ESTRO 36 Abstract Book

S23 ESTRO 36 _______________________________________________________________________________________________

Purpose or Objective Advances in definitive treatment of locally advanced cervical cancer (LACC) have increased the number of long- time survivors and subsequently the likelihood of late and persisting treatment-related side effects. Morbidity research has primarily focused on symptoms related to organs at risk, such as bladder, bowel, rectum or vagina. However, several patient reported outcome studies have pointed out the substantial impact of unspecific symptoms, such as fatigue, insomnia and hot flashes, on patients’ quality of life. The purpose of this descriptive report is to evaluate the pattern of development of these symptoms during the first years of follow-up within the prospective, observational, multi-center EMBRACE study (An international study on MRI-guided brachytherapy in locally advanced cervical cancer). Material and Methods From 2008-2015, 1419 LACC patients were included in the study and treated with combined EBRT ± chemotherapy and MRI-guided brachytherapy following the GEC-ESTRO guidelines. Fatigue, insomnia and hot flashes were prospectively assessed according to CTCAE v.3 at baseline, every 3 months (1 st year), and every 6 months (2 nd , 3 rd year) and yearly thereafter. Analyses of crude incidence showing the maximum grade over all follow-ups, prevalence rates showing the proportion of grades in each follow-up and actuarial probabilities (Kaplan-Meier method) were performed. Results In 1176 patients from 22 centers, information on morbidity was available at baseline and follow-up, with a median follow-up time of 27 months. Crude incidence rates revealed disabling G4 fatigue in two patients. Furthermore, severe G3 morbidity occurred rarely (all ≤ 4%). Moderate G2 morbidity was shown in 15% (hot flashes), 11% (insomnia) and 20% (fatigue). However, mild G1 morbidity was pronounced with 33%, 29% and 40%, respectively. The actuarial estimates for G≥1 are summarized in table 1 and display consistently a high risk at 5 years for hot flashes (61.3%), insomnia (54%) and fatigue (72.8%). The prevalence rates revealed that both fatigue and insomnia were already present at baseline and both symptoms did neither resolve nor worsen over time (figure 1a and 1b). The proportion of hot flashes increased considerably at the first follow-up after treatment and remained quite stable over time with only a small descriptive trend for improvement in G1 and G2.

Conclusion Fatigue, insomnia and hot flashes are prevalent after definitive treatment for LACC, mainly in the mild to moderate range, and do not resolve over time. Although both fatigue and insomnia are already present at baseline and seem to be not influenced by treatment, more research is needed to evaluate various risk factors in order to define intervention strategies which are available for hot flashes (hormonal replacement). In addition, the impact of these symptoms on patients’ quality of life needs to be determined in future projects, taking also patient reported outcomes into account. OC-0052 Physician assessed and patient reported bladder morbidity after RCHT and IGABT for cervical cancer L.U. Fokdal 1 , K. Kirchheiner 2 , N. Kibsgaard Jensen 1 , J.C. Lindegaard 1 , K. Kirisits 2 , C. Chagari 3 , U. Mahantshetty 4 , I.M. Jürgenliemk-Schulz 5 , B. Segedin 6 , P. Hoskin 7 , R. Pötter 2 , K. Tanderup 1 1 Aarhus University Hospital, Department of Oncology, Aarhus C, Denmark 2 Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria 3 Gustave-Roussy, Department of Radiotherapy, Paris, France 4 Tata Memorial Hospital, Department of Radiotherapy, Mumbai, India 5 Utrecht University, Department of radiotherapy, Utrecht, The Netherlands 6 Institute of Oncology Ljubljana, Department of