ESTRO 2020 Abstract Book

S166 ESTRO 2020

Focal boosting of the tumor up to 95Gy in patients with intermediate and high risk prostate cancer does not deteriorate patient reported QoL compared to standard treatment, provided the same dose constraints to organs at risk are maintained. This is in line with previously published (physician reported) toxicity outcomes in the FLAME trial at two year follow-up. OC-0316 Effect of exercise during ADT and radiation on patient-reported toxicity in men with prostate cancer OC-0317 Risk factors for persistent late fatigue after radiochemotherapy in cervical cancer (EMBRACE study) S. Smet 1,2 , K. Tanderup 3 , R. Nout 4 , I. Jürgenliemk-Schulz 5 , S. Spampinato 3 , C. Chargari 6 , J. Lindegaard 3 , U. Mahantshetty 7 , A. Strudza 1 , M. Schmid 1 , P. Hoskin 8 , B. Segedin 9 , K. Bruheim 10 , B. Rai 11 , F. Huang 12 , E. Van Der Steen-Basanik 13 , R. Cooper 14 , E. Van Limbergen 15 , M. Sundset 16 , R. Pötter 1 , K. Kirchheiner 1 1 Medical University of Vienna, Department of Radiation Oncology- Comprehensive Cancer Center, Vienna, Austria ; 2 Algemeen Ziekenhuis Turnhout, Department of Radiation Oncology, Turnhout, Belgium ; 3 Aarhus University Hospital, Department of Oncology, Aarhus, Denmark ; 4 Leiden University Medical Center, Department of Radiation Oncology, Leiden, The Netherlands ; 5 University Medical Centre Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands ; 6 Gustave-Roussy, Department of Radiotherapy, Villejuif, France ; 7 Tata Memorial Hospital, Department of Radiation Oncology, Mumbai, India ; 8 Mount Vernon Hospital, Cancer Centre, London, United Kingdom ; 9 Institute of Oncology, Department of Radiotherapy, Ljubljana, Slovenia ; 10 The Norwegian Radium Hospital- Oslo University Hospital, Department of Oncology, Oslo, Norway ; 11 Postgraduate Institute of Medical Education and Research, Department of Radiotherapy and Oncology, Chandigarh, India ; 12 Cross Cancer Institute and University of Alberta, Department of Oncology, Edmonton, Canada ; 13 Arnhem Radiotherapy Institute, Department of Radiotherapy, Arnhem, The Netherlands ; 14 St James’s University Hospital, Leeds Cancer Centre, Leeds, United Kingdom ; 15 University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium ; 16 St. Olavs Hospital, Clinic of Oncology and Women's Clinic, Trondheim, Norway Purpose or Objective Fatigue, characterized by a state of generalized weakness, is a common symptom after cancer treatment, with substantial impact on patient quality of life. Several patient-related risk factors, such as depression, baseline fatigue, anemia and inflammatory parameters are established, while radiotherapy-specific risk factors remain unclear. The purpose of this analysis is to evaluate patient- and treatment-related risk factors for persistent late fatigue within the prospective, observational, multi- center EMBRACE study (An intErnational study on MRI- guided BRachytherapy in locally advanced CErvical cancer; www.embracestudy.dk). Material and Methods From 2008-2015, 1416 patients with locally advanced cervical cancer participated in the study and received radiochemotherapy and MRI-guided adaptive brachytherapy (BT) per GEC-ESTRO guidelines. Fatigue was prospectively assessed (CTCAE v.3) at baseline and during Withdrawn from presentation

regular follow-up (FUP). Crude incidence was calculated using the maximum grade of late fatigue over all FUPs (starting at 6 months). Persistent late mild/moderate fatigue was defined, when G≥1/G≥2 was scored in at least half of the FUPs. Risk factors were evaluated with univariate and multivariable (MVA) logistic regression analyses. Results Overall, 1340 patients from 23 centers were treated according to protocol; of those 1177 had information on late morbidity (median FUP: 51 months). Crude incidence of fatigue was 62.8% (739 patients) for G≥1 and 24.1% (284) for G≥2. Persistent late G≥1 and G≥2 fatigue was present in 36.8% (433 patients) and 7.1% (83), respectively. Significant risk factors for persistent late G≥1 fatigue in MVA were: younger age, being overweight, baseline fatigue G≥1; of borderline significance were obesity and larger EBRT V57Gy (volume treated with ≥57Gy in external beam radiotherapy, taken to represent nodal boost). For persistent late G≥2 fatigue, significant independent risk factors in MVA were baseline fatigue G≥1, larger EBRT V57Gy and larger V60Gy EQD2 (isodose surface volume treated with EBRT and BT dose of ≥60Gy, in equivalent dose), with a trend for pre-existing chronic diseases [table 1]. In patients with no lymph node boost (V57Gy=0), limited (V57Gy<182ccm 3 ) and high volume boost (V57Gy>182ccm 3 ), the incidence of persistent, late G≥2 fatigue was 4-6%, 6-9% and 13-20%, respectively, further differentiated by size of BT volume [table 2].

Conclusion Mild but persistent fatigue is experienced by >1/3 of patients; 7% suffer moderate persistent fatigue after treatment. Fatigue fluctuates over time, shown in the discrepancy between crude incidence and persistent grading. Large high dose volumes (lymph node or BT boosts) are associated with increased risk of late persistent fatigue, along with patient factors at diagnosis such as younger age, body-mass index, presence of baseline fatigue and chronic disease. How post-radiotherapy