ESTRO 2024 - Abstract Book

S1880

Clinical - Mixed sites, palliation

ESTRO 2024

Regression analysis was used to identify factors contributing to poor outcomes and identify targets for prehabilitation and closer monitoring post RT, utilising our own proposed risk categorisation model.

Results:

156 patients who received pelvic RT and attended the PRD clinic were identified. The incidence of PRD was highest in anal (6.7%) and cervical cancers (5.5%), however overall incidence was low (1.7%). Factors associated with no QoL improvement following intervention included: female gender (OR 80.4, p=0.003), patients requiring psychology referral (OR 24.4, p=0.026), patients with fistula or stricture (OR 16.4, p<0.001) and vitamin D deficiency (OR 3.76, p=0.045). Increased time from RT to referral and younger age were also adverse features (p<0.05). Having identified the following features to be associated with increased risk: anal cancer, cervical cancer, female gender and young age (<50), we constructed a risk categorisation model (Table 1) that could be used prior to RT to inform an intervention and follow up strategy for individual patients.

Table 1 – Risk Categorisation Model Risk Group

Number of Adverse Features

Suggested Intervention

Prehabilitation. 3 monthly GSRS for 1 year, 6 monthly GSRS for 3 years. Prehabilitation. 6 monthly GSRS for 2 years. Prehabilitation. Patient information leaflet regarding symptoms offered post RT. No formal intervention/follow up required.

High Risk

2 or more

Moderate Risk

1

Low Risk

0

Conclusion:

Our study indicates that the incidence of PRD is low, however it is recognised this may be due to challenges of recognising and diagnosing PRD (1,2). There is an increased risk for patients with anal and cervical cancer, which might be explained by both cancer types utilising chemotherapy as a radiosensitiser and delivering higher doses of radiotherapy (3). We identified risk features and propose a risk categorisation model: high risk with 2 or more adverse features, moderate with 1 and low risk none. Depending on risk, patients would be offered prehabilitation to allow early correction of modifiable risk factors (e.g. replace vitamin D/ smoking cessation) and have GSRS questionnaires at regular intervals (via a patient reported outcomes / PROMs approach) to allow early identification of symptoms. Increased time to referral was recognised as associated with poorer outcomes, thus early identification is a key aim of the risk categorisation model. The development of this model requires validation in future studies.

Keywords: Supportive, Late Effects

References: