Abstract Book

S824

ESTRO 37

EP-1522 MRI early predictive factors for vaginal stenosis in cervical cancer patients after chemoradiation M. Campitelli 1 , M. Miccò 2 , N. Carra 1 , M. Sbarra 2 , D. Smaniotto 1 , A. Nardangeli 1 , R. Autorino 1 , E. Foti 3 , B. Costantini 3 , A.L. Valentini 2 , M.A. Gambacorta 1 1 Catholic University of the Sacred Heart, Radiation Oncology, Rome, Italy 2 Catholic University of the Sacred Heart, Radiological Sciences, Rome, Italy 3 Catholic University of the Sacred Heart, Obstetrics and Gynecology, Rome, Italy Purpose or Objective Vaginal Stenosis (VS) is recognised to be a toxicity after radiation therapy. Magnetic Resonance Imaging (MRI) predictive factors for VS have not been previously analysed. Thus, the aim of our study was to find any imaging predictive factors for the development of stenosis in a population of cervical cancer patients treated with chemoradiation (CRT). Material and Methods Our retrospective study included 43 patients (mean age 49,5y; range 18-75y) with FIGO IB2-IIIB cervical cancer treated with CRT administered with external beam radiation therapy. Neoadjuvant CRT included conformal irradiation of the whole pelvis with a total dose of 39.6 Gy (1.8 cGy/fraction, 22 fractions), plus additional irradiation of primary tumor and parametria with 10.8 Gy administered with concomitant boosts (0.9 cGy/fraction, 12 fractions, every other day). Concomitant chemotherapy included cisplatin (20 mg/m2, days 1-4 and 26-30 of treatment), and capecitabine (1300 mg/m2/daily, orally) during the first 2 and the last 2 weeks of treatment. Patients underwent clinical examinations and 1.5T pelvic diffusion weighted (DW)- MRI before (baseline), at 2 weeks from the start of the therapy (early) and at the end of the treatment (final). Tumor volume (TV) was calculated on baseline MRI. On all MRIs the length and the thickness of the vagina were measured. DWI were analysed qualitatively at each time point. VS was graded using Common Terminology Criteria for Adverse Effect v.4.03. Correlations between imaging data and clinical data were made with Mann-Whitney- test or Wilcoxon-test and χ2-test, as appropriate. ROC curves were generated for statistically significant DW-MRI parameters. Results According to CTCAE, asymptomatic toxicity or Grade 1 was in 15 pts and symptomatic vaginal toxicity or Grade ≥2 was in 28 pts. TV was higher in Grade1 than in Grade ≥2 (p=0,013). The mean vaginal length and thickness decreased between baseline and final MRI from 82,0 to 71,6 mm and from 3,3 to 2,6 mm respectively; both p- values <0,0001. The mean vaginal length and thickness decreased both in Grade1 and in Grade≥2, but without significant difference between the two groups. DWI had a lower signal intensity at the final MRI in Grade≥2 (p<0,0001). According to ROC analyses the AUC was 0,917 (p<0,0001) for DWI and 0,731 (p=0,013) for TV. Conclusion This is the first study using DW-MRI to find predictive factors for vaginal stenosis in cervical cancer after CRT. MRI shows a shortening and a thinning of the vagina during treatment. TV correlates with vaginal toxicity and DWI could point to vaginal fibrosis. More studies should be done to better characterize these imaging findings in order to generate new hypothesis for an early management of toxicity.

predictive of OS. Tumor size was an additional significant prognosticator DFS. Conclusion Pre- and post-treatment lymphopenia were associated with worse treatment response in patients given definitive ChRT for cervical SCC patients. Possible novel therapeutic strategies could include pre- or post- treatment immune preservation or modulation to improve response rates and survival in women with locally advanced cervical cancer. EP-1521 THE Hematologic Changes During Treatment In Cervical Cancer Patients Treated With Chemoradiotherapy B. Akkus Yildirim 1 , C. Onal 1 , F. Kose 2 1 Baskent Universitesi Tip Fakultesi- Adana Hastanes, Department of Radiation Oncology, Adana, Turkey 2 Baskent Universitesi Tip Fakultesi- Adana Hastanes, Department of Medical Oncology, Adana, Turkey Purpose or Objective The aim of the study is to investigate the prognostic significance of changes in absolute neutrophil count (ANC), absolute lymphocyte count [ALC], neutrophil/lymphocyte ratio (NLR), and hemoglobin (Hgb) values during cervical cancer treatment with definitive chemoradiotherapy (CRT). Material and Methods We retrospectively analyzed 104 cervical cancer patients treated with definitive CRT. The median values for each factor were used as cutoff values to stratify patients into the high hematological risk (HHR) and low hematological risk (LHR) groups. The baseline and weekly ANC, ALC and NLR values were compared according to tumor characteristics. Results The median follow-up for all patients and surviving patients was 53 months (range, 4–131 months) and 78 months (range, 35–131 months), respectively. The absolute white blood cell, ANC and ALC decrease during treatment, NLR increased throughout treatment and reached to a plateau at fifth week. No significant change was observed at Hb levels during treatment course. The ANC and NLR after 3rd week of definitive CRT were significantly higher and ALC after 3 rd week of treatment was significantly lower in patients with progressive disease compared patients with no evidence of disease. Patients in LHR group had significantly higher number of patients with smaller tumor size, early stage disease and without lymph node metastasis compared to HHR group. The 2 and 5-year overall survival (OS) and disease-free survival (DFS) were significantly longer in LHR group than HHR group. In multivariate analysis, age as a continuous variable [HR: 1.03 (95% CI: 1.01–1.05); p =0.01], HHR [HR: 3.17 (95% CI: 1.78–5.65); p <0.001], lymph node metastasis [HR: 2.88 (95% CI: 1.48–5.60); p =0.002] were negative prognosticators of OS. Similarly, HHR [HR: 2.80 (95% CI: 1.47–5.33); p =0.002] and lymph node metastasis [HR: 2.53 (95% CI: 1.43–4.51); p =0.002] impacted on DFS on multivariate analysis. Conclusion The ANC, ALC and NLR changes especially after 3 rd week of treatment potentially reflects the treatment outcomes of definitive CRT for cervical cancer patients. The presence of lymph node metastasis and HHR could serve as a predicative factor of poor prognosis for cervical cancer patients.