ESTRO 2022 - Abstract Book

S85

Abstract book

ESTRO 2022

Forty-seven EC patients were enrolled. All were referred to curative CRT (41.4-50.4 Gy in 23-28 fractions and carboplatin, paclitaxel) followed by surgery (nCRT), n=38 or CRT, n=9. Evaluation included cardiac biomarkers, electrocardiogram, ECHO at rest and during stress, and a cardiopulmonary exercise test before and after CRT. The primary endpoint was changes in LV global longitudinal strain (GLS). Secondary endpoints were LVEF, LV diastolic function, LVEF and GLS at peak exercise and maximal oxygen consumption. Results Median age was 67 years, 94% males. Tumors were 74% GEJ and 74% adenocarcinomas. TNM classification consisted of 89% ≥ T3 and 51 % ≥ N1. The median time from first examination to start CRT was 3 days (IQR 1,5) and to post CRT follow-up was 1 day (IQR 0,6). There was a significant drop in GLS and LVEF at rest 17.6% vs. 16.4% and 56.4% vs. 55.1%, respectively (p=0.004; p=0.030). Cardiac systolic reserve capacity was impaired, and 10 patients had an absolute fall of at least 5% in LVEF and 2.5% in GLS. Signs of LV diastolic dysfunction increased from 13% to 21%, p=ns. Peak VO2max percent of predicted decreased significantly 87.5% vs. 76.8% (p =0.000). Creatinine, leukocytes, and hemoglobin decreased significantly, and cardiac biomarkers did not change during CRT. Conclusion In EC patients LV function and physical performance were significantly reduced immediately after CRT. Additionally, the LV systolic reserve capacity was impaired which was related to the demonstrated decline of the maximal physical performance following CRT. The study highlights that the EC treatment is associated with acute cardiac side effects which might be avoided by individualized heart protective cancer treatment. I. van Goor 1,2 , A. Nagelhout 2 , M. Besselink 3 , B. Bonsing 4 , K. Bosscha 5 , L. Brosens 6 , O. Busch 3 , G. Cirkel 7 , R. van Dam 8 , S. Festen 9 , B. Groot Koerkamp 10 , E. van der Harst 11 , I. de Hingh 12 , G. Kazemier 13 , G. Meijer 1 , V. de Meijer 14 , V. Nieuwenhuijs 15 , D. Roos 16 , J. Schreinemakers 17 , M. Stommel 18 , R. Verdonk 19 , H. van Santvoort 2 , Q. Molenaar 2 , L. Daamen 20 , M. Intven 1 1 UMC Utrecht Cancer Center, Radiation Oncology, Utrecht, The Netherlands; 2 Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Surgery, Utrecht, The Netherlands; 3 Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Surgery, Amsterdam, The Netherlands; 4 Leiden UMC, Surgery, Leiden, The Netherlands; 5 Jeroen Bosch Hospital, Surgery, Den Bosch, The Netherlands; 6 Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Pathology, Utrecht, The Netherlands; 7 Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & Meander Medical Center Amersfoort, Medical Oncology, Utrecht, The Netherlands; 8 Maastricht UMC+, Surgery, Maastricht, The Netherlands; 9 OLVG, Surgery, Amsterdam, The Netherlands; 10 Erasmus MC, Surgery, Rotterdam, The Netherlands; 11 Maasstad Hospital, Surgery, Rotterdam, The Netherlands; 12 Catharina Hospital, Surgery, Eindhoven, The Netherlands; 13 Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit, Surgery, Amsterdam, The Netherlands; 14 UMC Groningen, University of Groningen, Surgery, Groningen, The Netherlands; 15 Isala, Surgery, Zwolle, The Netherlands; 16 Reinier de Graaf Gasthuis, Surgery, Delft, The Netherlands; 17 Amphia Hospital, Surgery, Breda, The Netherlands; 18 Radboud UMC, Surgery, Nijmegen, The Netherlands; 19 Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Gastroenterology, Utrecht, The Netherlands; 20 UMC Utrecht, Imaging, Utrecht, The Netherlands Purpose or Objective About 20% of patients develop isolated local recurrence (ILR) within a median interval of 12 months after pancreatic ductal adenocarcinoma (PDAC) resection. Stereotactic body radiation therapy might improve survival and quality of life in these patients. To start treatment as early as possible, patients with a high risk of developing ILR should be identified. However, little is known about the risk factors for ILR. In this study, we aimed to identify predictive factors for ILR. Materials and Methods This national cohort study was conducted among all patients who underwent PDAC resection in the Netherlands between 2014-2019. Patients were excluded in case of complication-related mortality within 90 days after resection, and macroscopic irradical resection. Furthermore, patients were also excluded in case of recurrence with unknown location. Baseline and perioperative data were collected from the mandatory, prospective Dutch Pancreatic Cancer Audit. Additional data on follow-up and survival was collected from the patients’ records. Patients were divided into two groups based on their initial recurrence location: ILR or distant metastases (whether or not combined with synchronous local recurrence). Patients with distant metastases were censored at date of recurrence diagnosis. Patients without disease recurrence were censored at date of last follow-up. Missing data was considered missing at random and handled using multiple imputation with the iterative Markov chain Monte Carlo method. Univariable and multivariable Cox proportional hazard analysis was performed to identify prognostic factors for ILR and Akaike’s information criterion was used to select the best model. Survival was estimated and compared using Kaplan-Meier curves and log-rank test. Results A total of 1355 patients with a median follow-up of 33 (IQR 21–54) months were analysed. 957 patients (70%) developed disease recurrence. Among these patients, 201 patients (21%) presented themselves with ILR within a median recurrence- free interval of 14 (IQR 10–23) months. Their median overall survival (mOS) was 25 (IQR 15–35) months, compared to a mOS of 16 (IQR 10–26) months in patients who had distant metastases at initial presentation (Figure 1). The best predictive model included all significant variables and had an area under the curve of 0.65. Factors associated with ILR were vascular resection (HR 1.70 [95%CI 1.26–2.29]; p <0.001), lymph vascular invasion (HR 0.73 [95%CI 0.54–0.98]; p 0.04), perineural invasion (HR 1.68 [95%CI 1.12–2.53]; p 0.01), lymph node status N2 (HR 1.69 [95%CI 1.13–2.52]; p 0.01) compared to N0, resection margin status R1 <1 mm (HR 1.65 [95%CI 1.23–2.22]; p <0.001), and adjuvant chemotherapy (HR 0.69 [95%CI 0.51–0.93]; p 0.02). Results are shown in Table 1. OC-0111 Prognostic factors for isolated local recurrence after resection of pancreatic ductal adenocarcinoma