ESTRO 36 Abstract Book

S753 ESTRO 36 _______________________________________________________________________________________________

Weight loss No loss: 12 <5%: 8 (29%) 5-10%: 2 (9%) Diet

patients with lung cancer at the start of oncological treatment, as well as a scheduled monitoring to control feeding problems and give adequate dietary guidelines EP-1409 Prospective study of hypofractionated radiotherapy for elderly patients with High Grade Glioma E. Clerici 1 , P. Navarria 1 , A.M. Ascolese 1 , F. Pessina 2 , S. Tomatis 1 , L. Cozzi 1 , M. Simonelli 3 , A. Santoro 3 , C. Franzese 1 , L. Bello 2 , M. Scorsetti 1 1 Istituto Clinico Humanitas, Radiotherapy and Radiosurgery, Rozzano Milan, Italy 2 Istituto Clinico Humanitas, Neurosurgery Oncology Department, Rozzano Milan, Italy 3 Istituto Clinico Humanitas, Oncology and Hematology Department, Rozzano Milan, Italy Purpose or Objective Published studies showed that a short course of radiation therapy (RT) in elderly and frail patients with diagnosed anaplastic glioma is safe, feasible and better tolerated compared to standard RT fractionation. Based on this background we designed a prospective trial of hypofractionated radiotherapy. The aim of this study was to evaluate patients outcome in terms of progression free survival (PFS) and Overall Survival (OS) rate, and treatment related toxicity. Material and Methods Elderly patients (≥70 years old) with poor Karnofsky performance status and histological confirmed high grade glioma (HGG) were included in this evaluation. All patients underwent hypofractionated radiotherapy with or without concomitant and adjuvant chemotherapy in relation to MGMT status, using temozolomide (TMZ). To precisely define the target volume, computer tomography (CT) scan with and without contrast and magnetic resonance images (MRI) were acquired and images were coregistered. The clinical tumor volume (CTV) corresponded to surgical cavity or to T1 FLAIR abnormality in case of biopsy only. Planning target volume (PTV) was generated adding an isotropic margin of 5 mm from CTV. All plans were optimized on PTV using volumetric modulated arc therapy (VMAT) mode. Dose prescription was 52 Gy in 15 consecutive daily fractions (BED 10 70.88 Gy). Clinical outcome was evaluated by neurological examination and brain MRI performed, one month after RT and then every 3 months. Response was recorded using the Response Assessment in Neuro-Oncology (RANO) criteria. The tumor progression was described as local, if it occurred in/or within 2 cm from primary site, and distant for new and non-contiguous enhancing or non-enhancing lesions. Hematologic and non-hematologic toxicities were graded according to Common Terminology Criteria for Adverse Events version 4.0. Results From February 2013 to February 2016, among patients referred to our institution for anaplastic gliomas, 24 patients were included in this evaluation. Biopsy was performed in 13 patients, complete resection in 5 and partial resection in 6. Concomitant and/or adjuvant chemotherapy was administrated in 7 patients. The median time and the 6 and 12 months progression-free survival (PFS) rate were 4.4 months, 46% and 12%. The median overall survival (OS) time and the 1 year OS rate were 7.3 months, 70.8% and 16.7%. On univariate and multivariate analysis MGMT status and administration of adjuvant chemotherapy more than concurrent chemotherapy significantly impacted on PFS and OS (p < 0.01). The treatment was well tolerated, no severe toxicity was recorded. Conclusion In our experience, hypofractionated radiotherapy with VMAT-RA in elderly and frail patients could be a safe and

(54%

Standard: 19 (86.5%) Deficient: 3 (13.5%) Feeding problems

NO problems: 11 (50%) Disphagia gr. 1: 11 (50%) Nutritional supplements NO : 18 (82%) YES: 4 (18%) END RADIOTHERAPY BMI mean: 27.6; median: 26.7 kg/m2 (20.15 37.34)

Weight loss No loss: 14 (63.5%)

<5%: 7 (32%) 5-10%: 1 (4.5%) Diet

Standard: 18 (82%) Deficient: 4 (18%) Feeding problems NO problems: 10 (45.5%) Disphagia: 12 (54.5%) gr. 1: 10 (45.5%) gr. 2: 2 (9%) Nutritional supplements

NO: 16 (72,7%) YES: 6 (27.3%)

Conclusion Most elderly patients have a BMI at the start of treatment not indicative of malnutrition, and hardly changes during treatment All patients have some degree of weight loss at the beginning of treatment. During the treatment and at the end, most do not progress in such loss or it is less than 5% Patients have a progressive difficulty in feeding, mainly due to dysphagia, but this does not translate for changing the type of diet It is essential to assess the nutritional status of elderly