ESTRO 36 Abstract Book

S25 ESTRO 36 _______________________________________________________________________________________________

2 Leiden University Medical Center, Radiation Oncology, Leiden, The Netherlands Purpose or Objective In this study, locally advanced cervical cancer patients are treated with an online adaptive Plan-of-the-Day (PotD) protocol, using a daily CBCT to select the plan that best fits the observed anatomy of that day from a patient- specific plan library. The objective is to reduce unnecessary dose to healthy normal organs and to maintain a favorable Quality of Life (QoL). Patient reported health-related QoL and symptoms, during and in the first year after treatment, were prospectively scored. Results are reported here. Material and Methods Between January 2012 and March 2016, all locally advanced cervical cancer patients treated with the PotD protocol and brachytherapy with or without chemotherapy or hyperthermia were eligible. QoL was assessed at baseline; weekly during the first five weeks of treatment; 1 week and 1, 3, 6 and 12 months after treatment, using the EORTC QLQ-C30 and the QLQ-CX24 questionnaires. Comparisons were made with an age-matched norm population. Results From January 2012 until March 2016 a total of 167 locally advanced cervical cancer patients were treated with a PotD protocol, of which 123 (74%) were included as responders (baseline score and at least 1 additional questionnaire). Scores of EORTC QLQ-C30 functioning and global health scales are shown in figure 1. At baseline, scores of all functional scales except global health status were lower compared to the age-matched norm population. Global health and functioning were temporarily decreased and returned to a plateau at baseline level 3 months after treatment, except for cognitive functioning. Compared to the norm population all functioning scores, except global health showed either a small decrease or a medium decrease (cognitive functioning) 1 year after treatment. Scores of symptoms and sexual functioning are provided in figure 2. Most symptoms showed a moderate-to-large increase, reaching a maximum at the end of treatment (5 th week), or first week after treatment with a return to baseline at 3 months. However, several symptoms persisted during further follow-up (diarrhea, bowel cramps, dysuria, pain, fecal leakage, insomnia, tingling/ numbness). While most symptoms gradually increased during the first five weeks, diarrhea and bowel cramps already markedly increased within the first three weeks to reach a plateau at the 5 th week of treatment. Sexual/ vaginal symptoms became apparent after treatment and increased in the first year after treatment. The increased vaginal symptoms were paralleled by increased sexual worrying and decreased sexual enjoyment.

Conclusion Moderate to severe limb edema G≥2 is limited in the first years after definitive radiochemotherapy including MRI- guided adaptive brachytherapy. Mainly mild limb edema CTCAE G1 with 5-10% inter-limb discrepancy in volume or circumference at point of greatest visible difference is observed. Nevertheless, a proportion of 8-14% of patients reports “quite a bit” and “very much” swelling of one or both legs during follow-up. Limb edema shows a progressive manifestation pattern over time both in the physician assessed and the patient reported outcome. Laparoscopic lymph node staging bears a considerable risk for the development of G≥1 limb edema. Further investigations are needed to evaluate various specific risk factors in a multivariate model. OC-0054 Dynamics of patient reported QoL and symptoms after IGRT for locally advanced cervical cancer S.T. Heijkoop 1 , R.A. Nout 2 , S. Quint 1 , J.W.M. Mens 1 , B.J.M. Heijmen 1 , M.S. Hoogeman 1 1 Erasmus MC Cancer Institute, Radiation Oncology, Rotterdam, The Netherlands