ESTRO 38 Abstract book

S261 ESTRO 38

K. Tanderup 4 , R. Pötter 1 , R.A. Nout 17 1 Medical University of Vienna / General Hospital of Vienna, Department of Radiation Oncology- Comprehensive Cancer Center, Vienna, Austria ; 2 University Medical Centre Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands ; 3 Gustave-Roussy, Department of Radiotherapy, Villejuif, France ; 4 Aarhus University Hospital, Department of Oncology, Aarhus, Denmark ; 5 Tata Memorial Hospital, Department of Radiation Oncology, Mumbai, India; 6 Institute of Oncology Ljubljana, Department of Radiotherapy, Ljubljana, Slovenia; 7 The Norwegian Radium Hospital- Oslo University Hospital, Department of Oncology, Oslo, Norway ; 8 Postgraduate Institute of Medical Education and Research, Department of Radiotherapy and Oncology, Chandigarh, India ; 9 St James's University Hospital, Leeds Cancer Centre, Leeds, United Kingdom; 10 Arnhem, Department of Radiotherapy, Arnhem, The Netherlands ; 11 Cross Cancer Institute and University of Alberta, Department of Oncology, Edmonton, Canada ; 12 St. Olavs Hospital, Clinic of Oncology and Women's Clinic, Trondheim, Norway; 13 UZ Leuven, Department of Radiation Oncology, Leuven, Belgium ; 14 Hospital of Navarra, Department of Radiation Oncology, Pamplona, Spain; 15 Amsterdam UMC- Location Academic Medical Center, Department of Radiation Oncology, Amsterdam, The Netherlands ; 16 Cambridge University Hospitals NHS Foundation Trust- Addenbrooke's Hospital, Oncology Centre, Cambridge, United Kingdom ; 17 Leiden University Medical Center, Department of Radiation Oncology, Leiden, The Netherlands Purpose or Objective To evaluate the pattern of sexual activity and its associations to sexual/vaginal functioning within the prospective, observational, multi-center EMBRACE study (An international study on MRI-guided brachytherapy in locally advanced cervical cancer). Material and Methods From 2008-2015, 1416 patients from 22 centers were included and treated with combined EBRT±chemotherapy and image-guided adaptive brachytherapy (IGABT) following the GEC-ESTRO guidelines. Sexual outcomes were prospectively assessed according to EORTC-QLQ-CX24 questionnaires at baseline and follow- ups (FUP) every 3 months (1 st year), every 6 months (2 nd ,3 rd year) and yearly thereafter. Prevalence rates over time were displayed. Associations between pain during intercourse (dyspareunia) and vaginal functioning were evaluated with Spearman´s rank correlations, pooling observations over all FUP (N=2670). Longitudinal analyses of individual patterns for sexual activity and dyspareunia were performed in patients with at least 3 FUP (N=850). Frequent dyspareunia was defined, if ≥50% of all sexual encounters were “quite a bit” or “very much” painful; occasional dyspareunia if less than half of all encounters were experienced painful. Results Information on baseline sexual activity was available in 1027, in FUP in 1044 patients, with a median FUP time of 36 months. Sexual functioning was assessed in sexually active patients (incidence in FUP: 611 patients, 58.5%). Prevalence rates (figure 1A-F) revealed a slow increase of sexual activity during the 1 st year of FUP, reaching a plateau up to 5 years. Vaginal functioning problems such as dryness, shortening, tightening and dyspareunia showed a substantial increase after treatment and remained either elevated or showed signs of slight improvement during the observation period. Sexual enjoyment was impaired over all time points, with a range of 37-48% of patients reporting to have “not at all” or “a little” sexual enjoyment.

was more common in North America and Europe than in other regions. In cervix cancer, hypofractionation was preferred in 30% of locally advanced cervical cancer cases in Africa, but in <10% of cases in other regions. For palliative symptom control, hypofractionation was preferred by 93%, 91%, and 84% of respondents for breast cancer, prostate cancer, and cervix cancer respectively, and in 95% for bone metastases (p<0.001) across geographic regions. Lack of long-term data, inferior local control, toxicity, and inadequate technology were the most commonly cited barriers. In adjusted analyses, hypofractionation preference was associated with age <55 (odds ratio [OR] = 1.46, 95% CI 1.23 to 1.88), practice in a high-income country (OR=2.72, 95% CI 2.12 to 3.49), in a university setting (OR=1.30, 95% CI 1.04 to 1.67), in a centre with a catchment area with >1,000,000 population (OR=1.57, 95% CI 1. to 2.0), and with intensity modulated radiotherapy (OR=1.70, 95% CI 1.22 to 2.34).

Conclusion Significant variation was observed in preference for hypofractionation across indications and between geographic regions, with greater concordance in preference for palliative indications. Improving the cost- effectiveness of radiotherapy and the quality of care delivered requires greater international attention to continuing medical education and policy reform that aligns evidence-based practice with physician incentives.

Proffered Papers: CL 10: Proffered papers : Pelvic Tumours

OC-0506 Patient-reported sexual outcomes after definitive RCHT+IGABT for cervical cancer (EMBRACE study) K. Kirchheiner 1 , I.M. Jürgenliemk-Schulz 2 , C. Haie- Meder 3 , J.C. Lindegaard 4 , A. Sturdza 1 , U. Mahantshetty 5 , B. Segedin 6 , K. Bruheim 7 , B. Rai 8 , R. Cooper 9 , E. Van der Steen-Banasik 10 , E. Wiebe 11 , M. Sundset 12 , E. Van Limbergen 13 , E. Villafranca 14 , H. Westerveld 15 , L.T. Tan 16 ,