ESTRO 36 Abstract Book

S663 ESTRO 36 2017 _______________________________________________________________________________________________

advanced esophageal cancer patients treated with total dose of 40 Gy/2.5Gy. Material and Methods we retrospectively reviewed the records of 19 patients diagnosed with locally advanced or metastatic esophageal cancer, treated in our institution from 2012 to 2015 with palliative EBRT. All patients had histologically confirmed diagnosis of squamous cell or adenocarcinoma of the esophagus and were symptomatic for dysphagia. Before the start of EBRT the dysphagia was scored according to scale 0-4 (0- no dysphagia , 1 -dysphagia with certain solid foods , 2 -able to swallow semi-solid soft foods , 3-able to swallow liquids only and 4 - unable to swallow saliva ). The prescribed total dose to all patients was 40Gy with daily dose of 2.5Gy, 5 fractions per week in sixteen fractions using Volumetric Modulated Arc technique . We evaluated the dysphagia score one months after the end of the EBRT. Results Grade 1 dysphagia was detected before RT treatment in 3 patients ( 15.8%), grade 2 in 8 patients (42.2%), grade 3 in 6 patients (31.5%) and grade 4 in 2 patients (10.5%).No patient discontinued RT due to acute toxicity. One month after the end of the EBRT 4 patients(21%) experienced complete dysphagia relief. Fourteen patients (73.7%) experienced improvement of symptomatic dysphagia. Four patients(21%) had no positive effect and one patient died 3 weeks after the end of treatment. Conclusion EBRT with mild hypofractionation is an effective treatment for esophageal cancer patients with symptomatic dysphagia. It is well tolerated and can provide symptom relief and quality of life improvement. EP-1243 A Study on predictive value of 18F-FDG PET- CT to Chemoradiation of Esophageal Cancer J. Li 1 , W. Sun 2 1 Fujian Cancer Hospital, radiation oncology, Fuzhou- Fujian, China 2 Fujian medical university, Provincial Clinical College, Fuzhou, China Purpose or Objective To evaluate whether the SUVmax and MTV predict short- term clinical curative effect of radiotherapy or chemoradiotherapy in nonoperative esophageal squamous cell cancer. Material and Methods A retrospective analysis was made on 98 cases patients with esophageal cancer from January 2014 to January 2016 in Fujian Provincial Cancer Hospital. All of them had an examination by FDG PET/CT before treatment. Respectively analysis was conducted on SUVmax, MTV's relationship with clinical factors and short-term clinical curative effect. Results There is no difference on SUVmax and MTV of different group of age, gender, morbid position and histology differentiated degree (P > 0.05). Significant difference was found on SUVmax and MTV of different group of lesion length, T grade, stage pathologic N stage and clinical (P < 0.05). And positive correlation was noticed between the SUVmax, MTV and lesion length, T grade, stage pathologic N stage and clinical stage (P < 0.05). Low MTV group and low SUVmax group were higher than high MTV group and high SUVmax group on the percentage of lesion length reduction(P < 0.05). And it was negative correlation between SUVmax , MTV and the percentage of lesion length reduction, but the correlation of MTV was stronger than SUVmax. Conclusion there was no significant effect on SUVmax and MTV for age, gender, morbid position and histology differentiated degree (P > 0.05), but lesion length, T grade, pathologic N

stage and clinical stage were significantly positive correlated with SUVmax and MTV. The SUVmax and MTV can predict short-term clinical curative effect of radiotherapy or chemoradiotherapy in nonoperative esophageal squamous cell cancer, but MTV was more valuable than SUVmax . EP-1244 Neoadjuvant Chemo Radiation followed by Surgery in Ca Esophagus – Retrospective Review from India V. Goel 1 , A.K. Anand 1 , H.K. Chaturvedi 2 , A. Verma 1 , P. Agarwal 1 , T. Saxena 1 , R. Shukla 1 , D. Arora 3 , A.K. Bansal 3 , A. Gulia 1 , C. Garg 1 , U. Mukherjee 4 1 Max superspecality hospital, Radiation Oncology, Delhi, India 2 Max superspecality hospital, Surgical Oncology, Delhi, India 3 Max superspecality hospital, Medical Physics, Delhi, India 4 Max superspecality hospital, Pathology, Delhi, India Purpose or Objective Neo-adjuvant Concurrent Chemoradiation (NACCRT) followed by Surgery is now the standard of care for middle & lower third esophageal carcinoma. However this is an intensive treatment regimen. Often there are concerns and doubts about its feasibility in Indian population, who do not have as good nutritional status as western patients. At our institute we have been following this treatment approach since 2009 and have analysed our own outcomes in terms of feasibility, toxicity, mortality and survivals. Material and Methods We treated 62 patients with NACCRT followed by surgery from October 2009 to December 2015 at Max Hospital, Delhi, India. All patients underwent esophageal endoscopy, biopsy and PETCT scan for diagnosis and staging purpose. Inclusion criteria for NACCRT followed by surgery were, patients with bulky primary tumour, enlarged lymph nodes (LN) on imaging, adherence to surrounding organs and clinical suitability for trimodality therapy. All patients received radiation therapy (RT) with IMRT technique with single/double agent concurrent chemotherapy. PET CT was used in target volume delineation for IMRT in all patients. RT doses were 41.4 Gy/23 fractions and 45 Gy/25 fractions with double & single agent chemotherapy respectively. Patients underwent open transthoracic esophagectomy with 2- Field lymph node dissection; 6-8 weeks after completion of NACCRT. Results Squamous cell carcinoma was present in 82% patients while only 18% patients had adeno carcinoma. Tumour was located in Middle, Lower and Lower and GE junction in 50%, 23% and 27% patients respectively. Total 60/62 (96.8%) patients completed NACCRT. Of these 46 (76.6%) were taken up for surgery. Three patients (5%) were considered unsuitable for surgery, 13.3% defaulted for surgery and 5% were lost to follow up after NACCRT. Resectability rate for patients taken up for surgery was 93.4%. Perioperative death occurred in 3 patients (6.6%). Pathological complete response was seen in 37.2% patients. At median follow up of 17.6 months, 3(7%) patients had a mediastinal nodal recurrence and 12% developed distant metastases. In all three patients with nodal recurrence, LN was located in superior mediastinum. Median disease free survival (DFS) and overall survival (OS) is not yet reached. The OS in our study at 1 and 2 year respectively was 76% and 62.8% for all patients. Conclusion NACTRT followed by surgery is feasible in middle and lower third carcinoma esophagus patients in Indian population and yields high DFS and OS. Most common locoregional pattern of failure was in superior mediastinal nodal station, which needs to be further addressed in