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SP-0544: Intensive physical training during adjuvant treatment
ESTRO 33, 2014 (n=17) identified support for a local community based radiotherapy role, to provide education and support their own practice, especially once patients had completed radiotherapy. Conclusions: Both patients and HCP would benefit from additional information and support in relation to radiotherapy before and after treatment. Some recommendations for how practice and support could be enhanced in the future will be discussed, especially in terms of rehabilitation and 'moving forward'. SP-0544 Intensive physical training during adjuvant treatment H. Van Waart1, M.M. Stuiver2, G.S. Sonke3, W.H. Van Harten1, N.K. Aaronson1 1 Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, The Netherlands 2 Antoni van Leeuwenhoek, Department of Physical Therapy, Amsterdam, The Netherlands 3 Antoni van Leeuwenhoek, Department of Medical Oncology, Amsterdam, The Netherlands Objective: Exercise programs have been demonstrated to have a beneficial effect on patients undergoing chemotherapy. The optimal intensity of such programs is as yet unknown. This study evaluated the efficacy of a low intensity, home-based, self-management physical activity program (Onco-Move), and a high intensity, structured, supervised exercise program (OnTrack) in terms of maintaining or enhancing cardiorespiratory fitness and muscle strength, minimizing fatigue, enhancing health-related quality of life, and maximizing chemotherapy completion rates of patients undergoing adjuvant chemotherapy for breast and colon cancer. Methods: In this multicenter, prospective, randomized trial, patients undergoing adjuvant chemotherapy for breast or colon cancer were randomized to one of three study arms: 1) OnTrack, a high intensity, structured, supervised exercise program; 2) Onco-Move, a low intensity, home-based, self-management physical activity program; or 3) a Usual Care Control group. Physical fitness (cardiorespiratory fitness and muscle strength), fatigue, health-related quality of life and chemotherapy completionrates were assessed prior to chemotherapy, at the end of chemotherapy, and 6 months later (only first follow-up results will be presented). Outcomes included both performance and self-report measures.
S213 (GU) toxicity and on erectile dysfunction after radiotherapy (RT) for prostate cancer; patients (pts) were treated with conventional (1.82Gy/fr, CONV) or moderate hypo-fractionation (2.5-2.7Gy/fr HYPO). The aim of this ad-interim analysis was to assess predictors of nicturia (NICT) at RT end as measured by the International Prostate Symptoms Score (IPSS). Materials and Methods: Pts had to fill in the IPSS questionnaire at RT start and end, at 3 months, then every 6 months up to 5 year after RT. Planning data were recovered and analyzed with a dedicated program (Vodca, MSSGmbH, Zurich), including absolute (cc/cm2) and % bladder dose-volume/surface (DVH/DSH) parameters relative to both the overall treatment and to the weekly delivered dose (DVHw/DSHw). Relevant clinical factors were prospectively collected, including T stage, concomitant morbidities and drugs, hormonal therapy (HT), previous abdominal surgery, smoking, age, BMI and prostate volume. For evaluation of NICT, an IPSS score≥4 at RT end was considered as the end point of moderate nicturia (i.e.: ≥4 bladder voiding per night, NICT4). Logistic uni- and backward multi-variate (MVA) analyses were performed, including dosimetry and clinical variables: a backward feature selection method based on prediction optimization (minimization of residual) was implemented in the KNIME software (KNIME GmbH, Germany) environment and applied. Results: At the time of this ad-interim analysis (November 2013), 339 pts were enrolled by 9 Institutes. Clinical data and baseline and end-RT IPSS of 264/339 pts were available (140 CONV and 124 HYPO). DVH/DSH were available for 227/264 pts. The number of pts with NICT4=1 increased from 19 to 56 from baseline to RT end. The resulting MVA model (p<0.0001, AUC: 0.80) of the risk of NICT4=1 at RT end included the basal NICT score (OR: 2.406, p<0.0001), Tstage (T2-3 vs T1-3, OR: 2.129, p=0.047), and the absolute fraction of bladder surface receiving 11.5 Gy/w (S11.5w, OR:1.020, p=0.032). The model was confirmed in the HYPO subgroup (AUC=0.79) while only basal NICT score and S11.5w remained in the model when excluding the pts with baseline NICT4=1 (AUC=0.82); the risk of NICT4 against S11. 5w is plotted in Fig.1 for basal NICT values from 0 to 3 (excluding pts with basal NICT ≥4). When replacing DSH with DVH parameters, absolute V12w was the best predictor, but the discriminative power of the resulting model was lower (AUC= 0.76).
Results: Participants in OnTrack had significantly less decline in cardiorespiratory fitness (p<0.005), and enhanced muscle strength (p=0.022) as compared to the control group. Both exercise groups reported significantly better physical functioning (p=0.001) and less physical fatigue (p=0.001), pain (p=0.026), nausea (p=0.040) and constipation (p<0.001) at follow-up than the control group. Significantly more participants in OnTrack completed their prescribed chemotherapy regimen without dose adjustments than those in the control group (84% versus 62%) (p=0.001). Conclusion: High intensity physical exercise during chemotherapy enhances muscle strength, reduces the decline in cardiorespiratory fitness and fatigue, and leads to less dose reductions in chemotherapy regimens. Low intensity exercise also has a salutary effect on physical fatigue and other symptoms, but less so than high intensity exercise.
POSTER DISCUSSION: 9: PHYSICS: MODELLING AND ADAPTIVE RADIOTHERAPY PD-0545 Modeling the risk of self-reported acute nicturia in prostate cancer RT: Ad interim results of a prospective study V. Carillo1, C. Cozzarini2, T. Rancati3, F. Civardi3, V. Casanova Borca4, M. Palombarini5, A. Pierelli6, E. Pignoli7, R. Valdagni3, C. Fiorino1 1 San Raffaele Scientific Institute, Medical Physics, Milano, Italy 2 San Raffaele Scientific Institute, Radiotherapy, Milano, Italy 3 Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milano, Italy 4 Ospedale ASL9, Medical Physics, Ivrea, Italy 5 Ospedale Bellaria, Medical Physics, Bologna, Italy 6 Cliniche Gavazzeni-Humanitas, Medical Physics, Bergamo, Italy 7 Fondazione IRCCS Istituto Nazionale dei Tumori, Medical Physics, Milano, Italy Purpose/Objective: A multicentric observational study was activated in April 2010 with the aim to develop predictive models of genito-urinary
Conclusions: Bladder DSHw/DVHw in the region of high dose/week predicted the risk of severe acute NICT as well as T stage and baseline IPSS NICT score, which emerged to be the main predictor: MVA models with relatively high discriminative power were developed for the whole population, the HYPO group and the group of patients with basal NICT<4. PD-0546 Effects of non-target dose on normal prostate cells L. Shields1, I. Vega-Carrascal2, F. Lyng2, B. Mc Clean3 1 University College Dublin, Physics, Dublin, Ireland Republic of 2 Dublin Institute of Technology, Radiation and Environment Science, Dublin, Ireland Republic of 3 St. Luke's Radiation Oncology Network, Medical Physics, Dublin, Ireland Republic of Purpose/Objective: Interest in non-target patient dose is increasing as new techniques such as VMAT are being introduced. These new techniques offer superior conformity of high dose regions to the target but can have a detrimental effect on non-target cells. The impact of non-target doses on healthy cells is not well understood and clinical concern has been raised in relation to their consequence. The aim of this study was to investigate the effect of non-target dose on cell survival
S213 (GU) toxicity and on erectile dysfunction after radiotherapy (RT) for prostate cancer; patients (pts) were treated with conventional (1.82Gy/fr, CONV) or moderate hypo-fractionation (2.5-2.7Gy/fr HYPO). The aim of this ad-interim analysis was to assess predictors of nicturia (NICT) at RT end as measured by the International Prostate Symptoms Score (IPSS). Materials and Methods: Pts had to fill in the IPSS questionnaire at RT start and end, at 3 months, then every 6 months up to 5 year after RT. Planning data were recovered and analyzed with a dedicated program (Vodca, MSSGmbH, Zurich), including absolute (cc/cm2) and % bladder dose-volume/surface (DVH/DSH) parameters relative to both the overall treatment and to the weekly delivered dose (DVHw/DSHw). Relevant clinical factors were prospectively collected, including T stage, concomitant morbidities and drugs, hormonal therapy (HT), previous abdominal surgery, smoking, age, BMI and prostate volume. For evaluation of NICT, an IPSS score≥4 at RT end was considered as the end point of moderate nicturia (i.e.: ≥4 bladder voiding per night, NICT4). Logistic uni- and backward multi-variate (MVA) analyses were performed, including dosimetry and clinical variables: a backward feature selection method based on prediction optimization (minimization of residual) was implemented in the KNIME software (KNIME GmbH, Germany) environment and applied. Results: At the time of this ad-interim analysis (November 2013), 339 pts were enrolled by 9 Institutes. Clinical data and baseline and end-RT IPSS of 264/339 pts were available (140 CONV and 124 HYPO). DVH/DSH were available for 227/264 pts. The number of pts with NICT4=1 increased from 19 to 56 from baseline to RT end. The resulting MVA model (p<0.0001, AUC: 0.80) of the risk of NICT4=1 at RT end included the basal NICT score (OR: 2.406, p<0.0001), Tstage (T2-3 vs T1-3, OR: 2.129, p=0.047), and the absolute fraction of bladder surface receiving 11.5 Gy/w (S11.5w, OR:1.020, p=0.032). The model was confirmed in the HYPO subgroup (AUC=0.79) while only basal NICT score and S11.5w remained in the model when excluding the pts with baseline NICT4=1 (AUC=0.82); the risk of NICT4 against S11. 5w is plotted in Fig.1 for basal NICT values from 0 to 3 (excluding pts with basal NICT ≥4). When replacing DSH with DVH parameters, absolute V12w was the best predictor, but the discriminative power of the resulting model was lower (AUC= 0.76).
Results: Participants in OnTrack had significantly less decline in cardiorespiratory fitness (p<0.005), and enhanced muscle strength (p=0.022) as compared to the control group. Both exercise groups reported significantly better physical functioning (p=0.001) and less physical fatigue (p=0.001), pain (p=0.026), nausea (p=0.040) and constipation (p<0.001) at follow-up than the control group. Significantly more participants in OnTrack completed their prescribed chemotherapy regimen without dose adjustments than those in the control group (84% versus 62%) (p=0.001). Conclusion: High intensity physical exercise during chemotherapy enhances muscle strength, reduces the decline in cardiorespiratory fitness and fatigue, and leads to less dose reductions in chemotherapy regimens. Low intensity exercise also has a salutary effect on physical fatigue and other symptoms, but less so than high intensity exercise.
POSTER DISCUSSION: 9: PHYSICS: MODELLING AND ADAPTIVE RADIOTHERAPY PD-0545 Modeling the risk of self-reported acute nicturia in prostate cancer RT: Ad interim results of a prospective study V. Carillo1, C. Cozzarini2, T. Rancati3, F. Civardi3, V. Casanova Borca4, M. Palombarini5, A. Pierelli6, E. Pignoli7, R. Valdagni3, C. Fiorino1 1 San Raffaele Scientific Institute, Medical Physics, Milano, Italy 2 San Raffaele Scientific Institute, Radiotherapy, Milano, Italy 3 Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milano, Italy 4 Ospedale ASL9, Medical Physics, Ivrea, Italy 5 Ospedale Bellaria, Medical Physics, Bologna, Italy 6 Cliniche Gavazzeni-Humanitas, Medical Physics, Bergamo, Italy 7 Fondazione IRCCS Istituto Nazionale dei Tumori, Medical Physics, Milano, Italy Purpose/Objective: A multicentric observational study was activated in April 2010 with the aim to develop predictive models of genito-urinary
Conclusions: Bladder DSHw/DVHw in the region of high dose/week predicted the risk of severe acute NICT as well as T stage and baseline IPSS NICT score, which emerged to be the main predictor: MVA models with relatively high discriminative power were developed for the whole population, the HYPO group and the group of patients with basal NICT<4. PD-0546 Effects of non-target dose on normal prostate cells L. Shields1, I. Vega-Carrascal2, F. Lyng2, B. Mc Clean3 1 University College Dublin, Physics, Dublin, Ireland Republic of 2 Dublin Institute of Technology, Radiation and Environment Science, Dublin, Ireland Republic of 3 St. Luke's Radiation Oncology Network, Medical Physics, Dublin, Ireland Republic of Purpose/Objective: Interest in non-target patient dose is increasing as new techniques such as VMAT are being introduced. These new techniques offer superior conformity of high dose regions to the target but can have a detrimental effect on non-target cells. The impact of non-target doses on healthy cells is not well understood and clinical concern has been raised in relation to their consequence. The aim of this study was to investigate the effect of non-target dose on cell survival