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EP-1273 PRELIMINARY RESULTS OF HELICAL TOMOTHERAPY FOR SOFT TISSUE SARCOMA OF THE THIGH
ESTRO 31
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classification was: one intermediate and three high grades. Only one patient had negative margins. (Table1) Median follow up was 38.5 months. Median metastasis- free survival was 41.6 months. The local tumor relapse was encountered in two patients at 24 and 43 months of follow-up, these patients died due to distant metastasis at 31 months and 90 months respectively after the initial diagnosis. The metastasis was found in three patients at 24, 68 and 33 months. One remained disease free at the last control. Acute radiation toxicity (nausea and asthenia grade 2) was detected in two patients. No late radiation toxicity was reported. (Table 1) Patient Sex Age Treatm. Margins Adjuvant Dose therapy 1. 2.
F F
53 Surgery Positive RT+CT 61 Surgery Positive RT
3. 4.
F F
65 Surgery Positive RT 59 Surgery Negative RT+CT
Local Metas Survival Metas relapse (mths) Free (mths) 66.6Gy Yes Lung 31* 24 50.4Gy Yes Lung, 90* 68 kidney, bone 45Gy No Breast 46 33 50.4Gy No No 11 0**
*deceased ** No metastasis found at the last control Conclusions: Complete resection with negative margins is the gold standard for treatment of leiomyosarcoma of IVC. Due to its rarity, there are no data about the medical management. Kyriazi et al in 2010 reported that aggressive and adjuvant RT-CT is showing the benefit of the disease-free survival. The experience in our institution, showed that adjuvant radiotherapy should be considered at the local control of this tumor. EP-1271 TREATMENT OUTCOME OF POSTOPERATIVE RADIOTHERAPY AFTER CONSERVATIVE SURGERY WITH EXTREMITY SOFT TISSUE SARCOMA J.E. Lee1, Y.J. Park1, D.S. Yang1, W.S. Yoon1, J.A. Lee1, S. Lee1, C.Y. Kim1 1 Korea university medical center, Radiation oncology, Seoul, Korea Republic of Purpose/Objective: We analyzed the treatment outcomes, prognostic factors of conservative surgery plus radiation therapy(RTx) in the treatment of patients with extremity soft tissue sarcoma(STS). Materials and Methods: Between January 1981 and December 2010, adult patients with non-metastatic extremity STS were treated at Korea University Medical Center. 24 were male and 19 were female. Ages ranged from 20 to 71 years with a mean of 44 years. The distribution of lesions was as follows, 10 were in the upper extremity and 33 were in the lower extremity. Histologic classification was as follows, 14 were liposarcoma, 10 were synovial sarcoma, 8 were malignant fibrous histiocytoma, 5 were chnodrosarcoma and 6 were other histology. AJCC staging I, II, III were 11, 21, 11, respectively. Histologic grade I, II, III were 11, 13, 19, respectively. Resection margin positive were 11, close margin were 12 and negative margin were 20. Daily dose was 1.8~2.0 Gy and total dose was 50~74.4 Gy (median 60.0 Gy). Chemotherapy(CTx) was given to 7. We retrospectively analyzed survival rate, prognostic factor and complications. RTOG grade were used for acute and chronic complication. Results: The follow-up time ranged from 5 to 302 months (median 70 months). Twelve sustained relapse of their disease. Local recurrence(LR) occurred in 3 (7.0%). No Regional nodal metastases developed and hematogenous metastases developed in 10 (23.3%). The most common site was lung (70%) followed by bone (20%), retroperitoneum (10%). The local control rates and distant relapsefree survival(DRFS) rates at 5 years were 90.7% and 73.3% respectively. Overall survival rates(OS), disease-free survival rates(DFS), disease-specific survival rate(DSS) at 5 years were 69.2%, 67.9% and 74.0% respectively. On univariate analysis, grade did not have a significant impact on local control, but did influence the development of DRFS, DSS and OS (p=0.01, p=0.01, p=0.03, respectively). No significant prognostic factors were associated with LR. AJCC stage, margin status and age influenced the development of distant metastases in the univariate analysis (p<0.05). On multivariate analysis, grade had a significant impact on DSS and OS (p=0.03, p=0.04, respectively). Severe acute radiation-related complications, RTOG grade 3 or 4, developed in 6 (14.0%). 4 had skin desquamation, 1 had pruritis and 1 had ulcer. Complications was higher among
patients receiving CTx(42.9%) compared with those not receiving CTx (8.3%). Severe late radiation-related complication developed in 2 patients (4.7%), ulcer and leg edema. Conclusions: In our series, conservative surgery with postoperative RTx achieves a satisfactory rate of local control with acceptable complication rate and it was comparable to other reported studies. Disease has a high distant metastatic propensity that correlates with tumor grade, stage, age and resection margin status. Tumor grade was the most important factor for OS and there was no significant factor associated with LR. Almost of LR developed in field regardless of surgical margin status or total radiation dose. New systemic treatment is needed to reduce distant metastasis. EP-1272 MEDICO-ECONOMICAL PROSPECTIVE RANDOMIZED TRIALS OF CARBON IONS THERAPY P. Pommier1, J. Balosso2, M. Lièvre3, S. Patin4, M.H. Baron5, G. Vogin6 1 Centre Léon Bérard, Department of Radiation Oncology, Lyon, France 2 University Hospital, Department of Radiation Oncology, Grenoble, France 3 Claude Bernard University, Department of statistics, Lyon, France 4 GCS ETOILE, Medical Unit, Lyon, France 5 Centre J. Perrin, Radiotherapy department, Clermont-Ferrand, France 6 Centre A Vautrin, Radiotherapy department, Nancy, France Purpose/Objective: Carbon ion therapy is an innovative radiotherapy modality mostly dedicated to cancers considered as unresectable and radio-resistant to photons thanks to its radiobiological properties combining the advantages of the high dose distribution conformity of protons for deep tumors and of the higher biological effectiveness of high Linear Energy Transfer (LET) particles. The accumulated clinical experience in more than 7000 patients has indicated that certain types of tumors such as advanced unrectable or R2 radio-resistant head and neck tumors (adenoid cystic carcinoma (ACC)) and sarcomas may beneficiate from this therapy. The main objective of this study is to bring high level evidences on the benefit of carbon ions therapy based on a prospective randomized study for selected tumors. The secondary objective will be to perform a prospective and comparative medico-economical evaluation between carbon ions and photons (+/- protons) Materials and Methods: 250 French patients with either unresectable or R2 sarcoma (all locations) or head and neck ACC will be randomized between two therapeutic strategies: a 'carbon ions strategy' (carbon ions alone for sarcoma; photons and a carbon ions boost for ACC) vs. a 'referent strategy' (photons alone or photons and protons as a boost). Carbon ions therapy will be performed in the Heidelberg Ion Therapy unit (HIT), and photons (+/- protons) in France. A specific network is being built to secure and permitt the exchange of clinical, radiological and radiotherapy data between French investigators and the HIT. A French national grants has been obtained in 2011 from the French National Cancer Institute after an international evaluation of the project, and the National Health Insurance has joined the project in financing carbon ions therapy and for the economical comparative assessments (societal perspective including the initial treatment phase, but aslo long term follow -up) Inclusions will begin in 2012 for a period of 4 years. Results: The expectation is to demonstrate a 20% increase of the Disease Free Survival with carbon ions at 5 years, and also a favorable cost/benefit ratio thanks to the avoided costs of recurrence and toxicity, despite a much higher initial cost. Conclusions: This study will be the first international collaboration to prospectively assess carbon ions therapy, in the framework of ULICE (Union for Light Ions in Europe) financed by a grant from the European Community. EP-1273 PRELIMINARY RESULTS OF HELICAL TOMOTHERAPY FOR SOFT TISSUE SARCOMA OF THE THIGH C. Verry1, C. Alapetite2, S. Zefkili2, A. Sedrati2, W. Ksouri2, R. Dendale2, A. Fourquet2, S. Helfre2 1 University Hospital Grenoble, Radiotherapy, Grenoble, France 2 Curie Institute, Radiotherapy, Paris, France Purpose/Objective: To report the feasibility and preliminary clinical results of Helical Tomotherapy (HT) for adjuvant treatment in primary soft tissue sarcoma of the thigh.
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Materials and Methods: Between January 2007 and July 2010, ten consecutive patients were treated in our institution for primary soft tissue sarcoma of the thigh with HT. Median tumor size was 17.5 cm and the grade was high in 80% of tumors. Median prescription dose for planning target volume (PTV) was 60 Gy in daily fractions of 1.8 to 2 Gy. The goal of the planning optimisation was to minimize the dose received by entire femur, healthy skin and healthy muscular tissue surrounding PTV. Patients were monitored for acute and chronic toxicity using the Common Toxicity Criteria v 3.0. Results: HT provided homogeneous PTV coverage (homogeneity index: 0.06 ± 0.02) associated with high conformity (conformity index: 1.3 ± 0.2). Dose covering 95% volume (D95) and volume receiving at least 95% of dose (V95) were both over 97% for each patient. HT proved to be very efficient in sparing organs at risk. Volume of femur receiving 40 Gy (V40 Gy) was 40.2 ± 21.8%. The contralateral limb received on average 2.7 ± 2 Gy. Among 10 patients, two developed grade 3 radiation dermatitis associated with grade 2 edema. Median follow-up was 14.5 months with only one local failure. No grade 3 or 4 late toxicities were reported. No patient developed bone fracture. Conclusions: Helical Tomotherapy provides excellent PTV coverage for large soft tissue sarcoma of the thigh sparing critical organs. Morbidity and local control appear favorable in this group of high-risk patients. EP-1274 PROGNOSTIC FACTORS OF EXTREMITY SOFT TISSUE SARCOMA IN ADULTS. A SINGLE INSTITUTIONAL ANALYSIS Y. Pointreau1, I. Atean1, P. Rosset2, P. Garaud1, G. De Pinieux3, G. Calais1 1 CHRU Tours Hôpital Bretonneau henry kaplan center, Radiotherapy, Tours, France 2 CHRU Tours Hôpital Trousseau, Department of Orthopaedic surgery, Tours, France 3 CHRU Tours Hôpital Trousseau, Department of Histopathology, Tours, France Purpose/Objective: To analyze the prognostic factors for patients treated with limb sparing surgery and radiation for extremity soft tissue sarcoma (E-STS). Materials and Methods: Medical records of 87 patients were reviewed retrospectively. A univariate analysis was used to determine prognostic factors for disease free survival (DFS) and disease specific survival (DSS). Results: With a mean follow-up of 69 months, most recurrences occurred within the first 2 years. Extent of resection margin was found to improve DFS (p = 0.004) and DSS (p = 0.004). Brachytherapy combined with external beam radiotherapy (EBRT) improved DFS (p= 0.034) and DSS (p = 0.019). Tumor size (< 10 cm) was related to DSS (p = 0.043) and its relation to DFS was almost significant (p = 0.057). Short time interval between surgery and radiotherapy (≤ 50 days) had an impact only on DSS (p = 0.030). Conclusions: Extent of sub-centimetre resection margin and use of brachytherapy combined with EBRT seems to improve the prognosis of E-STS. Small tumor size and short time interval between radiotherapy and surgery seem also to improve the outcome of E-STS. This study was limited by inadequate power and low number of recurrences. Lager randomised studies are needed to confirm these results. EP-1275 HIGH LEVEL PRE-OPERATIVE HELICAL TOMOTHERAPY (54 GY) FOR RETROPERITONEAL LIPOSARCOMA P. Sargos1, C. Dejean1, B. Henriques de figueiredo1, B. NGuyen Bui2, A. Italiano2, E. Stoeckle3, G. Kantor1 1 Bergonie, Radiation Oncology, Bordeaux, France 2 Bergonie, Medical Oncology, Bordeaux, France 3 Bergonie, Surgery, Bordeaux, France Purpose/Objective: To evaluate the feasibility of pre-operative radiotherapy (54 Gy) with Helical Tomotherapy (HT) followed by surgery for retroperitonela liposarcoma. Materials and Methods: Ten patients with non-resectable retroperitoneal liposarcomas were treated by pre-operative tomotherapy (54 Gy) and surgery. Clinical and biological toxicities were evaluated on the CTCAEV3.0 scale. For nine patients, tomotherapy plans were compared with retrospectively-planned dynamic intensity-modulated radiotherapy (IMRT) dosimetric studies. Results: No immediate or late Grade>2 toxicities were observed after radiotherapy. Post-operatively, one patient died and three patients
ESTRO 31
experienced Grade 3 toxicity (two digestive and one metabolic). These toxicities disappeared and only two patients presented persistent Grade 1 paresthesia. R0 resection was obatained for four patients, R1 for four and R2 resection for two. With a median follow up of 26 months, no local or distant relapse were observed. Dosimetric comparisons between HT and retrospectively-planned IMRT demonstrate an adequate target volume coverage for both techniques. Gastrointestinal sparing is higher with HT with a D200cc reduced by 5Gy. Integral dose (ID) was increased with HT. Conclusions: Pre-operative radiotherapy with high dose (54 Gy) for retroperitoneal liposarcoma is feasible and well tolerated. IGRT (image guided radiation therapy) is essential irrespective of the IMRT technique used. Futhermore, HT provides the ability to spare selected areas in such complex volumes. EP-1276 INTENSITY MODULATED RADIATION THERAPY FOR RETROPERITONEAL SARCOMA N. El-Bared1, D. Taussky1, S. Mehiri1, D. Donath1 1 Notre-Dame Hospital, Radiation Oncology, Montreal Qc, Canada Purpose/Objective: The extent and location of retroperitoneal sarcomas makes treatment of these tumors very challenging. The use of Intensity Modulated Radiation Therapy (IMRT) could allow the administration of higher doses while limiting toxicity to adjacent organs. The purpose of our study is to assess the outcome of patients with retroperitoneal sarcoma treated with adjuvant or neo-adjuvant external beam radiation (EBRT) therapy with IMRT. Materials and Methods: This is a retrospective study of 20 patients treated at our center between August 2005 and October 2011. The median age was 53 years (35-83 years) with 65% of the patients being women. The median tumor diameter was 12.6 cm (1.8-29.3cm) with grade 1 histology in 35% of patients. Twelve patients (60%) had liposarcomas and other histologies such as leiomyosarcomas and fibrosarcomas were less frequent. Eighteen patients received preoperative radiotherapy with 80% of the study group having received ≥50 Gy. All patients were treated with IMRT and 40% received IMRT with tomotherapy. Dose to critical organs had to be below criteria from RTOG 0529 for anal cancer. Margins varied between 1-2 cm around the GTV and were reduced to 5 mm towards the small bowel. Acute and chronic toxicities were assessed according to the CTCAE v. 3 criteria. Progression-free survival (PFS) and overall survival (OSA) was computed using KaplanMeier curves. Results: Median follow-up for all patients was 17.5 months (0-65), 25% had a follow-up of ≥ 3 years. Patients without recurrence had a median follow-up of 14 months (0-65). Nine patients (45%) had disease recurrence and 6 patients died. Only 2 recurrences occurred >27 months after EBRT (at 44 and 48 months). Mean estimated OS and RFS was 39.3 and 36 months, respectively. The 3 year estimate OS was 56% and the infield recurrence free survival was 34%. RFS was not influenced by whether surgical margins were microscopically negative (p=0.522), tumor grade (p=0.115), tumor diameter (p=0.634) or sex (p=0.291). OS was also not influenced by the above mentioned factors. Female sex (P=0.139) and high tumor grade (p=0.129) showed a trend towards a worse outcome. So far there was no ≥ grade 1 acute or chronic toxicity. Conclusions: IMRT allows for reduction of the doses to critical organs resulting in the absence of significant toxicity. Most tumors are large at the time of treatment (>12 cm) resulting in a rate of infield recurrence-free survival of two-thirds. Given the low toxicity encountered, higher radiotherapy doses are being considered. EP-1277 DEFINITIVE RADIATION THERAPY FOR ANGIOSARCOMA OF THE SCALP E. Katayama1, I. Asakawa1, K. Inoue1, C. Kajitani1, T. Tamamoto1, T. Fukumoto2, M. Hasegawa1 1 Nara Medical University, Radiation Oncology, Nara, Japan 2 Nara Medical University, Dermatology, Nara, Japan Purpose/Objective: Cutaneous angiosarcoma is a highly aggressive vascular tumor constituting less than 0.1% of head and neck malignancies. The aim of this study was to analyze the treatment outcomes of patients who received definitive radiotherapy (RT) for angiosarcoma of the scalp. Materials and Methods: Between 2008 and 2011, there were 7 patients with histologically proven angiosarcoma of the scalp without a history of prior radiotherapy at our institution. All tumors were over 10 cm in diameter. The median age was 80 years (range 73-92). The
S485
classification was: one intermediate and three high grades. Only one patient had negative margins. (Table1) Median follow up was 38.5 months. Median metastasis- free survival was 41.6 months. The local tumor relapse was encountered in two patients at 24 and 43 months of follow-up, these patients died due to distant metastasis at 31 months and 90 months respectively after the initial diagnosis. The metastasis was found in three patients at 24, 68 and 33 months. One remained disease free at the last control. Acute radiation toxicity (nausea and asthenia grade 2) was detected in two patients. No late radiation toxicity was reported. (Table 1) Patient Sex Age Treatm. Margins Adjuvant Dose therapy 1. 2.
F F
53 Surgery Positive RT+CT 61 Surgery Positive RT
3. 4.
F F
65 Surgery Positive RT 59 Surgery Negative RT+CT
Local Metas Survival Metas relapse (mths) Free (mths) 66.6Gy Yes Lung 31* 24 50.4Gy Yes Lung, 90* 68 kidney, bone 45Gy No Breast 46 33 50.4Gy No No 11 0**
*deceased ** No metastasis found at the last control Conclusions: Complete resection with negative margins is the gold standard for treatment of leiomyosarcoma of IVC. Due to its rarity, there are no data about the medical management. Kyriazi et al in 2010 reported that aggressive and adjuvant RT-CT is showing the benefit of the disease-free survival. The experience in our institution, showed that adjuvant radiotherapy should be considered at the local control of this tumor. EP-1271 TREATMENT OUTCOME OF POSTOPERATIVE RADIOTHERAPY AFTER CONSERVATIVE SURGERY WITH EXTREMITY SOFT TISSUE SARCOMA J.E. Lee1, Y.J. Park1, D.S. Yang1, W.S. Yoon1, J.A. Lee1, S. Lee1, C.Y. Kim1 1 Korea university medical center, Radiation oncology, Seoul, Korea Republic of Purpose/Objective: We analyzed the treatment outcomes, prognostic factors of conservative surgery plus radiation therapy(RTx) in the treatment of patients with extremity soft tissue sarcoma(STS). Materials and Methods: Between January 1981 and December 2010, adult patients with non-metastatic extremity STS were treated at Korea University Medical Center. 24 were male and 19 were female. Ages ranged from 20 to 71 years with a mean of 44 years. The distribution of lesions was as follows, 10 were in the upper extremity and 33 were in the lower extremity. Histologic classification was as follows, 14 were liposarcoma, 10 were synovial sarcoma, 8 were malignant fibrous histiocytoma, 5 were chnodrosarcoma and 6 were other histology. AJCC staging I, II, III were 11, 21, 11, respectively. Histologic grade I, II, III were 11, 13, 19, respectively. Resection margin positive were 11, close margin were 12 and negative margin were 20. Daily dose was 1.8~2.0 Gy and total dose was 50~74.4 Gy (median 60.0 Gy). Chemotherapy(CTx) was given to 7. We retrospectively analyzed survival rate, prognostic factor and complications. RTOG grade were used for acute and chronic complication. Results: The follow-up time ranged from 5 to 302 months (median 70 months). Twelve sustained relapse of their disease. Local recurrence(LR) occurred in 3 (7.0%). No Regional nodal metastases developed and hematogenous metastases developed in 10 (23.3%). The most common site was lung (70%) followed by bone (20%), retroperitoneum (10%). The local control rates and distant relapsefree survival(DRFS) rates at 5 years were 90.7% and 73.3% respectively. Overall survival rates(OS), disease-free survival rates(DFS), disease-specific survival rate(DSS) at 5 years were 69.2%, 67.9% and 74.0% respectively. On univariate analysis, grade did not have a significant impact on local control, but did influence the development of DRFS, DSS and OS (p=0.01, p=0.01, p=0.03, respectively). No significant prognostic factors were associated with LR. AJCC stage, margin status and age influenced the development of distant metastases in the univariate analysis (p<0.05). On multivariate analysis, grade had a significant impact on DSS and OS (p=0.03, p=0.04, respectively). Severe acute radiation-related complications, RTOG grade 3 or 4, developed in 6 (14.0%). 4 had skin desquamation, 1 had pruritis and 1 had ulcer. Complications was higher among
patients receiving CTx(42.9%) compared with those not receiving CTx (8.3%). Severe late radiation-related complication developed in 2 patients (4.7%), ulcer and leg edema. Conclusions: In our series, conservative surgery with postoperative RTx achieves a satisfactory rate of local control with acceptable complication rate and it was comparable to other reported studies. Disease has a high distant metastatic propensity that correlates with tumor grade, stage, age and resection margin status. Tumor grade was the most important factor for OS and there was no significant factor associated with LR. Almost of LR developed in field regardless of surgical margin status or total radiation dose. New systemic treatment is needed to reduce distant metastasis. EP-1272 MEDICO-ECONOMICAL PROSPECTIVE RANDOMIZED TRIALS OF CARBON IONS THERAPY P. Pommier1, J. Balosso2, M. Lièvre3, S. Patin4, M.H. Baron5, G. Vogin6 1 Centre Léon Bérard, Department of Radiation Oncology, Lyon, France 2 University Hospital, Department of Radiation Oncology, Grenoble, France 3 Claude Bernard University, Department of statistics, Lyon, France 4 GCS ETOILE, Medical Unit, Lyon, France 5 Centre J. Perrin, Radiotherapy department, Clermont-Ferrand, France 6 Centre A Vautrin, Radiotherapy department, Nancy, France Purpose/Objective: Carbon ion therapy is an innovative radiotherapy modality mostly dedicated to cancers considered as unresectable and radio-resistant to photons thanks to its radiobiological properties combining the advantages of the high dose distribution conformity of protons for deep tumors and of the higher biological effectiveness of high Linear Energy Transfer (LET) particles. The accumulated clinical experience in more than 7000 patients has indicated that certain types of tumors such as advanced unrectable or R2 radio-resistant head and neck tumors (adenoid cystic carcinoma (ACC)) and sarcomas may beneficiate from this therapy. The main objective of this study is to bring high level evidences on the benefit of carbon ions therapy based on a prospective randomized study for selected tumors. The secondary objective will be to perform a prospective and comparative medico-economical evaluation between carbon ions and photons (+/- protons) Materials and Methods: 250 French patients with either unresectable or R2 sarcoma (all locations) or head and neck ACC will be randomized between two therapeutic strategies: a 'carbon ions strategy' (carbon ions alone for sarcoma; photons and a carbon ions boost for ACC) vs. a 'referent strategy' (photons alone or photons and protons as a boost). Carbon ions therapy will be performed in the Heidelberg Ion Therapy unit (HIT), and photons (+/- protons) in France. A specific network is being built to secure and permitt the exchange of clinical, radiological and radiotherapy data between French investigators and the HIT. A French national grants has been obtained in 2011 from the French National Cancer Institute after an international evaluation of the project, and the National Health Insurance has joined the project in financing carbon ions therapy and for the economical comparative assessments (societal perspective including the initial treatment phase, but aslo long term follow -up) Inclusions will begin in 2012 for a period of 4 years. Results: The expectation is to demonstrate a 20% increase of the Disease Free Survival with carbon ions at 5 years, and also a favorable cost/benefit ratio thanks to the avoided costs of recurrence and toxicity, despite a much higher initial cost. Conclusions: This study will be the first international collaboration to prospectively assess carbon ions therapy, in the framework of ULICE (Union for Light Ions in Europe) financed by a grant from the European Community. EP-1273 PRELIMINARY RESULTS OF HELICAL TOMOTHERAPY FOR SOFT TISSUE SARCOMA OF THE THIGH C. Verry1, C. Alapetite2, S. Zefkili2, A. Sedrati2, W. Ksouri2, R. Dendale2, A. Fourquet2, S. Helfre2 1 University Hospital Grenoble, Radiotherapy, Grenoble, France 2 Curie Institute, Radiotherapy, Paris, France Purpose/Objective: To report the feasibility and preliminary clinical results of Helical Tomotherapy (HT) for adjuvant treatment in primary soft tissue sarcoma of the thigh.
S486
Materials and Methods: Between January 2007 and July 2010, ten consecutive patients were treated in our institution for primary soft tissue sarcoma of the thigh with HT. Median tumor size was 17.5 cm and the grade was high in 80% of tumors. Median prescription dose for planning target volume (PTV) was 60 Gy in daily fractions of 1.8 to 2 Gy. The goal of the planning optimisation was to minimize the dose received by entire femur, healthy skin and healthy muscular tissue surrounding PTV. Patients were monitored for acute and chronic toxicity using the Common Toxicity Criteria v 3.0. Results: HT provided homogeneous PTV coverage (homogeneity index: 0.06 ± 0.02) associated with high conformity (conformity index: 1.3 ± 0.2). Dose covering 95% volume (D95) and volume receiving at least 95% of dose (V95) were both over 97% for each patient. HT proved to be very efficient in sparing organs at risk. Volume of femur receiving 40 Gy (V40 Gy) was 40.2 ± 21.8%. The contralateral limb received on average 2.7 ± 2 Gy. Among 10 patients, two developed grade 3 radiation dermatitis associated with grade 2 edema. Median follow-up was 14.5 months with only one local failure. No grade 3 or 4 late toxicities were reported. No patient developed bone fracture. Conclusions: Helical Tomotherapy provides excellent PTV coverage for large soft tissue sarcoma of the thigh sparing critical organs. Morbidity and local control appear favorable in this group of high-risk patients. EP-1274 PROGNOSTIC FACTORS OF EXTREMITY SOFT TISSUE SARCOMA IN ADULTS. A SINGLE INSTITUTIONAL ANALYSIS Y. Pointreau1, I. Atean1, P. Rosset2, P. Garaud1, G. De Pinieux3, G. Calais1 1 CHRU Tours Hôpital Bretonneau henry kaplan center, Radiotherapy, Tours, France 2 CHRU Tours Hôpital Trousseau, Department of Orthopaedic surgery, Tours, France 3 CHRU Tours Hôpital Trousseau, Department of Histopathology, Tours, France Purpose/Objective: To analyze the prognostic factors for patients treated with limb sparing surgery and radiation for extremity soft tissue sarcoma (E-STS). Materials and Methods: Medical records of 87 patients were reviewed retrospectively. A univariate analysis was used to determine prognostic factors for disease free survival (DFS) and disease specific survival (DSS). Results: With a mean follow-up of 69 months, most recurrences occurred within the first 2 years. Extent of resection margin was found to improve DFS (p = 0.004) and DSS (p = 0.004). Brachytherapy combined with external beam radiotherapy (EBRT) improved DFS (p= 0.034) and DSS (p = 0.019). Tumor size (< 10 cm) was related to DSS (p = 0.043) and its relation to DFS was almost significant (p = 0.057). Short time interval between surgery and radiotherapy (≤ 50 days) had an impact only on DSS (p = 0.030). Conclusions: Extent of sub-centimetre resection margin and use of brachytherapy combined with EBRT seems to improve the prognosis of E-STS. Small tumor size and short time interval between radiotherapy and surgery seem also to improve the outcome of E-STS. This study was limited by inadequate power and low number of recurrences. Lager randomised studies are needed to confirm these results. EP-1275 HIGH LEVEL PRE-OPERATIVE HELICAL TOMOTHERAPY (54 GY) FOR RETROPERITONEAL LIPOSARCOMA P. Sargos1, C. Dejean1, B. Henriques de figueiredo1, B. NGuyen Bui2, A. Italiano2, E. Stoeckle3, G. Kantor1 1 Bergonie, Radiation Oncology, Bordeaux, France 2 Bergonie, Medical Oncology, Bordeaux, France 3 Bergonie, Surgery, Bordeaux, France Purpose/Objective: To evaluate the feasibility of pre-operative radiotherapy (54 Gy) with Helical Tomotherapy (HT) followed by surgery for retroperitonela liposarcoma. Materials and Methods: Ten patients with non-resectable retroperitoneal liposarcomas were treated by pre-operative tomotherapy (54 Gy) and surgery. Clinical and biological toxicities were evaluated on the CTCAEV3.0 scale. For nine patients, tomotherapy plans were compared with retrospectively-planned dynamic intensity-modulated radiotherapy (IMRT) dosimetric studies. Results: No immediate or late Grade>2 toxicities were observed after radiotherapy. Post-operatively, one patient died and three patients
ESTRO 31
experienced Grade 3 toxicity (two digestive and one metabolic). These toxicities disappeared and only two patients presented persistent Grade 1 paresthesia. R0 resection was obatained for four patients, R1 for four and R2 resection for two. With a median follow up of 26 months, no local or distant relapse were observed. Dosimetric comparisons between HT and retrospectively-planned IMRT demonstrate an adequate target volume coverage for both techniques. Gastrointestinal sparing is higher with HT with a D200cc reduced by 5Gy. Integral dose (ID) was increased with HT. Conclusions: Pre-operative radiotherapy with high dose (54 Gy) for retroperitoneal liposarcoma is feasible and well tolerated. IGRT (image guided radiation therapy) is essential irrespective of the IMRT technique used. Futhermore, HT provides the ability to spare selected areas in such complex volumes. EP-1276 INTENSITY MODULATED RADIATION THERAPY FOR RETROPERITONEAL SARCOMA N. El-Bared1, D. Taussky1, S. Mehiri1, D. Donath1 1 Notre-Dame Hospital, Radiation Oncology, Montreal Qc, Canada Purpose/Objective: The extent and location of retroperitoneal sarcomas makes treatment of these tumors very challenging. The use of Intensity Modulated Radiation Therapy (IMRT) could allow the administration of higher doses while limiting toxicity to adjacent organs. The purpose of our study is to assess the outcome of patients with retroperitoneal sarcoma treated with adjuvant or neo-adjuvant external beam radiation (EBRT) therapy with IMRT. Materials and Methods: This is a retrospective study of 20 patients treated at our center between August 2005 and October 2011. The median age was 53 years (35-83 years) with 65% of the patients being women. The median tumor diameter was 12.6 cm (1.8-29.3cm) with grade 1 histology in 35% of patients. Twelve patients (60%) had liposarcomas and other histologies such as leiomyosarcomas and fibrosarcomas were less frequent. Eighteen patients received preoperative radiotherapy with 80% of the study group having received ≥50 Gy. All patients were treated with IMRT and 40% received IMRT with tomotherapy. Dose to critical organs had to be below criteria from RTOG 0529 for anal cancer. Margins varied between 1-2 cm around the GTV and were reduced to 5 mm towards the small bowel. Acute and chronic toxicities were assessed according to the CTCAE v. 3 criteria. Progression-free survival (PFS) and overall survival (OSA) was computed using KaplanMeier curves. Results: Median follow-up for all patients was 17.5 months (0-65), 25% had a follow-up of ≥ 3 years. Patients without recurrence had a median follow-up of 14 months (0-65). Nine patients (45%) had disease recurrence and 6 patients died. Only 2 recurrences occurred >27 months after EBRT (at 44 and 48 months). Mean estimated OS and RFS was 39.3 and 36 months, respectively. The 3 year estimate OS was 56% and the infield recurrence free survival was 34%. RFS was not influenced by whether surgical margins were microscopically negative (p=0.522), tumor grade (p=0.115), tumor diameter (p=0.634) or sex (p=0.291). OS was also not influenced by the above mentioned factors. Female sex (P=0.139) and high tumor grade (p=0.129) showed a trend towards a worse outcome. So far there was no ≥ grade 1 acute or chronic toxicity. Conclusions: IMRT allows for reduction of the doses to critical organs resulting in the absence of significant toxicity. Most tumors are large at the time of treatment (>12 cm) resulting in a rate of infield recurrence-free survival of two-thirds. Given the low toxicity encountered, higher radiotherapy doses are being considered. EP-1277 DEFINITIVE RADIATION THERAPY FOR ANGIOSARCOMA OF THE SCALP E. Katayama1, I. Asakawa1, K. Inoue1, C. Kajitani1, T. Tamamoto1, T. Fukumoto2, M. Hasegawa1 1 Nara Medical University, Radiation Oncology, Nara, Japan 2 Nara Medical University, Dermatology, Nara, Japan Purpose/Objective: Cutaneous angiosarcoma is a highly aggressive vascular tumor constituting less than 0.1% of head and neck malignancies. The aim of this study was to analyze the treatment outcomes of patients who received definitive radiotherapy (RT) for angiosarcoma of the scalp. Materials and Methods: Between 2008 and 2011, there were 7 patients with histologically proven angiosarcoma of the scalp without a history of prior radiotherapy at our institution. All tumors were over 10 cm in diameter. The median age was 80 years (range 73-92). The