ESTRO 2020 Abstract book

S638 ESTRO 2020

Between 2008 and 2019 nine patients diagnosed of locally advanced cervical carcinoma during pregnancy were treated with concomitant radiochemotherapy in our institution. Medical records were retrospectively reviewed. Results Patients median age at diagnosis was 31 (27-43) years and gestational age was between 10 and 31 weeks. FIGO stages were IIB for seven patients (77.8%) and IIIB for the remaining two (22.2%). One patient (11.1%) was diagnosed in the 1 st trimester of pregnancy, five (55.6%) in the 2 nd and three (33.3%) in the 3 rd trimester. For patients (44.4%) underwent immediate caesarean section followed by radiation. Five patients (55.6%), with a median gestational age at diagnosis of 14 (10-16) weeks, were treated with external beam radiation therapy (EBRT) and Chemotherapy with the fetus in situ (mean dose 45.2 Gy) Weekly fetal monitoring was carry out in all patients. Negative fetal heartbeat was detected between the the 3 rd - 4 th week after the onset of radiotherapy (median dose of 25 (21-37) Gy). Fetal expulsion occurred at a median dose of 41 (30-45) Gy and stillbirth resulted in all patients during the EBRT treatment, except one. No complications related with expulsion were registered. In all cases weekly concomitant Cisplatin-based chemotherapy (4 to 7 cycles) was administered. High dose rate intracavitary brachyterapy (HDR-ICR) was delivered at weekly intervals after EBRT was concluded in seven patients (77.8%). Two patients (22.2%) received external boost with EBRT because of technical difficulties associated with applicators or catheters placements. D90 CTV High- Risk EQD2 10 > 85 Gy was achieved in all of our patients. No grade 3/4 (CTCAE) toxicities of the bladder, rectum or bowel were reported. One of the five patients treated with radiotherapy with the fetus in situ presented a local relapse. Salvage surgery was the treatment of choice after multidisciplinary management (free related-disease in last follow up). In the four patients treated with caesarean section previous to radiotherapy, two cases of progression were registered (one local and one distant). The two of them resulted in death related disease despite systemic treatment. Overall and progression-free survival at 5 years, since the end of radiotherapy, were 71% and 62% respectively. Conclusion For pregnant women diagnosed of locally advanced cervical carcinoma in a situation of fetal unviability, radiotherapy is a safe and effective treatment of choice. No complications related to the fetus expulsion were registered and in most cases spontaneous expulsion occurred. Despite that EBRT with the fetus in situ involved greater volume of treatment, no severe toxicities were observed in our sample, with an aceptable rate of overall and progression- free survival at 5 years. PO-1119 Sexual Toxicity in Cervix Cancer Survivors Treated with Chemo-Radiation and MR-guided Brachytherapy J. Conway 1 , L. Conroy 2 , S. Ferguson 3 , A. Zia 3 , A. Liu 4 , J. Weiss 4 , A. Rink 2 , C. Jennifer 5 1 Simcoe Muskoka Regional Cancer Centre- Royal Victoria Regional Health Centre, Department of Radiation Oncology- University of Toronto- Toronto- Canada, Toronto, Canada ; 2 Radiation Medicine Program- Princess Margaret Cancer Centre- University Health Network-, Department of Radiation Oncology- University of Toronto- Toronto- Canada, Toronto, Canada ; 3 Princess Margaret Cancer Centre- University Health Network, Department of Gynecologic Oncology- Toronto- Canada, Toronto, Canada ; 4 Princess Margaret Cancer Centre- University Health Network, Department of Biostatistics, Toronto, Canada ; 5 Radiation Medicine Program- Princess

Chemotherapy was frequently proposed (Carboplatin- Taxol q21: 67.9%, or CDDP-Taxol q21: 19.2%). Conclusion The present survey report a broad spectrum of opinions and clinical pathways in the clinical CC treatment in Italy. Availability and use of modern techniques is quite good, but a more wide distribution of brachytherapy resources and skills still remains a challenge for the future. PO-1117 Two-step adaptive 3-D conformal brachytherapy for advanced bulky cervical cancer I.J. Cho 1 , Y. Kim 1 , J. Jeong 1 , W. Chung 1 , S. Ahn 1 , T. Nam 1 , J. Song 1 , S. Cho 1 , M.S. Yoon 1 1 Chonnam National University Hwasun Hospital, Radiation Oncology, Hwasun-gun, Korea Republic of Purpose or Objective The role of adaptive conformal brachytherapy (ACB) in advanced bulky cervical cancer has not yet been determined. We evaluated feasibility and efficacy of two- step ACB to investigate whether reduced dwell time during brachytherapy (BT) based on tumor regression confers a benefit for delivering effective dose to high-risk clinical target volume (HR-CTV) with better local control. Material and Methods Two-step ACB were performed during brachytherapy in patients with >5 cm bulky cervical cancer. All patients received 3-D conformal external beam radiation therapy (EBRT) with concurrent cisplatin. Consecutive MRI were performed pre-radiotherapy, pre-BT and during interfraction of BT. Two-step ACB consisted of three channel with tandem and ovoid applicator following reduced 192 Ir dwell position to the regressed tumor with or without a cervical cylinder applicator. Two-step ACB was composed of several 5Gy fractions following with interim BT modification consisting of a few fractions of less than 5 Gy to point A. Results Fifty consecutive patients with >5cm FIGO stage IB2-IVA cervical cancer completed radiotherapy with concurrent weekly cisplatin from 2013 to 2016. Of patients, 90% received median EQD2 (α/β=10) 25Gy of first step ACB (range, 6.25-39.32) to whole uterus after median 45 Gy EBRT to whole pelvis. After second step ACB to HR-CTV, the cumulative median EQD2 (α/β=10) to point A was 84.66 Gy (64.71-126.32) with median total fraction of 8. The 3-year local control rates was 94%. No severe genitourinary and gastrointestinal acute toxicity was observed. Late toxicity of hematuria requiring transfusion occurred in 2 patients. Grade 3 and 4 late gastrointestinal late toxicity was observed in 7 and 1 patients, respectively. Actuarial overall and disease-free survival at 3 years was 80% and 63%, respectively. Conclusion Two-step adaptive conformal brachytherapy showed excellent local control with comparable toxicity for bulky cervical cancer. Using interim BT modification according to regressed cervical tumor, two-step ACB and 3-D EBRT is feasible in patients with >5cm bulky cervical cancer with acceptable morbidity and a high local control rate, resulting in a high disease-free survival. PO-1118 The dilemma of cervical cancer during pregnancy. A 10 year single-center experience L. Juan rodríguez 1 , M.H. Fassano Moore 1 , M.A. Mera Errasti 1 , B.J. Salazar Zúñiga 1 , J.F. Pérez- Regadera Gómez 1 1 Hospital Universitario 12 de Octubre, Radiation Oncology, Madrid, Spain Purpose or Objective To describe our experience in patients treated with concomitant radiochemotherapy with locally advanced cervical carcinoma during pregnancy. Material and Methods