disease sites: Gynaecological tumours

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surgery, in cases susceptible resection, it seems to be limited by the number of complete responses achieved before this one. The possibilities of increasing the radiotherapy dose, has supposed a higher number of clinic responses. However, in RtO treatments, the doses are limited by the tolerance of mediastinic structures and the limitant dose of the lung. In this scenario, the use of a complement of dose with brachytherapy, allows an increase of treatment intensity without a parallel increase of toxicity in the surgery ti me. Materials: Since March of 2004 we have treated in our service 26 patients (16 men and 10 women with ages between 41-84 years) afected of esophagus cancer (18 epidermoid y 8 adenocarcinoma)The distribution of the locations was 15% in high third, 19 % medium third y 53 % low third. All them recieved a concomitant RtO treatment, in a CLlNAC-2100 (Varian) accelerator by a external tridimensional conformed radiotherapy. The total dose delivered was 58 Gy (range 30-68.4 Gy). Nine of this patients were complemented with brachytherapy 9 24 Gy in 3-8 fractions of 300 500 cGy. Results: A complete response was obtained in 62 % of the cases, microscopic residual disease remains in 16.2% and macroscopic disease was proven in 31.8 %. Local control was achieved in 77 % in patients treated with external beam radiotherapy alone and 88% for those treated with complementary brachytherapy.Toxicities were moderate and degrees III & IV only was present in lesser as 10% of the patients. Conclusions: The brachytherapy in esophagus cancer is an feasible tech nique able to increase the local control of these patients with not repercussions in toxicity

848 poster TWO YEARS FOLLOW UP AFTER INTEROBSERVER VARIABILITY STUDY IN TARGET VOLUME DELINEATION IN POSTOPERATIVE RADIOCHEMOTHERAPY FOR GASTRIC CANCER. C. Moretones Agut!, A. Navarro', D. Leon ', A. M. Boladeras Inglada', M. Macia", M. Cambray ", V. Navarro", F. Guedea' , INSTITUT CATALA D'ONCOLOGIA, Radiation Oncology, L:Hospitalet de L1obregat, Spain 2 INSTITUT CATALA D'ONCOLOGIA, Research, l'Hospitalet de L1obregat, Spain

Purpose: In 2001, the INT0116 trial showed that adjuvant chemoradiotherapy has a significant role in reducing recurrence and increasing survival in gastric cancer. However, a previous study of interobserver variation between radiation oncologists in volu me delineation reported a signilicant difference in standard deviation between observers (ESTRO 27#4556), although no differences were found between observers in locoregional failure (ECCO 15#P6521). The aim of this study is to corroborate previous results on recurrence rates and patterns of failure after 2 years of follow up. Materials: In 2008, four physicians from our hospital trained in delineating upper abdomen volumes were asked to delimitate the planning target volume (PTV) according to the MacDonald scheme on the same 3D CT-images in 9 postoperative radiochemotherapy gastric cancer cases (this resulted in generation of 36 3D-CT, four physicians X nine patients). Instructions were given to include the tumor bed, the remaining stomach if partial surgery was performed, anastomosis, the duodenal loop and perigastric, celiac, local paraaortic, splenic, hepatoduodenal and pancreaticoduodenal lymph nodes. En hanced preoperative CT images were available. None of the observers had knowledge of the volumes outlined by the others. Two year later we analyzed the status of these patients by recording recurrences and reviewing the 30planning volumes, as either distant or loco regional (gastric or tumor bed, the anastomosis and regional lymph nodes), assuming that PTV included more than group 2 lymph nodes. Any lymph node or other recurrence outside the PTV was defined as distant metastasis. ReSUlts: As exactly as first year analysis 4 patients relapsed. The overall survival is 55% with amedian follow upof2t.8 months (range 7.6 - 29.2 months). The mean time to relapse was 14.56 months. Five patients remain free from disease. Distant metastases in the four patients were always present while 1 also had locoregional recurrence. The only local failure was within of the PTV in all four delineated volumes, Conclusions: No differences were found between observers in locoregional failure at two years of follow up. Locoregional recurrence rates and patterns of failure correlate to published results. Time confirms poor clinical impact of interobserver variation between radiation oncologists in volume delineation as reported in previous study.

849 poster UNRESECTABLE ESOPHAGEAL CANCER TREATED WITH RADIO-

THERAPY (LOW DOSE VS. HIGH) AND CHEMOTHERAPY A. M. Boladeras Inglada I. M. Carnbray", V. Navarro", M. Macia', M. aqut",

I. Modolell i Farre 3 1 INSTITUI CATALA D'ONCOLOGIA, Department of Radiotherapy, l'Hospitalet de L1obregat, Spain 2 INSTITUT CATALA D'ONCOLOGIA, Department of Biostatistics, l.Hospitalet de L1obregat, Spain 3 INSTITUT CATALA D'ONCOLOGIA, Department of Medical Physics, L.:Hospitaletde L1obregat, Spain

Purpose: The objective of this study was to evaluate the radiotherapeutic treatment of unresectable esophageal cancer and compare disease-free (DFS) and overall survival (OS) rates in patients treated with low vs, high dose radiotherapy Materials: From August 1996 to September 2009, 72 patients (pt) with unresectable esophageal cancer underwent radical radiotherapy (RT) at our institution. Patients were classified by stage, as follows: 20 pts (27.7%), stage T4N1MO; 9 pts (12.5%), T4NOMO; 4 pts (5.4%), T4Nl MIa; 14 pts (19.4%), T3N1MO; 4 pts (5.5%), T3N1M1a; 10 pts (13.8%), T3NOMO; 1 pt (1.39%), T3NOMI a; 4 pts (5.5%), T3NxMO; 1 pt (1.3%), Tl NO (inoperable due to comorbidities); 2 pts (2.6%). T2N1; 1pt (1.3%). T2N1 Ml a. Tumor locations were as follows: 34 cases (47.2%), middle thoracic esophagus; 17 cases (23.6%), upper esophagus; 14 cases (19.4%), distal esophageal cancer; and 7 (9.7%), cervical esophagus. Patients were divided into 2 groups. Group I consisted of 37 patients (51 .39% of the sample) who received 36 Gy to the CTV (clinical targel volume) and 64 Gy to lhe GTV (gross tumor volume). The GTV was defined by CT scan and the CTV included the GTV plus the regional lymph node drainage area, located in a cranlocaudal direction 4 em from the GTV. Group II patients included 35 pts (48%) who received> 36 Gy to the CTV; in 26 pts (36.1% of the sample), the dose was 44 Gy (CTV) and 66 Gy (GTV). The GTV was defined by a PET-CT scan. The CTV was defined using the same criteria as in group I. In all patients, the PTV (planning target volume) was defined as the CTV plus a 1 cm margin in all directions while the boost to the tumour was defined as the GTV plus a 1 cm margin in all directions. We administered four cycles of chemotherapy (COOP 80 mg/ m2/ day endovenous (EV) x 1 day + 5 FU 800 mg/m2/ day EV x 5 days on the first and fourth week of radiotherapy) in 55 pts (75%). Constrains were as follows: spinal cord max dose < 46 Gy, lung dose V20< 35%. and heart dose V60 < 30%. Results: The mean follow-up was 30 months. OS and DFS in patients treated with low dose RT was 22.7% and 26.9%, respectively, at 3 years. OS in patients treated with high dose RT was 22.2 % at 3.64 years and DFS was 30% at 3 years (p=0.996). Conclusions: Chemoradiotherapy in unresectable esophageal cancer is a good option for radical treatment. We found no significant differences in survival between patients treated with low or high doses to the CTV.

Clinical/Disease sites logical tumours

Gynaeco-

850 poster ACUTE TOXICITY PROFILE DURING PELVIC IMRT FOR GYNAECOLOGICAL CANCERS: A COMPARISON WITH 3D CONFORMAL IRRADIATION. C. Aquino-Parsons", F. Bachand', P. Lim', S. Lomas', C. Alexander', S. Harrow", C. Duzenli ' , B.C. CANCER AGENCY - VANCOUVER CENTRE, radiation oncology medical Physics, Vancouver, BC, Canada 2 THE BEATSON WEST OF SCOTLAND CANCER CENTRE, Radiation Oncology, Glasgow, United Kingdom

Purpose: The aim of the study is to quantify the occurrence 01 all grade acute toxicity in patients receiving post operative IMRT to the pelvis for gynaecological cancer. It is compared with the profile of patients treated by 3D conformal irradiation assessed in the same manner. Materials: The acute toxicity was documented with the Common Terminology Criteria for Adverse Events (CTCAE v3.0) in 2006-2007 for 32 patients treated with conformal pelvic irradiation (group A) and in 2008-2010 for 27 patients treated by IMRT (group B). The questionnaires were completed by the patient and a radiation therapist prior to and once a week during the treatment then 6 weeks after the radiation completion. Results: The analysis to date includes 59 patients. All patients received 45 Gy in 25 fractions to the pelvis. The toxicity rates were compared using Fisher's exact test (two-tailed pl. The toxicity rate was non-significantly higher in group A than group B before the radiation, with 60% vs 45% of patients presenting grade 2-3 toxicity respectively (Table 1). Of the completed 193 questionnaires, all patients showed at least grade 1 toxicity at one point during the treatment. At least grade 2 and grade 3 toxicity rate in group A was 91% and 15% vs group B with 80% and 0% (p=0.14). 1 patient in group A had grade 4 toxicity. The gastrointestinal (GI) grade 2-3 adverse side effects were

CLINICAL/DISEASE SITES: GYNAECOLOGICAL TUMOURS

similar in both groups (85% vs 80%, p;0.7). Grade 2 genitourinary (GU) (49% vs 35%, p;O.4) and sexual (27% vs 5%, p;0.07) toxicities were lower in group B. There was less skin reaction in group B (at least grade 1: 75% vs 65%, grade 2: 27% vs 15%, p;O.4). There was less weight loss dunng the treatment if the patient was treated with IMRT (grade 1: 24% vs 5%, p;0.13).

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852 poster ASSESSMENT OF HIGH RISK CLINICAL TARGET VOLUME POSITION WITH RESPECT TO THE APPliCATOR FOR MULTIPLE FRACTIONS OF BRACHYTHERAPY FOR CERVICAL CANCER R. cccper ' , P Bownes", E. Brearlei, P Hurmuz", S. SWift3 , C. J. Orton' I ST NHS 2 ST NHS e ST NHS

,5 ,5

GlJ- Il!"I1DUrlnarv

[ITabie 1: TmddlJ eofl1e Conclusions: This analysis confirms that postoperative pelvic irradiation with IMRT for gynaecological cancers decreases the acute toxicity rate by diminishing the skin reaction , the weight loss and GU toxicities. While no differences reached statistical significance because of the small cohort we believe it is clinically relevant.

851 poster ADYUVANT VAGINAL BRACHYTHERAPY WITHOUT PELVIC EXTERNAL BEAM RADIOTHERAPY FOR ENDOMETRIAL CANCER P. Vargas Arrabal", I. Tovar Martin i, R. Del Moral l , N. Rodriguez-Ibarria', C. De Haro Bueno', M. Zurita Herrera', R. Guerrero Tejada', M. Martinez Carrillo '. M. Navarro Gonzalez] 1 HOSPITAL UNIVERSITARIO VIRGEN DE LAS NIEVES. Radiation Oncology. Granada, Spain

Purpose: The aim of this study is to report the results obtained in patients diagnosed of endometrial carcinoma stage IA-IIA treated with radical hysterectomy, bilateral salpingo-oophorectomy. cytology and lymph node dissection tollowed by adyuvant brachytherapy at our institution. Materials: From 2006 until 2009, 57 patients with endometrial carcinoma stage IA-IIA have been treated with surgery and exclusive vaginal brachytherapy. Median age of the series was 62 years. Total hysterectomy. double anexectomy, pelvic lymphadenectomy and peritoneal washing was made in 61,4 % of the patients. The other 38,6 % were treated with abdominal hysterectomy, double anexectomy alone and random node sampling. The majority of the pathologycal FIGO stages were IB (77,2 %J, and histological degree were II (52,6 %). Exclusive brachytherapy was pertormed using vaginal cylinders with 3 em of diameter (50,9 % of patients). The reterence isodosis covering the proxi mal 3 cm of the vagina (96,4 % of cases). The dose was specified at 5 mm distant trom the surface of the cylinder. Dose schedule with high dose rate brachytherapy was 21 Gy in 3 tractions at 7 Gy (over a period at three weeks). The median of dose equivalent received in the rectum was 31,8 Gy and in bladder 38 Gy. Results: At the moment of this analysis there are 4 relapses (7.2 %j: 2 of them live with disease (3,5 %J, and 2 death for tumor (3,5 "!oJ; 51 cases live without disease (89,5 %J, and 2 cases death tor another cause (3,5 %). With median follow-up of 16 months, 1he 2 years free disease survival was 90.2% and 2 years overall survival was 88.3%. No loxicitywas reported in the 52,6% of patients, and When it was present the most frequent was cystitis (12.3%). Conclusions: The exclusive vaginal brachytherapy is effective in ensuring vaginal control, with few toxic effects. So, this schedu le should be an adyuvant treatment for patients with endometrial carcinoma with early stage

8297

I

JAMES INSTITUTE OF ONCOLOGY THE LEEDS TEACHING HOSPITALS TRUST, t st Clinical Oncology Department. Leeds, United Kingdom JAMES INSTITUTE OF ONCOLOGY THE LEEDS TEACHING HOSPITALS TRUST, Medicine Physics, Leeds, United Kingdom JAMES INSTITUTE OF ONCOLOGY THE LEEDS TEACHING HOSPITALS TRUST. Department of Radiology, Leeds, United Kingdom

Purpose: This retrospective study assesses the validity of the assumption that the high risk CTV (HRCTV) for cervical brachytherapy IS fixed with respect to the applicator Materials: Between November 2007 and October 2009 55 patients have been treated with brachytherapy as part of their radio/radiochemotherapy. Treatment consisted of 48Gy in 24 tractions of contormally planned external beam radiotherapy combined with weekly cisplafin (40mgIM 2 ) where permitted, followed by 21Gy in 3 tractions to point A or the high fisk clinical target volume (HRCTV) as defined by the GEC-ESTRO recommendations. A common reason identified for not implementing the GEC-ESTRO guidelines is the limited access to M R I for all fractions. Only 22 patients in this period, due to MR capacity, underwent a limited pelvic MRI4 days prior to treatment (to aid definition of H RCTV) and with the applicators in place on fraction one only. All patients underwent CT with app licators in place tor all 31ractions. Using image registration techniques and the assumption that the HRCTV is fixed with respect to the applicator the HRCTV is transferred onto the subsequent fraction CT image sets. The position of the applicator wnh respect to the uterus has been evaluated retrospectively to consider the validity of this assurnption.The applicator position relative to the uterus was assessed tor 9 patients using CT images obtained for each fraction. Position was assessed in all directions at three levels along the intrauterine applicator:- (i) at the tip of the appl icator (ii) midway between the ring surface and the tip of the applicator (iiii 1cm superior to the ring surface. Results: The mean volume of uterus (±95%CI) for this study was 62.3±7.3 ern" and the absolute vol ume di1ference between fraction 1 and subsequent fractions was 5.0::1::3.5 cm 3 . The mean differences (±95o/oCt) of applicator position relative to uterus when compared to traction 1 were: -(i) Tip of the applicator 2.7±0.5mm(ii) Midway between the ring surface and the tip of the applicator 1.5±0.4mm.(iii) 1cm superior to the ring surtace 1.t ±0.3mm. Conclusions: Even with limited MRI capacity image guided brachytherapy for the cervrx is feasible. Applicator position relative to the uterus is more reproducible closer to the ring surface that at the tip. If the assumption that the HRCTV is fixed with respect to the applicator is adopted then it is essential that the same applicator is used for all fractions and the organ at risk preparation is consistent for each fraction. This assumption does not allow for HRCTV shrinkage between brachytherapy fractions to be incorporated Into the HRCTV definition for subsequent tractions.

853 poster CAN PET-CT PREDICT RESPONSE TO CHEMO RADIATlON IN CERVIX CANCER? J. Panclatcharam'. D. N. Sharma', R. Kumar 2 , S. Pandit', S. Maharjan 2 S. Kumar ' , G. K. Rath 1 t ALL INDIA INSTITUTE OF MEDICAL SCIENCES, Radiation Oncology, New Delhi. India 2 ALL INOlA INSTITUTE OF MEDICAL SCIENCES, Nuclear Medicine, New Deihl, India

Purpose: To study the distribution of PET (Positron Emission Tomography) tumor VOlume and SUVmax in locally advanced cervix cancer in Indian patients and to Know the early treatment outcome following chsrno-radiation therapy. Materials: Twenty patients diagnosed as cancer of the uterine cervix were subjected to hybrid FOG-PET CT scan of the whole body. All of them received a dose of 5 to 10 mCi of 1sF-FluoroDeoxyGlucose before the scan. SUVmax and PET tumor volume were noted. PET tumor volume was delineated with a cut-off of 40% of SUVmax. All the patients were treated with external beam rad iation to the dose of 50 Gy in conventional lractionation with concurrent cisplati n followed by high dose rate [H DR] intracavitary brachytherapy. H 0 R brachytheracipy was given in trree sessions to a total dose of 21 Gy. The patients were followed up tor a penod ot one year. Results: 1- @page ( margin: 2cm} P { margin-bottom: 0.21cm} -> The median age was 49 years (Range-35 to 65 yrs). Eight patients had FIGO stage lib and twelve had stage Ilib disease. The mean SUVmax and the mean PET tumor volume was 8.3 (Range-2.9 to 22.4) and 43.5 cc (Range3.3 to 140.3cc) respectively. Sixteen patients had complete response and four had partial response to chemo radiation therapy. The mean SUVmax among complete responders was 79 (Range-2.9 to 12.6) while that among partial responders was 10 (Range-5A to 22.4). the mean PET tumor volume among complete and partial responders were 41(Range-3.3 to 140.3 ee) and

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53.4 ce (Rang e-31.5 to 72.1cc ) respec tively. Conclusions: Patients who had residu al disease after comp letion of rad ical tre atment were found to have highe r SUVmax as well as PET tumor volu me whe n compared to thos e with com plete response. Larg e sca le studies are req uired to confirm the findings of our study.

854 poste r CO N CUR REN T CHEM ORADI OTHERAP Y OF LOCALLY AD VAN CED UTERINE CERVICAL CANCER BY USE OF TWO 9 G Y HDRBT FRACTIONS. K. Akb arov' 1 NATIONAL O NCOLOGICAL CENTRE, Departm ent of Radiotherapy, Baku , Azerba ijan

and the volume enclo sed by Ihe presc ribed dose by 19% and 30% , resp ectively, were seen for the optimized plans whe n compared to the stan dard plans. Thi s was ass ociat ed with a significan t increas e in the mean con forma l index.Only 52% of the optimized plans fUlfilled the criteria of being satis fy ing (COIN1>0.5 ), mainly obta ined for the sma llest ta rget volumes , For large volumes it was in severa l cas es not pos sible to apply enough dose w ithout exceed ing the tolerance limits of the OA Rs, perhaps due to limitations in the flexibility of the appl ied applicator. Conclusions: The standard plans were found to exceed the dose limit set for the bladd er in one out of four patie nts. Opfi rnized tre atmen t plans wer e found to yield an overall bett er dose coverage with the possibility o t controllin g the dose to OARs to below cer tain tolerance limi ts. Satisf ying target coverage could not be full illed for the large target VOlumes wh en using this specif ic applicalor.

856 poster Purpose : Concurrent chemorad iothe rapy has been already considered as a gold standard treatment of cervical cancer at advanced stages. However. there is insufficient information available on early and late toxicity and few data from Azerbaijan practice. The aims of this study were to examine trea tment outcomes (survival and toxicity) in patients with cervical cancer treated with che moradiation and to compare these with outcomes in patients treated with radiat ion alone. Materials: We report our 3 year experience of che moradiotherapy for cervic al cancer. Betwee n March 2007 and Decemb er 2009, 78 patients with cerv ical cancer were treated by chemo radiotheray (group I) and 46 patient s by radio therapy alone (group II). The m edian ages was 49 and 52 years in I and II groups respectively. All pat ient s had histo logical proven squamous cell cervical cancer of liB to IIIB stages. All patients received exte rnal beam radiot herapy (EBRT) to the pelv is in 2 Gy daily lraction s, 5 time s wee kly up to 46-50 Gy. Beginnin g with the first fraction of external beam rad iother apy I group patients receive d also cispl atin in dose 40 mg/m2 weekly du ring 5 wee ks. After 46 Gy of external irradiation high dose rate brachytherapy (HDRBt) was initiated : two weekly fract ions of 9 Gy to point A by ring-tandem applicato r. Patien t in the II group received the same treatment but without chemotherapy. Results : Studentized statistic method was used for statistica l evaluation of the results. For all stat istical tests p<0 .05 was considered significant. Treatmen t respons e wa s eval uated at 3 mo nth after cou rse completion accord ing to REC IST criter ia : com plete (C R) and parti al respon se (PR), stabilization, progression . Compl ete response was del ined as no evidence of disease on med ical examination (in cas e of negative cyto logy investi gation) or on MR I. Med ian du ration of treatme nt course was 54 d ays ( ± 7 days). All pa tients completed rad iotherapy as plann ed and in the I gro up 96% patients received at least four cyc les chemotherapy. Complete response (CR) was obtained at 84 ,4% and 78,2% patients in I and II groups correspo ndingly. Treatment related toxicity (particularly hemato logical) which wa s asse ssed accordi ng to CTC RTOG scale was sign ificant ly high er in the I group. Conctuslons: EBRT, two 9 Gy fract ions of HDRBt plus cisplatin appears to be safe and effective, although acut e hematologi cal toxicity is increased but appears to be acceptable.

855 posle r CO N V ENT IO NA L POINT A AND CT BASED INDIVIDUAL TREATM EN T PLA NN ING FOR BRACH YTHERAP Y O F C ERVICA L CANCER A. Wanderas ! , M. Sundset 2 , I. Lan pdal ! , S. Daniels en I , A. B. Marthinsen ! I ST. O LAVS UNIVERSITY HOSPITAL TRONDHEIM, Department of On cology (Radiation Therapy). Trondhe im , Norway 'J ST. O LAVS UNIVERSITY HOSPITAL T RONDHEIM, Department of Gy naec ologh:al Oncology, Trondheim, Norway

Purpose: The Ge c-Es tro wor king group recomm ends that brachytherapy of loca lly advanc ed cervical cancer shou ld be based on volume delineation in MR images with the dose bein g prescr ibed to individ ual ta rget volumes while controlling the dose to the organs at risk (OA Rs) be low given limits. Tradition ally dose to such treatm ent has bee n prescribed to the geometrical point A. This retros pective study focuses on dos imet ric aspects whe n chaflg ing from stand ard presc ription of dose to point A to individual volume based plans for a classical 20 flexible Fletch er applicat or. MaterialS : Brach ytherapy data for 19 patient s with a tolal of 72 individual treatm ent fract ions perform ed with a FletCher type applicator (Sauerwe in Isotopen Teckn ik 926500) we re ret rospe ctively reviewed. Target volumes and OARs were delineated in CT images based on additiona l information acqu ired from diagnostic MR images and clinical examination . For each fract ion a sta ndard library plan, based on dose to po int A, and an optimized plan , based on a targe t volume. were made. Th e opt imization was done without exceed ing the tolerance limits for the OARs . Dose volume histograms were used to comp are treatment plans. Results : The standard plans were fou nd to yield better dose distributions for the smaller target volumes as compared to the larger target volum es. A relative ly low mea n target coverage (0.59) was seen. Furthermore, the dose distribut ion from the standard plans exceed ed the tol erance limits of the OARs in bladder in 26 % of the pat ients, rectum 4% , and sigmo id 15%, especially seen for the sm allest ta rget volumes .An increase in the mean target coverage

DISS EMINATED OR LO CAli ZED DISEASE? RESULTS OF CURA TIVE CONCOMITANT CHEMORADIOTHERAPY IN PATIENTS WITH UTERINE CERVICAL CANCER PRESENTING PARA-AORTIC AND LEFT SUPRACLAVICULAR LY M PH NODAL METASTASES Y. S. Kim l , S. S. Shin I , S. D. Ahn 1 , E. K. Chol " , Y. T. Kim 2 , Y. M. Kim 2 , J. 2

H. Kim 2 , J. H. Nam 1 ASAN MEDICAL CENTER, UNIV OF ULSAN, Radiation On colog y, Seoul , Korea Repub lic of 2 ASAN MEOICAL CENTER, UNIV OF ULSAN, Gynaecology, Seoul , Korea Republi c of

Purpose: To determ ine the efficacy and toxicity of curative radiot herapy with conc omitant chemotherapy in patients with cervical can cer presenting paraaortic and left supraclavicular lymph nodal meta stases . Materials: We review ed the clinical results of 12 wo men who underw ent cisplatin-based chemora diothe rapy. Each pat ient rece ived median dos e of 59.4 Gy to the para-aortic and left sup raclavicular lymph nodes and 50 .4 Gy to the pelv is, inclUding three -dime nsional conformal boost or inte nsitymodu lated radiation therapy. Nine patients also underwent high-dos e-rate brachytherapy (median, six applications, 5 Gy to point A per sess ion). Results: The mo st common acute toxicity was hematologic toxicity, Grade 3 -4 toxicity was obs erved in 10 women . Most patients suffered from Grad e 2 acute gastrointestinal toxicity, which was transient and self-li miting. A wom an com plained of late Grade 3 gen ~our;nary toxicity and anot her encountered late Grade 3 soft tissue toxicity around supracl avicular tossa. Eight patients showed a complete response, enco mpassing the primary mass, and the metastatic pel vic, para- acme and left suprac lavicular lymph nodes. With a median follow-up per iod of 17 months (26 months for surviving pati ents ), 4 wom en had no evidence of dis ease, whi le 4 showed persistent diseas e, 2 showed in-field tumor regrowth , and 2 sho wed distant failures. Five -year cancer-specific and disease-free survival rates were 39% and 27%, respec tively. Conclusions: Curative concurrent ch emoradiation for Stage iVB cervical carcinom a is feasible with acceptable late morbid ity and high response rate, despite its substantial acute toxicity. Major patte rn of failure was local , suggest ing the impo rtance ot loc al contro l even in case p resenting left sup raclavi cular lymp h node metas tasis.

857 poster DOSE PRE SCRIPTION A ND OPTI MI ZATION IN MR BASED G YNAE CO LOG IC A L B RAC HYTHERAPY J. Perez-Ca latayud " , S. Rodr iguez 2 , A. Torrno " , M. Santos" , A. Navarro" , J. Richart " , V. Ca rmona I , F. L1iso I , F. Balleste r3 , D. Grarero" I HOSPITAL UNIVERSITAR IO LA FE, Radiothe rapy, Valencia , Spain 2 CLINICA B ENiDORM, Radioth erapy, Benidorm , Spain 3 UNIVERSITY OF VALENCIA- IF IC , Valencia (Paterna), Spain 4 ERESA , HOSPITAL GENERAL UNIVERSITARIO, Radiotherapy, Valencia, Spain

Purpose: The GEC-ESTRO recomm enda tions in brachyt herapy, for cervix cancer, base d on magnet ic resonance (T2) state that D90 should be the ref eren ce value for the absorb ed dos e to GTV, HR CTV and IR CTV, at the time that D2cc to OAR is kept in tolerances. Th e dose evaluat ion shoul d be achieved using EQD2 bas ed on the linear quadratic model. While these rec ommendations were published in 2005 -2006, until the appearance of projects like EMBRACE no dose-volume reference values based on EOD2 were available. Stili yet planning systems do not allow this type ot optimization .The purpose of this work is to pres ent the pro cedure adopted in our hospitals to carry out the prescription and optimization in this type of implants. Materials: The usual protoc ol appli ed to eac h implant consis ts of deliverin g 45 Gy with external radiothe rapy (ERT) and 4 fractions of 7 Gy by means of two HDR implants. Once HR-CTV, IR-CTV, rectum , sigmoid and bladde r are contoured, equally distrib uted dose point s cove ring the outer surface of the HR-CTV are generated . The absor bed dose (7 Gy) is prescribed to these point s witho ut any optimiza tion. T his leads to having the same times at all

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source positions (uterine tandem and ovoids) are the same. The isodose values of 80%, 70% and 100% are used to perform a graphical optimization considering that the 100% isodose value should cover most of HR-CTV, without exceeding H points, and that 80% and 100% values have to intercept minimally rectum-sigmoid and biadder respectively. 70% should cover a significant volume of IR-CTV. The resulting DVH vaiues are entered into a home-made spreadsheet, built from existing GEC-ESTRO spreadsheets, to obtain the EQD2 for each structure, taking into account the ERT. The reference 090 and D2cc values (EQD2 with afl::l=10 and 3 for CTV's and OAR respectively) are: minimum for HR-CTV, 75 Gy; minimum for IR-CTV, 60 Gy; maximum value for rectum, 70-75; maximum value for Sigmoid, 75 Gy; and maximum for bladder, 90 Gy. The nominal prescribed dose of 7 Gy is modified by a multiplying factor on the spreadsheet, in order to get an optimal pian with respect to these reference doses. Results: This paper illustrates the process with which plans for all patients have been established. It is worth pointing out the importance of beginning with a uniform time distribution pattern as well as considering the volume of overdose, which is easily accomplished with the point H. Conclusions: A procedure has been established and a spreadsheet has been prepared for the implementation of the GEC-ESTRO recommendations on routine, in a simple and practical manner, meanwhile future planning systems integrate the entire process of prescription-optimization.

858 poster EXPERIENCE IN THE GEC-ESTRO RECOMMENDATIONS APPLICATION. DOSE PRESCRIPTION AND COMPARISON WITH PROTOCOL POINTS F. L1iso', A. Torrno! , S. Hodriquez ", S. Roldan' ,A. Navarro", J. Hichart", V. Carmona" M. Munoz 1 J. Perez-Calatayud ", F. Ballester", D. Granaro" i HOSPITAL UNIVERSITARIO LA FE, Radiotherapy, Valencia, Spain 2 CLiNICA BENIDORM, Radiotherapy, Benidorm, Spain 3 UNIVERSITY OF VALENCIA-IFIC, Valencia (Paterna), Spain 4 ERESA, HOSPITAL GENERAL UNIVERSITARIO, Radiotherapy, Valencia, Spain

Purpose: In our hospitals brachytherapy planning based on magnetic resonance (T2) has been carried out in clinical routine following the GEC-ESTRO recommendations. This working group states that cumulative dose voiume histograms (DVH) are recommended for evaiuation of the absorbed dose heterogeneity. DVH parameters for GTV, HR CTV and IR CTV are the minimum dose delivered to 90 and 100% of the respective volume: 090, 0100. The volume, which is enclosed by 150 or 200% of the prescribed dose (V150, V200) , is recommended for overall assessment of high dose volumes. V100 is recommended for quality assessment only within a given treatment schedule. For Organs at Risk (OAR) the minimum dose in the most irradiated tissue volume is recommended for reporting: 0.1, 1, and 2 ern"; optional 5 and 10 cmS,This paper compares the results obtained in the prescribed dose to the volumes with several protocol points (A-H points recommended by the ABS, ICRU-38 rectum and bladder points) for a sample of patients. Materials: We have evaluated the final planning for 35 patients, obtaining: 090 for HR-CTV and IR-CTV; dose points H; D2e<; lor the rectum, sigmoid and bladder', tradit.onal ICRU points for rectum and bladder All the absorbed doses values have been assessed using EQD2 with a/b« 10 for CTV's and a/b=3for the OAR. Results; The obtained results are as follows (mean, median, standard deviation, all in Gy): D90 for HR-CTV (83.8, 84.6, 9.3), D90 for IR-CTV (63.3, 63.2, 3.6), H point (70.8, 69.6, 7.4), Bladder D2cc (77.8, 79.0, 8.1), Rectum D2cc (61.8.6004 ,7.3), Sigma D2e<; (60.2, 60.1, 6.3), ICRU bladder (87.0,89.8, 23.9), ICRU Rectum (89.5, 9004, 15.8). At the same time, the comparison between the values derived from the HDV compared to traditional protocol values have been: the ratio between the dose value for HR-CTV and H points (1.2, 1.2, 0.2), the ratio between bladder D2cc and ICRU values (0.9, 0.9, 0.2) and the ratio between rectum D2cc and ICRU values (0.7, 0.7, 0.2). Conclusions: For all cases D90 and D2cc doses have been within the references (EMBRACE). Generally, the D90 was higher than the point H. From the results the disparity between dose values for actual volumes and protocol points is evident.

859 poster EXPERIENCE WITH STAGES I-II ENDOMETRIAL CARC INOMA (EC): A POPULATION·BASED STUDY IN TARRAGONA PROVINCE (SPAIN) M. Arenas Prat '. A. Rovirosa 2 , S. Sabater", A. Ameijide', V. Hernandez", I. Henriquez", G. David", M. Arguis 1, Y. Lopez! , T. Jordi ' , P. Alida l , L. Ana! ,

J. Gurna' ! HOSPITAL UNIVERSITARI SANT JOAN DE REUS, Reus, Tarragona, Spain HOSPITAL CLINIC I PROVINCIAL, Barcelona, Spain 3 COMPLEJO HOSPITALARIO ALBACETE (CHUA), Albacete, Spain 4 HOSPITAL SANT JOAN DE REUS, Tarragona, Spain

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Province (Spain). Materials: A retrospective population-based review was conducted on 173 patients (pts) with stages I-II EC treated between 1997 and 2000 from different gynaecological Department and in a single oncologist institution with RT Units. MUltivariate analysis of variables were performed for the end points of disease-free survival (DFS), overall survival (OS), adjuvant RT, RT toxicity (RTOG), prognostic factors for survival and the distance in Km to the RT Units. Results: Mean age: 62.56 years (35·88). Distance to RT Units" 70 Km in 84% pts, >70 Km in 16% pts. Median follow-up: 74 months (2-183). FIGO Stage (S): 11% lA, 48.6% IB, 23.1 % IC, 10.4% IIA, 6.9% liB. Pathology: endometrioid 75%, papillary 2.3%, serous 2.3%, clear-cell 3%, sarcoma 5.2%. Grade (G) 37.6% G1, 39.3% G2, 17.9% G3; Miometrial invasion: 30.6% >50%, 55.5% ,,50%, 11% not invasion. Treatment 1) Surgery in all patients (100%: 86% abdominal, 14% vaginal, 50.3% lymph nodes dissection (41% pelvic and paraaortic). 2) RT in 57.1%: 43.6% external beam radiotherapy (EBI) and brachytherapy (BT), 11.4% BT alone, 2.1% EBI aione. Mean dose EBI48.23Gy, mean dose BT: 24.26Gy. 3) Chemotherapy in 7.5% & Hormonal treatment in 2.3%. 3) Grade 3 & 4 toxicity: 7 (4%) pts, 4 eariy & 3 late. Relapses: 10/173 (5.8%) loco-regional recurrence S-I: 9 (6.5%), S-II: 1 (3.3%). Metastasis: 14/173 (8%) S-I: 7.2%, S-II: 13.3%. Metastases in endometriod were 7,9%, and sarcoma 14,3%, the other 4.8%. Survivals at 5 years: 1) OS in all stages was 86.7%; and 83% and 89.6% for SI and SII, respectively. 2) DFS was 84.9% for all pts; and 82.3% and 86.22% for SI and SII, respectively 3) LRFS was 86.2% for all pts: and 83% and 89.6% (or SI and SII, respectively. MUltivariate analysis: significant prognostic factors for good outcome were lymph nodes dissection and radiotherapy. Conclusions: Our results suggest that survivals, RT toxicity and relapse were similar to the other reported series. Predictors of good outcome were lymph nodes dissection and radiotherapy treatment.

860 poster EXTERNAL RADIOTHERAPY FOR LOCALLY ADVANCED CERVICAL CANCER: THE INFLUENCE OF THE TIMING OF PELVIC EXTERNAL IRRADIATION AND HIGH DOSE RATE BRACHYTHERAPY IN THE LOCAL CONTROL AND 5 AND 10 YEARS SURVIVAL RATES C. Campos ', J. V. Salvajole, P. E. Novass", J. A. 0liveira3 , F. J. Muniz 3 , M. Gurgel Carlos da Silva" 1 HOSPITAL DO CANCER DO CEARA, Fortaleza, Brazii 2 HOSPITAL A.C. CAMARGO, Department of Radiation Oncoiogy, Sao Paulo, Brazil 3 HOSPITAL UNIVERSITARIO WALTER CANTIDEO, Fortaleza, Brazil 4 HOSPITAL DO CANCER DO CEARA, Department of Epidemiology. Fortaleza, Brazil

Purpose: Locally advanced cervical cancer is a major worldwide health problem. The treatment might include radiotherapy and few trials evaluate the timing of pelvic external irradiation and high dose rate brachytherapy in local control and survival rates of these patients. The objective is to evaluate the timing of pelvic external irradiation and high dose rate brachytherapy in local control, 5 and 10 years survival rates in locally advanced cervix cancer patients, determine prognostic factors as: age, total treatment time, parametrial invasion and lower vaginal infiltration and correlate tumor response to local control and survival rates. Materials: A retrospective cohort study was carried out with 413 patients (181 stage liB and 232 stage IIIB) treated by exclusive radiotherapy 54 to 59,4 Gy in 33 fractions to the pelvis (parametrial boost included) and concomitant high dose rate brachytherapy. 24 Gy in 4 weekly insertions, without chemotherapy, from January 1996 to June 1998 in the Hospital do Cancer do Ceara. The mean follow-up time was 4,7 years (3 months to 13,4 years) and the Kaplan-Meier method was used 10 calculate survival curves. Differences were tested using nonparametric estimation and multivariate analysis was performed using backward stepwise regression model. P values =< 0,05 were considered significant. Results: Overall 5-year survival rate was 60% and 10-year, 58%. Five-year local control was 49% Mean overall treatment time was 60 days. Local control was influenced by clinical factors as age, stage, parametrial invasion and lower vaginal infiltration (p<0,05). Survival rates were influenced by age, stage and timing of brachytherapy within 4-6 weeks. Overall treatment time as well as tumor response did not influence local control nor survival rates (p>0,05). Conclusions Performing the high dose rate brachytherapy insertion after the 4th treatment week negatively influences 1O-year survival rates (Odds Ratio = 1,73) in locally advanced cancer patients. The suggestion is to perform the first insertion at least until the 6th treatment week to guarantee better 5-year survival rates (p<0,05).

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861 poster HELICAL TOMOTHERAPY IN ADVANCED UTERINE CERVIX CARCI-

Purpose: To evaluate outcome, tailure patterns. prognostic tactors and radiotherapy (RT) toxicity atter postoperative RT for Stages HI EC In Tarragona

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NO MA 1 F.L e Tmier • E. l.artiqau ! , P. Nickers ! . T. l.acom erie" , V. Cheval " , F. Bonodeau ! I CENTRE OSCAR LAMBRET , Academic Radiation Oncology Department. Lille, France

III-IV.We are expectant for the results of cur rent ongoing clinical trials testing concemitant CT with RT in these patients w~h high risk ot local recurrence as well as systemic relapse.

Purpose: Recent advances in diagnostic imaging and conformal radiotherapy require a high level of accuracy in the execution of whole radiotherapy treatment. IMRT may increase the tolerance of the treatment allowing an increase in the delivered dose to the PTV. Fifteen patients treated in Oscar Lambret Center tor cervi x uterine carcinoma by comb ined chemoradiotherapy using Tcmotherapy@ have bee n reviewed for dosi metric and early tolerance paramete rsThis study was designed to exam ine the safety of treatment using Tomotherapy@and how the bladder and rectum repletion may affect treatment planning Materials : t 5 patient s (mean age 49 i were treated at Oscar lambret Center between june 2009 and february 2010 for uterine cervix squamou s cell carcinoma. Treatment was delivered with Tomotherapy@ (MVCT capabilities) .Stages were: 2 Ibl , 2 Ib2 , t II a , 7 II b , 2 IV a. Irradiation delivered 50.4 Gy in fraction of 1.8 Gy in PTVl (nodes CTV + tumoral CTV with set-up margin of 3 mm ) and 60 Gy in PTV2 ( nodes GTV et tumo ral GTV with set up margin of 3 mm ) Treatment was performed with the followings instructions : use a g lycerine suppository befcre each treatment sessions to decreas e the rectal volume and urinate one hour before .Belore every treatment's sessions MVCT imaging was perform ed. Using Tomotherapy@Hi-Art@planned adaptative software , we have selected one MVCT imaging by treatment 's week. A copy of rectal , bladder, small intestine and sigmoide volume initially determined on planning image was recorded, this volume was corrected and new DVH was calculated for each selected MVCT. For every patient, we got 5 DVH and try to determine how the repletion of bladder or rectum may make a modification. Results : Treatment with helical tomotherapy is safe . No grade 3 and 4 toxic ities were observed Results about volum e histog ram dose according to organs replet ion will be presented. On preliminary results, this may play an import ant role on adaptive treatment Conclusions: He lical tomotherapy is a safe method to delive r IMRT in peivic tum ours. The impacl of organs repletion on weekly dosimetry will be presented

HT (HELIC AL TOMOTHERAP Y)· TREATME NT OF CHOI CE FOR CER VI CAL CANCER PTS WITH UNUSUAL OAR PLA CEMENT TREATED W IT H WHOLE PELVIC RADIOTHERAP Y( WPRT) A. Roszak ! , H. Wlodarczyk! , E_ Cikowska -Wozniak ' , T. Piotrowski ! , Z.

862 poster HIGH GRADE ENDOMETR IAL CARCINO MA : PROG NOSTIC VALUE OF T H E HISTOLOG ICAL S UBT YPE AND ADJ UVANT CH EM OTH ERAP Y (CT) M. Rico l , E. Villafran ca nurre " , P. Romero' , I. Marilla'. N. t ainez" . J. C. 3 Muruzabal , S. Aguir re 3 , M. Vila !. V.Chicata 1 , C. Eito ', E. Martinez " , A. Sola 1 , A. Mante rola 1 , F. Arias 1 , G. Asin! , M. A. Domfnguez I i HOSPITAL DE NAVARRA, Oncolog ia Hadioterapica, Pamplona, Spain 2 HOSPITAL DE NAVARRA, Oncologia Medica, Pamplona, Spain :J HOSPITAL DE NAVARRA, Gynaecology, Pampiona, Spain

Purpose: To analyze the prognostic value of the histological subtype and the sequential che motherapy in women with hig h grade endome trial cancer treated with surgery and postoperative radiotherapy (RT). Materials: Retrospective ana lysis of patients (pts) with high grade histologies: Gill Endometrio id, clea r cells, papilla ry-serous and undlfferenciated. All of them had surgery, (Hysterec1omy. bilateral anexec1omy, pelvic Iymphadenetcomy and in 12.5% of them paraorti c lymphadenectomy and omentectomy). After 4-6 weeks , all patients receive pelvic RT. In case of positive paraortic nodes, paraortic RT was also applied. Brachytherapy was given to an 85% of these pts. Since 2001 , pts with clear cells or papil lary-serous histology, stage 1-IVA;·received Caroboplatin 6AUC and Taxol 175 mg/m2 (46 cycles); Pts with grade III endornetriold carcin oma stage III-IVA received cisplafin 75mg/ m2 and adryamicine 50mg/m2 (6 cycles). Results : Between 1999 and 2009, 64 patients fulfilled the selection criteria. The characteristi cs of the series are : Stage : I: 41 pts (63%), II 5 pts (8%), III 28 pIs (43%), IVA 3 pts (6%); Histotogy: Grade til endornetrioid 28 pts (43%), clear cells 19 pts (30%), papillary-serous 14 pts (22%), undifferenciated 3 Pi S (5%). Follow-up median : 32,8 months (3.5 to 169.5). There was a 19 % of local relapse and a 20.6% of systemic relapse . Overall survival (OS) at 5 years didnt show differences between Gil l Endometrioid, clear cells and papillar yserous histologies . Only patients with undifferenciated carcinoma had worse prognosis: 5 years OS for patients with stage I-II: Endometriod 70.2%, Clear cells 80%. Papillary-serous 72.9% and Undifferentiated 50% (p=O.OOl ) ; 5 years OS for patie nts with stage 1I1·IVA: Endometriad 40%. Clear cells 50%, Papillary-seous 25%, Undifferentiated 0% (p~0 .02 )Th e use of chemotherapy in clear cells and papillary -serous, stage HI didnt show benefits: OS at 5 years 69.3% (without CT) vs 71.4% (with CT), pens: there was li11le benefit in 5 year OS adding GT in clear cells and papillar y-serous histo logies stage III-IVa (12 pts) : 14% without CT. 53% with CT, p=0.08. Conclusions: t .- In our experi ence women with grade Itl endometrioid carcinoma have as bad prognosis as those with clear cells and papillary-serous histologies .2.- The use of adjuvant chemothe rapy after surgery and RT didnt show benefit in stage I-II and only a tendency to improve the results in stage

863 poste r

Warenczak- Florczak l . I. Urbaniak I . B. Urbanski! I GREAT POLAND CANCER CENTRE , Poznan, Poland

Purpose: To assess the lmoact of using HT compare d to dyna mic intensitymodulated radiotherapy (IMRT) on the dose to organs at risk(OAR) and dose distribution in target volume using (WPRT) in advanced cervic al cancer patients. Materials: We analyzed 4111B cervical cancer pts with extraordinary OAR distribution undergoing definitive WPRT : 1pt with both pelvic kidneys .t patient with the only sufficient kidney in pelvis, 1pt with endoprothesis and t pt after preoperative rectal cancer radiotherapy(RT). Plans of 18MV-IMRT and tomotherapy were developed fer each patient. The dose of 45Gy was prescribed to the whol e pelvis .IT was reques ted that PTVs be covered by 95% isodose line and dose cons traints for OAR were established. Resulls : Mean doses in analysed OAR - kidneys, bladder. endopro thesis were: 62,48% and 41,49%, 97 ,56% and 69,64% , 42,08% and 16,94% for IMRT and HT respectively. PTV coverage was also significantly better using HT: V95%- 98.31 vs V95%- 90,67 for IMRT, differences in CTV coverage were V95%- 98,8 t for HT vs V95%- 88,00 for IMRT.Furtherm ore HT treatme nt delivery allowed for daily pal ients set-up verification with onboard imaging device(MVCT) Conclusions: In cervical cancer pis with unusual presence of OAR treated with WPRT, adequate target volume coverage and acceptable OAR sparing can be achieved using tomotherapy. IMRT appeared unsufficien t treatment modality in these unusual situations.

864 poster IMPACT OF PET O N THERAPEUT IC DECISI O NS IN C ERVI CAL CANCER PATIENTS J. Jonska-Grnyrek " , M. DZiuk2 , B. Lindne r" , J, Staniaszek" , L. GMYREK5 • R. Krynicki" , M. Kolodzielczyk '' , M. Olszyna-Serernenta " , J. PIETRlYKOWSKI 2 , M. KOZA 2 , L. Kepka" , D. Bodzak'' , K. Bednarczyk" , K. BujkO! ! THE MARIA SKLODOWSKA-CURIE MEMORIAL CANCER CENTER , Department of Radiation Oncolog y, Warsaw, Poland 2 MAZQVIAN PET CENTER, Warsaw, Poland 3 THE MARIA SKLODOWSKA-CURIE MEMORIAL CANCER CENTER, Radiat ion Oncology and Radiology, Warsaw, Poland 4 CANCER CENTER, Radiation Oncology, Warszawa, Poland 5 MARIA SKLODOWSKA ·C URIE MEMORIAL CANCER CENTER, Gynaecology, Warsaw, Poland 5 THE MARIA SKLODOWSKA-C URIE MEMORIAL CANCER CENTER. Warsaw, Poland

Purpose: To evaluate how often the use ot Positron Emission Tomography (PET) results in change of decisions about a radical RT for cervical cancer patients and how the treatment volumes and schedules are modified in patients who actually receive radical RT, based on PET results. Materials: All consecutive cervical cancer patients for whom a decision about a definitive radical radiotherapy (RT) was done, according to department al policy (FIGO stage IB2-IVA, Zubrod 0-1), underwent planning comput er tomography (CT), then target volumes, total dose and fractionation were defined. Treatment plans were prepared for pre-Pfi'T target volumes. Subsequently all patients underw ent PET imaging and final deci sion about type of treatment was dene.1f decision about radical radiotherapy was maintained, treatment volumes were adjusted for PET findings, if needed . For palien ts with a change of target volumes after PET new treatment plans were realized as definitive. During first 6 months, 60 consecutive patie nts were included into the study. The study was accepted by the Local Ethics Committee. All patients with periaortic lymph node metastases were irradiated on this area. The upper border of the field was accepted as 5 cm above the enlarged lymph nodes. Before this study. the standard irradiated field for per iaortic area reached the upper border TH 12. Results : After PET to /63 (16%) patients did not receive radical RT (6 distant metastases, 4 too extensive loco-region al disease). In 16/63 (25,4%) patients, periaortal lymph node metastases were confirmed. In 4(6,3%) patients palliative freatment was performed. Six (9,5%) patients were Ireated with chemotherapy. Fifteen (23,8%) patients were irradlafed on the periaortal and the pelvic area. In this group, in 5(7,9%) in CT scans periaortal lymph node metastases were not suspicious , but were confirmed with PET. Thirty eight (64%) patients were irradiated on pelvic area. In this group in 4(6,3%) patients, periaor tal lymph nodes metastases were suspicious, but were not

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conf irmed with PET. So. based on PET results, in 24(38%1 patients tech niq ue of radcal RT has been modified . In 15 (23.8%) periaortat irradiated field was reduced. In 29(46%) the technique has not been chan ged . Conclusions: The preliminary resu lts confirm a value of PET for staging proced ure and radi cal radiotherapy in cervical cancer patients. The future analysis will demonstrate, if the periaorta l field reduct ion was the right conduct

865 poster IM P LEM ENTAT IO N O F HD R I MAGI NG-BASED BR AC H YT HER A PY IN ADVANCED C ERV IC AL CAN CER T REATME NT DOSI METR IC ANALYSIS OF ORGANS AT RIS K V. Plesinac " , S. vuc kovlc" , A. Tornasevic " , S. Zoranovic " , N. Milosevic! , D. Marjanovic 1 1 INSTITUTE OF O NCOLOGY AND RADIOLOGY OF SERBIA, Department of Radiotherapy, Belgrade . Serbia 2 INSTITUTE OF ONCOLOGY AND RADIOLOGY OF SERBIA, Department of Radiotherapy Physics, Belgrade, Serbia

Purpose: Intracavitary brachytherapy (BT) has an impor tant role in developing complications in radiotherapy of cervical cancer, and is still Widely based on 2D X-ray dose pla nning . Major breakthro ugh has been made with MR I/CT based dose planning . The aim of this preliminary study is to make a dosimetric compar ison for orga ns at risk (OA R) using X-ray and CTIMR treatmen t planning. Materials: In November 2008 we started with implantation of imagingbase d brachyterapy. Till June 2009 , in six patients with advanced cervical cancer (stage lib - IlIb ), the planning was done using both, X-ray imaging and CT/MR imaging. All patients underwent pelv ic EBRT using ante rior-poster ior fields, conco mitant with BT, and concurrent week ly Cisplatin chem otherapy was administered when feasible . All 6 patients underwe nt X-ray 2D based planning. at 3 patient s CT and at 3 CT/MR bas ed planning was done at first BT application , with tand em and two ovoids in place and TD of 7Gy/A. Rectum , bladder , sigmo id colon and high-risk CTV delineation was done according to guidelines by Viswanathan et al and GEC-ESTRO. The maximum dose to rectum and bladder, based on ICRU recom mendation . calculated by X-ray imaging and dose to 0.1cm3 , Icm3 and 2cm 3 , lor the bladder. rectum and sigma calculated from DVHs were compared . The volume of HR-CTV and values of D100, 090 and V100 were calculated , Results: The median patient age was 51 years (range 45-57 year s). At the tim e 01the first BT application , the med ian dose 01delivered EBRT was 21Gy ( range 14-28G y). The mean values 01 HR- CTV volume was 56 + 25,9 cm 3 and dos e parameters D90 5,4 ± 1,2Gy ; Dt OO3,t ± 1Gy; V t OO 73,6 ± 12,5% . The mea n value of dose at rectum R max. was 3.98 ± 1,5Gy, at D 0,1om 3 7,5 ± 3Gy, at D l cm3 5,8 ± 1.8G y and at D2cm 3 5,2 ::c 1,5Gy_There 3 was statisticall y significan t d1tference in dose at R ma x. and DO,I cm with higher dose obtained at DO,1cm3 and no statistically signil icant diflerence at the dose D1cm3 and D2 em". The mean vaiu es at bladd er B max. was 4,1 ± 1,8Gy and at D 0, 1crrr' 6.9 ± 1,8Gy, D1crrr' 5,5 -I: t ,4Gy and D2cm3 5 ± t ,2Gy and statistica lly significant higher dose was obtained at 0 0,1ern" and D1cm 3 compared to B max. High dose to sig ma at [Xl ,tcm3 7,7 J.. 23Gy, D1cm 3 6 ,2 ± 1,7Gy and D2cm 3 5,7 1,5Gy was found . Conclusions : Inadequate coverage of large volume HR-CTV with presc ribed BT dose was obtain ed in the larger tumor size. Mean values of estimated volume-dose para meters DO,t ern" of rectum and bladd er were higher than the values obtained by 2D x-ray bas ed findings. 3D 8T provides additional informa tion ot dose to sigma. This findings gives us a starti ng point lor ad ditional investigation in establishing a 3D 8T at our institution and perhaps changing our present concom ita nt EB/BT treatment approach .

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866 post er INCLUSIO N O F VAG IN A IN STAND A RD EXTER NA L BEAM POR TALS IN PATI ENTS TREAT ED FOR CERV ICA L CA NC ER E. Fidarova I . P. Win ::zura ! , C. B. Shenl ield I . D. Berger l , J. C. A .

Dlrnopovlos" , R. Potter! 1 MEDICAL UNIVERSITY OF V IENNA, Department of Radiotherapy. Vienna, Austria 2 MEDICAL UNIVERSI TY OF GDANSK, Departmen t of Oncol ogy and Radiotherapy, Gdans k, Poland 3 CROSS CANCER INSTITUTE. Depa rtment of Radiation Oncology, Edmonton, Cana da

Purpose: Thoug h the target defi nition io r con formal EBRTIIMRT is based on 3D individual imaging, the placement of the inferior pelvic field border (IPFB) is still referred to the bony landmarks . Moreover, the stand ard of care lor the location 01IPFB is not uniformly establis hed and varies between institutions. Three types of recommen dations co ncerning the placement of the IPFB are reporte d in textbooks: inferior bo rder 01obturato r loramen, bottom of ischial tuberosity and midway through the obturator foramen, which corresponds to tne mid-pubis level. In case ot cervical cancer wi thout gross vagin al involvement this approach may result in irradiation of a larger volume 01intact vagina ,

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and conseque ntly, unnecessarily increase the risk of vagina l side ellects. The aim of the study was to evaluate fhe amo unt of inclusion of vagina into the treated/target volume when these th ree traditional IPFB are used. Materials : Data of sixteen patients with locally advanced cervical cance r FIGO IB and li B were analyzed, Patienl s received CT-base d 3D conforma l EBRT with "box' technique with concurrent cisplatin followed by HDR intracavitary brachytherapy. All patie nts underw ent MRI of the pelvis with intravaginal contrast (ultrasound gel) prior to the sta rt of EBRT. The length of the vagina was defined on MRI from the top of the posterior forni x to the urethral meatus level that was used as the landmark to define the introitus of vagina. The th ree definitions of IPFB (inferior border of the obturator foramen, bottom of the ischial tuberosity and the mid-pubis levef) wer e reproduced on the digitally reconstructed radiographs (DRR) and later tran sferred on the sagitt al MRI scans. Percentage of vaginal length included in the treatment fieids was calculated. ReSUlts : The med ian total vaginal lengt h as meas ured on MRI was 7.4 em (range 5.4-10.5 em . standard deviatio n 1.2 cm). The entire vagina (100"10) was included in the field for the inferior bord er placed at the bottom of ischial tuberosity . In case when IPFB was placed at the bottom of obturator loramen 100% of vagina was inclu ded in 56% of patients , in the remaining 44% of patients mean 85 % vagina length was within treatm ent fields (range 66% 93% ). Concerning the most cran ial field border (mid-pubis level) inclusion of the vagina in the treatment portal was me an 75% (range 55%-96 % ). Conclusions : When traditional bony-based IPFB is used, 75 to 100% of healthy vagina receives the entire prescri bed dose. An individualized placement of the inferior vaginal border wit h the routine use of vaginal markers andror comp leme nta ry MRI with vaginal contra st can spare the intact , not involved vagina considerably and will potentially decrease vaginal side effects.

867 poster INVE STI GAT IO N OF RECTAL AND B LA DDE R ACUT E TOX IC IT Y A FT ER EXTER NAL BEAM RAD IOTHER AP Y AND BRACHYTHERAP Y IN GY N ECOLO GIC A L CA N CER . A. Fiorenti no" , C. Chiurnanto", L. l.apadul a" , G. Castaldo ", P. Pedicini" , G. Califano ' , C, Stetan ia' . V. Fusco! 1 IRCC S/ C RO B, Division of Radiation Oncology , Rionero in Vulture, Italy

Purpose : To examine the acute toxicity profile of patients (pts) with endom etrial (EG) and cervical cance r (CC) treated by neo-adjuvant or adjuvant radiotherapy. Malerials : Patients with histolog ical confirm of EC and CC, treated with external beam radiotherapy (ERT) and intracavitary brachytherapy (BRT), were analyzed in this retrospective study. All ots received radical hysterectomy with bilateral salpingo-oo phorecto my and Iymp honode dissection. Stage was defined according to the FIGO definition.Patients received a tota l dos e of 45-50 Gy (180cGy/die). with a "box technique" on tumor and uterus if present or surgic al bed, plus pelvic Iymp honodes. High dose rate BRT was perform ed at t -week intervals with vaginal cyl lndres. 500-600 cGy/week prescribed to a deep of 0.5 em from the vagina surface . Acute toxicity was evaluated with RTOG scale, rectal and bladder dose constrai ns according to A.I.R.O, guid elines (V30 for rectum and V40 lor bladder). Results: From June 2008 to OCtober 2009 , 30 pIS With a media n age of 65 years (range 48-80) were treated , FIGO stage was as follows: 6 pts (20% ) IB, 7 pts (23.4%) IC. 4 pts (t 3.3%) JlA, 5 pts (16.6%) JIB, 7 pts (23.4%) lilA, 1 pt (3.3%) IIIC. Comp liance to treatment was 100%. Twenty-eight pIS receive d adj uvant radiother apy, only 2 pts neo-adjuvant radiation : 24 pts (80% ) reived 50 Gy in ERT, 6 pts (20% ) 45 Gy in ERT. BRT dose was performed as follows: 23 pts (76.6%) received 10 Gy (50OCGy/fr), 4 pts (13.3% ) 15 Gy (500cGy/fr). 1 pts (3.3%) 12 Gy (600cGy/fr). 1 pt (3,3%) 5 Gy/1 fr, 1 pt (3.3% ) 24 Gy (600cGy/tr). Acute toxicity was mild, During irradiation acute G 1-2 hematological toxicity occurred in 25 pts (83.3%) . while G3 in only 2 pts (6.6%j. During treatment 15 pts (50%) developed G1 rectal acu te toxicity and 6 pts (20% ) G2; while 14 pts (46 .6%) developed G1 bladder acute toxicity and 2 pts (6.6% ) G2 . In pts without rectal toxicity median V30 was 87 .2% (0.92%-98.15%), in G1 pts 94.3% (79_7% -100%) ; in G2 pts 88_5% (62.3%99.8% ). Media n bladder V40 was 95% (72.35%- 100%), 92% (55 .5%- I00%i and 100% in GO, G1 and G2 pts, respecti vely. We didn't observed a correlalion betwe en toxicity and these dose constraints. During BRT no patients experienc ed acute toxicity. At a median follow-up of 15 months (8-20) all pts are alive without dise ase. Conclusions : Our study confirmed the tollerabllity of ERT plus BRT in gynecolog ical cancer. However, in this selling of pts its needed more studies to evaluate the relationship between rectal and bladder toxicity and dose constraints.

868 poster LO NG TER M RES ULTS O F EXTERNAL RADIATION THERAP Y AND tM AG E GUIDED INT RA CAVITARYHDR BR ACH YTHERAP Y FOR C ERV ICAL CA NC ER (RT ALONE) '. IS THE PRESCRIBED DOSE TO

S302

C LINICAL/D ISEASE SITES

GYNAECOLOGICAL TUMOURS

IR-CTV REALLY NECESSARY?

K. Hatano", Llmaqunbai " , M. Sakai" , H. Araki" , N. Tohyama" , T. Kodama 2 , T. Kojima2 , T. Kawach? , N. I ana ka" , K. Suzuka" , T. Ohsaki3 , K. Nishikimi 3 1 CHIBA CANCER CENTER , Department of RadiationOncology, Chiba, Japan 2 CHIBA CAN CER CENTER , Department of Radiation Oncology, Division of Radiaiton Phsyics,Chiba, Japan 3 CHIBA CAN CER CENTER , Departmentof Gynaecology, Chiba, Japan

Purpose: We conducted a study to be given prescribed dose rule only to HR-CTV using IGBT, and RT alone treatment strategy for cervical carcinomas from 1995. The objective of this study is to evaluate the fong term results of Image guided intracavitary- HDR brachytherapy (IGBT) of this protocol. Materials: The study population consisted of 109 patients treated between January 1995 and December 2006, with FIGO stage distribution as follows: lb: 21, IIb:44, IIIb: 29, IVb: 15. All cases had histologically conlirmed squamous cell carcinoma of the uterine cervix. All patients were treated with external beam radiotherapy and MR/CT image·guided intracavitaryHDR brachytherapy (lGBT). The mean age of the patients was 61.3 years (range:33-86 years). The median follow-up period was 61 months (range:6183months). All patients were treated with 30Gy/15fx(BED:36Gyl0) whole pelvic irradiation followed by 20Gy/l0fx boost to the parametrium. Both CT and MR imaging were performed at the times of the first and third brachytherapy fractions. CT/MR compatible applicators (tandem&sylinder) were used. The total treatment time was less than 50 days. The GTV was defined by a high signal intensity region obtained using MR imaging at the first brachytherapy time. The planning target volume (PTV) was HR-CTV + included a 1-2 cm margin crania-caudally. We delivered 6 Gy per fraction to the PTV: one fraction per week, to a total dose of 24 Gy(BED:38 Gyl0). We did not prescribe the dose to IR-CTV. We evaluated the 5 and 10 year survival rates (OS:overall surv., LFFS:locoregional failure free surv., OFFS:distant failure free surv.), 0100 and the toxicity was also assessed using maximum rectal dose, bladder dose and late genitourinary morbidity rates. Results: The OS, LFFS and OFFS at 5 & 10 years according to stage were as follows; stage Ib:81.1 & 64.8%, 89.5 & 89.5%, 89.5 &89.5%, stage II b:81.4 & 64.0%, 94.9 &94.9%, 83.1 & 69.2%, stage IlIb:70.1 & 58.4%, 74.3 & 74.3%, 63.9 & 63.9, stage IV b:46.5 & 46.5%, 67.4 &67.4 %, 43.3 & 43.3%, respectively. In the patients without locoregional failure, the mean Dl DO of brachytherapy was 22-38Gyl0, whereas that was less than 20 Gyl 0 in the patients with locoregional failure. The reason for local failure was only geometrical under dose within HR-CTV. And we experienced no parametrial recurrence within the long follow-up duration. From an analysis of late rectal complication rate & maximum rectal dose in our historical non-IGBT data, about 44% of the treated patients experienced Grade 1&2 rectal bleeding and 5.6% of the patients experinced Grade 3 rectal complication. The 00.1cc of lhese palients was higher than or equal to 8Gy/lx to a total dose of 32Gy (BEO:122Gy3). Whereas in the current study group, the rate of Grade 1/2 late rectal bleeding was 9.7%/1.9%, and no grade 3 or higher rectal complication was experienced. The mean 0 0.1cc was 18.0Gy (BEO:45Gy3) and max 0 O.lcc was 26.8Gy (85.8Gy3). Image-guided brachytherapy enabled us to reduce the rate of grade 1-2 rectal bleeding from 44%(historical control) to 14% (one third ). Conclusions : The results indicate that IGBT only prescribed to HR-CTV using MRICT imaging has good local control and less morbidity than that of the non-IGBT dosimetry. Optimal prescribed dose of intracavitary HDR brachyherapy lor PTV should be at least 22Gyl0 for stage I , II patinets and higher dosel chemotherapy might be necessary for stage III patients. 869 poster METABOLIC MONITORING OF CERVICAL CANCER BY 18F-FOG PET : PREDI CTING RESPONSE AND OUTCO ME. .L l.eseur" , O. Williaume1 , E. Garirr', G. Louvsl " , E. Le Prise l , C. Fouqerou'", C. Bouriel", J. Leveque", R. de Crevoisier' , A. Oevillers2 1 CEN1RE EUGENE MARQUIS, RadiationOncology, Rennes, France 2 CENTR E EUGENE MARQUIS , Nuclear Medicine, Rennes, France 3 SERVICE DE PHARMACOL OGIE - CIC INSERM 0203 - CHU DE RENNE S UNIVERSITE DE RENNES 1 -, Biostatistics, Rennes, France 4 CENTRE EUGENE MARQUIS, Radiology,Rennes, France 5 CHU ANNE -DE-BRETAG NE, Gynaecology, Rennes, France

Purpose: The place 01 [18F] fluorodeoxyglucose (FOG) positron emission tomography (PET) is well established for initial staging in cervix carcinoma. The objective 01 the study is to investigate the role 01 FOG-TEP as prognosis and predictive factor, in the management of cervix carcinoma. Materials : The study included 2 series of patients (pts) with cervix carcinoma, treated between 2003 and 2009: either by brachytherapy (BT) followed by surgery (Sur) (early stage), or by cherno-radiotherapy (50 Gy) + BT + Sur (advanced stage).- a retrospective analysis: included 90 pts, initially evaluated by MRI and FOG PET. We analysed the prognostic value of following imaging parameters: standard uptake values ot the primary tumor (SUVmaxT), maximal tumor diameter and lymph nodes. - a prospective analysis: ineluded 15 pts with locally advanced cervical cancer. All pts were evaluated by FOG PET and MRI at different times: before treatment, at 40 Gy, and after BT (before Sur when performed). Following parameters were looked to be

correlated with local control at 6 months: SUV, maximal tumor diameter on PET and MRI. Therapeutic response was assessedby histopathology and/or clinical and radiological examination. Results : - In the retrospective study: SUVmax-T measured on initial FDG PET was correlated to histological response(p= 0.04). A baseline SUVmaxT > 10.9 was associated with a risk elevation of 5.1 to present residual disease at surgery (p=0.024). Positive pelvic lymph nodes on FDG PET had a significant impact on progression-free survival in multivariate analysis (RR= 7.02, p=0.0016).- In the prospective study: SUVmax-T measured on initial FOG PET and on early PET at 40 Gy were not correlated to local control at 6 months. However, all pts with complete metabolic response at 40 Gy were disease free at 6 months. SUVmax-T after 8T (before Sur) was correlated with 6 months local control (p=O.03). FDG PET after BT assessed residual cervical involvement with a specificity of 100% and negative predictive value of 86%. All pts with complete histological response were false positive on MRI. Conclusions : In addition to initial staging, FDG-PET is helplul in the management of patient with cervical cancer: - before treatment: to predict histological response and as prognostic factor- after BT (before Sur): to predict local control at 6 months and to avoid surgery for pts in complete response. 870 poster MR IMAGING FOR DELINEATION OF THE VAGINAL TUMOR BED IN PATIENTS RECEIVING POSTHYSTERECTOM Y IMRT L. Lin! , D. Torigian2 1 HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA, Radiation Oncology, Philadelphia, PA, USA 2 HOSPITALOF TH E UNIVERSITYOFPENNSYLVANIA, Radiology, Philadelphia, PA, USA

Purpose: MR imaging provides improved soft tissue contrast in the pelvic region. We examined the use of MR vs. CT imaging for vaginal tumor bed delineationin women receiving pelvic intensity modulated radiotherapy posthysterectomy for gynecologicmalignancies. Materials: Twelve patients with endometrial or cervical cancer who received radical or extrafascial hysterectomy and bilateral salpingo-oophorectomy with lymph node dissection underwent computed tomography (CT) imaging followed immediately by magnetic resonance (MR) imaging (T! and T2 weighted) for radiation therapy treatment planning. All patients were scanned in supine position using a Vac-Loc bag for irnrnob'lization with a full bladder. Images were transferred to the Eclipse treatment planning system and coregistered using ccny anatomy. Vaginal tumor bed volumes (CTVvagina)were defined separately on CT and T2 weighted MR datasels by a board-certilied radiologist (DT) on separate days at least two weeks apart. Clinical target volumes (CTVtotal) includinq the vagina and paravaginal tissues were then contoured by the radiation oncologist (L.L.) separately on each dataset with assistanceby the radiologist. The inferiorborder of the vagina was defined at the inferior margin of the obturator foramen on both CT and MR datasets. The superior border was defined based on anatomic imaging, and included the staple line. Target volumes tor both CTVvaginaand CTVtotal which encompassed the vaginal and paravginal tissues were calculated for each patient. Paired t testing was subsequentlyperformed. Result s: The vagina was well visualized on all MR images. The mean volumes for CTVvagina, were 29.9 mL (range 11.8-47.4 mL) and 41.46 mL (range 26.3-65.8) for MR and CT, respectively, p=0.008. The mean volumes for CTVtotal were 60.6 (range 28.9-137.4) and 84.0 mL (range 24.8-108.8) for MR vs CT, respectively, p=0.002. In 100112 patients, MR volumes were smaller than CT volumes for both CTVvagina as well as CTVtolal (median volume ratio of CT/MRI was 1.4 (range 0.70-3.24) and 1.4 (range 0.91-1.97) for CTVvagina and CTVtotal, respectively. Median vaginal length on MRI was 7.5 (range 5.4-9) vs. 6.9 em (range 4.2-9.6) on CT (p=0.29). Conclusions : MRI can be used for vaginal tumor bed volume contouring. The vagina is more easily defined on MR imaging and results in decreased vaginal tumor bed volume compared to CT. Tailoring of vaginal tumor bed volumes for IMRT may be feasible and reduction in toxicity with decreased volumes remains to be seen using MRI for contouring. 871 poster NEO-ADJUVANT IMAT CISPLATIN FOR PRIMARY IRRESECTABLE CARCINOMA OF THE CERVIX: CLINICAL RESULTS. K. Vandecasteete" , A. Makar2 , H. Denys3 , L. Delrue4 , W. De Nevel , R. Van den Broecke2 , K. t.ambein" , B. lambert" , M. Van Eijkerenl , G. De Meerleer l 1 UNIVERSITAIR ZIEKENH UIS GENT, Radiotherapie en kerngeneeskunde, Gent, Belgium : UNIVER SITAIRZIEKENHUI S GENT, Gynaecology, Gent, Belgium 3 UNIVERSITAIR ZIEKENH UIS GENT, MedicalOncology, Gent, Belgium • UNIVERSITA1R ZIEKENHlJlS GENT, Radiology, Gent, Belgium 5 UNIVERSITAIR ZIEKE NHUIS GENT, Pathology, Gent, Belgium 6 UNIVERSITAIR ZIEKENH UIS GENT, Nuel Med PET research, Gent, Belgium

CLINICAL/DISEASE SITES

Purpose: To report on toxicity, tumour response, resection rate and outcome after IMAT ± cisplatin for primary irresectable cervical cancer Materials: Twenty-nine patients with Figo liB-IVA cervix carcinoma were treated with IMAT ± cisplatin pre-operatively. Pre-treatment work-up included clinical examination and imaging (l BFDG-PET/CT and MRI). See Table 1 for patient characteristics.IMAT dose prescription was as follows: 62 Gy and 60 Gy (Dmed) to the primary tumour and PET/CT-positive lymph nodes respectively; 58 Gy and 56 Gy (Dmed) to CTV (uterus, cervix, upper vaginal 1/3 to 1/2 and parametria) and its PTV; minimal dose of 45 Gy to pelvic lymph nodes. IMAT was delivered in 25 fractions, resulting in a SIBWithin 4 weeks after IMAT, tumour resectability was assessed clinically and radiologically CBFDG-PET/CT and MRI). If resectable, Wertheim-Meigs hysterectomy (W-M) was performed within 6-8 weeks after end of IMAT.If irresectable, brachytherapy (BT) was performed.Acute toxicity was scored weekly during IMAT and 1 and 3 months thereafter. Late toxicity scoring started 2: 6 months after ending IMAT and was scored 3 monthly during the first 2 years, and 6 monthly thereafter. Disease control was evaluated clinically (3-monthiy) and with imaging (6-monthly).

All n=29

W-M n= 22

BT n=5

Age (years) median (range)

55 (27-80) 53 (27-80) 55 (43-64)

Follow-up (months)

14 (1-49)

15 (1-49)

13 (2-24)

IIB

17

15

2

IIIA IIIB IVA

3 7 2

3 4 0

0

2 1

15 14

12 10

2 3

25 4

18 4

5 0

median (range) Tumor Figo stage

Nodal status (PET /Ct) negative positive

GYNAECOLOGICAL TUMOURS

S 303

NODAL STATE DETERMINES OUTCOME IN VULVAR CANCER S. Rieken 1, A. Mohr l , H. Hol", M. Bischof', S. Combs', J. Debus',

K. Linde!' 1 UNIV. KLiNIKUM HEIDELBERG, Department of Radiation Oncology, Heidelberg, Germany

Purpose: Aim of the study was to determine outcome of patients with advanced vulvar cancer receiving radiotherapy and to evaluate prognostic factors for treatment outcome. Materials: From 1996 to 2010, 94 patients with pathologically confirmed vulvar cancer were treated at the Department of Radiation Oncology at the University Hospital of Heidelberg. 51 patients received radiotherapy during their first-line treatment. 43 patients received radiation therapy of recurrent vulvar carcinoma. Statistical analyses were performed using the Kaplan-Meier method, log-rank and Fischer-Exact-Test (SSPS15.0) Results: Median follow-up was 34 months. Overall survival was 85%, 75%, and 55% after 1, 3, and 5 years. Of all patients 46.8% presented with inguinal lymph node metastases at initial diagnosis. Of these, 77% were irradiated postoperatively, while 23% underwent irradiation only after relapse of disease. Overall survival was reduced significantly in case of primary inguinal lymph node metastases (p=0.001). T state, grading, extent of initial surgery, and additional chemotherapy did not significantly influence treatment outcome. Patients radiated with a total dose> 50 Gy either local or regional had a better overall survival (p=0.065). In case of radiotherapy for patients with recurrent carcinoma, overall survival was significantly lower for patients, who had been diagnosed with lymphatic spread at initial diagnosis (p=0.01). Conclusions: Inguinal lymph node metastases were the only significant prognostic factor for overali survival in vulvar cancer patients. For adjuvant radiation a total dose of more than 50 Gy is recommended.

873 poster PET-CT STAGING IN CERVICAL CANCER - SINGLE INSTITUTIONAL EXPERIENCE C. Gillham 1 , L. Walsh2 1 ST JAMES'S HOSPITAL, Academic Radiation Oncology Department, Dublin 8, Ireland Republic of 2 ST LUKE'S HOSPITAL, Academic Radiation Oncology Department, Dublin, Ireland Republic of

Tumor histology SCC adenoCA Urinary derivation yes no Chemotherapy yes no

5

3

1

24

19

4

22

16

5

7

6

0

Table 1: Patient CharacteristicsW-M: Wertheim-Meigs Hysterectomy; BT= Brachytherapy Results: Median FU is 15 months (1-49 m). In 28/29 patients, post-IMAT resectability was assessed (1 patient suddenly died). Twenty-two (79%) were considered resectable. Reasons for not being resectable were insufficient response (n=5) and disease progression (n=1, no BT boost). 1. W-M group Pathology revealed complete response and microscopic rest in 11 patients each. Surgical margins were free of disease in all cases. All 22 patients had pNO disease. There was no postoperative mortality and no excess in postoperative morbidity. One patient needed a re-intervention due to large Iymphocoeles. At 2 years, LRC, OS and DFS is 100%, 94% and 89% respectively. 2. BT group Locoregional control at 1 year is 53%, 2-y OS and DFS is 25% and O%.There was no grade 3 acute or late non-hematologic toxicity. There was 1 grade 3 hematologic toxicity (WBC). Late grade 2 toxicity was observed for urinary incontinence (n=3) and bowel frequency (n=2). There was 1 late grade 3 intestinal toxicity in the BT group. Conclusions: IMAT ± cisplatin has low toxicity and is excellent in rendering irresectable cervical cancer resectable. No pelvic relapses have been observed in the operated patient group.

872 poster

Purpose: The therapeutic modality for treatment of cervical is dependent on the stage at diagnosis. Poorer outcomes are observed in those who present with nodal metastases. Clinical FIGO staging does not incorporate nodal involvement and MRI is limited by nodal size. We sought to determine the additional benefit of PET-CT in the staging of newly diagnosed cervical cancer patients over conventional staging. Secondly, we evaluated the frequency with which PET-CT changed the planned treatment approach. Materials: A retrospective review of the institutional cervical cancer database was performed. Patients who, since 2007, had had a PET-CT in addition to conventional staging (EUA and MRI) were analysed. Results: Forty-seven patients underwent PET-CT following conventional staging. Tumour histological subtypes were squamous cell, adenocarcinoma, small-cell, clear-cell in 83%, 10%,4%,2% respectively. Conventional stage was 1A1 (4%), IB1 (2%), IB2 (2%), IIA (2%), liB (21%), lilA (2%), IIIB (35%), IVA (6%), IVB (23%). The median age was 47.7 years. Treatment approach consisted of definitive chemoradiotherapy, primary surgery, primary surgery plus adjuvant radiotherapy and palliation in 62%, 15%, 13% and 10% respectively. Compared to conventional staging 5 (10.6%) were up-staged with the addition of PET-CT,6 (12.7%) were down-staged and 36 (76.6%) had no change in disease stage. Of those up-staged, 4 had positive (confirmed histologically) para-aortic nodes and one had a fistula not seen on MRI. Of the 5 patients up-staged, a change in treatment approach occurred in all 5, to include the para-aortic nodes, in 4 cases, within the radiation field. Of the 6 patients down-staged, a change in treatment approach occurred in 4. In total, the addition of PET-CT changed the treatment approach in 9 (19.1%) patients. Conclusions: The addition of PET-CT to conventional imaging changed disease stage in 23.3% of cases and the treatment approach in 19.1%. PETCT should be considered as standard in the staging of women with cervical cancer.

874 poster POST-OPERATIVE RADIOTHERAPY (PORT) IN 292 PATIENTS (PTS) WITH CERVfX CARCfNOMA FROM 1970-2007 L. Uitterhoeve ", R. van OSI, L. Stalpers'. N. Sljker), M. Schitthuis". K. van der Velden2 , M. Buisr', A. Westermann 3 , K. Zwinderman", C. Koning I I ACADEMIC MEDICAL CENTER 1 UNIVERSITY OF AMSTERDAM, Division of Radiation Oncology, Amsterdam, Netherlands 2 ACADEMIC MEDICAL CENTER 1 UNIVERSITY OF AMSTERDAM, Gynaecol-

S 304

CLINICAL/DISEASE SITES

GYNAECOLOGICAL TUMOURS

ogy, Amsterdam, Netherlands 3 ACADEMIC MEDICAL CENTER 1 UNIVERSITY OF AMSTERDAM, Department of Medical Oncology, Amsterdam, Netherlands 4 ACADEMIC MEDICAL CENTER 1 UNIVERSITY OF AMSTERDAM, Department of Epidemiology and Biostatistics, Amsterdam, Netherlands

Purpose: Based on a retrospective analysis of 188 pts lreated with PORT from 1970-1993 (period 1) the treatment policy was adapted in 1994 (period 2 1994-2000, 44 pts). From 2000 chemotherapy was added in poor risk pts (period 3, 60 pts), Results of treatment between 1970-2007 are analysed for overall (OS), local disease-free (LDFS), metastases-free (DMFS) and complication-free (CFS) survival as well as for prognostic factors. Materials: Patient characteristicsBetween 1970-2007292 pts with cervix carcinoma I (2t2), IlA (77) or liB (3). squamous cell (243) or adenocarcinoma (49) received PORT. Indication were parametrium invasion (91pts), pathological lymph nodes (92 pts) or both (48 pts). In 61 pts various indications were present. The mean age of the pts was 57.9 (18-91). 54.1 (20-91) and 52.3(20-91) years inperiod 1, 2 and 3 respectively.Treatment characteristicsAil pts received radical surgery (AVRUEL 100 pts, Wertheim-Okabayashi 192 pts) in the AMC. RT was given to the pelvis with upper limit L4/L5 (259 pts) or pelvis and paraaortic area L1/Th12 (26 pts), The dose of RT was < 50 Gy in 104 pts and> 50 Gy in 188 ots. Brachytherapy was given to 89 pts, chemotherapy to 31 pts. A bellyboard was used in 67 pts. Results: OS , LDFS and DMFS did not diHer significantly per period and were 78-88%, 82-90% and 78-88% (5 y). Grade 3-4 CFS was 89-92% (5 y). No pts died of complications. Multivariate analysis showed the following negative significant factors for OS: histology adenocarcinoma (p=.0047), indication both (p=.0013), type of surgery AVRUEL (p=.00014), age breakpoint 40 yr (p=.014); for LDSF: histology (p=.0075). indication (p=.026}, type of surgery (p=.043), age breakpoint 40 yr (p=.034), brachytherapy (p=.04); for DMFS: histology (p=.0051), indication (p=.0008), brachytherapy (p=.043), type of surgery (p=.00019j. The addition 01 chemotherapy to poor risk pts did not lead to a statistically significant better OS (88% vs 78%) (p-.22). For Grade 1-2 and Grade 3-4 CFS only addition of chemotherapy was significant (p=.03).

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876 poster PROGNOSTIC FACTORS AFFECTING THE OUTCOME OF LOCAL AND DISTANT DISEASE IN CERVICAL CANCER PATIENTS TREATED WITH ADJUVANT RADIOTHERAPY I. G6rken 1, H. Alanyali". Z. Arican Alicikus 1, I. Arslan", U. saygili 2 C. C. Ebruli\ M. Koyuncuoqlu", F. obuz", R. Cetinqoz ' 1 DOKUZ EYLUL UNIVERSITY MEDICAL SCHOOL, Department of Radiation Oncology, Izmir, Turkey 2 DOKUZ EYLUL UNIVERSITY MEDICAL SCHOOL, Department of Gynaecology and Obstetrics, Izmir, Turkey 3 DOKUZ EYLUL UNIVERSITY MEDICAL SCHOOL, Department of Pathology, Izmir, Turkey 4 DOKUZ EYLUL UNIVERSITY MEDICAL SCHOOL, Department of Radiology, Izmir, Turkey

CEAgroup _\

CEAgroup 2

o.

complications of postoperative radiotherapy in selected groups of invasive cervical carcinoma. Material s: We retrospectively reviewed the medical records of 162 cervical cancer patients, treated with postoperative radiotherapy during 2003 year. Radiotherapy included doses of 30-46Gy of 6-15 MV external photons to pelvis in 12-26 fractions. Concomitant brachytherapy with Ir ' 92 HDR was delivered in 3-5 fractions to a total dose of 27- 32Gy. The mean age was 48,67 years (range 25-71). Majority of patients (130) were presented with stage Ib and others with stage la, lla or lib. Ten pts. were with residual disease. Radical hysterectomy with lymphadenectomy was performed in 122 pts. and simple hysterectomy in 40pts. Eight pts. received concurrent chemoradiotherapy. The negative node patients with Stage ta, Ib1 or Ib was stratified as a low risk group while pts. in Stage Ib2, lIa and lib with positive lymph node and residual disease were in a high risk group. Results: The 5-year actuarial overall survival (OS) for all patients was 92,6% and disease- free actuarial 5-year survival (DFS) was 90,9%. There was statistically significant difference In OS and DFS between the low and high risk group of patients (p
p < 000\

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Conclusions: -Results for survival and local control are excellent-Histology of adenocarcinoma, combination of lymph node metastases with parametrial invasion and the AV~,_,EL type of operation are poor prognostic factors for OS, LDFS and DMFS. Risk for death and local recurrence increased up to 40 years and then decreased.- The addition of chemotherapy led to a significant increase of mild and severe complications

875 poster POSTOPERATIVE RADIOTHERAPY OF CERVICAL CANCER WITH STAGE I-II DISEASE: SINGLE CENTRE EXPERIENCE A. Tornasevic", V. Plesinac", S. Zoranovlc ', Z. Milovanovic 2 , N. Milosevic 1 , D. Grz~ticl , M. Hadoniic", S. Milanovic ' I INSTITUTE OF ONCOLOGY AND RADIOLOGY OF SERBIA, Department for Radiotherapy, Belgrade, Serbia 2 INSTITUTE OF ONCOLOGY AND RADIOLOGY OF SERBIA, 1Department of Oncology-Pathology, Division of Clinical Cancer Epidemiology, Belgrade. Serbia

Purpose: Many studies have shown that postoperative radiotherapy reduce local recurrence in early stage cervical cancer, but the survival improvement is controversial. The purpose of the study was to analyze survival and late

Purpose: To report outcomes of local, distant disease control and prognostic factors in cervical cancer patients treated with adjuvant radiotherapy. Materials: In this retrospective study, includinq the period January 1992 to December 2008, we evaluated 134 patients with cervical cancer who were treated with adjuvant radiotherapy. The median age was 51 years (3179). Type III radical hysterectomy + pelvic lymphadenectomy performed in 102 (76%) patients and total abdominal hystrectomy + bilateral salphingooophorectomy in 32 {24%}. Distribution of stages according to FIGO 1995 was 1- IA (1%), 89-IB (66%), 20-IIA (15%), 18-IIB (13%), 6-IIiB (5%), respectively. The most common histopathology was squamous cell carsinoma (82%). Forty two percent of patients had Iymphovasculer space invasion, 37% lymph node metastasis, 14% positive surgical margin and 10% parametrial invasion. All patients were treated with external beam irradiation using anterior-posterior (AP/PA) or pelvic box techniques and high-energy fotons (1.8 -2 Gy/fraction). Median total external beam irradiation dose was 45 Gy (30.6-63.4 Gy). In patients who received ~ 45 Gy, midline block was used between 39.6 and 52.2 Gy. Boost irradiation was performed to involved side in patients with positive surgical margin and parametrial invasion. Median boost dose was 10 Gy (10-16.2). In 116 (87%) patients, high-dose-rate vaginal cuff brachytherapy was given away 0.5 cm from vaginal rnocoza, dose fraction sizes ranging from 1.7-10 Gy in 1-5 fractions (Manchester system). Total treatment time was 56 days (35-97). Kaplan-Meier method and Coxregresyon method were used for statistical analyses. Results: Median follow-up time was 66 months (4-205). The 5 and 10 year pelvic relapse free survival was 89% and 86%. The 5 and 10 year distant metastasis free survival was 85% and 81%. Using multivariate Cox regression analysis present of parametrial invasion (p=0.02) for pelvic disease and present of lymph node metastasis (p=0.04) for distant disease were tound to be independently related to patients' poor survival. RTOG late grade III - IV side effects were determined in bladder-1 %, rectum-1 % and small intestines1% of patients. Conclusions: In this study, parametrial invasion for pelvic disease control and lymph node metastasis for distant disease control are prognostic factors of cervical carcinoma patients treated with adjuvant radiotherapy.

877 poster PROSPECTIVE EVALUATION OF EARLY TOXICITY FOLLOWING THREE-DIMENSIONAL CONFORMAL RADIOCHEMOTHERAPY usING CONCOMITANT BOOST TECHN/QUE IN LOCALLY ADVANCED

CLINICAL/DISEASE SITES

CERVICAL CANCER: PRELIMINARY RESULTS. K. Bednarczyk' , B. Lindner". M. Kolodziejczyk2 , M. Olszyna-Serernenta", J. Jonska-Grnyrek", J. Staniaszek", R. Krynicki 3 , K. BUjk02 , D. Blatkiswicz ", D. Bodzak", P Karninskr", W. Michalski" i THE MARIA SKLODOWSKA-CURIE MEMORIAL CANCER CENTER, Radiation Physics, Warsaw, Poland 2 THE MARIA SKLODOWSKA-CURIE MEMORIAL CANCER CENTER, Radiation Oncology, Warsaw, Poland 3 THE MARIA SKLODOWSKA-CURIE MEMORIAL CANCER CE~TER, Gynaecology, Warsaw, Poland 4 THE MARIA SKLODOWSKA-CURIE MEMORIAL CANCER CENTER, Statistics Department, Warsaw, Poland

Purpose: The presence of lymph node metastases in cervical cancer pre-

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come. In the Cox regression model, tumor size> 4 em and partial response were predictive factors for disease progression and partial response and nonsquamous cell carcinoma were predictive factors for late death. Conclusions: Non-squamous histology and partial response were independent prognostic factors for overall survival and tumor size and partial response independent prognostic variables for 5-year disease survival.

879 poster RADIOTHERAPY FOR LOCALLY ADVANCED VAGINAL CARCINOMA S Riekenl, A. Mohr], H. Hot", M. Blschot", S. Combs", J. Debus', K

l.indal' i UNIV. KLiNIKUM HEIDELBERG, Department of Radiation Oncology, Heidelberg, Germany

dicts poor progression-free survival. To increase therapeutic ratio the dose escalation in the area of nodal disease using concomitant boost technique was performed. The aim of this interim analysis is to evaluate early toxicity of radiochemotherapy in locally advanced cervical cancer. Materials: 49 consecutive cervical cancer patients with stage IB2-1116 and CT or PET-CT positive pelvic/paraaortic lymph node were enrolled. Two schedules of radiotherapy were used. In patients With pelvic disease. the total dose of 60 Gy (including 45 Gy to the elective area) was delivered over 5 weeks in fractions of 2,4 Gy (1.8 Gy to the elective area). In patients with paraaortic nodal disease, the total dose of 59,4 Gy (45.9 Gy to the elective area) was delivered over 5,5 weeks in tractions of 2.2 Gy (1.7 Gy to the elective area). Brachytherapy was delivered at HDR schedules with 7.5 Gy in point A per fraction (total dose 30 Gy). Acute toxicity in bowel and bladder was scored according to the RTOG/EORTG scale and acute hematological toxicity according to the Common Toxicity Criteria (GTC). Results: The median treatment time was 34 days, ranged from 28 to 47 days. The patients received 45 Gy (range: 42,5-50,4 Gy) in elective area and concomitantly 15 Gy (range: 9,2-16,2 Gy) in boost. Forty four of 49 patients received cisplatin-based chemoradiation, five were treated with radiation alone. The median number of administered cisplalin courses was 4 (range: 1-6). Grade 3/4 bladder toxicity wasn't observed. In three (6.1%) patients acute Grade 3 gastrointestinal toxicity was reported, two of them needed interruption in the treatment. Grade 1 leucopenia was noted in 33 % of patients, Grade 2 in 39% and Grade 3 in 6% of patients. Leucopenia limited chemotherapy in 17 (44%) patients, in one patient short interruption in radiation was required. Conclusions: The three-dimensional conformal radiotherapy with concomitant boost is well tolerated technique for cervical cancer patients with nodal disease. The longer follow-up is needed to evaluate late toxicity.

Purpose: Due to its rare incidence, only little data exist about treatment and outcome of primary vaginal cancer. Patients undergo primary radiotherapy With or Without chemotherapy or surgical resection followed by postoperative radiotherapy. In the present retrospective study, we evaluated therapy results and prog nestle factors of 27 patients. Materials: Between 1998 and 2009, 27 patients with biopsy proven vaginal carcinoma were treated in the department of radiation oncology at the university hospital of Heidelberg. Median age was 68 years. 70% of the patients treated, had been diagnosed with advanced tumors (stages 3 and 4). 16 patients received primary radiotherapy, and 11 were treated postoperatively. Concomitant chemotherapy was administered to 8 patients. Statistical analyses were performed using the Kaplan-Meier method, log-rank and FischerExact-Test (SSPS15.0i Results: Median follow-up was 54.3 months. During this time, 14 patients died, of whom 12 died from vaginal cancer. Overall survival was 81% 43% and 37% after 1, 3, and 5 years. Loco-regional progression-free surviv~1 wa~ 73% and 58% at 1 and 3 years; distant progression-free survival was 72% and 67% at 1 and 3 years.Overall survival was significantly reduced in case 01 loco-regional (56.7 vs, 0%; P = 0.005) or distant relapse (46.8 vs. 0%, P ~ 0.07). Local failure correlated with distant metastatic dissemination (p = 0.025). Most metastases were haematological (88%). A latency between initial clinical signs and initiation of treatment of > 28 days predisposed for metastatic disease (p = 0.09). Tumor resection does not improve overall survival. Complete resection was only possible in Tl-tumors. Conclusions: Primary radiotherapy displays the treatment of choice in vaginal cancer. As opposed to cervical cancer, T- and N-state do not significantly Inlluence local or distant control. Distant metastases limit treatment outcome.

878 poster

880 poster

RADICAL RADIOCHEMOTHERAPY FOR LOCALLY ADVANCED CERVICAL CANCER. PREDICTIVE FACTORS OF RECURRENCE. A. M. Reig Castillejo', I. Membrive Coneio", P Foro Arnator'. J. Sanz

SALVAGE RADIOTHERAPY FOR LYMPH NODE RECURRENCE AFTER RADICAL SURGERY IN CERVICAL CANCER W Jcon'. H. J. Kim', S. W. Ha", H. G. Wu' ,S. B. Kang 2

Latiesas~, N. Rodriguez de Dios 2 , J. Lozano Galan", J. Dengra 2 , M. Lacruz 2 Basscls", Q. J. Jaurne''. E. Fernandez-Velilla , M. I. Algara t.opez"

SEOUL NATIONAL UNIVERSITY COLLEGE OF MEDICINE Department of Seoul, Korea Republic of ' • SEOUL NATIONAL UNIVERSITY COLLEGE OF MEDICINE Department of Gynaecology and Obstetrics, Seoul, Korea Republic of '

i

INSTITUT DONCOLOGIA RADIOTERAplCA PARC SALUT MAR, Department of

~adiation Oncology, Barcelona, Spain

HOSPITAL DE LA ESPERANJ;:A, Barcelona, Spain

I

~adiation Oncology,

Department of Radiation Oncology,

Purpose: The standard treatment in advanced cervical cancer is radical radiochemotherapy, since in 1999, the National Cancer Institute demonstrated in five prospective randomized trials that this association improved overall and disease-free survival .Further studies have shown an increase in acute toxicity .Dl'terent studies have identified a number factors. that influence local recurrence and survival .To evaluate the predictive factors of recurrence in patients treated with radical radiochemotherapy. Materials: We analyzed retrospectively 56 patients with advanced cervical cancer who received radiochernotherapy between January 2000 and December 2008. Patients were staged according to the FIGO criteria. A CT was made to all patients to detine the target volume and the organs at risk. External radiotherapy was administered with high-energy photons and volume included the pelvis, the pelvis with inguinal nodes or the pelvis and the paraaortic nodes. The total dose administered was 45 Gy with standard fractionated in 25 fractions. Chemotherapy was administered to all patients with weekly cisplatin. After external radiotherapy, brachytherapy or external radiotherapy was administered to boost the tumor. Acute and late toxicity was assessed by RTOG 1983 and hematological toxicity by the NCI criteria Response was assessed using the RECIST criteria. Patients without a complete response underwent surgery. Overall and disease free survival were estimated by the Kaplan-Meier method and the Cox proportional model was used to analyze predictors of recurrence. Results: Local recurrence was documented in 16 patients and distant metastases In 15 . The Kaplan-Meier survival probabilities were 951 ± 6.4% at 3 years and 80,4 ± 13.1% at 5 years and the Kaplan-Meier curve values lor disease-free survival were 60.3 ± 14.3% at 3 years and 53.0 -t- 15.7% at 5 years .Complete response after chemoradiation therapy, squamous cell carcinoma, and tumor size S 4 cm were significantly associated with out-

Purpose: To evaluate treatment outcomes and prognostic factors in patients treated with salvage radiotherapy (RT) for isolated lymph node (LN) recurrence of cervical cancer. Materials: Between 1984 and 2009, 23 cervical cancer patients with LN recurrence who had previously undergone radical hysterectomy and pelvic LN dissection were treated with salvage RT with (n = t9) or without (n = 4) chemotherapy. Of the 23 patients, 10 had supraclavicular LN (SCN) recurrence, 9 para-aortic LN, 3 inguinal LN. and 1 mediastinal LN. The median total dose ot RT was 60 Gy (range, 36.5 ' 70 Gy). Initial pathologic findings, latent period to LN recurrence and other clinical parameters such as symptoms, tumor markers (SCC) were evaluated as prognostic factors lor survival. Results: The median follow-up period after salvage RT was months (range, 2 - 120 months. The 3-year overall (OS) and disease free survival (DFS) rates of all patients were 41.5% and 31.8%, respectively. Longer latent period toLN recurrence (>18 months vs. S18 months, p = 0.007), higher RT dose (>50Gy vs. S50Gy, p = 0.048) and lower squamous cell carcinoma antigen (SCC-Ag) level at recurrence (>8ng/dL vs. S8ng/dL, p = 0.001) were significant predictors for OS; for DFS were concurrent chemoradiotherapy (p ~ 0.012), longer latent period to LN recurrence (p = 0.002) and lower SCC-Ag level at recurrence (p < 0.001). Treatment failure after salvage RT occurred in 14 (60.9%) of the 23 patients (local only: 4 (17,4%); distant only: 2 (8.7%); and both local and distant: 6 (26.1%)). Grade 3 acute skin toxicity developed In 2 patients. Conclusions: For isolated LN recurrence of cervical cancer, salvage RT with concurrent chemotherapy can achieve long-term survival. Longer latent penod and lower SCC level at the time of LN recurrence were crucial factors for better outcome.

is

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881 poster SALVAGE ROBOTIC RADIOSURGERY IN THE MANAGEMENT OF RECURRENT GYNECOLOGICAL MALIGNANCIES F. Yildiz 1 , M. Csnqiz ", G. Ozyigit 1 , G. Yava?", F. Zorlu", M. Gurkaynak", F. Akyoll --I HACETTEPE UNIVERSITY FACULTY OF MEDICINE, Department of Radiation Oncology, Ankara, Turkey

Purpose: Clinical management of locoregional relapse in patients with gynecological malignancies remains challenging. Treatment options are generally limited to patients previously received radiotherapy (RT). Stereotactic Body Radiotherapy (SBRT) may offer highly conformal radiotherapy and maximal sparing of normal tissues. In this retrospective study, we assessed therapeutic results and toxicities of the patients who were treated with SBRT for recurrent gynecologic malignancies. Materials: We retrospectively reviewed the medical charts of recurrent cervicalor endometrial cancer patients treated with salvage SBRT by Cyberknife (Accuray Inc, Sunnyvale, CAl at our department Among recurrent cervical cancer patients, there were 3 patients with prior radical surgery, 3 patients with definitive radiochemotherapy and 2 patients with combined surgery and adjuvant pelvic RT. Among endometrium cancer patients, one of them had prior surgery, one with surqery-adiuvant vaginal brachytherapy and one had surgery with adjuvant chemoradiotherapy. All patients were placed fiducial markers. A median number of 3 (3-4) fiducials were placed per patient. Computerized tomography using 1 mm thickness slices was obtained in all patients for treatment planning. After contouring the tumor and critical structures using axial, sagital, and coronal slices, optimal treatment plan was selected according to our institutional criteria. The median total dose was 28 Gy (ranged 15-35Gy). Median maximum dose was 35.7Gy (ranged 25-46.7Gy) whereas the normalized isodose was 76% (ranged 70-82%). The mean conformality index was 1.66 (1.42-2.64) and homogeneity index was 1.32 (1.221.67). All patients were evaluated with physical, gynecological examinations 1 month after SBRT and every 2 months thereafter. Four patients had undergone to PET/CT and the others were evaluated by pelvic MRI, 3 months after SBRT. Results: Eleven patients with recurrent cervical (8) or endometrial (3) cancer were treated with salvage SRT with Cyberknife between October 2007 and December 2009. The median age was 62 (range: 47-77). Median follow-up was 10 months (1-26 months). Three of 11 (27%) patients had complete response, 2 (18%) had near complete response and one had stabile disease after SBRT. Five patients were died of disease. Acute grade 1-2 and grade 34 gastrointestinal (GI) and genitourinary (GU) toxicity was observed in 73%, 64%, 26% and 36% ot patients respectively. Four out ot 11(36%) patients developed severe late toxicity. One patient with diabetes mellitus with history of previous thromboembolic events developed thrombosis of obturatory vessel and her right leg had to be amputated. Two patients developed either rectovaqinal or vesicovajinal fistulas or both and 1 patient who had 3 major surgeries and several chemotherapies had subileus attacks which did not need to surgical approach. Conclusions: SBRT with robotic radiosurgery appears to be effective with considerable morbidity in recurrent gynecological malignancies. Since most of our patients had prior aggressive therapies and cornorbidities, late toxicities were more common than we expected.

882 poster SALVAGE TREATMENT OF CENTRAL PELVIC RECURRENCE OF UTERINE CERVICAL CANCER L. Hatnout", P. Despres', T. V. Nguyen", D. Provencher", P. Drouin 2 , P. Gauthier", M. Jolicoeur! 1 CHUM - CAMPUS NOTRE-DAME, Department of Radiation Oncology, Montreal, Canada " 2 CHUM - CAMPUS NOTRE-DAME, Department of Gynaecological Oncology, Montreal, Canada

Purpose: The goal 01our study is to determine the overall survival (OS) and progression-free survival (PFS) after pelvic exenteration and radiation therapy of locally recurrent cervical cancer and to assess the related treatment toxicities. Materials: Twenty-eight patients with a central pelvic recurrence were treated with either pelvlc exenteration or salvage radiotherapy. Inclusion criteria were clinical and pathological evidence of central pelvic recurrence including pelvic sidewall recurrence of cervix cancer previously treated with radical therapy. All Immediate and delayed treatment related toxicities were reported according to the RTOG common toxicity criteria. Results: Median age at diagnosis was 44 years. The median follow up from recurrence was 27.5 months. Treatment for primary disease was radical surgery for 12 (42.9%) patients and radical radiation for 19 (67.9%) patients: 3 patients had radical surgery and radiation.On first recurrence, 13 (46.4%) patients were salvaged by radiation therapy. The remaining 15 (53.6%) patients underwent pelvic exenteration. Brachytherapy was used in 13 (46.4%) patients at recurrence.At recurrence, the 3-year OS was 54,3% , 53.8% and 44.1% lor the entire cohort, patients salvaged by pelvic exenteration and for

those salvaged by radiation therapy respectively (p=O.711). The median survival was 39 months for both groups. The median PFS was 23 months, 31 and 19 months for the entire group, patients salvaged by exenteration and radiation therapy respectively (p=0.255). The main surgical related toxicities were pelvic abscess, cardiac and pulmonary complications. The main radiation related toxicities were grade 1-2 gastrointestinal toxicities. Conclusions: No difference in OS or PFS was found between patients salvaged by pelvic exenteration and those salvaged by radiation therapy at recurrence. Despite an aggressive treatment at recurrence, outcome was not changed and was associated with significant toxicities. New therapeutic approaches should be conducted.

883 poster SMALL PELVIC FIELD POSTOPERATIVE RADIATION FOR EARLY STAGE UTERINE CERVICAL CANCER 1 1 H. Eto , H. Suefu]i", E. Oqo ", G. Suzuki , Y. Watanabe 1 , C. Tsuji" C. 2

Hattori" K. Fujiyoshi , K. Ushijima", T. xamura", N. Hayabuchi I 1 KURUME UNIVERSITY, SCHOOL OF MEDIC., Department of Radiation Oncology, Kurume, Japan 2 KURUME UNIVERSITY, SCHOOL OF MEDIC., Department of Gynaecology and Obstetrics, Kurume, Japan

Purpose: The established procedure of choice for the treatment of early stage uterine cervical cancer is surgery in Japan. Postoperative radiation therapy is often performed, however, if patients have a high risk for recurrence. We Investigated whether small pelvic field radiation therapy (SP) after surgical treatment may reduce the risk of both recurrence and serious late complications in comparison the administration of whole pelvic field irradiation (WP). Materials: SP was performed in 37 patients with stage and A uterine cervical cancer after they had undergone a standard operation between May 2002 and August 2008. They all demonstrated a node-negative status and risk factors for recurrence, including deep stromal invasion, lymph-vascular space invasion and positive or close for viginal margin. In comparison, 32 patients had the same risk factors for recurrence as did the SP group underwent WP between January 1996 and July 2005. We compared the SP group and the WP group. Squamous cell carcinoma was observed in 21 patients (56.8%) in the SP group and in 21 patients (65.6%) in the WP group. Radiation was delivered at a dosage of 45 to 46Gy at 22 to 23 fractions for the SP group, and at a dosage of 45 to 50.4Gy at 25 to 28 fractions for the WP group. The median radiation field size for the SP and WP group were 126 and 248 ern", respectively. The median tollow-up time for the SP and WP groups were 48 and 82 months. respectively. Any observed late adverse events were graded according to the Common Toxicity Criteria and then were compared between groups. Results: No grade 3 or higher complications associated with the gastrointestinal tract were observed in the SP group, while 4 such patients (12.5%) were found in the WP group. Two (50%) of them underwent surgical treatment for severe intestinal obstruction. No patients demonstrated any serious cystitis and leg edema in either group. The 5-year overall survival rate and pelvic control rate lor the SP group were both 97.3%, whereas the same rates for the WP group were 80.5% (p=0.042) and 90.2%, respectively. lntra-pelvlc recurrence was only observed in 1 patient (2.7%) in the SP group, but in 3 patients (9.4%) in the WP group. Conclusions: Late complications related to postoperative radiation therapy tend to be serious. Using small pelvic field radiation might therefore be useful for the treatment of early stage uterine cervical cancer in node-negative status patients demonstrating a high risk of recurrence postoperatively.

884 poster THE ASSESSMENT OF THE INFLUENCE OF SELECTED CLINICAL FACTORS ON IRRADIATED FIELD REPRODUCIBILITY J. Staniaszek", B. Lincner", J. Jonska-Grnyrek", M. Kclodzieiczyk", M. Olszyna-Serernenta", A. Zawadzka", K. Bednarczyk", P Czucnraniuk", P Kaminski 1 ,R. Krynicki 3 1 THE MARIA SKLODOWSKA-CURIE MEMORIAL CANCER CENTER, Depart~ent of Radiation Oncology, Warsaw, Poland THE MARIA SKLODOWSKA-CURIE MEMORIAL CANCER CENTER, DepartTent of Medical Physics, Warsaw, Poland THE MARIA SKLODOWSKA-CURIE MEMORIAL CANCER CENTER, Department of Gynaecological Oncology, Warsaw, Poland

Purpose: The assessment of the intJuence of selected clinical factors on irradiated field reproducibilityin gynecological malignancies patients. Materials: The retrospective analysis of 92 endometrial and cervical cancer patients, staged I, II and III, according to FIGO classification, treated between 2006 and 2008 at Radiotherapy Department of Maria SklodowskaCurie Memorial Cancer Center in Warsaw, was performed. The primary and complementary irradiation with intent to-treat was done. Four patients, due to the disease progression, were excluded from the study. Finally, the analysis of 88 patients, aged between 26 and 85 years (medium 59), was performed.

CLINICALIDISEASE SITES

The images of the simulation were documented with Vision system, as the reference. During each session of irradiation (number of fractions between 12 and 39: medium 25, the standard deviation 4.37), the verification images (portal imaging), for the set correctness comparison, eventually, movement of patient according to the reference data, were done. The data were verified in real time (relative movement and its median vaiue). If the difference values of the one among the three registered directions exceeded 7 rnrn, the additional therapeutic decisions were taken. As the routine action, the verification with the simultaneous (on-line) proof of the position was used. The Clinical data in aspect of their infiuence on irradiated field reproducibility, as age, educational status, WHO status, BMI index, coexistent illnesses, diagnosis, the clinical stage of malignancy, treatment with chemotherapy, the early radiationinduced reaction of bladder and rectum intensity, the anaigetic drugs taken). The chi2 test was used. The level of statistical relevance, p=0,05, was accepted. Results: Total of 385 portal movement verifying images and 1528 vector displacements ( square root of the squares sum displacements in each ot three directions) were analyzed.The statistical significance of the obesity (BMb30.0) and the surgical treatment on irradiated field reproducibility, expressed with vector displacement value, were confirmed. Conclusions: The influence of previous treatment with surgery and the early radiation-induced reaction on irradiated field reproducibility was demonstrated.

885 poster THE EFFECTIVENESS OF FDG-PET iN RESPONSE ASSESSMENT AFTER RADiOTHERAPY IN PATIENTS WITH CERVICAL CANCER H. C. Onal", E. Oyrnak", S. Akkan Eren", E. Topkan! 1 BASKENT UNIVERSITY FACULTY OF MEDICINE, Department of Radiation Oncology, Adana, Turkey

Purpose: To evaluate the feasibility of positron emission tomography (FDGPET) in treatment response in patient diagnosed with cervicai cancer and treated with external radiotherapy (ERT) and brachytherapy (BRT) together with chemotherapy. Materials: The clinical data of 55 patients with biopsy-proven cervical cancer, treated at our clinic between December 2007 October 2009 with concurrent chemotherapy and ERTand HDR-BRT, were retrospectiveiy analyzed. Patients with distant metastasis, hysterectomized and previously irradiated were excluded from this study. Patients were treated with conformal technique with a total dose ot 50.4 Gy!1.8 Gy with concurrent weekly cisplatin and 4x7 Gy HDR-BRT PET-CT scans were taken first prior to treatment for stagi~g anc radiotherapy planninq and then after the treatment to assess the treatment response. Response assesment PET scans were taken at a median 4.1 months (ranged 1.9-21 months) after the start of treatment. Pre- and post-treatment PET-CT SUVmax values scans were compared. Results: Patients were aged between 38 and 79 years (median 59 years). FIGO stages of patients were as following: 3 patients (5%) stage IB2, 2 patients (4%) stage IIA, 36 patients (65%) stage liB, 5 patients (9%) stage IliA, 6 patients (11%) stage IIiB and 3 patients (6%) stage IVA. 47 patients (86%) were diagnosed with squamous cell carcinoma and 8 patients (14%) with adenocarclnorna. In pre-treatment PET-CT scans all patients had increased FDG uptake at the cervical region, while 27 (49%) had lncreased uptake aiso in pelvic and para-aortic lymph nodes. Mean initial SUVmax value was 19,4 (4,2 62). Posttreatment PET-CT showed increased FDG uptake in 16 patients (29%). In 4 (7%) patients the uptake was limited 10cervix, in 2 oatients (4%) only in pelvic lymphatics, and in one patient (2%) only in para-aortic lymphatics, whereas 3 patients had an increased uptake both local and in pelvic lymphatics, one patient both local and in para-aortic lymphatics. One patient had both local involvement and peritoneal metastasis. Distant metastasis was seen in 4 patients: 2 patients with liver metastasis, mediastinal involvement in 1 and cervical lymphatic involvement in 1. Patients who had FDG uptake posttreatment had significantly higher mean pretreatment SUVmax vaiues than the patients with no posttreatment FDG uptake (30,4 + 14,3 vs. 15,0 + 4,4; P < 0.001). Conclusions: FDG-PET is feasible imaging technique in assessment of treatment response in patients with cervical cancer treated with curative radiotherapy. Increased pretreatment SUVmax values significantly increases the probability of residual disease, local recurrence or distant metastasis after treatment. Longer follow-up could also show the effect of increased SUVmax values on survival.

886 poster

GYNAECOLOGICAL TUMOURS

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radiotherapy (EBRT) boost on lymph-nodes positive at CTIPET Materials: Before the beginning of concurrent chemo-radiotherapy, 28 patients with histologically proven LACC underwent an 18F-FDG PET!CT scan. In all patients the 18F-FDG PETICT images were exploited to draw the GTV 2 and positive lymph-nodes. Each patient received weekly cisplatin (40mglm ) for 5 courses during EBRT Radiotherapy (RT) was performed with a combination of EBRT (45-46 Gy on the pelvis) and intracavitary brachytherapy (BRT) at a dose of 32-36 Gy by pulsed dose/rate or 7x3 Gyl6x4 Gy by high dose/rate). EBRT was deiivered by a 4-field box technique. The eight patients with positive lymph-nodes received a boost up to a total dose of 60 Gy: EBRT was employed in 5 patients while BRT was used in the remaining 3 cases with obturator positive lymph-nodes. Acute toxicity was assessed following the RTOG-EORTC scoring system. Results: The CTIPET identified pelvic arid/or paraortic node metastases in 8128 patients (28,6%) and allowed to change the treatment planning in five cases (17,8%). 01 the five patients, who received a boost with EBRT, jour showed a complete response at the first CT/PET performed after the treatment. One patient showed a nodal relapse outside the treatment field 4 months after the end of the treatment. All patients completed the chemoradiotherapy protocol: acute grade 1-2 genitourinary (GU) toxicity was observed in all patients. The patients treated with a boost did not show higher GU toxicity than those who did not. Acute grade 1-2 gastrointestinal (GI) side effects were registered in 10 patients. All the five patients that underwent EBRT boost presented a grade 2 GI toxicity. Conclusions: 18F-FDG PETICT appears a promising tool to tailor the radiotherapy treatment planning in LACC, allowing to better define both GTV and lymph-node areas suitable for a boost. Its delivery does not seem to increase GI and GU toxicity.

887 poster TOLERANCE AND EFFICACY OF SEQUENTIONAL RADiOCHEMOTHERAPY IN PATIENTS WITH ADVANCED ENDOMETRIAL CANCER. S. Jedrus'. S. Owczarek'. H. Grzbiela ' I MSC MEMORIAL CANCER CENTER AND INSTITUTE OF ONCOLOGY GLiWICE BRANCH, III Radiotherapy Clinic, Gliwice. Poland

Purpose: The aim of the study is the evaluation of tolerance and efficacy of sequentional radiochemotherapy in patients with endometrial cancer and poor prognostic factors. Materials: 70 patients diagnosed with endometrial cancer, aged 39-74 years (average 61.3), were treated with sequentional radiochemotherapy in our department. All patients underwent surgical treatment and were diagnosed with adenocarcinoma. Grading was determined as follows: Gl 17.15%, G2 60%, G3 22.85%. 68.57% of patients were diagnosed with FIGO stage lilA and 31.43% with IIiC (SPS).The patients were treated with: External-beam radiation therapy (high energy photon beams) to the pelvis with extended fields including periaortic lymph nodes; 1.8 Gy per fraction; total dose was 51 Gy to the pelvis and 41.4-45 Gy to the periaortic lymph nodes; Chemotherapy consisting of: Cisplatin (50 mglm 2 ) , Doxorubicin (50 mg/m2 ) and Cyclophosphamide (600 mg/m2 ) administered every 21 days; patients were given three courses of chemotherapy before and three courses after the radiotherapy; HDR brachytherapy to the upper vagina (20-25 Gy to the reference point given in 4-5 fractions). Results: The toxicity of radiotherapy didn't exceed grade 2 and was found in 44.28% of patients concerning rectum and in 17.14% of patients concerning urinary bladder (according to the EORTC/RTOG scale).Nausea and vomiting were on acceptance level most patients developed grade 1 or 2 toxicity (WHO scale). Low leucocyte count grade 3 and 4 (according to the WHO scale) caused interruption of treatment after three courses of chemotherapy and completion of radiotherapy in 12.86% of patients. Withdrawn consent and aggravation of chronic diseases caused interruption of treatment in 17.14% of patientsAl1 patients are in min, 24 months follow-up. No severe late reactions to radiation therapy or haematological complications were observed. Treatrnent failure was found in 6 patients (distant metastases to lungs or liver). Conclusions: The intensified sequentional radiochemotherapy in the analysed group of patients with advanced endometrial cancer is a well-tolerated treatment with a good therapeutic effect (91.43% disease-free survival).

888 poster TOMOTHERAPY REDUCES THE DOSE TO ORGANS AT RISK FOR GYNAECOLOGICAL MALIGNANCIES S. van de pOl', M. ten Brinke ', V. A1thof I , J. lrnrnerzee!", A. Minken'

THE ROLE OF CTIPET IN THE RADIOTHERAPY TREATMENT PLANNING OF LOCALLY ADVANCED CERVICAL CANCER (LAC C) M. La Macchia", A. Galuppi", P. De taco", L. Ricci Maccarini", S. Fanti", M.

I RISO, Deventer, Netherlands

Coe ", E. Salizzoni", R. Mazzarotto ", E. Barbieri ' ) POLlCLINICO SANT'ORSOLAMALPIGHI, Bologna, Italy

Purpose: To evaluate the dose reduction in organs a risk for gynaecological patients using Tomotherapy IMRT. Materials: Sixteen patients with endometrial cancer treated with post operative radiotherapy are evaluated. They received 48.6 Gy in 27 fractions. All patients receivec a planning Ctsean in prone position on a bellyboard and a second planning Ct-scan i~ supine position for the Tornotherapy IMRT

Purpose: To evaluate in locally advanced cervical cancer (LACC) feasibility and morbidity of radical chemo-radiotherapy followed by an external beam

S308

CLINICAL/DISEASE SITES

HEAD AND NECK

treatment after informed consent. On both Ct scans the clinical target volume (CTVI and the organs at risk (OAR): small bowel, bladder and rectum were delineated, The CTV was defined as the cranial 1/2 of the vagina, bilateral parametrial tissue,presacral, internal-, and external i1iacallymph node regions, The PTV was defined as de CTV plus a 1 em margin, Patients were treated with our conformal technique using a four field box Results: Using Tomotherapy IMRT, the average irradiated volume of small bowel, bladder and rectum was reduced for the high dose levels (» 35Gy) compared to conformal therapy, See table, For all organs at risk using Tomotherapy IMRT resuIted in a larger volume of normal tissues receiving low dose « 25 Gy), especially for small bowel.

a<>WeI

Rectum

> 30Gy > 40Gy z 4SGy

> 300y > 40Gy ;:.45Gy > 30Gy

o.la4lrler ~4QGy

~45Gy

IMRT

563

297

224

92

67

53

18<

119

94

Conf.

534

470

412

9"

92

87

2_~)

223

215

Conclusions: Tomotherapy IMRT reduces the volumes of small bowel, rectum and bladder receiving a high dose in patients being irradiated post operative for gynaecologic cancer, This to a cost at larger volumes receiving a low doseWe expect reduced toxicity of the treatment with Tomotherapy IMRT.

889 poster TWICE A DAY? TOLERANCE OF ACCELERATED RADIOCHEMOTHERAPY IN PATIENTS WITH ADVANCED CERVICAL CANCER, H, Grzbiela ', S, Jedrus ' 1 MSC MEMORIAL CANCER CENTER AND INSTITUTE OF ONCOLOGY GLiWICE BRANCH, III Radiotherapy Clinic, Gliwice, Poland

Purpose: The aim of our study is to evaluate the tolerance of accelerated radiotherapy combined with chemotherapy in patients with advanced cervical cancer, Materials: 54 patients diagnosed with cervical cancer clinical stage IlIB-IVA (FIGO), aged 25-65 (average 51), were treated in our department. Analysed were only women diagnosed with squamous cell carcinoma with completed treatment and at least 12 months foliow-upWe used two models of accelerated radiotherapy with high-energy photon beams (20 MV):1, In patients with no periaortic lymph node metastases: external beam radiation therapy to the whole pelvis, two fractions a day, 1,3 Gy dose per fraction (at least 6 hours interval between fractions), total dose was 52 Gy, Midline shield was shaped according to lhe patient's anatomy and was introduced after 22 fractions.z. In patients with periaortic lymph nodes involvement: externai beam radiation therapy with extended fields inciuding the periaortic nodes and the pelvis, two fractions a day, 1,2 Gy dose per fraction (at least 6 hours interval between fractions), total dose was 40,8 Gy (midline shield introduced after 26 fractions), then a boost to the pelvis to the total dose of 52.8 Gy.Concurrent chemotherapy with clsplatin was administered weekly at a dose of 40 mg/m 2 .After completion of the radiochemotherapy patients were treated with HDR brachytherapy and received a total dose of 30 Gy in uterine cavity and 40-48 Gy in vagina. Results: Most patients developed I or II grade of haematological toxicity (WHO scale) anaemia in 31% and low leucocyte count in 76% of patients, Severe haernatological toxicity (grade III or IV) was observed in 15% of patients. 72% of patients received full planned dose of chemotherapy.Severe side-effects (grade III according to the EORTC/RTOG scale) concerning lower alimentary tract were observed in 18.5% of patients. Early reactions of the urinary bladder dion't exceed grade II toxicity (13%). In the analysed group a complete response was achieved by 65% of patients. Conclusions: Accelerated radiotherapy combined with chemotherapy is a well-tolerated treatment, with an acceptable toxicity level, in patients with advanced carcinoma of the uterine cervix.

Clinical/Disease sites neck

Head and

890 poster 18F-FDG-PET GUIDED DOSE PAINTING IMRT IN OROPHARYNGEAL SCC: TCP AND NTCP VARIATIONS WITH DOSE AND AUTOMATED SEGMENTATION M. Lei" E. Adams", C. Clark", J. Crawshaw", S. Reise 2 , D, Rickard 2 , R. Jena", N. Kirkby", M. Hart", D. Visvikis 5 , J. Ha1l 3 , T. Jordan", S. Whitaker 1 ,

A. Nisbet", T. Guerrero-Urbano] 1 ROYAL SURREY COUNTY HOSPITAL Clinical Oncology, Guildford, Uni1ed Kingdom 2 ROYAL SURREY COUNTY HOSPITAL, Medical Physics, Guildford, United Kingdom 3 ROYAL SURREY COUNTY HOSPITAL, Radiology. Guildford, United Kingdom 4 UNIVERSITY OF SURREY, Faculty of Engineering and Physical Sciences. Guildford, United Kingdom 5 INSERM U650 LATIM, Brest, France G GUILDFORD DIAGNOSTIC IMAGING, ALLIANCE MEDICAL. Guildford, United Kingdom

Purpose: To evaluate the impact of dose-painting-IMRT 10 18F-FDG-PET avid biological GTV{b) as identified by different segmentation techniques. Materials: Co-registered 18F-FDG-PET and CT scans for five patients with SCC oropharynx were imported into Eclipse v8.2 (Varian Medical Systems). Target volume definition was performed as per departmental guidelines. The metabolically active ]8F-FDG avid GTVb(M) was manually contoured, On the basis of a previously reported volumetric and morphometric analysis of automated segmentation algorithms, 3 were selected for evaluation in this study: (i) a threshold of 36% of maximal signal intensity (GTVb36%), (ii) SUV of 2.5 (GTVbSUV2.5) and (iii) a Fuzzy Locally Adaptive Bayesian algorithm (GTVbflab). SIB-IMRT was planned to deliver 65Gy in 30 fractions to the PTV1 and 54Gy in 30 fractions to the PTV2, The GTVbM was dose painted to receive 100-115% of the PTV1 dose, in 5% dose increments. Estimates 01 TCP and NTCP were calculated using Biosulte software. Results: Dose volume objectives and constraints for PTV, spinal cord and contralateral parotid were achieved in all patients. Table 1 shows dosimetric, TCP and NTCP results. The median GTVbM V100 achieved to the different dose levels decreased as the dose increased with V100 of 78.4% at 71.5Gy and 70.2% at 74.75Gy observed on a patient with a GTVbM measuring 70cm 3 reflecting challenges of dose escalation for large volumes. Increases in estimaled TCP values were observed at all dose levels, No parameters for acute mucositis or late oropharyngeal toxicity have been published. Using oesophageal based parameters as an approximation, no significant changes in estimated acute NTCP were Observed. However, for late toxicity significant increases were observed particularly when the DVH on partial organ (tongue base) were input into the model. Doses to the pharyngeal constrictor muscles were similar for all dose levels. Dosimetry and TCP values for DVHs calculated for the automatically segmented GTVbs show reductions in V100 at the higher dose levels but only small reductions in estimated TCP values.

Gnt. IfIOln'"1l ....lI!'diiH- t4IIfIq-e

G'M>M eTIb3ft%.

G'M>SUYl.' 'M>....

%

W~G.

1168.25Gv

Y71.5Gu

V14.75Gv

99.5 8';3-too 925 85.6-mf 89.6 (~3.4-1ro

99.2 92.4-10dl

988 88.4--JOO

100 69.4--100

939 C7aHa5l 79,9 (39,3'-HLt! 7G9(2<9-9S?'l 99.3(#.&100

81,3 (7CL2·91.1

$6 $,9--10GI 96.S 465-911

so.e 34.7-100 722('>06-94.'" 9a4f38I·"'.~

TCP '0/0 Medin r
G'M>M GTVb36%

GMSUY2.5

G'M>fl...

E4 52.3-69.6)

65.2 51.9-7"-,,1 62,1 51.3-67,51 68.4 Sl,&69,ill

67.7 57,7-73

71.5(625-759)

66.3 $.9-74.6 65,5 55.9-71,4 72,5 57,9-738

67,5 59.5-14.9i

AcuteNTCP Tongue but!'

84 El3H5,;J

\'AlDie "na'lJlli!

77(76.3-&1-

as, I

TongQeb;lse 'YAIoleton'llQe

...... ... ~"" ~

Pes Y65 pt,

SPC+MPC

24,3 19.9-34. 17.4(10,9-2>1,8)

I

759 62-7~9) o Median ranGe

84.9-87,4

79.3 7/'.2--864 La~NTCP

7~4 67,7-78.4) 77.3 63,9-",.1) 6.2 621-77.:Ji 7a4 657-79,ill

67(60.8-77.8

8~1

87,1 8M-'l;.91 80.2 71.6·91.6)

85.7-9111

77.B 76.8-88.7) %

40,3 33.1·526 334 (1~8-
~edi.an rn.e)

535 456-~ 334(231-701)

I

79.3 67.7-99.g) 49.9 (35.6·93,1)

PhiJryngeal c:onstrictors V50/V60/W5 Gy Medi.a.n (r;lnge)

I

89;4 71.4--1

73,8(57,o-n~ I 33.8-67,4'1 I

57.6(41.3-64.

8'9.1 &":I2-1OJ)

&I."

61. 7 49.3-f,5.065.7 65.2-65,1)

I I

89,' 70.8-100 740 5~3..<:j9.E. 559 47,1-654 Mean dosf! GV'I'1edi.a.n ranoel

89,7 67.8·100 741 552-99,51 5'5.8 487·61,8)

622

5!)2~·5,3

6~4

65.7-67,1

627(49.9·65.41 66.4 058·67,8'1

7.18(56,1·99-

61.8 49,7·650 66.1 f5.4-6E.4"

Conclusions: Dose escalation of 18F-FDG-PET avid subvolumes is feasible. A dose level of 71.5Gy gives an increase in median estimated TCP of 7,5% for an estimated increase in late tongue NTCP of 16% versus 10.4% and 32.5% respectively for a dose level of 74.75Gy and the former seems a reasonable dose to be tested clinically. Automatic segmentation of GTVbs has little impact on estimated TCP.

891 poster