ESTRO 2020 Abstract book

S640 ESTRO 2020

(bladder, bowel, and rectum), however the vagina is both the target and an organ at risk. Only 4% of 380 articles assessed quality of life (QoL) among African women living with cervical cancer. The purpose of this study was to describe the sexual QoL of patients treated with chemoradiation for locally advanced cervical cancer in South Africa. Material and Methods This is a retrospective analysis of prospectively collected data from a phase III randomised controlled trial investigating the effects of the addition of hyperthermia to chemoradiation. In total, 76 participants from the control arm (enrolled from January 2014 to June 2017), with a median follow-up of 12 months, were included in this analysis. The EORTC QoL cervical cancer module (CX24) questionnaires were administered at baseline, every 3 months post-treatment during the first year, and every 6 months post-treatment in the second year. Results Poor body image and worry that sex would be painful were reported by 60% of participants at baseline and remained constant for the first year post-treatment but decreased to 35-40% thereafter. 11% of participants (n=8) reported being sexually active at baseline but this doubled by six months post–treatment (n=17) and plateaued to 30% of participants after 9 months post-treatment. 21% of women <30 years, 22% of those 31-50 years and 10% of participants > 50 years of age reported having sex in the last four weeks. 77% of reports from those sexually active are that sex was enjoyable whilst 65% reported having pain during sex. However 51% found it both enjoyable and painful. The main vaginal symptom was discharge that was almost two times more prevalent than vaginal discomfort throughout the first two years post-treatment (71% vs. 43% at baseline; 23% vs. 14% at 18 months). However there was a clear and significant improvement over time.

Radiation Physics, Mumbai, India ; 5 Actrec- Tata Memorial Centre, Radiation Oncology, Mumbai, India Purpose or Objective To evaluate the outcomes and toxicities of re-irradiation using brachytherapy (BT) for patients with post - radiation recurrent gynaecological cancers. Material and Methods A retrospective analysis of patients with post radiation recurrent cervical, endometrial and vaginal cancers who were treated with reirradiation using BT between 2000 to 2018 was carried out. 67 patients were eligible for the final analysis. Patients underwent biopsy, restaging evaluation, deemed unsuitable for radical surgery were treated with reirradiation using BT. Eighteen patients (26.9%) underwent chemotherapy before the consideration of brachytherapy. BT application was done using MUPIT in 35, Vienna applicator in 20, Syed Neblett in 6, central vaginal cylinder in 3, multi-catheter intravaginal applicator in 1 patient and freehand technique in 1 patient. Descriptive statistics, relapse status, survival outcome & factors affecting outcome and late toxicities were analyzed. Results The median age at recurrence was 53 years (range: 35-73). The median gap between the 1 st and 2 nd radiation treatments was 25 months (IQR: 12 - 44). Vaginal involvement was seen in 52 patients (78%). All the patients completed planned HDR BT with various fractionation schedules (3.4 -4 Gy per fraction x 8-10 # for templates; 7- 9 Gy per fraction x 3-4# to GTV at relapse. The median 2 Gy equivalent dose was 40 Gy (IQR: 33-42 Gy). At 3-6 months follow-up after BT, 55 patients (82%) had complete response, partial response in 9, stable disease in 2 and progressive disease in 1 patient. With a median follow-up of 20 months (1-139 m) after completion of re-irradiation, 37 patients (55%) were relapse free, 15 pts (22.5%) had local relapse, and 15 pts had systemic / non-local (pelvic) relapses. The overall survival and relapse free survival rates at 2 years were 86% and 56% respectively. Local control at 2 years was (52 / 67 pts) 78%. On further analyses, volume of disease, time interval between 2 radiation treatments or doses delivered did not show any significant effect on outcomes. Grade >3 bowel/bladder toxicities were seen in 15 patients (22.4%). Nineteen patients (28.4%) had grade 2-3 vaginal fibrosis, and 3 pts vaginal ulceration / necrosis. One patient developed rectovaginal and vesico-vaginal fistulae (no disease)) while another one with vesico-vaginal fistula (due to disease progression). Another patient developed intestinal obstruction after 5 months of treatment. Conclusion Patients with post radiation local recurrent disease treated with reirradiation using BT resulted in reasonably favorable clinical outcomes. Reirradiation with BT was associated with higher grade 3-4 morbidity predominantly vaginal. Further evaluation to understand dose-response relationship for target and OAR with re-irradiation BT schedules is warranted. PO-1122 Sexual function in cervical cancer patients treated with definitive chemoradiation in South Africa P. Pillay 1 , C. Minnaar 2 , J. Kotzen 3 1 University of Witwatersrand, Radiation Oncology, Johannesburg, South Africa ; 2 University of Witwatersrand, Radiation Sciences, Johannesburg, South Africa ; 3 Donald Gordon Medical Centre, Radiation Oncology, Johannesburg, South Africa Purpose or Objective Approximately 1200 new cases of cervical cancer in 2017 were referred to a Radiation Oncology unit in Johannesburg South Africa (>1/4 of all cancers at this hospital). Research in the area of radiation toxicity has focused on symptoms related to nearby organs at risk

Conclusion Providing care on a daily basis without an in-depth understanding of what is most meaningful to our patients only widens the gap in our care. We should focus on communicating and help managing their expectations and experiences. This analysis showed that participants' QoL and sexual functioning were greatly impaired before treatment and that their concerns persisted throughout the first year with an improvement in the subsequent year. The first year is the most fragile and fraught with poor body image and worry. We can reassure patients that symptoms like discharge do improve and so does their sexual experience. Worry that sex would be painful by itself shouldn’t prohibit patients trying to have sex, and although pain will be consistent enjoying sex is possible. Lest we forget women should not be defined solely by their age, disease or clinically relevant outcomes. PO-1123 Clinician and PRO of bladder and GIT toxicity after pelvic radiation in cervical cancer patients P. Pillay 1 , C. Minnaar 2 , J. Kotzen 3 1 University of Witwatersrand, Radiation Oncology, Johannesburg, South Africa ; 2 University of Witwatersrand, Radiation Sciences, Johannesburg, South