ESTRO 2020 Abstract book

S641 ESTRO 2020

The likelihood of lymph node metastases can be estimated from histological subtype, grading, presence of lymphovascular invasion and myometrial invasion. Following the establishment of routine pelvic nodal dissections for patients with endometrial cancer fulfilling the risk criteria, a retrospective audit was performed to assess the impact on the cohort treated in the first two years following the change in practice. Material and Methods Based on the biopsy findings and the pre-operative staging MRI, patients are considered for nodal dissections if the tumour is >2cm or there is evidence of deep myometrial invasion, or if the tumour is a grade 2 or 3 or non- endometroid histology. Data was obtained from online hospital records for the first cohort of patients treated between April 2016 and April 2018. Results A total of 179 patients were included with a median age of 70 (range 41-93) and 78% had a diagnosis of endometroid adenocarcinoma. 97 patients underwent nodal dissection, of which only 8 had nodal metastases and all these had suspicious nodes on pre-operative imaging. Due to suspicious nodes on the staging scans, six patients had para-aortic LN sampling and three were found to have metastases. The subgroups in whom nodal status can reduce the need for EBRT are FIGO IA and IB grade 1or 2 and LVI +ve, and also FIGO II grade 1 or 2 and LVI –ve. There were a total of 26 patients in these categories but only 14 of these patients (54%) underwent pelvic nodal dissection and all had no nodal metastases and were treated with vaginal brachytherapy. The remaining 12 patients did not have nodal dissections due to high BMI (3), co-morbidities (3), depth of myometrial invasion under staged on MRI (3), pre- operative MRI not done (1) and undocumented reasons (2). Of note with the criteria for nodal dissection used, 27% of patients with Figo 1A,Grade 1 LVI –ve (low risk) disease had pelvic lymph node dissection, mainly due tumour size of >2cm on MRI. All nodal dissections in this cohort were negative. Conclusion Nodal dissections have the potential to significantly reduce the need for EBRT in this patient cohort by up to 14.5% with a subsequent reduction in EBRT related toxicities. Unfortunately a major barrier to nodal dissection appears to be the patients’ elevated BMI and other associated co- morbidities that can make nodal dissection more hazardous. Possibly a more systematic pre-operative assessment and referral to a centre with experience in dealing with bariatric patients could increase the number of nodal dissections safely. PO-1125 Qol records filled by patient or psychologist? Ns. experience in sexual dysfunction (DS) after RT. F. Piro 1 , D. Cosentino 1 , A. Massenzo 1 , A. Martilotta 1 , U. Piro 1 , L. Marafioti 1 1 Ospedale Mariano Santo, U.O. Radioterapia, Cosenza, Italy Purpose or Objective Patients after pelvic RT have DS. Normally, self-tests are performed by the patient at home, with a response rate of 43-68%. In the PORTEC-2 (500 pts.) the rate is 65% after RT, for sexually active it rises to 81%. There is difficulty in facing such an intimate topic. The objective of the study: a psychological approach to overcome these limits in patients with and without pharmaceutical supportive therapy. Also evaluating how the correct therapy and information improve the quality of life. Material and Methods Based on the tests already used, the psychologist created ten questions to be included in an individual interview with the patient to assess the quality of life and the impact on sexual activity after brachytherapy (BRT). Some with answers of choice multiple (intended as a change of

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 complications. A comprehensive approach is needed for those reporting the severest symptoms to rapidly avert complications, and to support those who suffer the harrowing effects once they have developed it. PO-1124 Impact of lymph node dissection on adjuvant radiotherapy in endometrial cancer. E. Doyle 1 , L. Akyol 1 , M. Zahra 1 1 Edinburgh Cancer Centre- Western General Hospital, Oncology, Edinburgh, United Kingdom Purpose or Objective Pelvic lymph node dissection has not been shown to improve survival in endometrial cancer, but knowledge of the nodal status can help in tailoring adjuvant radiotherapy with the aim of trying to minimize the toxicity associated with EBRT in patients who might be suitable to be treated with vaginal vault brachytherapy.