ESTRO 2020 Abstract book

S637 ESTRO 2020

Conclusion The TRG is confirmed as a fundamental parameter in determining the outcomes in patients with rectal cancer subjected to NA-CRT. A prospect still open for the future is the integration of the TRG in the staging of the patient to identify the classes of patients at risk and worthy of adjuvant therapy.

PO-1115 What’s the role of tumor regression grade (TRG) in rectal cancer: an istututional experience A. Guaineri 1 , L. Triggiani 1 , F. Frassine 1 , J. Imbrescia 1 , F. Barbera 1 , P. Vitali 1 , F. Terraneo 1 , L. Pegurri 1 , E. Ranghetti 1 , A. Taddeo 1 , S.M. Magrini 1 , M. Buglione 1 1 Spedali Civili di Brescia, Radiation Oncology, Brescia, Italy Purpose or Objective The neoadjuvant treatment with long-course radiotherapy and concomitant chemotherapy (NA-CRT) or with short- course radiotherapy followed by surgery is now the standard treatment in locally advanced rectal tumors. A parameter that allows us to have a degree of prediction of the response to neoadjuvant treatment is TRG (tumor regression grade), which is always included in the histopathological report and which defines the degree of tumor regression. In the literature TRG has shown to predict outcome after NACRT. The objective of this retrospective study is to confirm the prognostic value of the TRG, evaluating if there is a significant correlation with disease features and the main The TRG was evaluated in 133 patients with histological diagnosis of adenocarcinoma of the rectum using the Ryan classification system (0-No viable cancer cells, 1-Single cells or small groups of cancer cells, 2-Residual cancer outgrown by fibrosis, 3-many tumor cells with poor fibrosis/extensive residual neoplasia). The patients undergo,from May 2004 to April 2017, a neoadjuvant treatment with long-course radiotherapy associated with fluoropyrimidine chemotherapy and subsequently undergo surgery. Disease basal and after surgery characteristics were analyzed and related to TRG and OS, DFS, DSS, MFS and LRFS. (SPSS® 25.0). Results 133 patients were treated. Median age 64,5 (68%<70aa and 31,6%>70aa). Ninety-two patients (69.2%) hadcT3 disease, and 28 (21,1%) cT2; 10 patients hadcN1a, 42 cN1b (Tab1). After surgery the most patients were pT3(n=63, 51,1%), the other pT2 n=42(31,6%); 87 patients (65,4%) were pN0, 14 (10,5%) pN1a, 14 (10,5%) pN1b, 6 (4,5%) pN2a, 6 (4,5%) pN2b(Tab1. Staging before treatment was performed with TC and EUS (n=42), only TC (n=48), RMN (n=42). Chemotherapy was 5-FU in 126 cases and Capecitabine in 20 cases, 2 other. Median days between Rt and surgery were 46 days. For the 133 patients analyzed, 25 (18.8%) showed a TRG 3, 49 (36.8%) a TRG 2, 46 (34.6%) a TRG 1 and 13 (9.8%) a TRG 0. The TRG was statistically related to DFS (p <0.001), to MFS (p = 0.003) but not to LRFS (p = 0.85) and to DSS (p = 0.132),indeed patients bad responders (TRG 4) have a minor time to relapse locally and for distant metastasis. At the multivariate analysis only the TRG and the pathological stage were significantly correlated with DFS. The Cox regression (p = 0.033) showed an increased risk for relapse in patients with TRG 4 compared to good responders (HR 5.3) in relation to DFS. oncological outcomes. Material and Methods

Poster: Clinical track: Gynaecological (endometrium, cervix, vagina, vulva)

PO-1116 Cervical cancer patterns of care in italy: a radiation oncology survey of mito and airo gyn groups G. Macchia 1 , A. Cerrotta 2 , F. Deodato 1 , B. Pappalardi 2 , A. Re 1 , R. Santoni 3 , M. Campitelli 4 , G. Scambia 5 , V. Valentini 6 , C. Aristei 7 , G. Ferrandina 5 1 Fondazione Giovanni Paolo II- Università Cattolica S. Cuore, Radiotherapy Unit, Campobasso, Italy ; 2 Fondazione IRCCS Istituto Nazionale dei Tumori, Radiotherapy Unit, Milan, Italy ; 3 University of Rome Tor Vergata- UNIROMA2, Radiotherapy Unit- Department of Biomedicine and Prevention, Roma, Italy ; 4 Fondazione Policlinico Universitario A. Gemelli IRCCS-, UOC di Radioterapia- Dipartimento di Scienze Radiologiche- Radioterapiche ed Ematologiche, Roma, Italy ; 5 Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Ginecologia Oncologica- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy ; 6 Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia- Dipartimento di Scienze Radiologiche- Radioterapiche ed Ematologiche, Roma, Italy ; 7 University of Perugia and Perugia General Hospital, Radiation Oncology Section, Perugia, Italy A not negligible heterogeneity of treatments options in Cervix cancer (CC) clinical settings was documented, despite the WHO has encouraged to adopt treatments based on high level of evidence. A national survey on the current patterns of care in every clinical setting of CC patients was set up in order to identify possible causes of variations from guidelines, and set up more effective educational efforts thus allowing optimization of treatments, and ultimately improving patient care. Material and Methods A questionnaire concerning CC management, focusing on demographic aspects, practice settings and equipment, was distributed online via SurveyMonkey to radiation oncologists. Results Ninety questionnaires, accounting for 46.3% of the 194 Italian radiotherapy centers were returned. The majority of respondents practiced at national community hospitals, with dedicated multidisciplinary tumor board (87.8%), modern equipment and techniques. Concerning brachytherapy (BT), 55.5% of centers reported >1 radioactive source projectors, but the remaining centers referred their patients outside for BT. Magnetic resonance was performed in >95% centers in early CC (ECC) and in locally advanced CC (LACC) settings, while positron emission tomography combined with computed tomography (PET-CT) scan was preferred in LACC patients (93.3%). ECC post-surgery treatment was performed in 96.7% of cases following the pathologically assessed high risk factors. Locally advanced CC treatment was exclusive chemoradiation in 84.4% of centers, with concomitant chemotherapy mostly represented by platinum-based schedule. Others different LACC approaches were reported in a variable rate (4.4%-28.9%). In the oligo-metastatic or recurrent setting 74.4% and 53.3% centers declared to have managed <5 recurrences post-surgery and post-irradiation, respectively. Purpose or Objective Background