ESTRO 2020 Abstract book

S665 ESTRO 2020

PO-1174 Results of a multinational clinical audit for prostate cancer radiotherapy: the IROCA project C. Lopes de Castro 1 , M. Fundowicz 2 , A. Roselló 3 , J. Jové 4 , L. Deantonio 5 , A. Aguiar 1 , C. Pisani 5 , S. Villà 4 , A. Boladeras 6 , E. Konstanty 2 , M. Kruszyna-Mochalska 2 , P. Milecki 7 , D. Jurado-Bruggeman 8 , J. Lencart 9 , I. Modolell 10 , C. Muñoz-Montplet 10 , L. Aliste 11 , M.G. Torras 12 , M. Puigdemont 3 , L. Carvalho 1 , M. Krengli 5 , F. Guedea 6 , J. Malicki 2 1 Instituto Português de Oncologia do Porto Francisco Gentil- EPE, Radiotherapy, Porto, Portugal ; 2 Greater Poland Cancer Centre, Radiotherapy, Poland, Poland ; 3 Institut Català d'Oncologia, Radiotherapy, Girona, Spain ; 4 Institut Català d'Oncologia, Radiotherapy, Badalona, Spain ; 5 Università degli Studi del Piemonte Orientale, 7 Department of Electroradiology- University of Medical Sciences, Radiotherapy, Poznan, Poland ; 8 Institut Català d'Oncologia, Physics, Girona, Spain ; 9 Instituto Português de Oncologia do Porto Francisco Gentil- EPE, Physics, Porto, Portugal ; 10 Institut Català d'Oncologia, Physics, Barcelona, Spain ; 11 Institut Català d'Oncologia, Statistics, Barcelona, Spain ; 12 Institut Català d'Oncologia, Epidemiology, Barcelona, Spain Purpose or Objective The IROCA project (Improving Quality in Radiation Oncology through Clinical Audits) was created to conduct clinical audits among member institutions to assess adherence to good clinical practice. Here we describe the results of the clinical audit of radiotherapy processes for prostate cancer (PCa) at six different European cancer centres in Spain, Portugal, Poland, and Italy. Material and Methods This multi-institutional retrospective cohort study included 240 randomly-selected patients who underwent radiotherapy for PCa. Clinical indicators were evaluated to assess three phases of care: 1) diagnosis and pre- treatment; 2) treatments administered; and 3) follow. Specific indicators included: presentation to multidisciplinary tumour board (MTB) and departmental clinical session (DCS); clinical record keeping; diagnostic tests; clinical trials; time between first visit and starting of radiotherapy; type of treatment administered; dose/fractionation and treatment duration; treatment delays, interruptions, and compensations; radiotherapy technique and image guidance; adjuvant treatment; and registration of adverse effects (AE) and appropriateness of follow-up. Results All audits were performed in the year 2017. We evidenced substantial inter-centre variability in clinical practice, particularly for the following indicators: 1) proportion of patients undergoing staging MRI (range, 27.5%-87.5%); 2) percentage of patients presented to the MTB (range, 2.5%- 100%); days elapsed between the 1st visit to the radiation oncology department and radiotherapy initiation (range, 42-102.5 days); treatment interruptions ≥ one day (range, 7.5%-97.5%). The most common divergence from generally-accepted good clinical practice was inconsistent data registration. Conclusion This multi-centre clinical audit reveals substantial inter- centre variability in clinical practice. Although overall adherence to clinical protocols and practices was strong, several areas amenable to improvement were detected, particularly with regard to data registration. These results show that external clinical audits are invaluable to identify areas of strength and weakness, which can then be used to improve radiotherapy practices. These findings underscore the value of conducting clinical audits and support the greater use of audits in the field of radiation oncology. Radiotherapy, Novara, Italy ; 6 Institut Català d'Oncologia, Radiotherapy, Barcelona, Spain ;

PO-1173 Long term results of IG-IMRT in high risk prostate cancer patients: a monoinstitutional experience N. Di Muzio 1,2 , C.L. Deantoni 2 , C. Cozzarini 2 , I. Dell'Oca 2 , F. Zerbetto 2 , P. Mangili 3 , S. Broggi 3 , M. Pasetti 2 , A. Chiara 2 , F. Borroni 2 , R. Tummineri 2 , L. Perna 3 , R. Calandrino 3 , C. Fiorino 3 , A. Fodor 2 1 Vita e Salute University, Medicine and Surgery, Milano, Italy ; 2 San Raffaele Scientific Institute, Radiotherapy, Milano, Italy ; 3 San Raffaele Scientific Institute, Medical Physics, Milano, Italy Purpose or Objective To evaluate long-term toxicity and outcomes in patients (pts) affected by unfavourable intermediate-, high- and very high- risk prostate cancer (PCa) according to NCCN 2019 classification, treated with image guided- intensity modulated radiotherapy (IG-IMRT) with radical intent. Material and Methods From December 2006 to May 2011, 100 PCa pts underwent a moderately hypofractionated IG-IMRT with radical intent. All pts underwent prophylactic irradiation on pelvic nodes to 51.8 Gy in 28 fractions (EQD2 52.2 Gy, for α/β=1.5 for prostate cancer), with simultaneous integrated boost to seminal vesicles up to 65.5 Gy (77.7 Gy EQD2) and to prostate up to 74.2 Gy (88 Gy EQD2). Neoadjuvant and/or adjuvant androgen deprivation therapy (ADT) was prescribed in 90/100 pts for a median of 28.9 months (3- 120 months). All pts were treated with helical IMRT (Tomotherapy®, Accuray, Wisconsin) and daily IGRT (MVCT). Pts’ characteristics are reported in Table 1.

Median ( range) age at diagnosis 75 (58-90) years Median (range) iPSA

10.9 (1.68-206) ng/ml

6:

13 14 28 25

7 7

(3+4): (4+3):

Median ( range) Gleason Score

8:

9: 1710: 3

cT1c: cT2a:

32

13

T Stage

cT2b-c: cT3: 13

42

Results Median follow up was 94 (23-215) months. Cumulative late gastro-intestinal (GI) toxicity was acceptable: 13% G2 and 6% G3 (rectal bleeding), the latter requiring Argon Plasma Coagulation (APC). At the last follow up none of the pts presented G3 GI toxicity. Cumulative late genito-urinary (GU) toxicities was 15% G2 and 13% G3-G4; 11 pts presented G3 urinary stenosis and in 7 the G3 toxicity was solved with urethrectomy, thus only 4 % of pts presented G3 GU toxicity at the last follow up. Two patients presented G4 events (1 urethrostomy, due to repeated urethrectomies, and 1 cystectomy, due to hyperactive bladder). Thirty pts were dead at the last follow up, but only 5 due to PCa progression. Eleven pts experienced biochemical relapse, 1 of whom also with an intraprostatic relapse and 2 with bone metastases. Fifty-nine pts are alive and free from biochemical progression. Conclusion IG-IMRT in high-risk PCa pts allows dose escalation and pelvic nodal irradiation, with very good long term outcomes, with 8-year biochemical relapse free survival of 89% and 8-year cancer specific survival of 95%. Rectal G3 toxicity was acceptable, and solved in all pts with APC. Genito-urinary G3 toxicity was fair, limited by the presence of the urethra in the field, and solved in 7 out of 11 pts.