ESTRO 2020 Abstract Book

S591 ESTRO 2020

PO-1119 Sexual Toxicity in Cervix Cancer Survivors Treated with Chemo-Radiation and MR-guided Brachytherapy J. Conway 1 , L. Conroy 2 , S. Ferguson 3 , A. Zia 3 , A. Liu 4 , J. Weiss 4 , A. Rink 2 , C. Jennifer 5 1 Simcoe Muskoka Regional Cancer Centre- Royal Victoria Regional Health Centre, Department of Radiation Oncology- University of Toronto- Toronto- Canada, Toronto, Canada ; 2 Radiation Medicine Program- Princess Margaret Cancer Centre- University Health Network-, Department of Radiation Oncology- University of Toronto- Toronto- Canada, Toronto, Canada ; 3 Princess Margaret Cancer Centre- University Health Network, Department of Gynecologic Oncology- Toronto- Canada, Toronto, Canada ; 4 Princess Margaret Cancer Centre- University Health Network, Department of Biostatistics, Toronto, Canada ; 5 Radiation Medicine Program- Princess Margaret Cancer Centre- University Health Network, Department of Radiation Oncology- University of Toronto, Toronto, Canada Purpose or Objective Sexual health is an important, yet often neglected, survivorship issue for cervical cancer patients. The objective of this study was to assess patient-reported sexual toxicity in the era of MR-guided brachytherapy and to correlate with dosimetry and physician-reported toxicity. Material and Methods Cervical cancer patients treated with definitive chemo- radiation and MR-guided HDR brachytherapy who were disease-free for a minimum of 3 months and attending routine follow-up were eligible. Consenting patients were asked to complete the validated Female Sexual Distress Scale-Revised (FSDS-R; cut-off for distress ≥11)), Female Sexual Function Index (FSFI; cut-off for risk of sexual dysfunction score ≤26), and EuroQol Group EQ-5D-3L (index value range: 0 (death) to 1 (perfect health)), as well as a socio-demographics questionnaire. Oncologists were asked to score vaginal/sexual toxicity using the CTCAE v4.0. Patient, treatment and dosimetric characteristics were collected and summarized using descriptive statistics. The association between FSDS-R/FSFI scores (both dichotomized) and dosimetric characteristics (ICRU recto-vaginal point dose and vaginal D2cc) were assessed using Wilcoxon rank test. The association between patient and physician reported (cut-off of grade ≥2) toxicities were assessed using Fisher’s exact test. All tests were two- sided. Results were considered statistically significant if the p-value was ≤0.05. Results Between August 2018 and May 2019, 42 patients were approached, 35 (83%) consented and 31 (89%) were eligible for analysis. Median age at diagnosis was 46 (range: 27-73), 47% were FIGO stage 2B, 52% were lymph node positive and 42% had vaginal involvement. Eighty-three percent of patients were partnered and 23% were not sexually active. None were currently receiving treatment/intervention for sexual concerns, although 85% had used a vaginal dilator post-treatment. The median HRCTV D90 was 92.8 Gy (81- 106.4), ICRU recto-vaginal point was 63 Gy (53.8-77.2) and median vaginal D2cc was 79.9 Gy (54.5-118.5). Median score for the FSDS-R was 14, with 18 (62%) meeting criteria for sexual distress. The median score for FSFI was 19.4, with 20 (83%) meeting criteria for sexual dysfunction. The median EQ5D-3L index value was 0.8 (0.6-1). FSDS-R had a significant positive correlation with the ICRU recto-vaginal point (p= 0.017). Total FSFI score and EQ5D-3L score were negatively correlated with the ICRU recto-vaginal dose, but did not reach statistical significance. There was no significant correlation between patient-reported sexual toxicity and physician-assessed vaginal/sexual toxicity. Conclusion Cervical cancer survivors self-report high rates of sexual dysfunction and distress. Sexual distress was positively

acceptable morbidity and a high local control rate, resulting in a high disease-free survival. PO-1118 The dilemma of cervical cancer during pregnancy. A 10 year single-center experience L. Juan rodríguez 1 , M.H. Fassano Moore 1 , M.A. Mera Errasti 1 , B.J. Salazar Zúñiga 1 , J.F. Pérez- Regadera Gómez 1 1 Hospital Universitario 12 de Octubre, Radiation Oncology, Madrid, Spain Purpose or Objective To describe our experience in patients treated with concomitant radiochemotherapy with locally advanced cervical carcinoma during pregnancy. Material and Methods Between 2008 and 2019 nine patients diagnosed of locally advanced cervical carcinoma during pregnancy were treated with concomitant radiochemotherapy in our institution. Medical records were retrospectively reviewed. Results Patients median age at diagnosis was 31 (27-43) years and gestational age was between 10 and 31 weeks. FIGO stages were IIB for seven patients (77.8%) and IIIB for the remaining two (22.2%). One patient (11.1%) was diagnosed in the 1 st trimester of pregnancy, five (55.6%) in the 2 nd and three (33.3%) in the 3 rd trimester. For patients (44.4%) underwent immediate caesarean section followed by radiation. Five patients (55.6%), with a median gestational age at diagnosis of 14 (10-16) weeks, were treated with external beam radiation therapy (EBRT) and Chemotherapy with the fetus in situ (mean dose 45.2 Gy) Weekly fetal monitoring was carry out in all patients. Negative fetal heartbeat was detected between the the 3 rd - 4 th week after the onset of radiotherapy (median dose of 25 (21-37) Gy). Fetal expulsion occurred at a median dose of 41 (30-45) Gy and stillbirth resulted in all patients during the EBRT treatment, except one. No complications related with expulsion were registered. In all cases weekly concomitant Cisplatin-based chemotherapy (4 to 7 cycles) was administered. High dose rate intracavitary brachyterapy (HDR-ICR) was delivered at weekly intervals after EBRT was concluded in seven patients (77.8%). Two patients (22.2%) received external boost with EBRT because of technical difficulties associated with applicators or catheters placements. D90 CTV High- Risk EQD2 10 > 85 Gy was achieved in all of our patients. No grade 3/4 (CTCAE) toxicities of the bladder, rectum or bowel were reported. One of the five patients treated with radiotherapy with the fetus in situ presented a local relapse. Salvage surgery was the treatment of choice after multidisciplinary management (free related-disease in last follow up). In the four patients treated with caesarean section previous to radiotherapy, two cases of progression were registered (one local and one distant). The two of them resulted in death related disease despite systemic treatment. Overall and progression-free survival at 5 years, since the end of radiotherapy, were 71% and 62% respectively. Conclusion For pregnant women diagnosed of locally advanced cervical carcinoma in a situation of fetal unviability, radiotherapy is a safe and effective treatment of choice. No complications related to the fetus expulsion were registered and in most cases spontaneous expulsion occurred. Despite that EBRT with the fetus in situ involved greater volume of treatment, no severe toxicities were observed in our sample, with an aceptable rate of overall and progression- free survival at 5 years.