ESTRO 2020 Abstract Book

S593 ESTRO 2020

relationship for target and OAR with re-irradiation BT schedules is warranted. PO-1122 Sexual function in cervical cancer patients treated with definitive chemoradiation in South Africa P. Pillay 1 , C. Minnaar 2 , J. Kotzen 3 1 University of Witwatersrand, Radiation Oncology, Johannesburg, South Africa ; 2 University of Witwatersrand, Radiation Sciences, Johannesburg, South Africa ; 3 Donald Gordon Medical Centre, Radiation Oncology, Johannesburg, South Africa Purpose or Objective Approximately 1200 new cases of cervical cancer in 2017 were referred to a Radiation Oncology unit in Johannesburg South Africa (>1/4 of all cancers at this hospital). Research in the area of radiation toxicity has focused on symptoms related to nearby organs at risk (bladder, bowel, and rectum), however the vagina is both the target and an organ at risk. Only 4% of 380 articles assessed quality of life (QoL) among African women living with cervical cancer. The purpose of this study was to describe the sexual QoL of patients treated with chemoradiation for locally advanced cervical cancer in South Africa. Material and Methods This is a retrospective analysis of prospectively collected data from a phase III randomised controlled trial investigating the effects of the addition of hyperthermia to chemoradiation. In total, 76 participants from the control arm (enrolled from January 2014 to June 2017), with a median follow-up of 12 months, were included in this analysis. The EORTC QoL cervical cancer module (CX24) questionnaires were administered at baseline, every 3 months post-treatment during the first year, and every 6 months post-treatment in the second year. Results Poor body image and worry that sex would be painful were reported by 60% of participants at baseline and remained constant for the first year post-treatment but decreased to 35-40% thereafter. 11% of participants (n=8) reported being sexually active at baseline but this doubled by six months post–treatment (n=17) and plateaued to 30% of participants after 9 months post-treatment. 21% of women <30 years, 22% of those 31-50 years and 10% of participants > 50 years of age reported having sex in the last four weeks. 77% of reports from those sexually active are that sex was enjoyable whilst 65% reported having pain during sex. However 51% found it both enjoyable and painful. The main vaginal symptom was discharge that was almost two times more prevalent than vaginal discomfort throughout the first two years post-treatment (71% vs. 43% at baseline; 23% vs. 14% at 18 months). However there was a clear and significant improvement over time.

and sexual functioning were greatly impaired before treatment and that their concerns persisted throughout the first year with an improvement in the subsequent year. The first year is the most fragile and fraught with poor body image and worry. We can reassure patients that symptoms like discharge do improve and so does their sexual experience. Worry that sex would be painful by itself shouldn’t prohibit patients trying to have sex, and although pain will be consistent enjoying sex is possible. Lest we forget women should not be defined solely by their age, disease or clinically relevant outcomes. PO-1123 Clinician and PRO of bladder and GIT toxicity after pelvic radiation in cervical cancer patients P. Pillay 1 , C. Minnaar 2 , J. Kotzen 3 1 University of Witwatersrand, Radiation Oncology, Johannesburg, South Africa ; 2 University of Witwatersrand, Radiation Sciences, Johannesburg, South Africa ; 3 Donald Gordon Medical Centre, Radiation Oncology, Johannesburg, South Africa Purpose or Objective Late toxicity from radiotherapy for cervical cancer has been extensively studied yet there is paucity of data where the greatest burden of cervix cancer resides in Sub- Saharan Africa. The purpose of this analysis is to determine the incidence of severe late (≥Grade 3 and >90 days after treatment completion) GIT and bladder complications, and describe the quality of life of these patients. Material and Methods This is a retrospective analysis of prospectively collected data from a phase III randomised controlled trial investigating the effects of the addition of hyperthermia to chemoradiation. In total, 76 participants from the control arm (enrolled from January 2014 to June 2017), with a median follow-up of 12 months, were included in this analysis. The Kaplan Meier time to event analysis was used to determine actuarial probability of complications. Clinician reported morbidity (RTOG criteria) and patient reported outcomes (PRO) (EORTC QLQ-CX24) were assessed at baseline, every 3 months during the first year, and every 6 months in the second year post-treatment. Results The mean age was 50 years (SD 10.6). 50% of participants were HIV positive. All patients completed entire course of 50Gy in 25 fractions of external beam radiation, three 8Gy brachytherapy fractions and 1-2 doses of concurrent cisplatin within 56 days. Bladder complications are predominantly fistulas, are highest in the first year, and are half as likely in those with no evidence of disease (NED); compared to the appearance in the second year of the predominant obstructive bowel complications with a similar risk, irrespective of disease presence. Local rectal fistulas were more common in patients who died from disease progression. In those with NED, 5.3% developed bladder complications with an actuarial probability of 3.3% and 12.5% at 1 and 2 years respectively; 3.5% developed GIT complications with 0% at 1 year and 23.1% actuarial risk at two years. Patients with complications experienced more severe symptoms than those without (bladder 20% vs. 5% and GIT 21% vs 8%) and these tend to be very complication specific symptoms e.g. incontinence in fistulas or related obstructive symptoms. There was a discordancy between clinician graded severe toxicity and PRO of severe GIT (7.9% vs 10%) and bladder related symptoms (9.2% vs. 7%). Clinicians grading using the worst toxicity underestimated the time and quality of life that patients endure with grade 3/4 toxicity before a grade 5 fatality (median time to death 7 months [range 4-12]). Conclusion There is a high risk of developing severe complications in those who survive the first year and their QoL outlook is significantly worse than those without it. Patterns of tell- tale symptoms and their intensity by patients is our best early warning system to detect severe late

Conclusion Providing care on a daily basis without an in-depth understanding of what is most meaningful to our patients only widens the gap in our care. We should focus on communicating and help managing their expectations and experiences. This analysis showed that participants' QoL