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EP-1241: Locally advanced gastroesophageal junction cancer: Neoadjuvant treatment with VMAT and concomitant chemotherapy
ESTRO 33, 2014
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correlations (p<0.05) were found between DVHs and arm stiffness, arm pain, use of arm and arm/shoulder abduction, typically for shoulder/arm volumes receiving doses ≥ 15 Gy (V15).
limit radiation dose scalation with 3-dimensional conformal RT. Our aim was to compare two RT schemes and evaluate the toxicity profile using dose volume histogram (DVH) data.
Conclusions: 3D conformal locoregional radiotherapy of breast cancer results in long-term arm/shoulder morbidity. Large shoulder volumes receiving doses of ≥15 Gy should be avoided to minimize the risk.
Materials and Methods: We evaluated 16 patients with rectal cancer (IIA-IIIC), treated with neoadjuvant RT. All were treated in prone position with a belly board. For each patient, 2 dose-plans were calculated: scheme 1: 45 Gy and scheme 2: 50.4 Gy. For each scheme, bladder, femoral head and neck, small and large bowel (individual loops), bowel bag doses and DVH metrics (V45, V50, maximum and mean dose of all OARs and V150 and V195cc of small/large bowel and bowel bag) were recorded.
ELECTRONIC POSTER: CLINICAL TRACK: GASTROINTESTINAL TUMOURS (UPPER AND LOWER GI) EP-1241 Locally advanced gastroesophageal junction cancer: Neoadjuvant treatment with VMAT and concomitant chemotherapy A. Tozzi1, C. Iftode1, T. Comito1, M.C. Campisi1, P. Navarria1, E. Clerici1, G. Maggi1, P. Mancosu1, A. Stravato1, M. Scorsetti1 1 Humanitas Clinical and Research Center, Radiotherapy and Radiosurgery, Rozzano (Milan), Italy Purpose/Objective: In patients with locally advanced gastro-esophageal junction cancer, neoadjuvant concurrent chemo-radiotherapy increases the rate of disease local control. The aim of our study was to evaluate the feasibility and effectiveness of volumetric modulated radiation therapy (VMAT) and concomitant chemotherapy in the neoadjuvant setting for patients with locally advanced gastroesophageal junction cancer. Materials and Methods: Patients with locally advanced gastroesophageal junction cancer, age <70 years and good performance status (PS 0-1) underwent to concurrent chemo-radiotherapy. Multidisciplinary assessment was performed for all patients. Total body computed tomography (CT) scan, FDG positron emission tomography (PET) and esophagogastroduodenoscopy with biopsy were performed in each patient before treatment and 2 months after the end of neoadjuvant treatment for planning surgery. The histology was adenocarcinoma in 13 cases and squamous cell carcinoma in the remaining 3 patients. Simulation CT scan was performed with intravenous and oral contrast enhancement and all patients were immobilised by means of a thermoplastic body mask. Radiation treatment was performed with VMAT. Eleven patients received chemotherapy with platinum and fluorine (Al- Sarraf), and concomitant radiotherapy up to total dose of 45Gy/25 fractions. Five patients underwent chemotherapy with platinum and Paclitaxel (CROSS protocol) and concomitant radiotherapy up to total dose of 41.4 Gy/23 fr. Cone beam CT imaging (CBCT) was performed before every treatment session to verify the exact position of the patient. Acute toxicity were evaluated by RTOG score. Evaluation of tumour response was defined according to the Response Evaluation Criteria in Solid Tumor (RECIST) v.1.1. Results: Between January 2011 and September 2013 were treated 16 patients. In 90 % of cases the treatment was completed without interruption. Acute esophageal toxicity Grade 2 occurred in 23% of patients. No grade 3 toxicity occurred. Local control was 100 % at 2 months after the end of treatment. Thirteen patients underwent surgery with pathological complete response in 46% of cases (6/13) and pathological partial response in 64% of cases (7/13). In 3 patients has not been shown to proceed with surgery for distant progression of disease. Conclusions: Radiation treatment with VMAT technique and concomitant chemotherapy in locally advanced gastro-esophageal junction cancer is well tolerated, with an acceptable rate of acute toxicity and it is associated with good local control. EP-1242 Dosimetric comparison among 45 and 50.4Gy in neoadjuvant radiotherapy for rectal cancer. Preliminary results E. Jimenez1, P. Mateos2, J. Pardo1, J.C. Font2, A. Mena1, I. Alastuey1, S. Montemuiño1, C. Chiaramello1, L. Bodi1, S. Sabater3 1 Hospital Universitari Son Espases, Radiation Oncology Research Group. IBS, Palma de Mallorca, Spain 2 Hospital Universitari Son Espases, Medical Physics Department, Palma de Mallorca, Spain 3 Complejo Hospitalario Universitario de Albacete, Radiation Oncology Department, Albacete, Spain Purpose/Objective: Neoadjuvant radiotherapy (RT) and chemotherapy are standard treatment in locally advanced rectal cancer. RT accurate dose is not clearly established. Doses between 45 Gy-50.4 Gy are commonly used. Studies suggest that dose increase correlates with a pathological complete response. However, pelvic organs at risk (OAR)
Results: Only small differences between schemes were observed, with respect to V45, V50 and volumetric measurements. Regarding mean dose received for small bowel (17.3-Gy scheme1 versus 17.9-Gy scheme2; p = 0,585), for large bowel (23.7-Gy scheme1 versus 23.8-Gy scheme2; p = 0.665) and for bowel bag (19.7-Gy scheme1 versus 20.4-Gy scheme2; p = 0.585) no significant differences were found. However, large maximum dose values were observed with scheme 2. Bladder was the OAR that most increased the dose absorbed with scheme 2, especially considering maximum dose (probably because of its proximity to boost area). Table 1 summarizes DVH values according to dose-scheme.
Conclusions: Both schemes respected OARs dose-constraints. We found similar DHV-metrics to OARs according to the final dose (45 or 50.4Gy). This is especially remarkable for the most radiosensitive OARs, the bowel bag and small bowel. Because DHV-data of small bowel and bowel bag are very similar we recommend contouring bowel bag due to the rapidity. Regarding bladder, the increment of dose absorbed is compensated by its radioresistence. As all reported studies suggest that dose increasing improves outcomes, and according our preliminary results, we recommend dose escalation to at least 50.4Gy in the neoadjuvant setting. EP-1243 Neoadjuvant treatment of Klatskin Tumours (KT) with Stereotactic Body Radiotherapy (SBRT) & Capecitabine O. Hernando Requejo1, M. López1, R. Ciervide1, J. Valero1, M.O. GarcíaAranda1, E. Sanchez1, E. Vicente2, A. Cubillo3, Y. Quijano2, C. Rubio2 1 Hospital Universitario Madrid Sanchinarro - Grupo Hospital de Madrid, Radiation Oncology, Madrid, Spain 2 Hospital Universitario Madrid Sanchinarro - Grupo Hospital de Madrid, Surgical Oncology, Madrid, Spain 3 Hospital Universitario Madrid Sanchinarro - Grupo Hospital de Madrid, Medical Oncology, Madrid, Spain Purpose/Objective: KTs are the primary cancer of the bile ducts arising from malignant transformation of cholangiocites. According to BismuthCorlette classification, tipe IV non-multifocal cholangio carcinomas are those extending to the bifurcations of both right and left hepatic ducts. The objective of this study is to analyze the potential role of SBRT combined with capecitabine as neoadjuvant treatment for locallyadvanced Klastkin tumours. Materials and Methods: From August 2008 to January 2011 we treated 9 patients with a Novalis LINAC. All the patients where treated according to our G-I tumour board protocol with SBRT and Capecitabine as a neoadjuvant combined treatment. Surgery was planned on a second time after initial chemoradiation. The outlined PTV includes CTV=GTV + 5 mm margin. Previous to treatment, a internal marker is placed near de tumour, this is necessary for respiratory gating where the tumour is strictly irradiated in a
S69
correlations (p<0.05) were found between DVHs and arm stiffness, arm pain, use of arm and arm/shoulder abduction, typically for shoulder/arm volumes receiving doses ≥ 15 Gy (V15).
limit radiation dose scalation with 3-dimensional conformal RT. Our aim was to compare two RT schemes and evaluate the toxicity profile using dose volume histogram (DVH) data.
Conclusions: 3D conformal locoregional radiotherapy of breast cancer results in long-term arm/shoulder morbidity. Large shoulder volumes receiving doses of ≥15 Gy should be avoided to minimize the risk.
Materials and Methods: We evaluated 16 patients with rectal cancer (IIA-IIIC), treated with neoadjuvant RT. All were treated in prone position with a belly board. For each patient, 2 dose-plans were calculated: scheme 1: 45 Gy and scheme 2: 50.4 Gy. For each scheme, bladder, femoral head and neck, small and large bowel (individual loops), bowel bag doses and DVH metrics (V45, V50, maximum and mean dose of all OARs and V150 and V195cc of small/large bowel and bowel bag) were recorded.
ELECTRONIC POSTER: CLINICAL TRACK: GASTROINTESTINAL TUMOURS (UPPER AND LOWER GI) EP-1241 Locally advanced gastroesophageal junction cancer: Neoadjuvant treatment with VMAT and concomitant chemotherapy A. Tozzi1, C. Iftode1, T. Comito1, M.C. Campisi1, P. Navarria1, E. Clerici1, G. Maggi1, P. Mancosu1, A. Stravato1, M. Scorsetti1 1 Humanitas Clinical and Research Center, Radiotherapy and Radiosurgery, Rozzano (Milan), Italy Purpose/Objective: In patients with locally advanced gastro-esophageal junction cancer, neoadjuvant concurrent chemo-radiotherapy increases the rate of disease local control. The aim of our study was to evaluate the feasibility and effectiveness of volumetric modulated radiation therapy (VMAT) and concomitant chemotherapy in the neoadjuvant setting for patients with locally advanced gastroesophageal junction cancer. Materials and Methods: Patients with locally advanced gastroesophageal junction cancer, age <70 years and good performance status (PS 0-1) underwent to concurrent chemo-radiotherapy. Multidisciplinary assessment was performed for all patients. Total body computed tomography (CT) scan, FDG positron emission tomography (PET) and esophagogastroduodenoscopy with biopsy were performed in each patient before treatment and 2 months after the end of neoadjuvant treatment for planning surgery. The histology was adenocarcinoma in 13 cases and squamous cell carcinoma in the remaining 3 patients. Simulation CT scan was performed with intravenous and oral contrast enhancement and all patients were immobilised by means of a thermoplastic body mask. Radiation treatment was performed with VMAT. Eleven patients received chemotherapy with platinum and fluorine (Al- Sarraf), and concomitant radiotherapy up to total dose of 45Gy/25 fractions. Five patients underwent chemotherapy with platinum and Paclitaxel (CROSS protocol) and concomitant radiotherapy up to total dose of 41.4 Gy/23 fr. Cone beam CT imaging (CBCT) was performed before every treatment session to verify the exact position of the patient. Acute toxicity were evaluated by RTOG score. Evaluation of tumour response was defined according to the Response Evaluation Criteria in Solid Tumor (RECIST) v.1.1. Results: Between January 2011 and September 2013 were treated 16 patients. In 90 % of cases the treatment was completed without interruption. Acute esophageal toxicity Grade 2 occurred in 23% of patients. No grade 3 toxicity occurred. Local control was 100 % at 2 months after the end of treatment. Thirteen patients underwent surgery with pathological complete response in 46% of cases (6/13) and pathological partial response in 64% of cases (7/13). In 3 patients has not been shown to proceed with surgery for distant progression of disease. Conclusions: Radiation treatment with VMAT technique and concomitant chemotherapy in locally advanced gastro-esophageal junction cancer is well tolerated, with an acceptable rate of acute toxicity and it is associated with good local control. EP-1242 Dosimetric comparison among 45 and 50.4Gy in neoadjuvant radiotherapy for rectal cancer. Preliminary results E. Jimenez1, P. Mateos2, J. Pardo1, J.C. Font2, A. Mena1, I. Alastuey1, S. Montemuiño1, C. Chiaramello1, L. Bodi1, S. Sabater3 1 Hospital Universitari Son Espases, Radiation Oncology Research Group. IBS, Palma de Mallorca, Spain 2 Hospital Universitari Son Espases, Medical Physics Department, Palma de Mallorca, Spain 3 Complejo Hospitalario Universitario de Albacete, Radiation Oncology Department, Albacete, Spain Purpose/Objective: Neoadjuvant radiotherapy (RT) and chemotherapy are standard treatment in locally advanced rectal cancer. RT accurate dose is not clearly established. Doses between 45 Gy-50.4 Gy are commonly used. Studies suggest that dose increase correlates with a pathological complete response. However, pelvic organs at risk (OAR)
Results: Only small differences between schemes were observed, with respect to V45, V50 and volumetric measurements. Regarding mean dose received for small bowel (17.3-Gy scheme1 versus 17.9-Gy scheme2; p = 0,585), for large bowel (23.7-Gy scheme1 versus 23.8-Gy scheme2; p = 0.665) and for bowel bag (19.7-Gy scheme1 versus 20.4-Gy scheme2; p = 0.585) no significant differences were found. However, large maximum dose values were observed with scheme 2. Bladder was the OAR that most increased the dose absorbed with scheme 2, especially considering maximum dose (probably because of its proximity to boost area). Table 1 summarizes DVH values according to dose-scheme.
Conclusions: Both schemes respected OARs dose-constraints. We found similar DHV-metrics to OARs according to the final dose (45 or 50.4Gy). This is especially remarkable for the most radiosensitive OARs, the bowel bag and small bowel. Because DHV-data of small bowel and bowel bag are very similar we recommend contouring bowel bag due to the rapidity. Regarding bladder, the increment of dose absorbed is compensated by its radioresistence. As all reported studies suggest that dose increasing improves outcomes, and according our preliminary results, we recommend dose escalation to at least 50.4Gy in the neoadjuvant setting. EP-1243 Neoadjuvant treatment of Klatskin Tumours (KT) with Stereotactic Body Radiotherapy (SBRT) & Capecitabine O. Hernando Requejo1, M. López1, R. Ciervide1, J. Valero1, M.O. GarcíaAranda1, E. Sanchez1, E. Vicente2, A. Cubillo3, Y. Quijano2, C. Rubio2 1 Hospital Universitario Madrid Sanchinarro - Grupo Hospital de Madrid, Radiation Oncology, Madrid, Spain 2 Hospital Universitario Madrid Sanchinarro - Grupo Hospital de Madrid, Surgical Oncology, Madrid, Spain 3 Hospital Universitario Madrid Sanchinarro - Grupo Hospital de Madrid, Medical Oncology, Madrid, Spain Purpose/Objective: KTs are the primary cancer of the bile ducts arising from malignant transformation of cholangiocites. According to BismuthCorlette classification, tipe IV non-multifocal cholangio carcinomas are those extending to the bifurcations of both right and left hepatic ducts. The objective of this study is to analyze the potential role of SBRT combined with capecitabine as neoadjuvant treatment for locallyadvanced Klastkin tumours. Materials and Methods: From August 2008 to January 2011 we treated 9 patients with a Novalis LINAC. All the patients where treated according to our G-I tumour board protocol with SBRT and Capecitabine as a neoadjuvant combined treatment. Surgery was planned on a second time after initial chemoradiation. The outlined PTV includes CTV=GTV + 5 mm margin. Previous to treatment, a internal marker is placed near de tumour, this is necessary for respiratory gating where the tumour is strictly irradiated in a