ESTRO 36 Abstract Book

S665 ESTRO 36 2017 _______________________________________________________________________________________________

exclusive EBRT with Carboplatin-Taxol compared to FOLFOX-4 regimen. Material and Methods Patients were matched 1:1 with respect to age at diagnosis (±5 years), stage (I-II vs III-IV), biopsy proven histology (squamous vs adeno) and topography (upper, middle or lower third or cardia). 46 patients followed the above criteria and remained for the final analysis : 23 patients were treated with FOLFOX-4 regimen (group A) and 23 patients with Carboplatin AUC2 mg/mL per min and Taxol 50mg/m 2 , weekly (group B). Comparison between the 2 groups was performed using Mac Nemar test for paired data. Statistical analyses were performed using SAS 9.3 software. All tests were two sided and P values were considered significant when less than 0.05. Results The mean age in group A was 69.4 years (12.5) and 72.4 years (12.6) in group B (p=ns). In each group, 11 patients had a stage III disease at diagnosis (47.8%) with only 2 stage IV in group A (8.7%) vs none in group B. The median delivered RT doses were 50Gy [14-60] in group A while it was 50Gy [20-70] in group B. We found no difference in the compliance with chemotherapy in each group : 6 courses were delivered in 12 patients in group A (52.2%) and 14 patients in group B (60.9%) (p=0.51). No difference in dose reduction was observed between each group for each course of chemotherapy. After chemoradiation, G1 or higher esophagitis was observed in 5 patients (26.3%) in group A and 3 patients (13.0%) in group B of whom 0 vs 2 G3 were observed in group A and B, respectively. Four patients (21.1%) had a pulmonary infection in group A and 3 in group B (13.0%). Looking at haematological toxicity, 2 patients (8.7%) vs 4 patients (17.4%) had G3 neutropenia, with only 0 and 2 neutropenic fever in group A and B, respectively. No patient had G-CSF. Neither G3 anemia, nor G3 thrombopenia occured. After a median follow-up of 17.7 months [0.0-46.9], 25 patients had died, 14 in group A (60.9%) and 11 in group B (47.8%). The median PFS rates were 14 months in group A [7.7-NR] vs 12.1 months [4.4-NR] in group B (p=0.32). The median OS rates were 20.3 months in group A [6.2- 39.3] vs 17.0 months [4.8-NR] in group B (p=0.82). Conclusion Exclusive chemoradiation with Carboplatin and Taxol seems feasible with similar toxicity and survival outcomes than FOLFOX-4. The safety and efficacy of the CROSS regimen needs to be tested prospectively with EBRT doses >41.4Gy in a phase II or III trial. EP-1248 Adjuvant radiotherapy for gastric cancer patients underwent gastrectomy and D2 lymph node dissection Y. Wang 1 , J.M. Hwang 1 , Y.K. Chang 1 , W.Y. Kao 2 , H.L. Wan 2 , S.Y. Chang 2 , C.C. Wu 3 1 Taipei Tzu Chi Hospital, Radiation Oncology, New Taipei City, Taiwan 2 Taipei Tzu Chi Hospital, Medical Oncology, New Taipei City, Taiwan 3 Taipei Tzu Chi Hospital, General Surgery, New Taipei City, Taiwan Purpose or Objective The benefit of adjuvant chemoradiation (CRT) has been confirmed by the Intergroup 0116 (INT-0116) study. However, as D2 lymph node dissection has been linked to lower recurrence rate, the role of adjuvant radiotherapy (RT), whether with or without concurrent chemotherapy, following D2 dissection is controversial. The goal of this study is to review the clinical outcome of patients with locally advanced gastric adenocarcinoma underwent gastrectomy and D2 lymph node dissection with or without adjuvant RT. Material and Methods

We reviewed 420 patients who were diagnosed with gastric cancer at Taipei TzuChi Hospital during Jan, 2008 to Sep, 2015, while excluding the following patients: those a) >80 years old, b) didn’t undergo gastrectomy and D2 dissection, c) with distant metastases at diagnosis, d) stage IA or IB without nodal metastases, or e) patients who had never been disease-free. The overall survival (OS) and disease-free survival (DFS) rates were compared between patients treated with or without adjuvant RT. Chi-square test or unpaired t-test were used to compare the age, gender, positive lymph nodes (LN) numbers, stage, and chemotherapy status distribution between these two Of those selected patients, thirty-one underwent adjuvant RT and 40 didn’t. The characteristics were described in Table 1. The median follow-up time was 26.87 months. Regional lymph node recurrence alone was only noted in one patient who didn’t undergo RT. Distant metastases (DM) were noted in 17 patients (with RT: 8; without RT: 9). Out of those nine patients who developed DM and didn’t undergo RT, five had been given chemotherapy. Age is significantly related to worse OS (Pearson correlation coefficient=-0.248, p=.037) but not to DFS (-0.191, p=0.111). Positive LNs number is significantly related to both worse OS (-0.244, p=0.041) and DFS (-0.261, p=0.028). Adjuvant RT didn’t significantly improve OS (median: 34.3 vs. 19.7 months, p=0.123) and DFS (median: 30 vs. 17.7 months, p=0.86) (Fig. 1). The patients received adjuvant chemotherapy were with significantly longer OS (median: 31.9 vs. 14.7 months, p=0.007) but not DFS (median: 28.6 vs. 14 months, p=0.42). Conclusion Although the patients who underwent adjuvant CRT were significantly younger, they were also with more advanced diseases. Most of the recurrent events were distant metastases in our study, indicating that D2 dissection might have largely decreased the locoregional failure rate. Adjuvant RT didn’t show significant benefit prolonging OS or DFS. On the other hand, the patients received adjuvant chemotherapy were observed to have significantly longer OS but not DFS. It is possible that the prolonged OS is correlated to the age of patients, rather than a result of chemotherapy. Further randomized controlled trials are required to draw a concrete conclusion. EP-1249 Changes in normal liver volume after high dose radiation in cancer of the liver K. Rajamanickam 1 , S. Chopra 1 , R. Engineer 1 , V. Ostwal 1 , P. Patil 2 , S. Mehta 2 , E. Dhandpani 3 , K. Joshi 3 , S.K. Shrivastava 1 1 Tata Memorial Hospital, Radiation Oncology, Mumbai, India 2 Tata Memorial Hospital, Digestive Diseases and Clinical Nutrition, Mumbai, India 3 Tata Memorial Hospital, Medical Physics, Mumbai, India Purpose or Objective To report liver volume changes and its impact on liver function following hepatic radiation in patients with primary or secondary hepatic malignancies. Material and Methods From Jan 2015 - April 2016, consecutive patients with unresectable hepatic lesions (hepatocellular cancer (HCC), Cholangiocarcinoma (CCA) or liver metastasis (LM)) who received either high dose radiation (HDRT) or stereotactic radiation (SBRT) and without disease progression were included. All patients were required to have Child Pugh status A-B6 prior to radiation. Total liver volume, gross tumour volume (GTV), normal liver volume (total liver volume- GTV) was determined. Follow up scans were used to determine changes, if any, in normal liver volume. As the dose prescription of each patient was individualised, biologically equivalent dose (BED) were groups. Results