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PO-0758: Dose escalation with intensity modulated radiotherapy in the treatment of locally advanced cervical cancer
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ESTRO 33, 2014 Purpose/Objective: To retrospectively analyse clinical outcome of definitive radiotherapy for cervix cancer at our institution before implementation of 3D conformal EBRT and image guided brachytherapy (BT). Materials and Methods: Consecutive patients (pts) treated for cervix cancer with curative intent from Jan 1998till Dec 2002 were included in the analysis. All pts were treated with EBRT +/-concomitant chemotherapy (ChT) and LDR BT with dose prescribed to point A. Retrospective survival analysis wasperformed; the impact of age, haemoglobin level, histology, tumour grade andstage, nodal status, dose to point A and overall treatment time (OTT) onsurvival and local control (LC) was evaluated. Tumor size was not systematically recorded, so its impact could not be assessed. RTOG criteria were applied to retrospectively assess acute side effects, late side effects were prospectively assessed at follow-up visits using LENT-SOMA scale. Results: 98pts (mean age 60.1) were treated. Histology was squamous cell carcinoma in 92%.Distribution of FIGO stage was: 10% IB, 7% IIA, 37% IIB, 4% IIIA and 42% IIIB,nodal involvement was present in 9 pts. Mean cumulative EQD2 to point A was 66.5 Gy (range 38.7-93.6Gy) and was higher than 80 Gy in only 5% of pts. Mean cumulative EQD2 to ICRU-R and ICRU-B point was 62.2 Gy (range 38.3-82.5Gy) and 56.9 Gy (range 37.575.3Gy), respectively. Only 6 pts received concomitant ChT.Median follow-up (FU) was 41 months (mts) for all pts and 120 mts for surviving pts.Complete response was achieved in 96% (92/98) of pts. LC was 74.9% at 5 years and 72.5% at 10 years FU. OS and DSS rates were 47.2% and 54.7% at 5 and30.7% and 50.2% at 10-years, respectively.Patterns of relapse are depicted in Table 1. Acute GI toxicity was reported in12.2% of pts (8.3% G1, 2% G2, 2% G3) and acute GU toxicity in only 4% of pts (2%G1, 1% G3, 1% G4). 15 pts (15.3%) experienced late GI toxicity – 9.2% G1-2,6.1% G3-4; 10 pts (10.2%) experienced late GU toxicity, 8.2% G1-2, 2% G3-4 and12 pts (12.2%) experienced late vaginal morbidity, 10.2% G12, 2% G3-4. In multivariate analysis, point A dose was a prognostic factor for LC and OS rate,nodal involvement for DSS and histological type (SCC : other types) of tumor for OS.
mainly associated with poor coverage of vaginal extent of disease with the standard intracavitary applicator. Our analysis, like other series, confirmed the importance of dose to point A, nodal involvement and histology as prognostic factors. Numbers of distant failures will probably be reduced with more accurate pre-treatment staging with MR and CT/PET-CT and a more systematic introduction of concomitant chemotherapy after 2002. Further improvement of local control with similar orlower late toxicity rates may be expected with the implementation of 3D CRT and especially MRI based adaptive BT at our institution after 2006. PO-0758 Dose escalation with intensity modulated radiotherapy in the treatment of locally advanced cervical cancer H. Caglar1, B. Atalar2, A. Ikizler2, N. Sozen2, E. Ozyar2 1 Medipol University, Radiation Oncology, Istanbul, Turkey 2 Acibadem University, Radiation Oncology, Istanbul, Turkey Purpose/Objective: The standard treatment of locally advanced cervical cancer is concurrent chemoradiation. Radiotherapy with newer treatment technologies such as intensity modulated radiotherapy (IMRT) seems to be effective with minimized toxicity. Materials and Methods: Patients who were diagnosed with locally advanced cervical cancer between 7/2009 – 8/2012 and treated with IMRT + concurrent weekly cisplatin with a minimum follow up of 6 months were included in this retrospective analysis. All patients had a CT based treatment planning with proper immobilization prior to treatment. PET-CT and MRI fusion was performed with the planning CT images. The GTV is defined as all known gross disease determined from radiographic studies, clinical information, physical examination and biopsy results and GTVln was determined to be metastatic lymph nodes seen in the PET-CT. CTV1 consisted GTV + cervix and uterus, CTV 2 consisted of parametria and superior third of the vagina, CTV3 included the common, external and internal iliac and presacral lymph nodes. Around CTV1, a 15mm; around CTV2 a 10mm; around and CTV3 a 7mm uniform expansion was used for PTV1, PTV2 and PTV3. For PTVln 7mm uniform expansion was used around GTVln. A total of 45Gy in 25 fractions was given to PTV1+PTV2+PTV3 and 62.5Gy to PTVln using simultaneous integrated boost (SIB) technique. Image guidance was performed daily with electronic portal kV and weekly with cone beam CT. All patients were evaluated for 3D conformal inracavitary brachytherapy. Treatment response was evaluated with physical examination and PET-CT 3 months after the conclusion of the treament. Results: A total of 49 patients were included. Median age was 55 and 80% were stage IIB. Forty seven percent of the patients had pelvic and 10% had paraaortic metastases according to the PET-CT. All of the patients who had lymph node metastases received escalated dose with SIB except 3 patients who had dissection. The majority of the patients concluded planned chemotherapy and intracavitary brachytherapy. Forty seven patients had a PET-CT for response evaluation and there were 76% complete and 11% partial metabolic response. Progressive disease was seen in 6 patients (13%) and only 1 of them was within the irradiated area. With a median follow up of 19 months (6–41 months) estimated 2 year local, regional and distant control rates were 93%, 80% and 78%. Among the 22 patients who were treated with SIB, 2 of them received in field recurrence. Two year overall survival rate was 89%. None of the patients experienced ≥ grade 3 toxicity. Conclusions: Concurrent chemoradiation with IMRT and dose escalation can be performed efficaciously in locally advanced cervical cancer.
POSTER: CLINICAL TRACK: PAEDIATRICS PO-0759 Anesthesia for external beam radiation therapy in children ñ an audit of clinical practice S. Sarkar1, A. Kumari1, I. Mallick1, S. Chatterjee1, R. Achari1 1 Tata Medical Center, Radiation Oncology, Kolkata, India Purpose/Objective: A retrospective audit was done to evaluate the current practice of general anesthesia for children undergoing radiation therapy in a new tertiary care oncology hospital. The audit identifies reasons for anesthesia, choice of drugs, safety of the procedure, average radiation room occupancy time and the side effects of repeated sedation.
Conclusions: 2Dbased BT approach was associated with good LC in stage IIIB pts. We believe that high pelvic failure rate in stage II and IIIA pts is
Materials and Methods: Data from electronic hospital medical records, paper charts and electronic radiation oncology management systems were evaluated for demographics, diagnosis,failure of behavioral
ESTRO 33, 2014 Purpose/Objective: To retrospectively analyse clinical outcome of definitive radiotherapy for cervix cancer at our institution before implementation of 3D conformal EBRT and image guided brachytherapy (BT). Materials and Methods: Consecutive patients (pts) treated for cervix cancer with curative intent from Jan 1998till Dec 2002 were included in the analysis. All pts were treated with EBRT +/-concomitant chemotherapy (ChT) and LDR BT with dose prescribed to point A. Retrospective survival analysis wasperformed; the impact of age, haemoglobin level, histology, tumour grade andstage, nodal status, dose to point A and overall treatment time (OTT) onsurvival and local control (LC) was evaluated. Tumor size was not systematically recorded, so its impact could not be assessed. RTOG criteria were applied to retrospectively assess acute side effects, late side effects were prospectively assessed at follow-up visits using LENT-SOMA scale. Results: 98pts (mean age 60.1) were treated. Histology was squamous cell carcinoma in 92%.Distribution of FIGO stage was: 10% IB, 7% IIA, 37% IIB, 4% IIIA and 42% IIIB,nodal involvement was present in 9 pts. Mean cumulative EQD2 to point A was 66.5 Gy (range 38.7-93.6Gy) and was higher than 80 Gy in only 5% of pts. Mean cumulative EQD2 to ICRU-R and ICRU-B point was 62.2 Gy (range 38.3-82.5Gy) and 56.9 Gy (range 37.575.3Gy), respectively. Only 6 pts received concomitant ChT.Median follow-up (FU) was 41 months (mts) for all pts and 120 mts for surviving pts.Complete response was achieved in 96% (92/98) of pts. LC was 74.9% at 5 years and 72.5% at 10 years FU. OS and DSS rates were 47.2% and 54.7% at 5 and30.7% and 50.2% at 10-years, respectively.Patterns of relapse are depicted in Table 1. Acute GI toxicity was reported in12.2% of pts (8.3% G1, 2% G2, 2% G3) and acute GU toxicity in only 4% of pts (2%G1, 1% G3, 1% G4). 15 pts (15.3%) experienced late GI toxicity – 9.2% G1-2,6.1% G3-4; 10 pts (10.2%) experienced late GU toxicity, 8.2% G1-2, 2% G3-4 and12 pts (12.2%) experienced late vaginal morbidity, 10.2% G12, 2% G3-4. In multivariate analysis, point A dose was a prognostic factor for LC and OS rate,nodal involvement for DSS and histological type (SCC : other types) of tumor for OS.
mainly associated with poor coverage of vaginal extent of disease with the standard intracavitary applicator. Our analysis, like other series, confirmed the importance of dose to point A, nodal involvement and histology as prognostic factors. Numbers of distant failures will probably be reduced with more accurate pre-treatment staging with MR and CT/PET-CT and a more systematic introduction of concomitant chemotherapy after 2002. Further improvement of local control with similar orlower late toxicity rates may be expected with the implementation of 3D CRT and especially MRI based adaptive BT at our institution after 2006. PO-0758 Dose escalation with intensity modulated radiotherapy in the treatment of locally advanced cervical cancer H. Caglar1, B. Atalar2, A. Ikizler2, N. Sozen2, E. Ozyar2 1 Medipol University, Radiation Oncology, Istanbul, Turkey 2 Acibadem University, Radiation Oncology, Istanbul, Turkey Purpose/Objective: The standard treatment of locally advanced cervical cancer is concurrent chemoradiation. Radiotherapy with newer treatment technologies such as intensity modulated radiotherapy (IMRT) seems to be effective with minimized toxicity. Materials and Methods: Patients who were diagnosed with locally advanced cervical cancer between 7/2009 – 8/2012 and treated with IMRT + concurrent weekly cisplatin with a minimum follow up of 6 months were included in this retrospective analysis. All patients had a CT based treatment planning with proper immobilization prior to treatment. PET-CT and MRI fusion was performed with the planning CT images. The GTV is defined as all known gross disease determined from radiographic studies, clinical information, physical examination and biopsy results and GTVln was determined to be metastatic lymph nodes seen in the PET-CT. CTV1 consisted GTV + cervix and uterus, CTV 2 consisted of parametria and superior third of the vagina, CTV3 included the common, external and internal iliac and presacral lymph nodes. Around CTV1, a 15mm; around CTV2 a 10mm; around and CTV3 a 7mm uniform expansion was used for PTV1, PTV2 and PTV3. For PTVln 7mm uniform expansion was used around GTVln. A total of 45Gy in 25 fractions was given to PTV1+PTV2+PTV3 and 62.5Gy to PTVln using simultaneous integrated boost (SIB) technique. Image guidance was performed daily with electronic portal kV and weekly with cone beam CT. All patients were evaluated for 3D conformal inracavitary brachytherapy. Treatment response was evaluated with physical examination and PET-CT 3 months after the conclusion of the treament. Results: A total of 49 patients were included. Median age was 55 and 80% were stage IIB. Forty seven percent of the patients had pelvic and 10% had paraaortic metastases according to the PET-CT. All of the patients who had lymph node metastases received escalated dose with SIB except 3 patients who had dissection. The majority of the patients concluded planned chemotherapy and intracavitary brachytherapy. Forty seven patients had a PET-CT for response evaluation and there were 76% complete and 11% partial metabolic response. Progressive disease was seen in 6 patients (13%) and only 1 of them was within the irradiated area. With a median follow up of 19 months (6–41 months) estimated 2 year local, regional and distant control rates were 93%, 80% and 78%. Among the 22 patients who were treated with SIB, 2 of them received in field recurrence. Two year overall survival rate was 89%. None of the patients experienced ≥ grade 3 toxicity. Conclusions: Concurrent chemoradiation with IMRT and dose escalation can be performed efficaciously in locally advanced cervical cancer.
POSTER: CLINICAL TRACK: PAEDIATRICS PO-0759 Anesthesia for external beam radiation therapy in children ñ an audit of clinical practice S. Sarkar1, A. Kumari1, I. Mallick1, S. Chatterjee1, R. Achari1 1 Tata Medical Center, Radiation Oncology, Kolkata, India Purpose/Objective: A retrospective audit was done to evaluate the current practice of general anesthesia for children undergoing radiation therapy in a new tertiary care oncology hospital. The audit identifies reasons for anesthesia, choice of drugs, safety of the procedure, average radiation room occupancy time and the side effects of repeated sedation.
Conclusions: 2Dbased BT approach was associated with good LC in stage IIIB pts. We believe that high pelvic failure rate in stage II and IIIA pts is
Materials and Methods: Data from electronic hospital medical records, paper charts and electronic radiation oncology management systems were evaluated for demographics, diagnosis,failure of behavioral