ESTRO 2023 - Abstract Book

S490

Sunday 14 May 2023

ESTRO 2023

EMBRACE-I is a prospective, observational, multicentre cohort study (1416 patients, 2008-2015). Physician-assessed (CTCAE v.3) and patient-reported outcomes (EORTC C30) were collected during follow-up at intervals of 3 months in the 1st year, 6 months in next 2 years, and annually thereafter. CTCAE scores were converted into MOSES score which integrates severity of symptoms over time by imputing proportionate time weightage (P) to CTCAE grade (S) by using the mathematical formula Ʃ (PxS). This score was calculated for each GI symptom (diarrhea, flatulence, incontinence, proctitis, stenosis, fistula, bleeding) and then summated to determine cumulative MOSES (C-MOSES). The EORTC C30 questionnaire was used to calculate five functioning subscales: physical, role, emotional, cognitive, social and global health/QoL by linear transformation into a continuous scale (0-100 score), according to EORTC guidelines. Different patient subgroups were identified based on: CTCAE maximum grade during follow-up (CTCAE ≥ G1, ≥ G2 and ≥ G3) and C-MOSES ≥ 2.0 (90th percentile), and ≥ 2.5 (94th percentile) (Fig1, Table1). Inter-group comparison was carried out for the mean QoL score of each functional subscale. Results Of 1416 patients, 977 patients had both CTCAE and QoL data available. The median follow-up was 48 months. The C-MOSES groups ≥ 2.0 and ≥ 2.5 include patients with CTCAE maximum G1 to G4 suggesting that these groups include both patients with severe toxicity ( ≥ G3) as well as patients with considerably persistent moderate (G1 and G2) toxicity (Table1). Fig1 shows the mean values of QoL functional subscales for different subgroups of patients. The inter-group comparisons suggest differences in mean QoL of varying magnitude. In summary, patients with higher CTCAE maximum grades had worse QoL. Patients with C-MOSES ≥ 2.0 and C-MOSES ≥ 2.5 had in most instances worse QoL than patients with incidence of ≥ G1, ≥ G2 and ≥ G3, respectively. The subgroup of patients with C-MOSES ≥ 2.5 and CTCAE maximum grade combined showed further deteriorating mean scores of medium to small magnitude, compared to the maximum method, indicating clinical relevance. (Cocks et al.,2012). For example, for role function, the mean QoL scores in patient groups with maximum G1, G2 and G3 were 15-22 points lower when maximum grade was also combined with C-MOSES ≥ 2.5 (Fig 1). Conclusion This analysis demonstrated that C-MOSES combined with CTCAE maximum grade method can identify specific groups of patients with worse QoL. This finding highlights the need to take into account not only the maximum severity of toxicity after treatment but also the cumulative duration of each severity grade over time. OC-0607 Pattern of brain metastases after HA-PCI and SRCF in SCLC: pooled findings of NCT01780675 and PREMER H. Zeng 1 , S. Schagen 2 , L. Hendriks 3 , G. Sánchez-Benavides 4 , J. Jaspers 5 , R. Manero 6 , Y. Lievens 7 , M. Murcia-Mejía 8 , M. Kuenen 2 , M. Rico-Oses 9 , M. de Ruiter 2 , F. Couñago 10 , E. Dieleman 11 , K. de Jaeger 12 , P. Calvo-Crespo 13 , M. Lambrecht 14 , P. Samper 15 , J. Belderbos 16 , D. De Ruysscher 17 , N. Rodríguez de Dios 18 1 GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Department of Radiation Oncology (Maastro), Maastricht, The Netherlands; 2 The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, The Netherlands; 3 GROW - School for Oncology and Re production, Maastricht University Medical Center+, Department of Pulmonary Diseases, Maastricht, The Netherlands; 4 Hospital del Mar Medical Research Institute (IMIM), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; 5 Erasmus MC Cancer Institute, Department of Radiotherapy, Rotterdam, The Netherlands; 6 Hospital del Mar, Department of Neurology, Barcelona, Spain; 7 Ghent University Hospital and Ghent University, Radiation Oncology, Gent, Belgium; 8 Hospital Universitario Sant Joan de Reus, Department of Radiation Oncology. , Reus, Spain; 9 Complejo Hospitalario Navarra, Department of Radiation Oncology, Pamplona, Spain; 10 San Francisco de Asís and La Milagrosa Hospitals, Genesis Care Madrid Clinical Director, Madrid, Spain; 11 Amsterdam UMC- Location AMC, Radiation Oncology, Amsterdam, The Netherlands; 12 Catharina Hospital, Radiation Oncology, Eindhoven, The Netherlands; 13 Hospital Universitario de Santiago de Compostela, Department of Radiation Oncology, Santiago de Compostela, Spain; 14 Leuven Cancer Institute, , Department of Radiation Oncology, Leuven, Belgium; 15 Hospital Universitario Rey Juan Carlos. Móstoles. Spain., Department of Radiation Oncology. , Madrid, Spain; 16 The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Radiation Oncology, Amsterdam, The Netherlands; 17 GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands., Department of Radiation Oncology (Maastro), Maastricht, The Netherlands; 18 Hospital del Mar, Radiation Oncology, Barcelona, The Netherlands Purpose or Objective To investigate whether hippocampus-avoidance prophylactic cranial irradiation (HA-PCI) increases the risk of brain metastases (BM) development within the HA area and preserves self-reported cognitive functioning (SRCF) in small cell lung cancer (SCLC) using the pooled data of two phase III randomized clinical trials: NCT01780675 (Dutch-Flemish) and PREMER/NCT02397733 (Spanish). Materials and Methods Patients with stage I-IV SCLC were randomized to PCI or HA-PCI. Brain MRI with contrast enhancement was performed at baseline, 4, and 12 months in the Dutch trial and at baseline, 3, 12, and 24 months in the PREMER trial. In patients who developed new neurological symptoms, brain MRI /CT was preformed ad interim. In case of BM in the proximity of the lower dose regions, the MRI/ CT-scan were matched to the planning CT-scan and visually inspected to see if the BM were located in the HA zone (hippocampus with 5mm volumetric expansion). χ 2-test/Fisher’s exact test was performed to compare the BM location between arms. SRCF was assessed using the cognitive functioning scale of the EORTC-QLQ-C30 at pre-specified time points (both: baseline, 12, and 24 months after completion of PCI; Dutch: 4, 8, and 18 months; Spanish: 3 and 6 months). Measurements within the time window (until the start of PCI for baseline, within 2 weeks for 3~8 months, within 1 month for 12~24 months) were analyzed, others were scored as missing. We used the threshold of SCRF<75 to examine clinically relevant cognitive impairment. Generalized estimating equation (GEE) was performed to identify the impact of HA on SRCF. Proffered Papers: Lung

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