ESTRO 2020 Abstract Book

S193 ESTRO 2020

miR-615-5p. Based on the previously established weighting factors of the expression levels, patients were divided into a high-risk and a low-risk group. Kaplan-Meier analysis was performed for high- and low-risk patients to assess the progression-free survival from the beginning of radiochemotherapy until first diagnosis of progression on MRI. Results The 4-miRNA risk score was assessed in plasma samples from 22 glioblastoma patients (median age 55 years; 14 male, 8 female; 6 definitive, 16 adjuvant cases; MGMT promotor methylation in 13/22 cases) and resulted in 10 low-risk and 12 high-risk cases. Progression-free survival was significantly longer in low-risk patients (mean 22.6 months (95%-CI 17.1 – 28.1 months)) than in high-risk patients (mean 9.6 months (95%-CI 6.3 – 12.9 months), p=0.005) with a hazard ratio of 5.6 (95%-CI 1.5 – 21.7). The median progression-free survival has not yet been reached in low-risk patients after a median follow-up of 19 months. Conclusion Blood plasma based risk stratification through the 4-miRNA risk score shows strong differences in progression-free survival of glioblastoma patients. PH-0360 Neutrophils and lymphocytes ratio as a prognostic marker in glioblastoma O. Kaidar-Person 1 , E. Ben-Zvi 2 , T. Tzuk-Shina 2 1 Rambam Health Care Campus - Faculty of Medicine, Oncology Institute, Haifa, Israel ; 2 Rambam Medical Center, Oncology Institute, Haifa, Israel Purpose or Objective High grade gliomas (HGG), mainly Glioblastoma (GB) are the most common primary brain tumor in adults. The standard treatment after maximal safe resection includes radiation therapy with chemotherapy (CRT) followed by maintenance of such chemotherapy (TMZ). Evidently, this tri-modally treatment resulted in 14.6 months’ median survival with less than 10% of patients alive at 5-years. Recent years have shown an advancement in the understanding of the relationship between tumors and the patient’s immune system. The current study was to evaluate the ratio between neutrophils and lymphocytes in the peripheral blood (NLR) at pre-defined time points, as a prognostic marker for long term survival in HGG patients. Material and Methods After ethics committee approval, a retrospective review of the medical records of consecutive HGG patients treated between 2005-2017 was conducted. The data collected included demographic, and disease/treatment related features and the NLR at 3 different time points [pre- surgery (A), pre-CRT (B), pre-adjuvant TMZ (C)] was calculated. Statistical analysis included receiver operating characteristic (ROC), Mann-Whitney and Pearson chi- square tests. Kaplan Meier was used for survival outcome and compared using the Log-rank test. Results A total of 277 patients were included, median age 59 years (range 23-80), 88% had GB, 65% had gross total resection (GTR), 22% had biopsy only. Median overall survival was 17 months. A value of NLR > 3.7 at B and C points was identified as indicators for shorter survival. A statistical relation was found between NLR < 3.7 at these points and favorable prognostic factors such as younger age, less comorbidities and less steroids use. Conclusion A NLR of less than 3.7, measured at two time points (between the surgery and CRT and between CRT to the

adjuvant TMZ) were found to be independent significant prognostic factors for longer survival. More studies are needed to understand this relationship, and the significance of the level of the lymphocytes in peripheral blood in patients with HGG who are treated with a tri- modality approach. PH-0361 Reactivation of HCMV during RT of the brain results in critical illness and early mortality B. Frey 1 , N. Goerig 1 , B. Ina 1 , D. Anna-Jasmina 1 , K. Klaus 2 , Ü. Klaus 2 , S. Manuel 3 , D. Arnd 3 , E. Tobias 3 , E. Ilker 4 , P. Florian 1 , S. Sabine 1 , G. Udo S. 1 , F. Rainer 1 1 Universitätsklinikum Erlangen- Friedrich-Alexander- Universität Erlangen-Nürnberg, Department of Radiation Oncology, Erlangen, Germany ; 2 Universitätsklinikum Erlangen- Friedrich-Alexander-Universität Erlangen- Nürnberg, Institute of Clinical and Molecular Virology, Erlangen, Germany ; 3 Universitätsklinikum Erlangen- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute of Neuroradiology, Erlangen, Germany ; 4 Universitätsklinikum Erlangen- Friedrich-Alexander- Universität Erlangen-Nürnberg, Department of Neurosurgery, Erlangen, Germany Purpose or Objective Neurological deterioration and early death of patients suffering from brain tumours or brain metastases are mostly attributed to tumour growth and/or therapeutic side effects. Encephalopathy caused by human- cytomegalovirus-(HCMV)-reactivation remains undetected due to an inconclusive routine diagnosis. We therefore prospectively analysed HCMV-reactivation as a prominent condition leading to neurological decline and worse clinical outcome after the start of radiochemotherapy in Brain tumour patients who are irradiated at the brain have been included in the GLIO-CMV01 trial (NCT02600065). HCMV-analyses and immunophenotyping of peripheral blood as well as extended MRI-studies including additional independent retrospective neuroradiological evaluation are performed. Up to now, 118 adult patients (63 histologically proven high-grade gliomas, 55 with brain metastases) were included in the study and had a follow up of up to 600 days. The Department of Virology is analysing virus load according to standard procedures, while immune phenotyping of whole blood is performed according to established in-house procedures. Study endpoints are symptomatic viremia and overall survival (OS). Results An amount of 24% (28/118) of all included patients (12/44 glioblastoma, 3/13 anaplastic astrocytoma; 8/31 non- small-cell lung cancer (NSCLC), 13/24 other brain metastases) were diagnosed with HCMV-viremia during or within 4 weeks after radio(chemo)therapy. All patients who developed HCMV-viremia were CMV-IgG positive, meaning, that they had a prior infection with HCMV during their lifetime. Moreover, 21/28 of the patients showing HCMV-viremia suffered from significant neurological decline, which was effectively reversed during and after antiviral treatment. The patients who suffered from the HCMV-viremia displayed a pre-therapeutically significantly reduced basophil count (glioblastoma: P=0.002, NSCLC: P=0.02). While all patients with HCMV reactivation did not show any MRI-signs of tumour progression, the median OS was significantly reduced; after HCMV-associated encephalopathy symptoms patients with glioblastoma had a calculated 1-year OS of 22% vs 69% (P=0.01) and patients brain cancer patients. Material and Methods