Abstract Book

ESTRO 37

S366

organ involved mean survival was only 1,347 months (σ=0,53) and median survival 0,6 months (σ=0,25). All but one patient in this group died in the next three months after begin of radiotherapy. The only patient, from this group who survived more than 6 month had a relapse of hormone positive breast cancer with malignant pleura effusion and pleura drainage. In the Cox regression analysis the age adjusted hazard ratio for death in this group was 6,7 (p<0,001) compared with patients with normal markers and without extracranial involvement. The difference in overall survival between the two best groups of EC-S however was not significant (p=0,78). In multivariate analysis including age adjusted DS-GPA and EC-S each DS-GPA class showed significant correlation with survival contrary to the EC-S.

not controlled

220 41,8

Number of brain metastases one

144 27,4 107 20,3 275 52,3

two or threee

multiple

Conclusion This is an independent validation of the prognostic score suggested by Nieder et. al. which allows to select patients whose life expectancy is improved by cranial irradiation. This is the case in patients with elevated LDH, low albumin and metastatic involvement of more than one organ or system. We are planning to perform an analysis of combined patient cohorts from several centers. It appears warranted to study a possible combination of DS-GPA with EC-S or serum markers. PO-0716 High dose chemoradiation in glioblastoma patients: feasibility and safety of a phase I trial M. Ferro 1 , G. Macchia 1 , S. Cilla 2 , A. Ianiro 2 , S. Cammelli 3 , V. Picardi 1 , G. Giglio 4 , M. Specchia 4 , G.P. Frezza 5 , G. Siepe 3 , A. Arcelli 3,5 , R. Frakulli 3 , S. Ciabatti 3 , S. Chiesa 6 , M. Balducci 6 , V. Valentini 6 , A.G. Morganti 3 , F. Deodato 1 1 Radiotherapy Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Campobasso, Italy 2 Medical Physics Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Campobasso, Italy 3 Radiation Oncology Center- Department of Experimental- Diagnostic and Specialty Medicine - DIMES, University of Bologna- S.Orsola-Malpighi Hospital, Bologna, Italy 4 Oncology Unit, A. Cardarelli Hospital, Campobasso, Italy 5 Radiation Oncology Unit, Bellaria Hospital, Bologna, Italy 6 Department of Radiotherapy- Policlinico Universitario «A. Gemelli», Università Cattolica del Sacro Cuore, Roma, Italy Purpose or Objective To determine the maximum tolerated dose (MTD) of Volumetric Modulated Arc Therapy (VMAT) with standard concurrent and sequential-dose temozolomide (TMZ) in patients with resected glioblastoma multiforme. Material and Methods Histological proven glioblastoma patients underwent VMAT dose escalation. VMAT was delivered over 5 weeks with the simultaneous integrated boost (SIB) technique to the two planning target volumes (PTVs) defined by adding 5-mm margin to the respective clinical target volumes (CTVs). CTV1 was defined by adding a 10-mm isotropic margin to the tumor bed plus any MR enhancing residual lesion; CTV2 was defined as the CTV1 plus 20-mm isotropic margin. Radiation dose was escalated to the PTV1 with the SIB-VMAT strategy. Four dose levels were planned: Level 1 (PTV2: 45/1.8 Gy; PTV1: 77.5/3.1 Gy), Level 2 (PTV2: 45/1.8 Gy; PTV1: 80/3.2 Gy), Level 3 (PTV2: 45/1.8 Gy; PTV1: 82.5/3.3 Gy) and Level 4 (PTV2: 45/1.8 Gy; PTV1: 85/3.4 Gy). All treatments were delivered in 25 fractions. Patients were treated in cohorts of between three and six per group using a Phase I study design. The recommended dose was exceeded if two of the six patients in a cohort experienced dose- limiting toxicity within 3 months from treatment. Concurrent and sequential TMZ chemotherapy was administered according to Stupp’s protocol. Results Eleven consecutive glioblastoma patients (male/female: 7/4; median age: 59 years) were treated, 9 of them at first dose level, with none of them experiencing a dose- limiting toxicity (DLT) (grade >3). Being the MTD not exceeded, the PTV1 dose was escalated to the higher planned dose level (80/3.2 Gy) and accrual is actually

Parameter

n %

Female

243 46,2

Male 283 53,8 Median age, years (range) 63,6 (20-92) Primary Lung 270 51,3 Breast 67 12,7 Kidney 22 4,2 Malignant melanoma 75 14,3 Head and neck 6 1,1 Gastrointestinal tumours 37 7,0 Unknown primary 19 3,6 Other 30 5,7 Karnofsky score class KPS<70% 145 27,6 KPS=70% 100 19,0 KPS>70% 281 53,4 DS-GPA class 1 178 40,4 2 148 33,6 3 88 20,0 4 27 6,1 EC-Score 0 15 9,6 1 69 43,9 2 60 38,2 3 13 8,3 Primary control controlled 306 58,2