ESTRO 2020 Abstract book

S619 ESTRO 2020

Switzerland ; 3 University of Frankfurt, Senckenberg Institute for Pathology, Frankfurt, Germany

Poster: Clinical track: Lower GI (colon, rectum, anus)

Purpose or Objective Definitive chemoradiotherapy (CRT) is the primary treatment option for non-metastatic anal squamous cell carcinoma (ASCC). In general, treatment outcomes are good but relapse occurs in up to 40% of all patients. In order to effectively improve outcomes for patients with worse prognosis easily assessable biomarkers are needed to select patients for treatment escalation or de- escalation strategies. The role of the immune system and inflammation in cancer progression has been elucidated in recent decades and gains more attention as more substances that specifically target pathways of the immune system become available. The prognostic impact of inflammation associated blood cells like leukocytes or neutrophils has been reported in ASCC and other malignancies as well. Recently, the ratio of CRP and albumin (CAR) was studied in several malignancies and a high CAR was associated with worse prognosis in head and neck squamous cell carcinomas, bladder cancer, esophageal cancer and others. In this study we examined a possible new prognostic marker for patients with ASCC that is easily available. Material and Methods We identified 126 patients with ASCC that were treated with standard chemoradiotherapy at our department with available baseline blood parameters. CRP to albumin ratio was calculated by dividing baseline CRP through baseline albumin levels. Associations with clinicopathology parameters were evaluated and the prognostic impact of CAR was tested using univariate cox regression analysis. In order to dichotomize patients in high and low risk groups we used maximally selected rank statistics for disease-free survival (DFS) using the R maxstat package. Results After a median follow-up of 34 months, the 3-year locoregional control rate (LRC) and disease-free survival (DFS) was 84% and 78%, respectively. Advanced T-stage and male gender was associated with a higher baseline CAR (p < 0.001, p < 0.01, respectively). Using the log transformed CAR we found a significant association of CAR with distant metastasis free survival (DMFS, HR: 1.31, p= 0.016), DFS (HR: 1.22, p= 0.019) and OS (HR: 1.35, p<0.01) but not LRC. Using the calculated cutoff of 0.117, a high CAR was also associated with worse LRC (p=0.004), DMFS (p=0.01), DFS (p=0.003) and OS (p=0.002). In a multivariate cox regression model, including T-Stage, N-Stage and dichotomized CAR, only N-stage and CAR were significantly associated with worse DFS, whereas only CAR remained significant for LRC. Conclusion Elevated CAR indicates inflammation and poor nutritional status and both these factors can promote tumor progression. Baseline CAR could become a new and cheap biomarker to stratify patients with ASCC to investigate new treatment strategies. Prospective validation of these and other described biomarkers is certainly needed. PO-1081 Patterns of care analysis of treatment of anal squamous cell carcinoma in German speaking countries D. Martin 1,2,3 , J. Von der Grün 1,3 , C. Rödel 1,2,3 , E. Fokas 1,2,3 1 University of Frankfurt, Department of Radiotherapy and Oncology, Frankfurt, Germany ; 2 FCI, Frankfurt Cancer Institute, Frankfurt, Germany ; 3 German Cancer Consortium DKTK, partner site: Frankfurt a. M.- Germany., Frankfurt, Germany Purpose or Objective Anal squamous cell carcinoma (ASCC) is a rare disease with increasing incidence. The radiotherapy dose and treatment volumes prescription varies considerably among the different treatment guidelines (NCCN, UK, French, ESMO). There are several international treatment

PO-1079 Systematic review of colorectal/anal cancer guidelines: managing long-term symptoms and functioning L. Wiltink 1 , K. White 2 , M. King 3 , C. Rutherford 1 1 University of Sydney, Quality of Life Office and Cancer Nursing Research Unit, Sydney, Australia ; 2 University of Sydney, Cancer Nursing Research Unit, Sydney, Australia ; 3 University of Sydney, Quality of Life Office, Sydney, Australia Purpose or Objective The number of colorectal and anal cancer survivors is increasing, leading to more patients with long-term symptoms after treatment. A systematic review was conducted to investigate the extent to which clinical practice guidelines for colorectal and anal cancer provide recommendations for managing long-term symptoms and functioning impairments. Material and Methods Four electronic databases were searched from database inception to July 2019 and websites of more than 30 international cancer societies. We included papers on clinical practice guideline, consensus statement or best practice recommendation for colorectal or anal cancer. The AGREE II tool was used to assess the quality of included guidelines. Information about recommendations for management strategies or interventions for long-term symptoms and functioning impairments were extracted and narratively synthesized. Results We found 51 guidelines or consensus statements; 20 through electronic searches and 31 from websites. Only 25.4% of guidelines included recommendations for managing long-term symptoms or functioning impairments. The guidelines that did include recommendations were published by the NCCN, ESMO, ASCO, Cancer Care Ontario, Alberta provincial GI tumor team, German Guideline program in oncology, and the NHMRC. All 13 guidelines recommend physical activity and a healthy lifestyle, diet and body weight. The ASCO Colorectal Cancer Survivorship Care Guideline is the most comprehensive, including recommendations for interventions ranging from cognitive and pain to bowel and sexual issues, but also acknowledges that evidence is limited to inform management strategies. Other guidelines include some suggestions for treating chronic diarrhea, incontinence and distress, and highlight need for greater awareness for sexual dysfunction and survivorship clinics and referrals to specific supportive care interventions. Conclusion Few clinical practice guidelines for colorectal or anal cancer provide recommendations for how to manage or treat long-term symptoms and functioning impairments . What is unclear is whether the lack of inclusion is due to limited evidence or lack of appropriate management strategies and interventions for these patient-centered outcomes. There is need for clear recommendations for managing long-term symptoms and functioning to assist health professionals in supporting colorectal and anal cancer survivors, and to ameliorate suffering due to persistent symptoms and functioning impairments that often go unmanaged. PO-1080 C-reactive protein-to-albumin ratio is a predictive marker for anal squamous cell carcinoma D. Martin 1 , F. Rödel 1 , P. Balermpas 2 , R. Winkelmann 3 , C. Rödel 1 , E. Fokas 1 1 University of Frankfurt, Department of Radiotherapy and Oncology, Frankfurt, Germany ; 2 University Hospital Zürich, Department of Radiation Oncology, Zürich,