ESTRO 2023 - Abstract Book

S61

Saturday 13 May

ESTRO 2023

Proffered Papers: Upper GI

OC-0099 Quality of life after ablative 5-fraction radiation therapy from the phase II SMART pancreas trial M. Chuong 1 , P. Parikh 2 , D. Low 3 , J. Kim 2 , K. Mittauer 1 , M. Bassetti 4 , C. Glide-Hurst 4 , A. Raldow 3 , Y. Yang 3 , L. Portelance 5 , B. Zaki 6 , H. Kim 7 , J. Mancias 8 , J. Ng 9 , R. Pfeffer 10 , A. Mueller 11 , P. Kelly 12 , L. Boldrini 13 , M. Fuss 14 , P. Lee 15 1 Miami Cancer Institute, Radiation Oncology, Miami, USA; 2 Henry Ford Health - Cancer, Radiation Oncology, Detroit, USA; 3 UCLA, Radiation Oncology, Los Angeles, USA; 4 University of Wisconsin, Radiation Oncology, Madison, USA; 5 University of Miami, Radiation Oncology, Miami, USA; 6 Dartmouth-Hitchcock Medical Center, Radiation Oncology, Lebanon, USA; 7 Washington University School of Medicine in St. Louis, Radiation Oncology, St. Louis, USA; 8 Dana-Farber Cancer Institute, Radiation Oncology, Boston, USA; 9 Weill Cornell Medicine Sandra and Edward Meyer Cancer Center, Radiation Oncology, New York, USA; 10 Assuta Medical Center, Radiation Oncology, Tel Aviv, Israel; 11 Thomas Jefferson University, Radiation Oncology, Philadelphia, USA; 12 Orlando Health Cancer Institute, Radiation Oncology, Orlando, USA; 13 Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Radiation Oncology, Rome, USA; 14 ViewRay, Inc., Radiation Oncology, Denver, USA; 15 City of Hope National Medical Center, Radiation Oncology, Los Angeles, USA Purpose or Objective Prospective trials have demonstrated that patient-reported quality of life (QoL) does not significantly change after non ablative pancreas stereotactic body radiation therapy (SBRT). However, QoL outcomes after ablative SBRT are unknown. Acute grade 3+ toxicity from the phase II SMART pancreas trial (NCT03621644) for borderline resectable (BRPC) and locally advanced pancreas cancer (LAPC) was uncommon, as previously reported. We present QoL outcomes from the SMART pancreas trial, which were assessed as a secondary endpoint. Materials and Methods 136 patients completed study therapy. Eligibility criteria included adenocarcinoma or adenosquamous histology, absence of distant metastatic disease on re-staging after completing 3+ months of induction chemotherapy, CA19-9 <500 U/mL, and no prior pancreas surgery. The prescription dose was 50 Gy in 5 fractions (BED10=100 Gy). SMART was delivered on a 0.35T MR-guided device with intrafraction cine-MRI, soft tissue tracking, and automatic beam gating. On-table adaptive replanning using an isotoxicity approach was performed prior to each fraction as needed. Surgery was performed in 39 patients (28.7%) within 90 days of SMART. QoL assessments using the NCCN-FACT FHSI-18 survey instrument were acquired at 3 time points (TP): prior to SMART (TP1), 3 months after SMART (TP2), and 12 months after SMART (TP3). Median follow up after SMART was 8.8 months and therefore evaluation of QoL in this analysis was limited to TP1 and TP2. Results QoL assessment was completed at TP1 and TP2 by 133 (97.8%) and 106 (77.9%) patients, respectively. There was no difference in mean total FACT FHSI-18 scores at TP1 vs. TP2 (25.1 vs. 25.2; p=0.629). No significant differences were observed in mean subscale scores: physical (13.6 vs. 14.1; p=0.535), emotional (2.5 vs. 2.5; p=0.449), treatment side effects (1.5 vs. 1.2; p=0.071), or function/well-being (7.5 vs. 7.4; p=0.408). Mean scores for the 18 individual survey questions were not significantly different over time except for an increase in pain (0.8 vs. 1.1; p=0.002) and discomfort in the stomach area (1.0 vs. 1.3; p=0.013). No significant increase in mean pain score was noted among unresected patients (1.0 vs. 1.1; p=0.076) in contrast to resected patients (0.4 vs. 1.0; p=0.003). Likewise, no significant increase in mean score related to discomfort in the stomach area was observed among unresected patients (1.2 vs. 1.4; p=0.297) in contrast to resected patients (0.4 vs. 1.2; p<0.001). Conclusion This is the first analysis of prospectively evaluated patient-reported QoL outcomes following 5-fraction SMART for BRPC/LAPC. Despite the ablative prescription dose, we observed no significant overall QoL change within the first 3 months after SMART for unresected patients. Additional follow-up is planned to evaluate long-term QoL within 12 months after SMART. OC-0100 Short course radiation improves pain from pancreatic cancer: A prospective phase II study (NTR5143) C.P. Tello Valverde 1 , G. Ebrahimi 2 , J.W. Wilmink 3 , M.A. Sprangers 4 , M. Jacobs 4 , A. Bruynzeel 5 , M.G. Besselink 6 , H. Crezee 7 , G. van Tienhoven 5 , E. Versteijne 5 1 Amsterdam UMC, Radiation Oncology, Amsterdam , The Netherlands; 2 Instituut Verbeeten, Radiation Oncology, Tilburg, The Netherlands; 3 Amsterdam UMC, Medical Oncology, Amsterdam, The Netherlands; 4 Amsterdam UMC, Medical Psychology, Amsterdam, The Netherlands; 5 Amsterdam UMC, Radiation Oncology, Amsterdam, The Netherlands; 6 Amsterdam UMC, Pancreatic and Hepatobiliary Surgery, Amsterdam, The Netherlands; 7 Amsterdam UMC, Radiaton Oncology , Amsterdam, The Netherlands Purpose or Objective To assess the effect of short course palliative radiotherapy on pain severity, global quality of life (QoL), acute toxicity and overall survival (OS) in patients with pancreatic cancer-related pain. Materials and Methods In this single-arm, prospective phase II study, after informed consent, 30 patients with moderate-to-severe pain of refractory pancreatic cancer were treated with short course palliative radiotherapy; 24Gy in three fractions, once a week, between 2015-2018. Primary endpoint was a change in pain severity with a clinically significant decrease of ≥ 2 points compared to baseline, measured using the Brief Pain Inventory questionnaire. Secondary endpoints were, change in global QoL measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C15 PAL, acute toxicity based on clinician reporting and OS. Questionnaires were scheduled to be measured at nine time-points: at baseline (before the start of the radiotherapy), before the second and third radiotherapy fraction, and at four, five, seven, 11 and 19 weeks after the first radiotherapy fraction, and every three months thereafter if the patient was still alive. Patient-reported outcome measures were analyzed using joint modelling integrating a Cox regression and a mixed

model. Results

Overall, 29 patients received palliative radiotherapy. A total of 24 patients (80.0%) experienced pain relief, for whom 21 patients (70.0%) until death or last follow-up. Patients reported a significant mean pain severity reduction from 5.9 to 2.9 (p=0.017) during the first 11 weeks, followed by a slight increase to 3.4 (p=0.006) up to week 21 after the first radiotherapy