ESTRO 36 Abstract Book

S363 ESTRO 36 _______________________________________________________________________________________________

Modulated Arc-Therapy or Tomotherapy. Concomitant chemotherapy (Cht) consisted in oral capecitabine at a dose of 1250 mg/m 2 /day. Results From 11/2010 to 09/2016, 24 pts were treated. Characteristics of pts: median age: 69 years (45-83), 12 M and 12 F, median KPS: 90. Eighteen pts (75%) had Klatskin disease, 6 pts (25%) had common and distal bile duct disease (3: intra-pancreatic). Treatment: All pts underwent surgery (19 pts R1, 5 pts R0: 3 pts were N+, 1 pt pT4 and 1 pt had hilary infiltration). Only 3 pts were previously treated with neoadjuvant Cht (2 pts: GEM+CDDP, 1 pt: capecitabine). Four pts received adjuvant Cht (1 pts: PEXG, 1 pt: GEM, 1 pt: GEMOX, 1pt: CDDP+GEM). Seventeen pts (71%) received Cht concomitant to RT. Ten pts (42%) underwent c-e CT and CTPET simulation, 6 pts (25%) underwent 4D c-e CT and 8 pts (33%) only c-e CT. Eight pts (50%) were PET positive. AcuteToxicity: all pts were evaluable. Most toxicities were G1-G2: 2 pts (8%) experienced diarrhea, 14 (58%) nausea/vomiting, 9 (37%) abdominal pain, 3 (12%) cholangitis, 2 (8%) gastric ulcer. Only one pt developed gastro-duodenitis G3. Late toxicity: 20/24 pts were evaluable, no toxicity ≥ G2 occurred. Responses: 23/25 pts were evaluable. Nine pts (39%) had PD (3 local and distant progression, 5 only distant and 1 only local progression). Median TTLP and OS, evaluated using the Kaplan-Meier method, were calculated from start of RT and resulted 31.0, 34.5 months respectively. Conclusion Adjuvant Hypo-IGRT delivering 44.25 Gy in 15 fractions concomitant to oral capecitabine in patients with extra- hepatic cholangiocarcinoma is feasible with a good toxicity profile. PO-0695 Neo-adjuvant chemoradiotherapy and resection for esophageal cancer: outcomes in daily practice. E.S.H. Portier 1 , K.J. Neelis 1 , M. Fiocco 2 , W.O. De Steur 3 , A.M.J. Langers 4 , J.J. Boonstra 4 , H.H. Hartgrink 5 , M. Slingerland 6 , F.P. Peters 1 1 Leiden University Medical Center, Department of Radiation Oncology, Leiden, The Netherlands 2 Leiden University Medical Center, Department of Medical Statistics and Bioinformatics, Leiden, The Netherlands 3 Leiden University Medical Center, Deparment of Surgery, Leiden, The Netherlands 4 Leiden University Medical Center, Department of Gastroenterology, Leiden, The Netherlands 5 Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands 6 Leiden University Medical Center, Department of Medical Oncology, Leiden, The Netherlands Purpose or Objective Since the first results of the Dutch randomized CROSS trial (van Hagen et al, 2012), neo-adjuvant chemoradiotherapy (CRT) followed by resection for primary resectable non- metastastic esophageal cancer (EC) was implemented as standard curative treatment in the Netherlands. We evaluated clinical outcomes with this treatment in daily practice. Material and Methods We retrospectively studied consecutive patients treated for primary resectable non-metastatic EC between May 2010 and December 2015 at our institution. Patients were included if they started treatment with the intention to undergo neo-adjuvant CRT followed by resection. Patients with neuro-endocrine histology and treatment for recurrent EC were excluded. Treatment consisted of external beam radiotherapy (23 fractions of 1,8 Gy), 5 weekly courses of carboplatin (AUC 2) and paclitaxel (50 mg/m2) and transthoracic or transhiatal resection. We recorded patient and tumour characteristics, survival,

disease progression, acute and late toxicity/complications (CTCAE version 4, Clavien-Dindo classification) and send quality of life (QOL) questionnaires (EORTC QLQ-C30 and QLQ-OES18, EQ-5D-5L and a self-developed questionnaire on dumping complaints) to surviving patients. Results One hundred forty-five patients were included (table 1). Median follow-up was 43 months (95% CI 32.6-53.4 months). All patients completed radiotherapy as intended and 86.9% received the full chemotherapy regimen. One hundred thirty-seven patients underwent surgery, with a resection of the tumour in 130 patients (90%). One patient had a microscopically irradical resection(<1%). Median overall survival (OS) was 35 months (95% CI 29.8-40.2 months, fig. 1). Median progression free survival (PFS) was 30 months (95% CI 19.7-40.3 months). Three-year OS and PFS were 49.6% (95% CI 40.4-58.8%) and 45.6% (95% CI 36.6-54.6%) respectively. Three year cumulative incidence for locoregional progression and distant metastasis were 31% (95% CI 22.9-39.1%) and 45.3% (95% CI 36.5-54.19%) . In univariate analysis, tube feeding before start of neo- adjuvant chemoradiotherapy, dysphagia score (0-1 versus 2-4), length of the tumour, clinical T-stage, number of chemotherapy cycles, pathological response (pT- and pN- stage) and extracapsular extension of lymphnode metastases were significantly associated with OS. Tube feeding and extracapsular extension were significant in multivariate analysis. Toxicity and QOL are currently analysed, results will be available at presentation.