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OC-0054: Dynamics of patient reported QoL and symptoms after IGRT for locally advanced cervical cancer
S25 ESTRO 36 _______________________________________________________________________________________________ 2
Leiden University Medical Center, Radiation Oncology, Leiden, The Netherlands
Conclusion Moderate to severe limb edema G≥2 is limited in the first years after definitive radiochemotherapy including MRIguided adaptive brachytherapy. Mainly mild limb edema CTCAE G1 with 5-10% inter-limb discrepancy in volume or circumference at point of greatest visible difference is observed. Nevertheless, a proportion of 8-14% of patients reports “quite a bit” and “very much” swelling of one or both legs during follow-up. Limb edema shows a progressive manifestation pattern over time both in the physician assessed and the patient reported outcome. Laparoscopic lymph node staging bears a considerable risk for the development of G≥1 limb edema. Further investigations are needed to evaluate various specific risk factors in a multivariate model. OC-0054 Dynamics of patient reported QoL and symptoms after IGRT for locally advanced cervical cancer S.T. Heijkoop1, R.A. Nout2, S. Quint1, J.W.M. Mens1, B.J.M. Heijmen1, M.S. Hoogeman1 1 Erasmus MC Cancer Institute, Radiation Oncology, Rotterdam, The Netherlands
Purpose or Objective In this study, locally advanced cervical cancer patients are treated with an online adaptive Plan-of-the-Day (PotD) protocol, using a daily CBCT to select the plan that best fits the observed anatomy of that day from a patientspecific plan library. The objective is to reduce unnecessary dose to healthy normal organs and to maintain a favorable Quality of Life (QoL). Patient reported health-related QoL and symptoms, during and in the first year after treatment, were prospectively scored. Results are reported here. Material and Methods Between January 2012 and March 2016, all locally advanced cervical cancer patients treated with the PotD protocol and brachytherapy with or without chemotherapy or hyperthermia were eligible. QoL was assessed at baseline; weekly during the first five weeks of treatment; 1 week and 1, 3, 6 and 12 months after treatment, using the EORTC QLQ-C30 and the QLQ-CX24 questionnaires. Comparisons were made with an age-matched norm population. Results From January 2012 until March 2016 a total of 167 locally advanced cervical cancer patients were treated with a PotD protocol, of which 123 (74%) were included as responders (baseline score and at least 1 additional questionnaire). Scores of EORTC QLQ-C30 functioning and global health scales are shown in figure 1. At baseline, scores of all functional scales except global health status were lower compared to the age-matched norm population. Global health and functioning were temporarily decreased and returned to a plateau at baseline level 3 months after treatment, except for cognitive functioning. Compared to the norm population all functioning scores, except global health showed either a small decrease or a medium decrease (cognitive functioning) 1 year after treatment. Scores of symptoms and sexual functioning are provided in figure 2. Most symptoms showed a moderate-to-large increase, reaching a maximum at the end of treatment (5th week), or first week after treatment with a return to baseline at 3 months. However, several symptoms persisted during further follow-up (diarrhea, bowel cramps, dysuria, pain, fecal leakage, insomnia, tingling/ numbness). While most symptoms gradually increased during the first five weeks, diarrhea and bowel cramps already markedly increased within the first three weeks to reach a plateau at the 5th week of treatment. Sexual/ vaginal symptoms became apparent after treatment and increased in the first year after treatment. The increased vaginal symptoms were paralleled by increased sexual worrying and decreased sexual enjoyment.
S26 ESTRO 36 _______________________________________________________________________________________________ 8
Aarhus University Hospital, Department of Oncology, Aarhus, Denmark
Conclusion Treatment had a profound impact on QoL. For some systems this was temporarily, other symptoms persisted during further follow-up. End of external beam treatment is the most sensitive time point to measure future improvements in online adaptive radiotherapy with a PotD approach. OC-0055 Local failures after radiochemotherapy and MR-image-guided brachytherapy in cervical cancer patients M. Schmid1, C. Haie-Meder2, U. Mahanshetty3, I.M. Jürgenliemk-Schulz4, B. Segedin5, P. Hoskin6, C. Kirisits7, J. Lindegaard8, K. Tanderup8, R. Pötter7 1 Medizinische Universität Wien Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria 2 Gustave Roussy, Department of Radiotherapy, Paris, France 3 Tata Memorial Hospital, Department of Radiation Oncology, Mumbai, India 4 Utrecht University, Department of Radiation Oncology, Utrecht, The Netherlands 5 Institute of Oncology, Department of Oncology, Ljubiljana, Slovenia 6 Mount Vernon Cancer Center, Department of Radiotherapy, Northwood, United Kingdom 7 Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
Purpose or Objective To report patterns of local failure (LF) after radiochemotherapy and MR-image-guided adaptive brachytherapy (IGABT) in patients with loc ally advanced cervical cancer (LACC) observed within the international prospective observational multicenter study „EMBRACE“ (An international study on MRI-guided brachytherapy in locally advanced cervical cancer, www.embracestudy.dk). Material and Methods From 2008-2015, 1419 patients with LACC treated with radiochemotherapy and MR-IGABT (GEC-ESTRO recommendations) were included in the study. 1230 patients with completed treatment without major protocol violations (n=73) and with at least one follow up examination were available for this analysis (106 excluded). A LF was defined as incomplete remission in case of persistent disease 3 months after treatment which did not resolve at six months and as local recurrence after complete remission in case of recurrent disease. LFs were described based on their relation to (1) the clinical target volumes (CTV) and to (2) infiltrated organs / compartments. Results After a median follow-up of 25 months 80 local fai lures (24 incomplete remissions and 56 local recurrences) were observed. Synchronous nodal or distant metastases were reported in 42 patients (52%, not reported: 5%). Median time to local recurrence was 11.5 months, 47 (86%) occurred within 24 months. Information about the location of LF was available in 63 patients (79%): The cervix and uterus were involved in 50 patients (80%), the proximal parametria in 8 patients (13%), the distal parametria/pelvic wall in 18 patients (29%), the vagina in 18 patients (29%), the urinary bladder in 12 patients (19%) and the rectum in 2 patients (3%), respectively (more than one location possible). An allocation to CTV was possible in 53 patients (66%): In 51% the LF were located inside the high risk (HR) CTV (n=27), in 17% inside the intermediate (IR) CTV (n=9) and in 30% inside the HR+IR CTV (n=16). 2% was not related to the CTVs (n=1). Conclusion Local failures occur in a very limited number of patients after radiochemotherapy and IGABT. They are in about 50% synchronous with nodal or distant disease. The vast majority occurs within two years. Most patients fail locally within the HRCTV and IR CTV. OC-0056 Bowel morbidity in cervix cancer after RCHT+IGABT; physician and patient reported outcome EMBRACE N.B.K. Jensen1, K. Kirchheiner2, L.U. Fokdal1, J.C. Lindegaard1, C. Kirisits2, R. Mazeron3, U. Mahantshetty4, B. Segedin5, I.M. Jürgenliemk-Schulz6, P.J. Hoskin7, R. Pötter2, K. Tanderup1 1 Aarhus University Hospital, Department of Oncology, Aarhus C, Denmark 2 Medical university of Vienna / General Hospital of Vienna, Department of Radiation OncologyComprehensive Cancer Center, Vienna, Austria 3 Gustave-Roussy, Department of Radiotherapy, Villejuif, France 4 Tata Memorial Hospital, Department of Radiation Oncology, Mumbai, India 5 Institute of Oncology Ljubljana, Department of Radiotherapy, Ljubljana, Slovenia 6 University Medical Centre Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands 7 Mount Vernon Hospital, Cancer Centre, London, United Kingdom
Leiden University Medical Center, Radiation Oncology, Leiden, The Netherlands
Conclusion Moderate to severe limb edema G≥2 is limited in the first years after definitive radiochemotherapy including MRIguided adaptive brachytherapy. Mainly mild limb edema CTCAE G1 with 5-10% inter-limb discrepancy in volume or circumference at point of greatest visible difference is observed. Nevertheless, a proportion of 8-14% of patients reports “quite a bit” and “very much” swelling of one or both legs during follow-up. Limb edema shows a progressive manifestation pattern over time both in the physician assessed and the patient reported outcome. Laparoscopic lymph node staging bears a considerable risk for the development of G≥1 limb edema. Further investigations are needed to evaluate various specific risk factors in a multivariate model. OC-0054 Dynamics of patient reported QoL and symptoms after IGRT for locally advanced cervical cancer S.T. Heijkoop1, R.A. Nout2, S. Quint1, J.W.M. Mens1, B.J.M. Heijmen1, M.S. Hoogeman1 1 Erasmus MC Cancer Institute, Radiation Oncology, Rotterdam, The Netherlands
Purpose or Objective In this study, locally advanced cervical cancer patients are treated with an online adaptive Plan-of-the-Day (PotD) protocol, using a daily CBCT to select the plan that best fits the observed anatomy of that day from a patientspecific plan library. The objective is to reduce unnecessary dose to healthy normal organs and to maintain a favorable Quality of Life (QoL). Patient reported health-related QoL and symptoms, during and in the first year after treatment, were prospectively scored. Results are reported here. Material and Methods Between January 2012 and March 2016, all locally advanced cervical cancer patients treated with the PotD protocol and brachytherapy with or without chemotherapy or hyperthermia were eligible. QoL was assessed at baseline; weekly during the first five weeks of treatment; 1 week and 1, 3, 6 and 12 months after treatment, using the EORTC QLQ-C30 and the QLQ-CX24 questionnaires. Comparisons were made with an age-matched norm population. Results From January 2012 until March 2016 a total of 167 locally advanced cervical cancer patients were treated with a PotD protocol, of which 123 (74%) were included as responders (baseline score and at least 1 additional questionnaire). Scores of EORTC QLQ-C30 functioning and global health scales are shown in figure 1. At baseline, scores of all functional scales except global health status were lower compared to the age-matched norm population. Global health and functioning were temporarily decreased and returned to a plateau at baseline level 3 months after treatment, except for cognitive functioning. Compared to the norm population all functioning scores, except global health showed either a small decrease or a medium decrease (cognitive functioning) 1 year after treatment. Scores of symptoms and sexual functioning are provided in figure 2. Most symptoms showed a moderate-to-large increase, reaching a maximum at the end of treatment (5th week), or first week after treatment with a return to baseline at 3 months. However, several symptoms persisted during further follow-up (diarrhea, bowel cramps, dysuria, pain, fecal leakage, insomnia, tingling/ numbness). While most symptoms gradually increased during the first five weeks, diarrhea and bowel cramps already markedly increased within the first three weeks to reach a plateau at the 5th week of treatment. Sexual/ vaginal symptoms became apparent after treatment and increased in the first year after treatment. The increased vaginal symptoms were paralleled by increased sexual worrying and decreased sexual enjoyment.
S26 ESTRO 36 _______________________________________________________________________________________________ 8
Aarhus University Hospital, Department of Oncology, Aarhus, Denmark
Conclusion Treatment had a profound impact on QoL. For some systems this was temporarily, other symptoms persisted during further follow-up. End of external beam treatment is the most sensitive time point to measure future improvements in online adaptive radiotherapy with a PotD approach. OC-0055 Local failures after radiochemotherapy and MR-image-guided brachytherapy in cervical cancer patients M. Schmid1, C. Haie-Meder2, U. Mahanshetty3, I.M. Jürgenliemk-Schulz4, B. Segedin5, P. Hoskin6, C. Kirisits7, J. Lindegaard8, K. Tanderup8, R. Pötter7 1 Medizinische Universität Wien Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria 2 Gustave Roussy, Department of Radiotherapy, Paris, France 3 Tata Memorial Hospital, Department of Radiation Oncology, Mumbai, India 4 Utrecht University, Department of Radiation Oncology, Utrecht, The Netherlands 5 Institute of Oncology, Department of Oncology, Ljubiljana, Slovenia 6 Mount Vernon Cancer Center, Department of Radiotherapy, Northwood, United Kingdom 7 Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
Purpose or Objective To report patterns of local failure (LF) after radiochemotherapy and MR-image-guided adaptive brachytherapy (IGABT) in patients with loc ally advanced cervical cancer (LACC) observed within the international prospective observational multicenter study „EMBRACE“ (An international study on MRI-guided brachytherapy in locally advanced cervical cancer, www.embracestudy.dk). Material and Methods From 2008-2015, 1419 patients with LACC treated with radiochemotherapy and MR-IGABT (GEC-ESTRO recommendations) were included in the study. 1230 patients with completed treatment without major protocol violations (n=73) and with at least one follow up examination were available for this analysis (106 excluded). A LF was defined as incomplete remission in case of persistent disease 3 months after treatment which did not resolve at six months and as local recurrence after complete remission in case of recurrent disease. LFs were described based on their relation to (1) the clinical target volumes (CTV) and to (2) infiltrated organs / compartments. Results After a median follow-up of 25 months 80 local fai lures (24 incomplete remissions and 56 local recurrences) were observed. Synchronous nodal or distant metastases were reported in 42 patients (52%, not reported: 5%). Median time to local recurrence was 11.5 months, 47 (86%) occurred within 24 months. Information about the location of LF was available in 63 patients (79%): The cervix and uterus were involved in 50 patients (80%), the proximal parametria in 8 patients (13%), the distal parametria/pelvic wall in 18 patients (29%), the vagina in 18 patients (29%), the urinary bladder in 12 patients (19%) and the rectum in 2 patients (3%), respectively (more than one location possible). An allocation to CTV was possible in 53 patients (66%): In 51% the LF were located inside the high risk (HR) CTV (n=27), in 17% inside the intermediate (IR) CTV (n=9) and in 30% inside the HR+IR CTV (n=16). 2% was not related to the CTVs (n=1). Conclusion Local failures occur in a very limited number of patients after radiochemotherapy and IGABT. They are in about 50% synchronous with nodal or distant disease. The vast majority occurs within two years. Most patients fail locally within the HRCTV and IR CTV. OC-0056 Bowel morbidity in cervix cancer after RCHT+IGABT; physician and patient reported outcome EMBRACE N.B.K. Jensen1, K. Kirchheiner2, L.U. Fokdal1, J.C. Lindegaard1, C. Kirisits2, R. Mazeron3, U. Mahantshetty4, B. Segedin5, I.M. Jürgenliemk-Schulz6, P.J. Hoskin7, R. Pötter2, K. Tanderup1 1 Aarhus University Hospital, Department of Oncology, Aarhus C, Denmark 2 Medical university of Vienna / General Hospital of Vienna, Department of Radiation OncologyComprehensive Cancer Center, Vienna, Austria 3 Gustave-Roussy, Department of Radiotherapy, Villejuif, France 4 Tata Memorial Hospital, Department of Radiation Oncology, Mumbai, India 5 Institute of Oncology Ljubljana, Department of Radiotherapy, Ljubljana, Slovenia 6 University Medical Centre Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands 7 Mount Vernon Hospital, Cancer Centre, London, United Kingdom