ESTRO 36 Abstract Book

S728 ESTRO 36 2017 _______________________________________________________________________________________________

A. Bresolin 1 , L.C. Bianchi 1 , G. Staurenghi 2 1 Centro Diagnostico Italiano, Cyberknife, Milano, Italy 2 Luigi Sacco Hospital - University of Milan, Eye Clinic, Milan, Italy Purpose or Objective We report our clinical experience of a Hypofractionated Cyberknife Stereotactic Radiotherapy schedule for uveal Between April 2014 and October 2015 12 patients (pts), mean age 65 years (range 36 – 82 years) suffering from uveal melanoma (11 choroidal melanoma and 1 ciliary body melanoma) were treated at Cyberknife Center, Centro Diagnostico Italiano, Milan. All of the pts had received a diagnosis and referral from an ophthalmologist. Cyberknife robot-controlled LINAC radiotherapy was performed delivering a total dose of 54 - 60 Gy (mean 60 Gy) given in 3 or 4 fractions (mean 3) of 15 - 20 Gy (mean 20 Gy) prescribed to the 79 - 82% (mean 80%) isodose surface. All pts underwent orbit MRI with gadolinium for coregistration with the planning CT scans. The planning target volume (PTV) included the contrast-enhancing lesion on MRI plus a 2.5 mm margins in all directions. All pts were irradiated eyelids closed, without peribulbar anesthesia, using a contention with a thermoplastic mask. At presentation the mean PTV volume was 2148 mm³ (range 701.82 – 5792 mm³), mean tumor base measured ultrasonographically 11.75 mm (range 7-15 mm), mean thickness 4.6 mm (range 2.5 - 7.1 mm), with a mean distance of 5.7 mm (range 0 – 15 mm) from fovea and 6.1 mm (range 0 – 13 mm) from optic nerve. Results After a mean follow-up of 11.5 months (range 3 – 24) local control was achieved in 100% of pts. No patient underwent enucleation and none developed distant metastases (all pts underwent abdomen ultrasound and liver blood examination once every six months and chest CT once a year). We observed a reduction of 17% in median base and of 40% in median thickness that were respectively 10 mm (range 4.8 – 13 mm) and 2.75 mm (range 0.5 – 5 mm) at last follow-up. Visual acuity was reduced in 58% of pts, while in the others no change was found. Three pts suffered of radiation maculopathy, associated in one case with atrophy and in two cases with cystoids macular edema. Moreover radiation-induced optic neuropathy and radiation vasculopathy occurred respectively in 2 and 4 cases. 5 pts developed choroidal ischemia and 3 retinal detachment. At the last follow-up none had corneal anomalies and only one cilia loss. Conclusion These initial results of our Cyberknife schedule are consistent with data in literature and show a safe, minimally invasive and well tolerated method for treating uveal melanoma. Further follow-up is necessary. EP-1373 Will appropriate TSEI timing help to find effective dose for patients with mycosis fungoides? A. Chourova 1 , M. Doleckova 1 , D. Kralova 1 , P. Berkovsky 1 , T. Juraskova 1 1 Hospital Ceske Budejovice, Oncology, Ceske Budejovice, Czech Republic Purpose or Objective Mycosis fungoides (MF) is the common type of cutaneous T cell lymphoma, CD4+, with great heterogeneity, but incidence is low. TSEI is the most effective single agent for the treatment MF. It is a complex method for delivering superficial irradiation to entire skin surface. Recommended doses are in range 8-36Gy (The International Lymphoma Radiation Oncology Group, 2015). Presently, the attention is focused on low dose (10-12Gy) TSEI, the complete response rate is lower, but lower are also the complications. Now is the opportunity for retreatment TSEI. melanoma treatment. Material and Methods

Material and Methods In Department of Oncology, Hospital Ceske Budejovice, Czech Republic, from 1993 to October 2016, 65 patients, who had cutaneous T cell lymphoma, mostly MF, received TSEI. Different treatment modalities (chemotherapy, PUVA, Interferon, Targretin, local irradiation, ...) have been used prior TSEI for majority of patients. We have modified TSEI technique developed at McGill University, Montreal (Freeman C.R., 1992) for our condition. The patient is in „ballet dancer“ position and rotates on the carrousel, two arc fields produce an uniform treatment field over the total patient height, with SSD 355 cm, 6 MeV electron beam. The oblique fields achieve with rotational radiotherapy technique maximal dose on the surface of the skin, with stationary radiotherapy technique there is 88% of max. dose on the surface (max. dose in 9 mm) with PLEXI glass in front of patient, without PLEXI 77% (max. dose in 14 mm). A total dose 18- 40 Gy (10 Gy/week). Dose distribution was monitored by thermoluminescent dosimeters (TLD) with subsequent “patch treatments“ and “boost treatments“. In the last 2 years (December 2013- June 2016) we used time for complication decreasing in TSEI and better evaluation of MF response to treatment (n=9). TSEI week timing: first week TSEI, second week break, third week TSEI... Fractionation: 2Gy/fraction, 5 fraction/week. Total dose 18-36Gy., median dose 26Gy. Applied dose depended on MF response to TSEI. Median age: 75 years (42-80), T2N0M0B0 (n= 2), T3N0M0B0 (n=3), T3N1M0B0 (n=2), T3N2M0 B0 (n=1), T4N0M0B0 (n=1). Results • ·Complete response: in 100% • Relapse: 4 patients in 4, 6, 7 and 12 month -2 patients with relapse - solved by retreatment TSEI (8 a 10 Gy) and Roferon A application, both patients are without MF 1 patient with relapse (4 months) - treated by local irradiation, relapse repeated, become worse, died of reaction GVH. 1 patient relapse (in 6 months) - treated by Targretin • · Follow-up: 4 – 20 months, median 14 months • · 5 alive without MF • ·1 alive with MF • ·3 died - 1 patient died of IM without MF - 1 patient (non mycosis fungoides) died of GVH reaction, with MF -1 patient died of IM with MF • All patients without acute complications of TSEI (erythema, dry desquamation) Conclusion • · For all of TSEI patients week timing improves quality of life. • · Protraction of the whole time TSEI with week timing allows to get time for treatment effect evaluation. L. Ferella 1 , S. Parente 1 , G.L. Gravina 1 , P. Bonfili 2 , M. Di Staso 2 , P. Franzese 2 , M.E. La Verghetta 1 , M. Cerasani 1 , D. Di Genova 1 , E. Di Cesare 1 1 Università degli studi de L'Aquila, Divisione radioterapia e radiobiologia, L'aquila, Italy 2 ospedale San salvatore L'Aquila, Uo Radioterapia, L'aquila, Italy Purpose or Objective To evaluate clinical outcome of an Hypofractionated schedule in elderly pts with NMSC ≥3cm. Material and Methods EP-1374 Hypofractionated radiotherapy in non- melanoma skin cancer ≥ 3 cm in elderly PTS .