ESTRO 36 Abstract Book

S747 ESTRO 36 _______________________________________________________________________________________________

EP-1396 Versatis® and focal neuropathic pain in cancer patients (screening tool) C. Prieto Prieto 1 , E. López Ramirez 2 1 Hospital Universitario Virgen de las Nieves, Radiation Oncology, Granada, Spain 2 Oncosur, Oncología Radioterápica, Granada, Spain Purpose or Objective Lidocaine 5% patch (L5%P) = (Versatis®) represents a novel therapeutic approach to neuropathic pain in cancer patients. The objective of this study is to evaluate its role in treating acute or chronic focal neuropathic pain (FNP) in cancer patients, regardless of its causal relationship with the tumour. Material and Methods We collected information from 33 cancer patients with focal neuropathic pain (FNP) treated with L5%P. Some interesting data related to L5%P use were analyzed: NP nature, body areas affected, previous and concomitant analgesic treatment, time from patch application to analgesic effect, duration of therapy with L5%P, analgesic efficacy and adverse reactions. Therapeutic indication with L5%P was established in all patients using a validated FNP screening tool (ST) consisting in 4 simple questions. Results All patients underwent radiotherapy in our Departments. 66.7% of them (n=22) suffered from FNP related with cancer and its therapies. In the other 33.3% of cases (n=11), FNP was not considered related. Potent analgesic effect of L5%P was observed in 23 cases (69.7%), and partial effect in 5 cases (15,2%). It represents an 84.9% of efficacy in our sample. 81.3% of patients did not report adverse reactions at all. 45.5% of patients achieved pain control within one week after starting L5%P treatment. 39.4% of patients did not need concomitant analgesic Our data support that L5%P (alone or in association with other drugs) may be an effective and safe approach for FNP in cancer patients. EP-1397 Dose painting guided by diffusion-weighted MRI applied to recurrent glioblastoma: a phase I protocol M. Iori 1 , M. Galeandro 2 , A. Botti 1 , R. Sghedoni 1 , P. Ciammella 2 , M. Orlandi 1 , M. Napoli 3 , S. Tanzi 4 , R. Pascarella 3 , S. Cavuto 5 , A. Pisanello 6 , M. Russo 6 , E. Cagni 1 , D.E. Chiari 7 , M. Campioli 8 , C. Iotti 2 1 Arcispedale S. Maria Nuova - IRCCS, Medical Physics Unit, Reggio Emilia, Italy 2 Arcispedale S. Maria Nuova - IRCCS, Radiation Oncology Unit, Reggio Emilia, Italy 3 Arcispedale S. Maria Nuova - IRCCS, Neuroradiology Unit, Reggio Emilia, Italy 4 Arcispedale S. Maria Nuova - IRCCS, Palliative Care Unit, Reggio Emilia, Italy 5 Arcispedale S. Maria Nuova - IRCCS, Infrastructure Research and Statistic, Reggio Emilia, Italy 6 Arcispedale S. Maria Nuova - IRCCS, Neurology Unit, Reggio Emilia, Italy Purpose or Objective Standard treatment for glioblastoma (GBM) is surgery, followed by radio- & chemo-therapy. However, disease recurs in almost all patients and re-irradiation is an option to be considered. Although the topic of re-irradiation is generally controversial because of the toxicity risk, literature provides consistent data supporting both the feasibility and the survival-strengthening capability of radiation, compared to supportive care only. In the 7 UNITN, Dipartimento di Fisica, Trento, Italy 8 UNIMORE, Dipartimento di Scienze e Metodi dell’Ingegneria, Reggio Emilia, Italy treatment. Conclusion

present study, voxel-based re-irradiations guided by magnetic resonance imaging (MRI) were simulated and planned with apparent diffusion coefficient (ADC) used as biomarker for tumor cellularity. Material and Methods The relapse areas of 6 selected GBM patients treated with STUPP protocol were monitored with MRI. The ADC patterns, considered in the literature as a surrogate biomarker of cellularity was analyzed and chosen to define a signal-to-dose transfer function. This decision, coupled with our clinical data in re-treating GBM with moderate hypo-fractionation regime (Ciammella et al, Clin Neurol Neurosurg, 2013, 115: 1609-14), have formed the basis of a phase I study undertaken on 12 GBM relapse patients, simulated with multi-parametric MRI and re-treated with a dose-painted hypo-fractionated regime. The study foresees dose levels of 30-50Gy/5fr with a cumulative BED 10 >120Gy in an attempt to achieve some changes in the recurrence pattern, without causing excessive radiation necrosis (<12 Gy/fr) inside the irradiated area and respecting the previously irradiated healthy tissue (EQD 2 < 100Gy). To realise the ADC data extraction and DPBN (Dose Painting By Numbers) planning procedure with RapidArc technique, home-made MATLAB software and automatic scripting procedure on a commercial treatment planning system (TPS) were realised. Nine target sub- volumes were used for the volume-based TPS plan optimisation. Phantom (PTW, Octavius 4D) and portal dosimetry (EPID) based on g-index (2%, 2mm) were applied for the pre-treatment plan evaluation. Results Considering follow-up data that correlates patient outcomes with histogram changes in the tumour recurrence ADC values of the 6 relapsed patients, a double threshold transfer function was defined. The first patient was enrolled in the study and treated. To a first control to three months after treatment, the first patient has not had acute toxicity, has a performance status of 100%, and has a radiological picture of stable disease albeit associated with signs of pseudo-progression. The pre- clinical check of the delivered treatment, verified with portal and phantom dosimetry, has provided a minimum g-index of 90.7%. The total beam-on time with 4 non- coplanar 6MV FFF arcs was less than 5 min. Conclusion The phase I protocol, approved by Ethical Committee, has enrolled its first patient. Data on planning, dosimetric and patient follow-up aspects will be presented and discussed. EP-1398 Application of radiosurgery in treatment of oligometastases T. Chebotarova 1 , N. Spizhenko 1 , N. Lisovzka 1 , O. Yarmak 1 1 Cyber Clinic of Spizhenko, Radiation therapy, Kapitanivka -Kyiv region, Ukraine Purpose or Objective Development of genetic researches in the field of oncology found out proofs of genomic instability in solid tumors which results in their clonal heterogeneity. Oligometastatic disease considered as an intermediate biological state with limited ability of tumor to promote numerous metastases. In this transition stage of growth tumor could gave oligometastatic clones expressed with single metastatic lesions. Now it’s known, that the cells of oligometastatic tumors expressed specific microRNAs able to block tumor-promoting genes, and as a result make the spread of tumors slower. We are focusing on the group patients with metastatic lesion aiming to detect clinical application for local ablative radiosurgery treatment. Material and Methods The results of treatment of 335 patients with metastases of brain, lung, liver, renal and epinephrine were analyzed. The localization of primary tumors in this group of patients