ESTRO 36 Abstract Book

S725 ESTRO 36 2017 _______________________________________________________________________________________________

pelvis, and it was shrunk to the bladder or tumor as a boost. Systemic chemotherapy combined with radiotherapy was performed in 10 of the 15 cases. The 1- year and 3-year overall survival rates were 66.7% and 40.0%, respectively, and the 1-year and 3-year local control rates were 70.0% and 60.0%, respectively. Chemotherapy contributed to improvement of overall survival and relapse-free survival (p = 0.001). There were no serious adverse events in the observation period. The bladder was maintained in all cases. Conclusion Radiotherapy has an important role from the point of view of the patient’s QOL and is likely to become an option for local treatment. Chemotherapy combined with radiotherapy is considered to be essential for systemic tumor control. EP-1367 Conservation treatment of Carcinoma Penis with surface mould brachytherapy M. Anjanappa 1 , A. Kumar 1 , P. Raghukumar 2 , F. James 1 1 Regional Cancer Center, Radiation Oncology, Trivandrum, India 2 Regional Cancer Center, Radiation Physics, Trivandrum, India Purpose or Objective To assess the rate of organ preservation and to identify factors related to local control in patients treated with surface mould brachytherapy for carcinoma penis. Material and Methods A retrospective analysis of patients treated with surface mould brachytherapy for carcinoma penis at our institution during the period 2000 to 2011 was carried out. The details of age and date of diagnosis of these patients, tumour size, histology, stage, size of residual disease after biopsy were collected. Further, the treatment details regarding the type of brachytherapy treatment, dose prescribed, response to treatment and recurrences were documented. Local control was calculated from the date of diagnosis to documented date of local recurrence or residual disease. In addition, nodal and systemic relapses were documented separately. Results A total of seventeen patients were identified from database and the records of sixteen patients were available for the analysis. The mean age was 47.3 years (range 31-73). All patients had histologically verified squamous cell carcinoma. Nine patients had lesion on the glans, six on the prepuce and one on the shaft. Three patients did not have any disease palpable after biopsy and the rest had a tumor size of less than 2cm. Three fourths of the total number had T1 disease. Majority of the patients (fourteen) were treated with pre-loaded LDR source brachytherapy and the rest with remote after loading HDR source. The dose prescribed ranged from 55Gy to 65 Gy at surface for LDR and the HDR dose was 50Gy in 15 fractions and 30Gy in 10 fractions treated twice daily. At a median follow up of 37.5 months (range 9-167), the local control was 75%. Among the twelve patients with T1 disease, one patient had residual disease after brachytherapy and the other had a local recurrence after seven months resulting in local control rate of 83.3%. Three out of sixteen patients had partial response after brachytherapy for which they underwent salvage surgery. The local control with salvage surgery after residual disease or recurrence was 100%. Furthermore, among the patients with residual disease following brachytherapy, two were having T2 disease. Among them, one patient subsequently developed systemic recurrence (lung and bone) and succumbed to disease. Regional nodal relapse was documented in one patient for whom inguinal block dissection was performed. The nodal and systemic relapses were in T2 patients. Conclusion

Three fourth of patients had local control with organ preservation by mould brachytherapy for Penile squamous cell carcinoma and the rest had surgical salvage to achieve local control . It appeared that the control was better for T1 disease than T2. Mould brachytherapy may be considered as a safe alternative to surgical treatment in patients with early stage penile carcinoma who wish to retain entire penis. EP-1368 Impact of post-operative Radiotherapy in bladder cancer after loco-regional relapse. M.J. Mañas 1 , X. Maldonado 1 , F. Lozano 2 , C. Raventós 2 , R. Morales 3 , V. Reyes 1 , S. Micó 1 , D. SantaMaria 1 , J. Carles 3 , J. Morote 2 , J. Giralt 1 1 Radiation Oncology. H.U. Vall d’Hebrón, Barcelona, Spain 2 Urology. H.U. Vall d’Hebrón. Barcelona, Spain, 3 Medical Oncology. H.U. Vall d’Hebrón. Barcelona, Spain, Purpose or Objective To assess the role of radiotherapy in bladder carcinoma after loco-regional relapse or pathologic adverse factors in patients previously treated with or without cystectomy after chemotherapy. To evaluate the toxicity of these treatments. Material and Methods Since September 1998 to September 2016, seventy-eight patients with bladder cancer (68 men, 10 women, median age 53 years, range 37-87 years) have been postoperatively treated with radiation therapy in our department. 63 patients had transitional carcinoma, 7 squamous cell carcinoma and 8 sarcomatoid carcinoma. The aim of the treatment was adjuvant in 27 patients (34.6%), consolidative after nodal relapse post- chemotherapy 19 patients (24.3%) and for local tumor persistence in 32 patients (41.0%). Mean radiotherapy dose was 50.4 Gy (range 37.5 Gy - 64,8 Gy) 1,8 Gy/fraction, 5 fraction/week (40 Gy to the pelvis and a boost to the GTV up to 55,8 Gy if cystectomy or 64,8 if the bladder was present). RTOG Late Toxicity scale and CTCAEv3.0 were used. Survival was calculated by means the Kaplan-Meier method. Results Cystectomy was previously performed in 42 patients (53.8%). Clinical prognostic factor were: pT1, 5 (6%); pT2, 29 (37.1%); pT3, 30 (38.4%); pT4 14 (18%); N+, 53 (67.9%); N0 25 (32%). With a median follow-up of 30.6 months (m). Median time between infiltrative bladder tumor diagnoses and local relapse was 13m (3-77 m), nodal relapse, 11 m (3-39 m). Actuarial survival at 16 m and 36 m were 68% and 51% respectively. At 60 m, actuarial survival post- radiotherapy was 34%. Median survival after treatment for nodal relapse, local relapse and adjuvant Radiotherapy were 15.5 m(11-92 m), 22.5 m (9-180 m) and 18.5 m (15-84 m) respectively. Failures after consolidative radiotherapy were: bone metastases (7.7%), nodal relapse (25.6%), local relapse (20.5%), soft tissues metastases (12.8%). No grade 4 late toxicity has been reported. 8 patients (10%) presented late GI toxicity grade 2 and in 2 was grade 3. In 4 patients (5.1%) grade 2 GU toxicity was reported and grade 3 in 2. Conclusion Post-operative radiotherapy in bladder cancer with loco- regional relapse or with pathological adverse factors is feasible with a low late toxicity profile. Half of our patients are alive at 3 years. In these patients with loco-regional relapses after radical cystectomy or with macroscopic residual tumor after maximal surgical effort with curative intent, loco-regional control rate is improved with respect to the chemotherapy alone standard treatment.