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EP-1057 BODY GAMMA-KNIFE RADIOSURGERY FOR SMALL HEPATOCELLULAR CARCINOMA
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(15%) were stage IB, 2 patients (10%) were stage IIA and 15 patients (75%) were stage IIB. Surgical margins were positive in 7 patients (35%). The full course of radiation therapy (45 Gy) was completed by all patients, as well as for the CT protocol. A total of 15 relapses (88.2%) were recorded: 11 local relapses (68.8%), 10 regional relapses (62.5%) and 9 distant relapses (56.3%). By the end of our study, 4 patients (22.2%) were still alive. Median disease-free survival was about 6.2 months (95% CI 2.3 – 10.1) with significant advantage in favour of stage IB patients (median DFS 11.8 months, mean DFS 41.6 mo). A median survival of 18 months was achieved without statistical differences between stages. Overall Survival was 34.8% at 2 years, 13.9% at 5 years. Gastro-intestinal toxicity was most frequent: 12 patients (66.7%) developed nausea, mostly (58.8%) grade I. 8 patients (47%) developed diarrhea among which 75% were grade I. We recorded 3 episodes (23%) of febrile neutropenia, 7 patients (43.8%) suffered of neutropenia while 5 patients (33%) had anemia. 12 patients (80%) required multiple admissions to the hospital. Conclusions: Adjuvant chemoradiation for locally resectable pancreatic cancer is one of the standards in our institution. Our results show acceptable improvement in MS, median DFS and OS at 2/5 years, with tolerable side effects. However longer follow-up and larger sample size are needed to obtain more accurate data. EP-1055 INVESTIGATING LONGCOURSE CHEMORADIOTHERAPY REGIMEN FOR RECTAL CANCER WITH BOSSETT, WEEKLY 5FU AND CAPECITABINE S. Aslam1, M. King1, M. Churn1 1 New Cross Hospital, Oncology, Wolverhampton, United Kingdom Purpose/Objective: We conducted a retrospective audit to test the hypothesis that concurrent Capecitabine based chemotherapy given with long course radiotherapy for rectal cancer was equivalent in terms of side effect and response to 5FU based chemotherapy. Three concurrent chemotherapy regimens are used at New Cross Hospital, Bossett Regime (Folinic Acid 20mg/m2 FU 350mg/m2 Day 1-5 and 2933), Weekly 5FU 350mg/m2 Days 1-5 and capecitabine 825mg/m2 twice daily with radiotherapy 45-50.4 Gray in 25 fractions. Materials and Methods: A database of patients were obtained of patients treated at New Cross hospital who had long course chemoradiotherapy for colorectal cancer from the August 2010 to January 2011. Patient records and radiotherapy treatment charts were analysed and performance status and toxicities were documented using common toxicity criteria. Results: Thirty six patients were treated with long course chemoradiotherapy for their rectal carcinoma. There was no significant difference between the three chemotherapy regimens in terms of hand and foot syndrome, neutropenia and skin reaction. The main toxicity was diarrhoea with over twice as many patients experience diarrhoea with capecitabine. Of those surgical specimens analysed postoperatively there was not significant difference in response. Conclusions: There is no clear consensus on which chemotherapy regimen should be used with long course chemoradiotherapy. Regimens are often chosen on the basis of the patient’s performance status. This audit shows there are no significant differences in the toxicities between the different schedules except for diarrhoea which is increased with capecitabine. Some of the implications of this audit would mean the use of oral chemotherapy would free up time and space in the chemotherapy department and would lead to substantial savings in the department. Patients should be selected carefully for oral fluropyrimadines with long course radiotherapy. EP-1056 THE IMPORTANCE OF AN EXPERIENCED MULTI-DISCIPLINARY TEAM IN THE TREATMENT OF RECTAL CANCER O. Zoleto1, J. Quirós1, J. Muñoz1, J. Cabrera1, Y. Rios1, E. Capelo1, A. Corbacho1, M.F. Ropero1 1 Hospital Universitario Infanta Cristina, Radiation Oncology, Badajoz, Spain Purpose/Objective: To compare the results of local recurrence free survival (LRFS), disease-free survival (DFS), cancer specific free survival (CSFS) and overall survival (OS), in patients with locally advanced carcinoma of rectum treated with QT-RT neoadjuvant divided into two groups those treated in our Center and belonging to the Viking project versus those who were treated in other hospitals. Materials and Methods: Retrospective cohort studies of 103 patients (pts) with locally advanced adenocarcinoma of rectum treated with
ESTRO 31
neoadjuvant QT-RT from October 2002 until March of 2011. Median age: 64 years (28 – 84). 73.6% were men. The medium and low rectum were the most frequent localization (41.7 % and 42.7% respectively ). Clinical diagnosis was carried out by MRI and endorrectal ultrasound in the 59.2% and 47.3%, respectively. All patients received mono or polychemotherapy in base a fluoropirimidines and 3D conformal radiotherapy at a media dose of 50,4 Gy (45 – 54Gy)/1.8 Gy fraction/day/5 days a week in 5.4 weeks, with photons of 18 MV. The media delay of the start of radiotherapy was 72.7 days (17 – 189). After the neoadjuvant treatment 89.3% of the pts were operated (33.7 % of the Viking project and 66.3 % in other hospitals). The type of surgery was low anterior resection in 48.5% of the patients and amputation abdominoperineal in 38.8%. Due to progression of disease and rejection 11 cases did not have surgery, which were not analyzed. Results: Median follow up: 36.35 months (2 – 98), Viking group showed 19.4% pathological complete response and 38.7% partial response. The median of OS, CSFS, DFS and LRFS in both groups were: 82 vs 34; 93 vs 34; 75 vs 31 and 85 vs 34 months respectively. The CSFS, DFS and LRFS at 2 year for the study group were: 80.5%; 82.8%; 96.2% respectively. Conclusions: In our experience the neoadjuvant RTQT offers good survival rates with significant reduction of locoregional recurrence, comparable to the published clinical trials. Due to the number of patients, and poor follow-up no statistically significant differences between groups of study, on the other hand, patients in the Viking project showed better results in local control and higher rates of pathological complete response. EP-1057 BODY GAMMA-KNIFE RADIOSURGERY FOR SMALL HEPATOCELLULAR CARCINOMA G. Li1, Y. Wang1, Y. Zhao1, S. Jin1, Y. Gao1 1 Chinese People's Armed Police Forces General Hospital, Dept.of Radiation Oncology, Beijing, China Purpose/Objective: To evaluate the efficacy and toxicity of body gamma-knife for the treatment of small hepatocellular carcinoma (SHCC). Materials and Methods: During Jan 2005 to Oct 2007, 22 patients with SHCC (21 men and 1 woman, mean age 55 years, range 44-71, The median tumor diameter was 2 cm) were treated with body gammaknife radiosurgery at cancer center, The Chinese People's Armed Police Forces General Hospital : A total dose of 36-50 Gy was delivered at 4-5 Gy/fraction to the 50%-70% isodose line covering the planning target volume. Magnetic Resonance Imaging (MRI) was obtained every 2-3 months following body gamma-knife. Follow-up MRI was possible in 22 patients at a mean follow-up duration of 35.5 months (range, 3-69). The records of all patients were reviewed, and treatment response was scored according to Response Evaluation Criteria in Solid Tumors v1.1. Toxicity was graded according to the Common Terminology Criteria for Adverse Events v4.0. Local control (LC), Cumulative survival rates and overall survival (OS) were calculated according to the method of Kaplan and Meier. Results: Three months after treatment, the overall response rate for body-gamma knife radiosurgery was 72.73%.Follow-up MRI showed tumor disappearance in 4, tumor shrinkage in 12, no change in tumor size in 4, and tumor growth in 2 patients, which translated into a local tumor control rate of 90.9% (20 of 22 tumors). The 1, 2, 3 year Cumulative survival rates of SHCC were 81.20%, 68.7% and 62.4%, respectively. The overall survival time after GKRS was 40.0 months. 8(36.36%) died due to SHCC, hepatic failure or complications of cirrhosis, and other causes by October 2010. The side effects are slight and there is no serious radiation liver injury. Conclusions: The treatment of small hepatocellular carcinoma (SHCC) by γ-knife is safe, feasible, low toxicity can be tolerated. EP-1058 ADJUVANT CHEMORADIOTHERAPY FOR GASTRIC ADENOCARCINOMA OPERATED WHITH COMPLETE MACROSCOPIC LYMPHADENECTOMY=D2 M. Eguiguren1, S. Caffiero1, G. Rodriguez1, C. Blanco1, A. Querejeta1, E. Guimon1, I. Uranga1, J.M. Urraca1, J.P. Ciria1, J. Minguez1 1 Hospital Donostia, Department of Radiotherapy, San Sebastian, Spain Purpose/Objective: The adjuvant therapy in gastric adenocarcinoma is supported by the U.S. Intergroup INT-0116. To apply the same treatment and see if the results are comparable. Materials and Methods: In our study we included 93p. with gastric adenocarcinoma underwent to surgery R0 -1 and D2 lymphadenectomy who received adjuvant QTRT like INT-0116 scheme.
(15%) were stage IB, 2 patients (10%) were stage IIA and 15 patients (75%) were stage IIB. Surgical margins were positive in 7 patients (35%). The full course of radiation therapy (45 Gy) was completed by all patients, as well as for the CT protocol. A total of 15 relapses (88.2%) were recorded: 11 local relapses (68.8%), 10 regional relapses (62.5%) and 9 distant relapses (56.3%). By the end of our study, 4 patients (22.2%) were still alive. Median disease-free survival was about 6.2 months (95% CI 2.3 – 10.1) with significant advantage in favour of stage IB patients (median DFS 11.8 months, mean DFS 41.6 mo). A median survival of 18 months was achieved without statistical differences between stages. Overall Survival was 34.8% at 2 years, 13.9% at 5 years. Gastro-intestinal toxicity was most frequent: 12 patients (66.7%) developed nausea, mostly (58.8%) grade I. 8 patients (47%) developed diarrhea among which 75% were grade I. We recorded 3 episodes (23%) of febrile neutropenia, 7 patients (43.8%) suffered of neutropenia while 5 patients (33%) had anemia. 12 patients (80%) required multiple admissions to the hospital. Conclusions: Adjuvant chemoradiation for locally resectable pancreatic cancer is one of the standards in our institution. Our results show acceptable improvement in MS, median DFS and OS at 2/5 years, with tolerable side effects. However longer follow-up and larger sample size are needed to obtain more accurate data. EP-1055 INVESTIGATING LONGCOURSE CHEMORADIOTHERAPY REGIMEN FOR RECTAL CANCER WITH BOSSETT, WEEKLY 5FU AND CAPECITABINE S. Aslam1, M. King1, M. Churn1 1 New Cross Hospital, Oncology, Wolverhampton, United Kingdom Purpose/Objective: We conducted a retrospective audit to test the hypothesis that concurrent Capecitabine based chemotherapy given with long course radiotherapy for rectal cancer was equivalent in terms of side effect and response to 5FU based chemotherapy. Three concurrent chemotherapy regimens are used at New Cross Hospital, Bossett Regime (Folinic Acid 20mg/m2 FU 350mg/m2 Day 1-5 and 2933), Weekly 5FU 350mg/m2 Days 1-5 and capecitabine 825mg/m2 twice daily with radiotherapy 45-50.4 Gray in 25 fractions. Materials and Methods: A database of patients were obtained of patients treated at New Cross hospital who had long course chemoradiotherapy for colorectal cancer from the August 2010 to January 2011. Patient records and radiotherapy treatment charts were analysed and performance status and toxicities were documented using common toxicity criteria. Results: Thirty six patients were treated with long course chemoradiotherapy for their rectal carcinoma. There was no significant difference between the three chemotherapy regimens in terms of hand and foot syndrome, neutropenia and skin reaction. The main toxicity was diarrhoea with over twice as many patients experience diarrhoea with capecitabine. Of those surgical specimens analysed postoperatively there was not significant difference in response. Conclusions: There is no clear consensus on which chemotherapy regimen should be used with long course chemoradiotherapy. Regimens are often chosen on the basis of the patient’s performance status. This audit shows there are no significant differences in the toxicities between the different schedules except for diarrhoea which is increased with capecitabine. Some of the implications of this audit would mean the use of oral chemotherapy would free up time and space in the chemotherapy department and would lead to substantial savings in the department. Patients should be selected carefully for oral fluropyrimadines with long course radiotherapy. EP-1056 THE IMPORTANCE OF AN EXPERIENCED MULTI-DISCIPLINARY TEAM IN THE TREATMENT OF RECTAL CANCER O. Zoleto1, J. Quirós1, J. Muñoz1, J. Cabrera1, Y. Rios1, E. Capelo1, A. Corbacho1, M.F. Ropero1 1 Hospital Universitario Infanta Cristina, Radiation Oncology, Badajoz, Spain Purpose/Objective: To compare the results of local recurrence free survival (LRFS), disease-free survival (DFS), cancer specific free survival (CSFS) and overall survival (OS), in patients with locally advanced carcinoma of rectum treated with QT-RT neoadjuvant divided into two groups those treated in our Center and belonging to the Viking project versus those who were treated in other hospitals. Materials and Methods: Retrospective cohort studies of 103 patients (pts) with locally advanced adenocarcinoma of rectum treated with
ESTRO 31
neoadjuvant QT-RT from October 2002 until March of 2011. Median age: 64 years (28 – 84). 73.6% were men. The medium and low rectum were the most frequent localization (41.7 % and 42.7% respectively ). Clinical diagnosis was carried out by MRI and endorrectal ultrasound in the 59.2% and 47.3%, respectively. All patients received mono or polychemotherapy in base a fluoropirimidines and 3D conformal radiotherapy at a media dose of 50,4 Gy (45 – 54Gy)/1.8 Gy fraction/day/5 days a week in 5.4 weeks, with photons of 18 MV. The media delay of the start of radiotherapy was 72.7 days (17 – 189). After the neoadjuvant treatment 89.3% of the pts were operated (33.7 % of the Viking project and 66.3 % in other hospitals). The type of surgery was low anterior resection in 48.5% of the patients and amputation abdominoperineal in 38.8%. Due to progression of disease and rejection 11 cases did not have surgery, which were not analyzed. Results: Median follow up: 36.35 months (2 – 98), Viking group showed 19.4% pathological complete response and 38.7% partial response. The median of OS, CSFS, DFS and LRFS in both groups were: 82 vs 34; 93 vs 34; 75 vs 31 and 85 vs 34 months respectively. The CSFS, DFS and LRFS at 2 year for the study group were: 80.5%; 82.8%; 96.2% respectively. Conclusions: In our experience the neoadjuvant RTQT offers good survival rates with significant reduction of locoregional recurrence, comparable to the published clinical trials. Due to the number of patients, and poor follow-up no statistically significant differences between groups of study, on the other hand, patients in the Viking project showed better results in local control and higher rates of pathological complete response. EP-1057 BODY GAMMA-KNIFE RADIOSURGERY FOR SMALL HEPATOCELLULAR CARCINOMA G. Li1, Y. Wang1, Y. Zhao1, S. Jin1, Y. Gao1 1 Chinese People's Armed Police Forces General Hospital, Dept.of Radiation Oncology, Beijing, China Purpose/Objective: To evaluate the efficacy and toxicity of body gamma-knife for the treatment of small hepatocellular carcinoma (SHCC). Materials and Methods: During Jan 2005 to Oct 2007, 22 patients with SHCC (21 men and 1 woman, mean age 55 years, range 44-71, The median tumor diameter was 2 cm) were treated with body gammaknife radiosurgery at cancer center, The Chinese People's Armed Police Forces General Hospital : A total dose of 36-50 Gy was delivered at 4-5 Gy/fraction to the 50%-70% isodose line covering the planning target volume. Magnetic Resonance Imaging (MRI) was obtained every 2-3 months following body gamma-knife. Follow-up MRI was possible in 22 patients at a mean follow-up duration of 35.5 months (range, 3-69). The records of all patients were reviewed, and treatment response was scored according to Response Evaluation Criteria in Solid Tumors v1.1. Toxicity was graded according to the Common Terminology Criteria for Adverse Events v4.0. Local control (LC), Cumulative survival rates and overall survival (OS) were calculated according to the method of Kaplan and Meier. Results: Three months after treatment, the overall response rate for body-gamma knife radiosurgery was 72.73%.Follow-up MRI showed tumor disappearance in 4, tumor shrinkage in 12, no change in tumor size in 4, and tumor growth in 2 patients, which translated into a local tumor control rate of 90.9% (20 of 22 tumors). The 1, 2, 3 year Cumulative survival rates of SHCC were 81.20%, 68.7% and 62.4%, respectively. The overall survival time after GKRS was 40.0 months. 8(36.36%) died due to SHCC, hepatic failure or complications of cirrhosis, and other causes by October 2010. The side effects are slight and there is no serious radiation liver injury. Conclusions: The treatment of small hepatocellular carcinoma (SHCC) by γ-knife is safe, feasible, low toxicity can be tolerated. EP-1058 ADJUVANT CHEMORADIOTHERAPY FOR GASTRIC ADENOCARCINOMA OPERATED WHITH COMPLETE MACROSCOPIC LYMPHADENECTOMY=D2 M. Eguiguren1, S. Caffiero1, G. Rodriguez1, C. Blanco1, A. Querejeta1, E. Guimon1, I. Uranga1, J.M. Urraca1, J.P. Ciria1, J. Minguez1 1 Hospital Donostia, Department of Radiotherapy, San Sebastian, Spain Purpose/Objective: The adjuvant therapy in gastric adenocarcinoma is supported by the U.S. Intergroup INT-0116. To apply the same treatment and see if the results are comparable. Materials and Methods: In our study we included 93p. with gastric adenocarcinoma underwent to surgery R0 -1 and D2 lymphadenectomy who received adjuvant QTRT like INT-0116 scheme.