ESTRO 36 Abstract Book

S606 ESTRO 36 2017 _______________________________________________________________________________________________

Material and Methods The clinical records of 20 adult patients diagnosed with pathologically-confirmed craniopharyngioma and treated with both NS and RT at Addenbrooke’s Hospital (Cambridge, United Kingdom) from 2001 to 2013 were reviewed. All patients received either subtotal or gross total neurosurgical resection of their craniopharyngioma. Post –operative RT was 50 Gy in 30 fractions, in either the adjuvant or salvage setting. Patients were assessed for evidence of HPA dysfunction throughout the course of diagnosis, treatment, and follow-up. Those found to have hypopituitarism were prescribed estradiol (women), testosterone (men), hydrocortisone, thyroxine, growth hormone (GH), or desmopressin in accordance with the deficient axis, and as clinically indicated. Clinical records were reviewed for HRT both before and after radiotherapy. Results Patients included 10 males and 10 females with a median age at diagnosis of 44 years (range, 18-76 years). The mean and median lengths of endocrine follow-up were 5.2 and 5.0 years, respectively (range, 0.5 – 9.6 years). Pre- RT HRT data were available for 15 of the 20 patients. Unlike other hormone axes, testing for GH deficiency was not routinely performed prior to the delivery of RT. When hormone supplementation excluding GH was considered, all but one patient were taking some form of HRT prior to RT. Before RT 53% of patients were receiving at least 3 HRT medications, compared to 73% of patients after RT (Figure 1). The post-RT increase in the mean and median HRT for all patients were 0.7 and 1 additional medications, respectively (Figure 2). Eight patients (53%) required no change in HRT following RT, and only 2 patients required an increase of more than 1 HRT from pre- to post-RT treatment. Conclusion While radiotherapy may cause or exacerbate HPA dysfunction, the actual requirement for additional hormone replacement therapies in routine clinical practice appears to be relatively modest, especially in those patients with pre-existing hormone deficits. Accordingly, the probability of increased tumor control with adjuvant or salvage radiotherapy outweighs the risk of increased HPA morbidity. EP-1119 Radiosurgery for meningioma:Evaluation of radiological outcome and factors of recurrence S. Hassas yeganeh 1 , M. Tabatabiefar 1 , R. Sarghampour 1 1 Imam Hussain Hospital-, clinical oncology, tehran, Iran Islamic Republic of Purpose or Objective Meningioma is one of the most common benign brain tumors with various clinical manifestations . Since the most common prevalence age of meningioma is forth to fifth decades which are the active population, the attention to optimal treatment and contributing factors for recurrence would result in health improvement by reduction in mortality. In this study the therapeutic outcomes and contributing factors for recurrence were evaluated among patients with treated meningioma by radiosurgery. Material and Methods In this retrospective study 1082 consecutive meningioma patients treated in Gamma-Knife Center since 2003 to 2011 were enrolled and the required data were collected form existing medical documents including the therapeutic outcomes. Results Totally 1082 cases including 1164 lesions were included. The mean age was 52 years (7 to 88 years). 293 patients (27.1%) were male and 789 subjects (72.9%) were female. The mean follow-up time was 39.4 ± 24.9 months. In 403 cases, the follow-up was not complete and in remaining cases, the size of lesion was reduced in 338 lesions (44%),

5mm) and transferred into clinical routine. Patients were matched one to one with 66 patients with HGG undergoing conventional radiation therapy (RT) with 60.0 Gy photons (range: 59.4 – 60.0 Gy) in 2.0 Gy fractions (range: 1.8 – 2.0 Gy)(median PTV volume: 369.4ccm). Matching criteria were age, WHO grade, Karnofsky performance status, PTV size, temozolomide therapy (each p>0.1). The majority of all patients in both groups received concomitant and adjuvant temozolomide. The study assessed overall survival (OS) using the log-rank test, treatment-related toxicity using the CTCAE classification (version 4.03) and pseudoprogression according to the Response Assessment in Neuro-Oncology (RANO) criteria for the complete study cohort (n = 132). Results Median overall survival was similar in both treatment groups (bimodality RT, 19.1 months [4 to 41 months]; photon-only RT, 20.4 months [3 to 53 months]; p = 0.306). The median PTV volume of the proton boost was significantly smaller compared to the median PTV volume of the photon plans (each p<0.001). Acute toxicity was mild in both treatment groups. Toxicity ≥ grade II was observed in 6 patients (9.1%) receiving bimodality RT and 9 patients (13.6%) receiving photon-only RT. Two types of severe adverse events (CTCAE grade III) occurred solely in the photon-only group: severe increase in intracranial pressure (3 cases; 4.5%); and generalized seizures (2 cases; 3.0%). Median PTV of these patients was 384.4ccm. The intensity of all symptoms decreased after corticosteroid therapy or anticonvulsant therapy. Pseudoprogression was rare, occurring on average 6 weeks after radiotherapy, and was balanced in both treatment groups (n = 4 each; 7.6%). Conclusion Using a sequential proton boost in HGG is safe and feasible. Delivering a proton boost to significantly smaller target volumes when compared to photon-only plans, yielded comparable survival rates at lower CTCAE °III toxicity rates. Pseudoprogression occurred rarely and evenly distributed in both treatment groups. Thus, bimodality RT was at least equivalent regarding outcome and potentially superior with respect to toxicity in patients with HGG. EP-1118 Radiotherapy-related endocrine dysfunction in patients treated for craniopharyngioma N. Taku 1,2 , A. Powlson 3 , M. Gurnell 3 , N. Burnet 1 1 University of Cambridge Department of Oncology, Addenbrooke’s Hospital, Cambridge, United Kingdom 2 Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA 3 Metabolic Research Laboratories- Wellcome Trust-MRC Institute of Metabolic Science- University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge, United Kingdom Purpose or Objective Craniopharyngioma is a rare, histopathologically benign intracranial tumor originating in the sellar region. Neurosurgery (NS) remains the primary management strategy. However, radiotherapy (RT) is an important adjuvant and salvage treatment. The probability of improved disease control with RT must always be weighed against the risk of RT-related morbidity, including damage to the hypothalamic- pituitary axis (HPA). Many patients will require lifelong treatment with hormone replacement therapies (HRTs). Thus, the objective of minimizing RT-related HPA dysfunction is primarily to reduce the number of required HRTs. The current study evaluates a historical cohort of adult patients treated with NS and RT for craniopharyngioma and seeks to examine the development of RT-related endocrine dysfunction using HRT as a proxy for clinical hypopituitarism.