts with resecable locally advanced gastric cancer treated with adjuvant RTQT in our department from April 2002 until June 2011. Median age was 61.7 (35-83). 70% were men. The antrum and distal stomach (55.5%) were the most frequent localization. Median KPS score was 100% (70-100%). Subtotal gastrectomy was the most frequent surgical procedure (59.1%) and 88.2% were R0. A lymph node dissection including more than 12 lymph nodes was performed in 40% pts. 51.8% pts had an histologic subtype intestinal of adenocarcinoma. Pathological stage: Ib: 15.5%; IIa: 9.1%; IIb: 9.1%; IIIa: 30.9%; IIIb: 17.3; IIIc: 8.2%; IVa: 10%. The most used type of QT were fluoropirimidines in monotherapy. All patients received 3D conformal radiotherapy with photons of 18 MV, with a median dose of 45 Gy (1250.4)/1.8 Gy. The median delay period of the start of radiotherapy according to the date of surgery was 95.27 days (40-223) Results: Median follow-up: 31.87 months (5-113). 45.5% pts died, 6 pts died due to causes not directly related with cancer and 20% had local recurrence. CSFS and DFS at 3 and 5 years were 57% and 49%, and 50% and 46% respectively. In the univariate analysis the stage and type of lymphadenectomy had a significant impact in CSFS (p=0.02 and p=0.01, respectively) and DFS (p=0.048 and p=0.00, respectively) and the grade of differentiation only with CSFS (p=0.03). The most common acute effects were nausea and vomiting (10%), weight loss during treatment (32%) and blood disorders (5%). Conclusions: In our experience, the results in terms of survival and toxicity in pts with resectable locally advanced gastric cancer treated with adjuvant radio-chemotherapy are similar to published so far in the literature. EP-1063 PREOPERATIVE HYPERFRACTIONATED RADIOTHERAPY WITH ORAL FLUOROPYRIMIDINES IN LOCALLY ADVANCED RECTAL CANCER C. Fuentes Sanchez1, R. Hernández González Ruth1, J.J. Martín Ortega1, J.M. Ponce Ortega2, R. Cabrera Diaz-Saavedra3, M.E. Espiñeira Yanes1, J.C. Martínez Cedrés1, A.N.A. Armijo Mallorquín1, L.F. Otón Sánchez4, C.A. Otón Sánchez4 1 Hospital Universitario Candelaria, Oncología Radioterápica, Santa Cruz de Tenerife, Spain 2 IMO, Oncología Radioterápica, Murcia, Spain 3 Hospital U. Dr Negrín, Oncología Radioterápica, Las Palmas, Spain 4 Hospital Universitario Canarias, Oncología Radioterápica, La Laguna, Spain Purpose/Objective: Preoperative chemoradiation with standard fractionation and hypofractionation are the most widely schemes used in locally advanced rectal cancer (T3 or N +).There is little information about the efficiency and advantage of hyperfractionated schemes in these tumors. The hyperfractionation has the theoretical advantage of less toxicity, currently an issue of concern in Oncology, and a longer time of interaction with chemotherapy.Objetive: To report long-term results of hyperfractionated radiotherapy with and without oral fluoropyrimidines in a retrospective study with a maximum follow up of 13 years (1995-2008). Materials and Methods: Between January 1995 and August 2008, 191 non metastatic rectal cancer patients were treated with hyperfractionated radiation therapy. The total dose was 39.1 Gy to the whole pelvis, with a boost to the tumor of 11.5 Gy (total dose of 50.60 Gy), 1.15 Gy per fraction, with a minimum interval of 6 hours between those two fractions. 149 patients (78%) were treated with concurrent oral fluoropyrimidines. Results: 40 patients were treated with radiotherapy alone, 41 with UFT, 58 with Tegafur, and 50 with capecitabine. In two patients we could not ensure whether they received chemotherapy or not. 73 patients (38.2%) were treated with abdominoperineal excision after radiotherapy, 68 (38.6%) patients underwent anterior resection with total mesorectal excision (TME) and 49 patients (25.6%) anterior resection without TME. Pathological complete remission was found in 16.2% (15% without chemotherapy and 16.9% with chemotherapy). Local recurrences at 5 years were 10.4%. Although there was no statistical difference between the different groups, in the group of anterior resection with TME and chemotherapy we could find a lower local recurrence rate (5.6%). Overall survival (Kaplan-Meier) at 5 year was 64% (69% in the chemotherapy group and 47% in the exclusive radiotherapy group) and 51% at 10 years. Sphincter preservation surgery could be performed in 61.8% of all patients. 92% of patients completed treatment as planned. 92% of patients had toxicity grade 0 or 1. Grade 3 complications were 6% (bowel occlusion mainly 4.7%). Conclusions: Hyperfractionated preoperative chemoradiation is an effective and well tolerated scheme. Although it appears to be
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superior to the same regime without chemotherapy, we could not obtain any conclusion because the two groups were not comparables (more elderly patients and with worse clinical condition in the radiotherapy group).The results obtained with this scheme are comparable to other schemes with a higher biologically effective dose with a favorable comparison to side effects. Randomized studies are needed to determine the real benefit (efficacy and toxicity) of this regime of treatment. EP-1064 ADJUVANT CHEMORADIATION (CRT) FOR HIGH-RISK GASTRIC CANCER (GC) EMPLOYING INFUSIONAL 5-FLUOROURACIL (5FU) V. Vassiliou1, K. Papademetriou2, P. Kountourakis2, D. Papamichael2, D. Andreopoulos1 1 Bank of Cyprus Oncology Centre, Radiation Oncology, Nicosia Cyprus, Cyprus 2 Bank of Cyprus Oncology Centre, Medical Oncology, Nicosia Cyprus, Cyprus Purpose/Objective: Postoperative CRT is a standard treatment option for fully resected high risk GC. Adjuvant CRT using bolus 5FU significantly improves overall (OS) and disease free survival (DFS) versus surgery alone. However, this regimen is associated with significant toxicity and poor tolerability. In this retrospective study we evaluated the effectiveness and toxicity of adjuvant CRT employing infusional 5FU. Materials and Methods: Sixty eight patients (pts) with high risk GC were referred following surgery for adjuvant CRT. The treatment comprised six cycles of the 'modified de Gramont' regimen [leucovorin: 350 mg iv (d1) and 5-FU: 400 mg/m2 iv-bolus (d1), 2,800mg/m2 over 46 hours]; the third and fourth cycle of chemotherapy given concurrently with RT as follows: total dose of RT 4,500 cGy in 25 fractions of 180 cGy. Pts were evaluated retrospectively for toxicity, DFS and OS. Results: With a median follow-up period of 32 months (mo; range: 5– 90), 68 patients (36 men, 32 women), median age 59 years (range: 3076) were treated; stage IB: 4,4% (3/68 pts), IIA:7,35% (5/68 pts), IIB:13% (9/68 pts), IIIA: 11,7% (8/68 pts), IIIB: 30,8% (21/68 pts), IIIC: 32,3% (22/68 pts). The median DFS and OS were 25,2 and 32 mo, respectively. Three year DFS and OS were 24% and 29%. Grade III or higher myelotoxicity was: neutropenia 16% (11 pts); two pts grade IV neutropenia, thrombocytopenia 3% (2 pts). Grade III or higher non hematologic toxicity were: diarrhea 19% (13pts), vomiting 3% (2 pts), stomatitis/esophagitis 8% (6 pts) and constipation 3% (2 pts). There was no grade IV non hematologic toxicity. Fifty-three pts (78%) completed the treatment. Discontinuation was necessary in 5 pts due to diarrheas, 3 due to neutropenia, 3 due to performance status deterioration, 1 patient due to infection, 1 due to arythmia and 2 pts after informed consent withdrawal. Two pts died during treatment: one from possible/unconfirmed cardiovascular event and the other one due to sepsis. Conclusions: Despite a relatively short median follow-up and small sample size, our findings suggest that this regimen could be an alternative therapeutic option, with favorable toxicity and tolerability in patients with fully resected high risk GC. EP-1065 RADIOTHERAPY WITH VOLUMETRIC MODULATED ARC THERAPY FOR HEPATOCELLULAR CARCINOMA PATIENTS W. Hsu1, P.M. Wang1, N.N. Chung1, B.A. Chang1, G. Nicolini2, A. Clivio2, A. Fogliata2, L. Cozzi2 1 Cheng-Ching General Hospital, Radiation oncology, Taichung, Taiwan 2 IOSI, Medical Physics, Bellinzona, Switzerland Purpose/Objective: To report about the dosimetric and clinical findings in the treatment of primary hepatocellular carcinoma (HCC) with volumetric modulated arc therapy. Materials and Methods: Hundred forty-five patients (81% male) received a radiotherapy treatment for HCC. Dose prescription (at 95% of the planning target volume (PTV)) ranged from 45 to 66Gy. Most patients (89%) presented AJCC stage III or IV and 83% of the patients presented with N0-M0 status. All were classified as BCLC stage A to C. All patients were treated with volumetric modulated arc therapy in the RapidArc form using 10MV photons using single or multiple, coplanar or non-coplanar arcs, and cone-down technique in case of early response of tumor Results: Patients median age was 66 years (range 27-87), 81% of the patients were treated with 60Gy (13% at 45, 6% at 66Gy), 63% with cone-down, 98% with multiple arcs. Mean initial PTV was 777±632cm3,
Materials and Methods: Retrospective cohort study of 110 pts with resecable locally advanced gastric cancer treated with adjuvant RTQT in our department from April 2002 until June 2011. Median age was 61.7 (35-83). 70% were men. The antrum and distal stomach (55.5%) were the most frequent localization. Median KPS score was 100% (70-100%). Subtotal gastrectomy was the most frequent surgical procedure (59.1%) and 88.2% were R0. A lymph node dissection including more than 12 lymph nodes was performed in 40% pts. 51.8% pts had an histologic subtype intestinal of adenocarcinoma. Pathological stage: Ib: 15.5%; IIa: 9.1%; IIb: 9.1%; IIIa: 30.9%; IIIb: 17.3; IIIc: 8.2%; IVa: 10%. The most used type of QT were fluoropirimidines in monotherapy. All patients received 3D conformal radiotherapy with photons of 18 MV, with a median dose of 45 Gy (1250.4)/1.8 Gy. The median delay period of the start of radiotherapy according to the date of surgery was 95.27 days (40-223) Results: Median follow-up: 31.87 months (5-113). 45.5% pts died, 6 pts died due to causes not directly related with cancer and 20% had local recurrence. CSFS and DFS at 3 and 5 years were 57% and 49%, and 50% and 46% respectively. In the univariate analysis the stage and type of lymphadenectomy had a significant impact in CSFS (p=0.02 and p=0.01, respectively) and DFS (p=0.048 and p=0.00, respectively) and the grade of differentiation only with CSFS (p=0.03). The most common acute effects were nausea and vomiting (10%), weight loss during treatment (32%) and blood disorders (5%). Conclusions: In our experience, the results in terms of survival and toxicity in pts with resectable locally advanced gastric cancer treated with adjuvant radio-chemotherapy are similar to published so far in the literature. EP-1063 PREOPERATIVE HYPERFRACTIONATED RADIOTHERAPY WITH ORAL FLUOROPYRIMIDINES IN LOCALLY ADVANCED RECTAL CANCER C. Fuentes Sanchez1, R. Hernández González Ruth1, J.J. Martín Ortega1, J.M. Ponce Ortega2, R. Cabrera Diaz-Saavedra3, M.E. Espiñeira Yanes1, J.C. Martínez Cedrés1, A.N.A. Armijo Mallorquín1, L.F. Otón Sánchez4, C.A. Otón Sánchez4 1 Hospital Universitario Candelaria, Oncología Radioterápica, Santa Cruz de Tenerife, Spain 2 IMO, Oncología Radioterápica, Murcia, Spain 3 Hospital U. Dr Negrín, Oncología Radioterápica, Las Palmas, Spain 4 Hospital Universitario Canarias, Oncología Radioterápica, La Laguna, Spain Purpose/Objective: Preoperative chemoradiation with standard fractionation and hypofractionation are the most widely schemes used in locally advanced rectal cancer (T3 or N +).There is little information about the efficiency and advantage of hyperfractionated schemes in these tumors. The hyperfractionation has the theoretical advantage of less toxicity, currently an issue of concern in Oncology, and a longer time of interaction with chemotherapy.Objetive: To report long-term results of hyperfractionated radiotherapy with and without oral fluoropyrimidines in a retrospective study with a maximum follow up of 13 years (1995-2008). Materials and Methods: Between January 1995 and August 2008, 191 non metastatic rectal cancer patients were treated with hyperfractionated radiation therapy. The total dose was 39.1 Gy to the whole pelvis, with a boost to the tumor of 11.5 Gy (total dose of 50.60 Gy), 1.15 Gy per fraction, with a minimum interval of 6 hours between those two fractions. 149 patients (78%) were treated with concurrent oral fluoropyrimidines. Results: 40 patients were treated with radiotherapy alone, 41 with UFT, 58 with Tegafur, and 50 with capecitabine. In two patients we could not ensure whether they received chemotherapy or not. 73 patients (38.2%) were treated with abdominoperineal excision after radiotherapy, 68 (38.6%) patients underwent anterior resection with total mesorectal excision (TME) and 49 patients (25.6%) anterior resection without TME. Pathological complete remission was found in 16.2% (15% without chemotherapy and 16.9% with chemotherapy). Local recurrences at 5 years were 10.4%. Although there was no statistical difference between the different groups, in the group of anterior resection with TME and chemotherapy we could find a lower local recurrence rate (5.6%). Overall survival (Kaplan-Meier) at 5 year was 64% (69% in the chemotherapy group and 47% in the exclusive radiotherapy group) and 51% at 10 years. Sphincter preservation surgery could be performed in 61.8% of all patients. 92% of patients completed treatment as planned. 92% of patients had toxicity grade 0 or 1. Grade 3 complications were 6% (bowel occlusion mainly 4.7%). Conclusions: Hyperfractionated preoperative chemoradiation is an effective and well tolerated scheme. Although it appears to be
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superior to the same regime without chemotherapy, we could not obtain any conclusion because the two groups were not comparables (more elderly patients and with worse clinical condition in the radiotherapy group).The results obtained with this scheme are comparable to other schemes with a higher biologically effective dose with a favorable comparison to side effects. Randomized studies are needed to determine the real benefit (efficacy and toxicity) of this regime of treatment. EP-1064 ADJUVANT CHEMORADIATION (CRT) FOR HIGH-RISK GASTRIC CANCER (GC) EMPLOYING INFUSIONAL 5-FLUOROURACIL (5FU) V. Vassiliou1, K. Papademetriou2, P. Kountourakis2, D. Papamichael2, D. Andreopoulos1 1 Bank of Cyprus Oncology Centre, Radiation Oncology, Nicosia Cyprus, Cyprus 2 Bank of Cyprus Oncology Centre, Medical Oncology, Nicosia Cyprus, Cyprus Purpose/Objective: Postoperative CRT is a standard treatment option for fully resected high risk GC. Adjuvant CRT using bolus 5FU significantly improves overall (OS) and disease free survival (DFS) versus surgery alone. However, this regimen is associated with significant toxicity and poor tolerability. In this retrospective study we evaluated the effectiveness and toxicity of adjuvant CRT employing infusional 5FU. Materials and Methods: Sixty eight patients (pts) with high risk GC were referred following surgery for adjuvant CRT. The treatment comprised six cycles of the 'modified de Gramont' regimen [leucovorin: 350 mg iv (d1) and 5-FU: 400 mg/m2 iv-bolus (d1), 2,800mg/m2 over 46 hours]; the third and fourth cycle of chemotherapy given concurrently with RT as follows: total dose of RT 4,500 cGy in 25 fractions of 180 cGy. Pts were evaluated retrospectively for toxicity, DFS and OS. Results: With a median follow-up period of 32 months (mo; range: 5– 90), 68 patients (36 men, 32 women), median age 59 years (range: 3076) were treated; stage IB: 4,4% (3/68 pts), IIA:7,35% (5/68 pts), IIB:13% (9/68 pts), IIIA: 11,7% (8/68 pts), IIIB: 30,8% (21/68 pts), IIIC: 32,3% (22/68 pts). The median DFS and OS were 25,2 and 32 mo, respectively. Three year DFS and OS were 24% and 29%. Grade III or higher myelotoxicity was: neutropenia 16% (11 pts); two pts grade IV neutropenia, thrombocytopenia 3% (2 pts). Grade III or higher non hematologic toxicity were: diarrhea 19% (13pts), vomiting 3% (2 pts), stomatitis/esophagitis 8% (6 pts) and constipation 3% (2 pts). There was no grade IV non hematologic toxicity. Fifty-three pts (78%) completed the treatment. Discontinuation was necessary in 5 pts due to diarrheas, 3 due to neutropenia, 3 due to performance status deterioration, 1 patient due to infection, 1 due to arythmia and 2 pts after informed consent withdrawal. Two pts died during treatment: one from possible/unconfirmed cardiovascular event and the other one due to sepsis. Conclusions: Despite a relatively short median follow-up and small sample size, our findings suggest that this regimen could be an alternative therapeutic option, with favorable toxicity and tolerability in patients with fully resected high risk GC. EP-1065 RADIOTHERAPY WITH VOLUMETRIC MODULATED ARC THERAPY FOR HEPATOCELLULAR CARCINOMA PATIENTS W. Hsu1, P.M. Wang1, N.N. Chung1, B.A. Chang1, G. Nicolini2, A. Clivio2, A. Fogliata2, L. Cozzi2 1 Cheng-Ching General Hospital, Radiation oncology, Taichung, Taiwan 2 IOSI, Medical Physics, Bellinzona, Switzerland Purpose/Objective: To report about the dosimetric and clinical findings in the treatment of primary hepatocellular carcinoma (HCC) with volumetric modulated arc therapy. Materials and Methods: Hundred forty-five patients (81% male) received a radiotherapy treatment for HCC. Dose prescription (at 95% of the planning target volume (PTV)) ranged from 45 to 66Gy. Most patients (89%) presented AJCC stage III or IV and 83% of the patients presented with N0-M0 status. All were classified as BCLC stage A to C. All patients were treated with volumetric modulated arc therapy in the RapidArc form using 10MV photons using single or multiple, coplanar or non-coplanar arcs, and cone-down technique in case of early response of tumor Results: Patients median age was 66 years (range 27-87), 81% of the patients were treated with 60Gy (13% at 45, 6% at 66Gy), 63% with cone-down, 98% with multiple arcs. Mean initial PTV was 777±632cm3,