ESTRO 36 Abstract Book

S743 ESTRO 36 _______________________________________________________________________________________________

objective of this study was to examine temporal trends in opioid prescribing among cancer patients with different pain severity. Material and Methods Approach: Our study cohort comprised of Ontario residents ≥18 years with a history of cancer who were eligible for the government’s paid pharmacare program and who had a pain assessment using the Edmonton Symptom Assessment Scale (ESAS). Use of ESAS is the result of a population-based provincial initiative to screen ambulatory cancer patients for 9 common cancer symptoms. For each year between 2007 and 2013, we used the date of an individual’s highest pain score as the index date to calculate annual opioid prescription rates for claims within -30 days to +7 days of the index date. We evaluated prescriptions for drugs for neuropathic pain as a secondary outcome. Results Results: During the study period, individuals meeting the cohort inclusion criteria increased over 7-fold with 12,066 individuals aged 18-64 years and 43,715 individuals aged ³65 years eligible in 2013. Over time, changes in the distribution of patients across cancer types and pain scores were observed. For example, for those aged 18-64, 33% of patients had pain 7-10 in 2007 decreasing to 22% with pain 7-10 in 2013. Similarly, for those aged ≥65, 21% had pain 7-10 in 2007 decreasing to 11% in 2013. In both age groups, opioids were prescribed most frequently for those with pain 7-10 and least frequently for those with no pain. Among 18-64 year olds with pain 7-10, opioid prescription rates decreased from 46% in 2007 to 38% in 2013 (p<0.05). The respective values for those ³65 years were 61% to 39% (p<0.05). Prescriptions for drugs for neuropathic pain increased modestly. Conclusion Conclusion: Over time, pain assessment among cancer patients has increased. However, the proportion with pain who receive an opioid prescription has decreased. This finding may be due to increased detection of non-cancer related pain, but may also be the result of increased scrutiny of opioid prescribing and policy changes intended to decrease prescribing in non-cancer patients. EP-1388 Clinical features of bone metastases and their importance for radiotherapy N. Bychkova 1 , E. Khmelevsky 1 1 Gertzen Moscow Research Oncological Institute, Radiotherapy Department, Moscow, Russian Federation Purpose or Objective To study the features of bone metastases according to different primary tumors and their importance for radiotherapy Material and Methods We analyzed 680 cases of symptomatic bone metastases included in the randomized controlled trial and treated with EBRT. The primary breast tumors were diagnosed in 426 (62,6%), prostate in 57 (8,4%), lung in 57 (8,4%), renal in 47 (6,9%), colon in 18 (2,6%), bladder in 11 (1,6%) and other tumors in 64 (9,5%) cases. Patient selection criteria for radiotherapy were pain, risk of pathological fracture/malignant spinal cord compression, increasing neurologic dysfunction. Irradiation of one anatomical area was applied («block concept»). Treatment schedules included 2, 3 and 4 fractions of 6,5Gy and standard treatment schedule with 23 fractions of 2 Gy. Results The average follow-up period was 70 months. Pain intensity before treatment was significantly higher for bone metastases of prostate and lung cancer compared to breast cancer (p<0,01) and for the men in general (p<0,001 for non-prostate cases). Average relative lesion length in irradiation’s areas was significantly lower for

renal cancer – 1,8 (for the three-level scale) and significantly higher for prostate cancer – 2,28 (p=0,017). The risk of pathological fracture was the lowest only for prostate cancer metastases – 0,21 compared to 0,46 for breast cancer lesions (p=0,0002). Overall effectiveness of EBRT was 96,1%. Complete response rate (CRR) was observed in 59,1% of cases. CRR correlated with the level of total dose. CRR was significantly higher for bone metastases of breast cancer compared to lung and renal cancer (63,6% as opposed to 40,4% and 28,3%, р<0,02) and for melanoma metastases (75%) compared to renal cancer (p=0,036). It is interesting, that bone metastases of melanoma and soft-tissue sarcomas were one of the most radiosensitive. In the multifactorial analysis MANOVA tumor primary site and pain intensity before radiotherapy were the only independent prognostic factors of the effectiveness of radiotherapy. Conclusion Tumor primary site is a clinical predictor of radiosensitivity of bone metastases, it significantly affect the CRR. Revealed features of bone lesions according to different primary tumors allow to develop individual treatment programs with a view to high efficiency and ease of realization. EP-1389 Superficial hyperthermia with radiotherapy: toxicity and outcome of 62 metastatic lesions G. Cattari 1 , A.G. Di Dia 2 , M. Gatti 1 , E. Delmastro 1 , E. Garibaldi 1 , G. Belli 1 , A. Salatino 1 , P. Gabriele 1 1 FPO-IRCCS Candiolo, Radiotherapy, Candiolo- Turin, Italy 2 FPO-IRCCS Candiolo, Medical Physic, Candiolo- Turin, Italy Purpose or Objective The purpose of this study is to evaluate the safety, feasibility and toxicity of radiotherapy-hyperthermia (RT- HT) in the treatment of superficial recurrent and metastatic tumors in this setting of patients Material and Methods Thirty-nine patients (mean age 69 years; range: 49-93) with histologically confirmed superficial recurrent/metastatic tumours were treated: 19 breast, 10 head & neck, 2 malignant melanoma, 4 sarcomas, 1 uterine, 1 hepatocarcinoma and 2 pancreatic carcinoma. The total number of treated lesions was 62. The mean Karnofsky Index value is 75. Pre-treated patients (70%) received a previous mean RT dose of 50 Gy. Patients underwent RT treatment using 3D-conformal RT (16/39) or Helical Tomotherapy (23/39). External beam RT was delivered in 5-27 fractions of 1.7-5 Gy to a total dose of 20-57.5 Gy (mean external dose: 39 Gy). Hyperthermia (HT) treatment is performed with a double electromagnetic superficial applicators operating at the frequency of 434 MHz. HT session was delivered once/twice weekly during the period of RT , 1-2 hours after RT [mean value: 5; range: 1-9 sessions]. Average, maximum and minimum temperature parameters were recorded during HT treatment. The treatment goal was to reach 40- 42°C in > 90% (T90) of measured points for a duration of 60 minutes. Acute and late toxicity was evaluated according to the CTCAE criteria. Local control was assessed after the end of the treatment on the basis of the RECIST Criteria Results During HT treatment the median temperature [range] reached was 40.5 °C [39 – 42.9°C]. Five patients interrupted the treatment: 2 pts (5%) for G3 toxicity, 2 (5%) for poor compliance and 1 (2.5%) for clinical progression disease. Two pts (5%) had acute cutaneous toxicity ≥ G3 at 1 month. Four patients had toxicity > G2 at 3 months, three patients had > G2 at 6 months and only one patients at 12 months. No patients showed toxicity ≥