ESTRO 36 Abstract Book

S692 ESTRO 36 2017 _______________________________________________________________________________________________

Purpose or Objective To determine outcomes of patients with locally advanced cervical cancer who presented with deranged renal functions necessitating urinary diversion with Percutaneous Nephrostomy (PCN) before and during course of pelvic radiation Material and Methods The retrospective audit was approved by institutional review board. The hospital database from January 2010- June 2015 was reviewed to identify patients with locally advanced cervical cancer and deranged serum creatinine at baseline. Patients wherein PCN was advised at baseline or during treatment were selected for this audit. Pretreatment patient, tumour and treatment related factors that impacted choice of treatment and overall survival in patients undergoing PCN were analysed using univariate and multivariate analysis Results Over a 5 year study period, 128 patients with primary or recurrent cervical cancer underwent PCN. Of these 56 (44%) underwent PCN before and during treatment and 60 patients (44%) received PCN after completion of primary treatment within the setting of local or distant recurrence that necessitated systemic chemotherapy. Overall 12 (9%) patients did not receive any treatment after PCN due to anticipated poor tolerance. Median serum creatinine before and after a week of PCN was 3.8mg/dl (0.4-7.4 ) and 1.6 mg/dl ( 0.6-1.7 ). Median hospital stay was 13 days(4-67). Overall 62.5% patients developed procedure related urinary infection following PCN and 8% patients died secondary to infective complications. Of the 56 patients that received PCN before treatment, 54 received either radical (n=31) or palliative radiation (n=23). Of those planned for radical radiation, 34 were stage III, 15 were Stage IV with median tumour size of 4.5 cms. Only 16/54 patients could complete planned concurrent chemoradiation (29%). Median survival for the cohort undergoing PCN prior to treatment was 205 days (7-369) For 16 patients that completed radical chemoradiation the median survival was 254 days (107- 380) and 18/54 for those receiving palliative radiation was 146 days (41 - 146). On univariate analysis restricted to cohort of patients receiving radiation Karnofsky performance score <70 at time of PCN (p=0.005), Serum creatinine >3mg/dl (p=0.004), post procedure infection (p=0.002) were factors for poor outcomes of procedure. Conclusion Conclusion - There is significant fall in serum creatinine and improvement in renal function occurs after percutaneous nephrostomy. Yet the median survival was dismal and patients had considerable procedure related morbidity further adding to the duration of hospital stay. Careful selection of patients to undergo percutaneous nephrostomy is important for the success of the procedure EP-1304 A moderate ipofractionation schedule with IMRT in preoperative locally advanced cervical cancer R. Autorino 1 , M. Campitelli 1 , A. Martino 1 , A. Nardangeli 1 , G. Mattiucci 1 , V. Frascino 1 , D. Smaniotto 1 , A. Valentini 2 , G. Ferrandina 3 , M. Gambacorta 1 1 Polyclinic University A. Gemelli- Catholic University, Institute of Radiotherapy, Rome, Italy 2 Polyclinic University A. Gemelli- Catholic University, Institute of Radiology, Rome, Italy 3 Polyclinic University A. Gemelli- Catholic University, Institute of Oncological Gynecology, Rome, Italy Purpose or Objective To analyze the efficacy and tolerability of intensity modulated radiation therapy (IMRT) simultaneous integrated boost (SIB) associated to cisplatin based chemotherapy. in preoperative setting of patients with locally advanced cervical cancer Material and Methods

From September 2014 to December 2015, we analyzed patients with locally advanced cervical cancer undergone to neoadjuvant intensity-modulated extended-field chemoradiation plus simultaneous integrated boost. A radiation dose of 39.6 Gy, 1.8 Gy/fraction, was delivered to the pelvis plus a radiation dose to the primary tumor delivered with SIB-IMRT strategy for a total of 50.6 Gy, 2.3 Gy/fraction in 25 fractions. Cisplatin based chemotherapy was delivered associated to radiotherapy. Radical hysterectomy plus pelvic with or without aortic lymphadenectomy was performed within 6 to 8 weeks from CRT. Statistical analysis was performed using Systat program. Results 29 patients (median age: 52 years; The International Federation of Gynecology and Obstetrics (FIGO) stage IB2: 1, IIB: 19, IIIA: 1; IIIB: 5; IVA: 3) were analyzed. The treatment was well tolerated with a good compliance: no patients had grade 3/4 gastrointestinal or genitourinary toxicity; grade 3 leukopenia and neutropenia were reported in only 1 case (stage FIGO IVA) without interruption of the treatment. pCR was documented in 15 cases (51%) and 4 patients (13%) had a microscopic residual disease (persistent tumor foci of 3 mm maximum dimension). At median follow-up of 12.5 months (range: 7-19 months), the 1-year local control was 95%, whereas the 1-year disease-free and overall survival rates were 95% and 100%, respectively. Conclusion The treatment was globally well tolerated with a good compliance. Results in terms of efficacy were comparable with literature data. Local control and overall survival will be further evaluated with a longer follow-up. EP-1305 Hemoglobin monitoring in Endometrial Carcinoma: how preoperative anemia impacts overall survival. K. Holub 1 , A. Biete 1 1 Hospital Clínic i Universitari de Barcelona, Radiation Oncology Dpt., Barcelona, Spain Purpose or Objective To investigate the hematological parameters for anemia in relation to survival in endometrial carcinoma (EC) and to audit hemoglobin (Hb) monitoring before, during and after radiotherapy. Material and Methods We retrospectively evaluated 233 patients (p) out of a total cohort of 248p diagnosed with EC and treated with radiotherapy (RDT) in our center between January 2011 and December 2015. We analyzed the presence of anemia defined as Hb<12g/dL in four specific intervals: pre- treatment (Hb), before RDT(Hb2), during (Hb3) y after RDT (Hb4). We estimated how many patients with basal Hb<12g/dL were monitored for anemia afterwards and if pretreatment Hb level has prognostic value for Overall Survival (OS). Statistics: Ch2, Kaplan-Meier test, T-test. Results Age at diagnosis (years): mean 64.9 (range 36-90). All patients underwent surgery before RDT, with pelvic lymphadenectomy in 187p (80.3%). Histology: endometrioid 172p(73.8%), non-endometrioid 61p(26.2%). FIGO stage (2009): IA-60p (27.8%), IB-92p(39.5%), II- 32p(13.7%), IIIA-9p(3.9%), IIIB-0, IIIC1-20(8.6%), IIIC2- 8(3.4%), IVA-9(3.9%), IVB-3(1.3%). Grade: I-50p(21.5%), II- 91p(39%), III-88p(37.8%). Majority of patients was treated with combination of EBRT+BT (mean dose 41.2 Gy, range 5-75). Mean follow-up (months): mean 32. Progression was observed in 40p (17.2%): only 1p developed pelvic node recurrence, 39p developed distant recurrence (4p with vaginal progression, 3p with regional progression and 1p with both vaginal and regional progression, remaining 31p presented exclusively distant progression). Mortality: 31p (13.3%), including 28p (12%) cancer-deaths and 3deaths (1.3%) not related with EC. Remaining 202p were alive