ESTRO 2021 Abstract Book

S1004

ESTRO 2021

Results Median age of presentation was 53.6 years. 35(76%) patients had KPS of 60 or less. 73.2 % were males. Median follow-up time was 6 months. Median length of disease in this study 6.3 cm . 17(26.9%) patients were lost to follow up, the lost to follow ups were excluded from final analysis, final analysis included 46 patients. 39(84.8%) were disease restricted to thoracic esophagus, remaining 7 had involvement of GE junction , of the patients with disease in thoracic esophagus 9(19.5%) had in upper thoracic, 30(65%) in middle thoracic . There was a significant improvement in dysphagia scores ( p =0.002) at 6 weeks and also at 3 months. 26(56.5%) patients had improvement in dysphagia scores and 20(43.5)% maintained the improvement of scores till their last follow up. The median dysphagia free survival for the entire cohort was 5.3 months . There was significant improvement in weight 3 months after completion of ILBT ( p = 0.001 ).25 (54%) patients required nasogastric (NGT) insertions eventually and 10 (21.7%) needed hospitalization for supportive care. Most common complication following ILBT was stricture 14(31%), followed by fistula 2(4.3%), and bleeding 1(2.2%). Conclusion In carefully selected population palliative radiotherapy followed by ILBT is effective for palliation of dysphagia, improvement in symptom scores being evident and sustained with acceptable toxicity. PO-1212 Outcome of adjuvant hypofractionated radiotherapy concomitant to chemotherapy in bile duct carcinoma N. Slim 1 , P. Pacifico 1 , P. Passoni 1 , R. Tummineri 1 , M. Ronzoni 2 , F. Pedica 3 , C. Fiorino 4 , A.M. Deli 1 , A. Casadei Gardini 5 , S. Cascinu 5 , F. De Cobelli 6 , L. Aldrighetti 7 , N.G. Di Muzio 8 1 IRCCS San Raffaele Scientific Institute, Radiation Oncology, Milan, Italy; 2 IRCCS San Raffaele Sientific Institute, Medical Oncology, Milan, Italy; 3 IRCCS San Raffaele Scientific Institute, Pathologic Anatomy, Milan, Italy; 4 IRCCS San Raffaele Scientific Institute, Medical Physics, Milan, Italy; 5 IRCCS San Raffaele Scientific Institute, Medical Oncology, Milan, Italy; 6 IRCCS San Raffaele Scientific Institute, Radiology, Milan, Italy; 7 IRCCS San Raffaele Scientific Institute, Surgery, Milan, Italy; 8 IRCCS San Raffaele Scientific Institute, Vita e salute University, Radiation Oncology, Milan, Italy Purpose or Objective Adjuvant radiochemotherapy (RT/ChT) is controversial in patients (pts) with bile duct carcinoma. It improves outcome in pts with R1, lymph nodes (LNs) positive or stage ≥ T2. We report our results of hypofractionated adjuvant IGRT in bile duct carcinoma. Materials and Methods Pts with intra, extra-hepatic or gallbladder cancer were treated. Simulation consisted in contrast-enhanced computed tomography (c-e-CT) or FDG CT/PET, CTV included surgical bed and regional LNs depending on tumor site. PTV was defined adding standard margins (1, 1, 1.5 cm) to CTV. Median RT dose was 44.25 Gy (EQD2=54 Gy) in 15 fractions with SIB up to 50 Gy to R1 or PET + sites when possible respecting OARs. RT was delivered with tomotherapy or VMAT concomitant to capecitabine. Results From 05/2009 to 07/2020, 57 pts (32 M; 25 F) were treated. Median age: 68 years (45-86). Twenty-six pts (46%) had Klatskin tumor, 17 pts (30%) common or distal bile duct carcinoma, 7 pts (12%) intrahepatic and 7 pts (12%) gallbladder carcinoma. Pathological staging is reported in the table. ChT was administered as follows: neoadjuvant 5 pts (9%), adjuvant 22 pts (39%), capecitabine concomitant to RT 43 pts (75%). CT/PET simulation was performed in 26 pts (46%) and 14 pts (25%) were PET positive. RT was delivered with tomotherapy: 35 pts (61%), VMAT: 22 pts (39%). Average PTV was 387 cc (110-861). No G3-G4 acute toxicity occurred; only 5 pts (9%) had G3 late toxicity (1 gastric ulcer, 2 stenotic fibrosis, 2 cholangitis). At a median follow up of 21 months (2 m- 118 m) the median overall survival (OS) was 31 months. Median time to local progression (TTLP) and time to local progression (TTDP) from the end of RT were 26 months for both. One, 3 and 5 years OS were 91%, 44% and 23%, respectively. One, 3 and 5 years local failure for survival (LFFS) were 84%, 32% and 11%, respectively. Grading was a significant prognostic factor for OS (G1-G2: 33 m vs G3: 20 m; p=0.038), a trend in favour of G1-G2 was shown for TTLP (G1-G2: 28 m vs G3: 18 m; p=0.08) and TTDP (G1-G2: 27 m vs G3: 19 m; p=0.065). Margin status showed a trend in favour of R0 in term of TTDP (R0: 31 m vs R1: 20 m; p=0.061) and OS (R0: 38 m vs R1: 27 m; p=0.081) but no difference in term of TTLP (R0: 31 m vs R1: 22 m; p=0.12). No significant difference in term of OS, TTLP and TTDP between pT1-T2/pT3-T4 (32 vs 30m, 27 vs 25m and 25 vs 20 m, respectively) and pN0/pN+ (31 vs 35 m, 29 vs 26 m and 29 vs 23 m, respectively).