ESTRO 2021 Abstract Book


ESTRO 2021

Abstract not available

SP-0136 For the motion (rebuttal) E. Senkus-Konefka Poland

Abstract not available

SP-0137 Against the motion (rebuttal) S. Rivera 1 1 Gustave Roussy, radiation oncology, Villejuif, France

Abstract Text As estimated by GLOBOCAN 2020 the global cancer burden is increasing. Worldwide, women breast cancer is the most commonly diagnosed cancer with 2.3 million new cases in 2020. Globally a 47% rise in cancer new cases is expected from 2020 to 2040. A large proportion of these patients will requier radiotherapy therefore the increasing interest in hypofractionated breast radiotherapy is crucial. The obvious practical benefits of very hypofractionated radiotherapy regimens delivering a maximum of 5 fractions should not lead us to an over interpretation of the available data. After breast conservative surgery, there is still a significant proportion of patients requiring lymph node irradiation with aggressive diseases for which a lower anti-cancer dose might be problematic. Up to now, five- week normofractionated locoregional radiotherapy is still the standard of care in most countries for breast cancer with an indication for regional lymph node irradiation. Several trials are ongoing comparing normofractionated radiotherapy to moderate hypofractionated radiotherapy on regional nodes (NCT03127995, NCT02690636, NCT03829553, NCT04025164, NCT02912312, and NCT04228991). However, there is no phase III trial published evaluating a 5 fractions regimen when including lymph nodes. A sub study on patients in the FAST-Forward trial comparing 40 Gy in 15 fractions and 26 Gy in 5 fractions for patients requiring regional radiotherapy has started but no results are known and therefore no conclusion should be extrapolated. Indication for neoadjuvant chemotherapy are increasing with a higher chance of breast conserving surgery requiring radiotherapy and a higher probability of postoperative response-guided systemic treatment paving the way for more concomitant radiotherapy. There is currently no evidence on the combination of systemic treatments with breast radiotherapy regimens with a maximum of 5 fractions. Here as well careful evaluation is needed before we can be safely in favor of the motion. Radiotherapy has been a personalized treatment a long time before it became a fashionable expression in oncology. The fast forward trial should not lead radiotherapy backward with a one size fits all short course radiotherapy just because of convenience or reduced costs. In the future, the majority of our patient should receive a radiotherapy regimen based on a personalized and shared choice integrating radio sensitivity heterogeneity, predictive models and prognostic factors. Abstract Text Introduction To evaluate the effect of the Covid-19 pandemic on radiotherapy, ESTRO has surveyed heads or representatives of 500 departments in Europe in 2020 and 2021. Materials and Methods In the 1st survey in May 2020 [1] 139 questionnaires were received (RR 28%) from 29 countries, and in the 2nd survey in February 2021 104 (RR 21%) from 28 countries. Results In the 1st survey, in 58% of departments some treatments were deferred. In 78% of the departments, telemedicine was used, for patients under treatment (22%) and for follow-up (72%). In 60% , a decline in patient volume (median 20%) was noticed, due to delays (65%), reduced referrals (75%) and/or staff shortage (15%). A reduction in staff occurred in 57%, mainly due to family care responsibilities (29%), staff COVID-19 illness (26%) and transfer to other clinical areas (13%). Screening of patients at the entrance was performed in 82%, and 88% of the departments didn’t allow visitors. In the 2nd survey, a decline in cancer screening was seen in 69% of the centers and 71% noticed that patients presented with more advanced disease. 53% reported a decrease (median 10%) in patient volume and 38% noticed no change. Main causes were deferrals (38%) and reduced referral rates (34%). Telemedicine was used in 65%, but mainly for follow-up (64%) . Most departments (73%) created procedures for treatment of Covid-19 positive patients. A staff reduction was observed in 70% . Main reasons included Covid-19 illness (50%), family care (43%) and transfer to other clinical areas (16%). The department heads expressed concerns related to the well-being of health professionals (76%), creating flexible work arrangements (66%), burnout (61%), and work/life balance (54%). Conclusion Radiotherapy departments throughout Europe managed to continue treatment of their patients. Most centers observed a back-log in referred patientes and noticed an increase in patients presenting with more advanced disease. Joint symposium: ESTRO-CARO: COVID-19 SP-0139 Effect of Covid on radiotherapy practice B. Slotman 1 1 AmsterdamUMC, Radiation Oncology, Amsterdam, The Netherlands

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