ESTRO 36 Abstract Book

S248 ESTRO 36 _______________________________________________________________________________________________

Doyeux 1 , R. De Crevoisier 3 , F. Martinetti 1 , I. Dumas 1 , E. Deutsch 1 , C. Chargary 1 1 Gustave Roussy Cancer Campus, Brachytherapy Unit- Radiation Oncology, Villejuif, France 2 Gustave Roussy Cancer Campus, Department of Surgery, Villejuif, France 3 Eugene Marquis Cancer Center, Radiation Oncology, Rennes, France Purpose or Objective Penile carcinoma is a very rare disease, for which total glansectomy is frequently proposed as first intent treatment. However, functional sequelae of surgery have prompted to look at organ sparing strategies. Here is reported the largest experience of brachytherapy as a We examined the outcome of 201 patients treated in our Institution over 45 years for a histologically confirmed invasive squamous cell carcinoma of the penile glans, with emphasis on long-term complications and probability to achieve organ preservation. All had undergone circumcision prior to brachytherapy. Low dose rate or pulse dose rate interstitial brachytherapy was used. Median dose of brachytherapy was 65 Gy (36.5 to 76 Gy). Results With a median follow-up of 10.7 years, local relapses were reported in 38 patients (18.9%) and 22/29 (75.9%) patients with local failure only were in complete remission after salvage surgery or second brachytherapy. At last follow- up, 18 (12.9%) underwent partial surgery and eight (4%) total penectomies for relapse. Fifty patients (25%) presented urethral stenosis requiring at least one dilatation and 13 (6%) required limited surgeries for toxicities. A tumour diameter > 4cm and a dose < 62 Gy correlated with a higher probability of local relapse (p = 0.009 and p = 0.015, respectively). At five years, overall survival rate and local-failure free survival were 79% (95%CI: 76–82%) and 82% (95%CI: 79–85%), respectively. Presence of inguinal lymph node metastasis correlated with a poorer overall survival (p = 0.02). Neutrophilia at diagnosis correlated with a higher probability of distant relapse (p = 0.014). The risk of complication correlated with the dose, treated volume, and dose rate. At five years, the probability of surviving while preserving the penile was 85% (95%CI: 82–88%), taking into account the need for surgery for complications. Conclusion This large institutional experience confirms the high local control achieved with brachytherapy with the advantage of organ preservation in selected patients. Most local relapses are efficiently salvaged by second intent surgery. OC-0467 Investigating reporting-and-learning systems of Irish radiation therapy: Can standards be improved? K. Dowling 1 , C. Poole 1 , L. Mullaney 1 , S. Barrett 1 1 Trinity College Dublin, Discipline of Radiation Therapy, Dublin, Ireland Purpose or Objective Wide variation exists between event (incidents and near- misses) reporting-and-learning systems utilised in the field of radiation oncology. Due to the high potential for error associated with this field of medicine, evidence-based and rigorous systems are imperative. The implementation of such systems facilitates the reactive enhancement of patient safety following an event. This research study was undertaken so as to evaluate Irish event reporting-and- learning procedures and to propose recommendations as to how the national standard can be improved to the optimal standards outlined in the literature. The methodology used to undertake this research was developed with the aim of ensuring its applicability to conservative approach. Material and Methods

OC-0465 Organ preservation for rectal cancer: the GRECCAR 2 randomized phase III trial V. Vendrely 1 , P. Rouanet 2 , J.J. Tuech 3 , H. Mosnier 4 , B. Lelong 5 , M. Rivoire 6 , J.L. Faucheron 7 , M. Jafari 8 , G. Portier 9 , B. Meunier 10 , B. Sastre 11 , M. Prudhomme 12 , F. Marchal 13 , M. Pocard 14 , D. Pezet 15 , A. Rullier 16 , J. Asselineau 17 , A. Doussau 17 , E. Rullier 1 1 CHU de Bordeaux, Gironde, Pessac, France 2 Institut Regional du Cancer Montpellier, Herault, Montpellier, France 3 CHU Charles Nicolle, Seine-Maritime, Rouen, France 4 Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, Paris, France 5 Département de Chirurgie Oncologique- Institut Paoli Calmette, Bouches-du-Rhone, Marseille, France 6 Département de Chirurgie Oncologique- Centre Léon Bérard, Rhone, Lyon, France 7 Service de Chirurgie Digestive- Hôpital A. Michallon, Isere, Grenoble, France 8 Centre Oscar Lambret, Nord, Lille, France 9 Hopital Purpan - Pavillon Dieulafoy, Haute-Garonne, Toulouse, France 10 CHU Pontchaillou, Ille-et-Vilaine, Rennes, France 11 CHU Timone, Bouches-du-Rhone, Marseille, France 12 Hôpital Universitaire Carémeau, Gard, Nimes, France 13 Centre Alexis Vautrin, Meurthe-et-Moselle, Nancy, France 14 Hopital Lariboisiere, Paris, Paris, France 15 CHU Hotel-Dieu, Puy-de-Dome, Clermont-Ferrand, France 16 CHU de Bordeaux- Hopital Pellegrin, Gironde, Bordeaux, France 17 CHU de Bordeaux- USMR, Gironde, Bordeaux, France Purpose or Objective The objective was to compare local excision (LE) and total mesorectal excision (TME) in patients with a good response after radiochemotherapy for low rectal cancer. Material and Methods Patients with T2-T3 low rectal carcinoma, maximum size 4 cm, received neoadjuvant radiochemotherapy. Good clinical responders (residual tumor ≤ 2 cm) were randomized between LE and TME. In the LE group, a completion TME was required if ypT2-3. The primary end point was a composite outcome including death, recurrence, morbidity and after-effects at 2 years. Secondary outcomes were pathologic response, 3-year local recurrence and survival. Results A hundred forty eight good clinical responders to radiochemotherapy were randomized, 3 were excluded and 145 were analyzed: 74 in the LE group and 71 in the TME group. In the LE group, 26 patients had a completion TME. At 2 years, significant events occurred in 56% in the LE group and 48% in the TME group (p=0.320). In intention- to-treat analysis, there was no difference between LE and TME in all components of the composite outcome. Per protocol analysis showed a lower morbidity (11%/21%/48%,p=0.001) and fewer after-effects (17%/29%/62%,p<0.001) according to type of surgery LE, TME and completion TME. Pathologic results showed a low rate of positive lymph nodes in ypT0-1 (0%) and ypTx/cN0 (2%). 3-year local recurrence (5%) and overall survival (92%) were similar between LE and TME groups. Conclusion LE is oncologically safe as compared to TME. Globally it is not superior to TME, due to a high rate of completion TME that increases morbidity and after-effects. A better patient selection removing unnecessary completion TME (ypT2/cN0) will improve the strategy. OC-0466 Brachytherapy for conservative treatment of penile carcinoma: prognostic factors and outcome A. Escande 1 , C. Haie-Meder 1 , R. Mazeron 1 , P. Castelnau- Marchand 1 , P. Maroun 1 , A. Cavalcanti 2 , F. Marsolat 1 , K.