ESTRO 2020 Abstract Book

S559 ESTRO 2020

PO-1050 SBRT in liver cancer versus TACE. A prospective, non-randomised observational trial (HERACLES) T. Brunner 1 , E. Gkika 2 , D. Bettinger 3 , M. Schultheiss 3 , L. Maruschke 4 , N. Bartl 2 , S. Kirste 2 , F. Bamberg 4 , R. Thimme 3 , A. Grosu 2 1 Otto-von-Guericke-Universität, Dept. Radiation Oncology, Magdeburg, Germany ; 2 University Medical Center Freiburg, Department of Radiation Oncology, Freiburg, Germany ; 3 University Medical Center Freiburg, Department of Internal Medicine, Freiburg, Germany ; 4 University Medical Center Freiburg, Department of Radiology, Freiburg, Germany Purpose or Objective To compare SBRT with TACE in a prospective, non- randomised observational trial as a baseline for a randomised trial. Material and Methods Patients who were discussed in a multidisciplinary tumour board over a predefined period of 12 months were included in the study. Patients received SBRT when TACE was contraindicated, in case of progressive disease after TACE or when TACE was rejected by the patient. All other patients received TACE. The impact of predefined patient and treatment related factors on HRQOL (EORTC QLQ-C30 and EORTC QLQ-CR29) was evaluated. Results Between 06/2016 and 06/2017 19 patients received TACE and 19 patients SBRT, of whom one patient dropped out during SBRT because of pulmonal progression. The median follow-up for patients alive was 32 months. In the TACE- arm the median age was 69 years, median tumor size was 40 (10-80) mm and median Child-Pugh Score 5 points (A5: 15, A6: 2, B7: 1, B8: 1 patient); 8 patients had an ALBI grade 1, 9 an ALBI Grade 2 and 1 an ALBI grade 3, seven patients were BCLC stage A and twelve B and two C. Patients in the SBRT-arm had a median of 76 years, median tumor diameter was 50 (21-215) mm and median Child- Pugh score was 5 points (A5: 10, A6: 4, B8:2, B9:2 patients), 11 patients had an ALBI grade 1 and 7 patients an ALBI grade 2, nine patients were BCLC stage B and nine C, three of them had a metastatic disease. A portal vein thrombosis was present in 6 patients only in the SBRT group. Six patients in the TACE arm had HCC-directed therapy before trial specific therapy and seven in the SBRT arm (most of them had > 1 line of therapy). Seven patients in the TACE group received further TACEs and one patient a liver transplantation. The median time between diagnosis and treatment was 1 month in the TACE group and 18 months in the SBRT group. In the SBRT group 1 and 2-year overall survival rate was 60% and 60% versus 93% and 73% in the TACE group (p=0.1). The 1-year and 2-year local control rate (LCR) was 90% and 90% in the SBRT group and 50% and 50% in the TACE group(p=0.08) and the PFS was at a median of 7 months in the SBRT group and 11 months in the TACE group (p=0.04). There was no statistically significant difference in the QOL at baseline for both groups, an no difference between baseline and follow-up. One patient had a grade 5 fistula in the SBRT group and one patient had a grade 5 hepatic failure in the TACE group, 2 a hepatic failure grade 3, 1 grade 3 pancreatitis, 1 grade 3 cholangitis and one abscess in the The primary endpoint feasibility was achieved with 38 patients included during 12 months in asingle center. SBRT leads to good local control in far HCC compared to TACE with acceptable toxicity compared with TACE despite of more advanced disease in the SBRT group which is responsible for shorter survival after SBRT. A randomized trial is required to further elucidate the role of SBRT in this setting and is in preparation on the basis of this trial. TACE group. Conclusion

PO-1051 Role of radiotherapy in resected R0/R+ pancreatic cancer: real life single institution experience. M. Lutsyk 1 , R. Ben Yosef 1 1 Rambam Health Care Campus - Faculty of Medicine, Department of Oncology and Radiotherapy, Haifa, Israel Purpose or Objective to evaluate the role of XRT following resection of pancreatic cancer Material and Methods Patients who underwent either Whipple procedure or distal pancreatectomy and treated with either chemo- radiotherapy (chemo-rad) or chemotherapy alone were enrolled to this study. The chemotherapy was based on cisplatin and either gemcitabine or 5FU/leukovorin. The total radiation dose was 50.4Gy given in 1.8Gy 5 times a week. Overall survival, based on resection margin, nodal status and treatment type were estimated in all patients. Results 134 out of 734 referred patients underwent either Whipple procedure or distal pancreatectomy during the years 2000- 2018. 93 had complete tumor resection (R0 group) and 41 had involved resection margins (R+ group). 49 out of 93 were treated with chemotherapy alone (R0 chemo) and 44 were treated with chemo-rad (R0 chemo-rad). The median overall survival for R0 group was 28 months; R0 chemo- 29m and R0 chemo-rad -27m (p n.s.). For the 41 R+ group it was 17m and was significantly lower from R0 (p <0.001). The survival of R+ chemo-rad (26 pts) was 23m and for R+ chemo (15 pts) it was 12m (p = 0.01). 72 with positive nodes (N+) had shorter overall survival than those with N negative (22 and 27m, p =0.015). The survival of patients with N+/R0 chemo-rad and chemo were similar-31 and 27m (p value n.s.) and in N+/R+ group the survival was 22 and 16m in the chemo-rad and chemo only, respectively (p = 0.006). Conclusion XRT increased significantly the overall survival of R+ resected pancreatic cancer but not N+ patients. Additional studies to delineate the role of chemo-rad in this setting are warranted. PO-1052 Hypofractionated VMAT for Fragile Patients with Oesophageal Cancer L. Deantonio 1 , S. Cima 1 , S. Leva 1 , A. Richetti 1 , M. Valli 1 1 Istituto Oncologico della Svizzera Italiana, Radiotherapy, Bellinzona, Switzerland Purpose or Objective To evaluate feasibility, safety, and dosimetric results of volumetric modulated radiotherapy (VMAT) to deliver hypofractionated radiotherapy in oesophageal cancer patients, unfit for a multimodality strategy. Material and Methods From 2010 to 2017, twenty-two patients were treated with hypofractionated VMAT for exclusive setting. Dose prescription of 40 Gy in 16 fractions ( EQD2 41.7 Gy considering an alfa/beta of 10, and 44 Gy considering an alfa/beta of 3). Results Eight patients (36%) presented a grade 3 baseline dysphagia. RT was generally well tolerated, no patient interrupted the daily treatment. Acute toxicity was generally mild, none G3 acute toxicities were reported. During treatment, 86% of patients experienced a stable or an improvement of baseline dysphagia, while only 3 patients reported a worsening of esophagitis. Among the 19 patients suitable for short-term follow-up, 15 (79%) had a complete clinical recovery (G0-1) of the symptomatic moderate/severe dysphagia. At 3 months, 7 patients (31.8%) achieved a partial or complete response. Two coplanar arcs were employed for VMAT delivery. Dosimetric results were consistent in term of both target