ESTRO 38 Abstract book

S368 ESTRO 38

The median follow-up was 32 months (range, 2-64 months). LC was 83%. In pts that underwent complete macroscopic surgery followed by PT, LC was 100%, in pts with uncomplete resection/only biopsy and PT/CIRT, LC was 79%. The 3-year LRFS and OS were 80% and 90% respectively. In field recurrence occurred in 13% (18 pts). In 16 out of 18 cases of recurrences the tumor was in close contiguity to the brainstem. Out of field recurrence was found in 5 pts: 2 cases occurred within surgical way, attributable to surgical seeding, One case of histologically confirmed cervical lymph-node relapse, 2 cases of newly appeared nodules of recurrence. Six pts (4%) developed distant metastasis after a mean interval of 12 months. The toxicity profile was favorable. Only 2 pts developed acute radiation induced high grade toxicity: with oral mucositis (grade 3). High grade (G3-G4) late toxicity occurred in 4% of pts: 1 case of complete visual loss (G4) expected because of optic nerve in field, 1 case of soft tissue necrosis, 2 cases of cranial nerve neuropathy and 2 cases of pituitary dysfunction Conclusion Particle therapy is the most innovative and conformal RT for treatment of skull base chordomas. It allows to deliver higher (biologically effective) dose levels and to obtain high tumor control rates, minimizing radiation-related side effects PO-0717 Addition of chemotherapy to hyperfractionated radiotherapy in advanced head and neck cancer H. Jan 1 , T. Balint 1 , E. Boelke 1 , D. Freddy Noel 1 , B. Wilfried 1 , K. Kai 2 , M. Christiane 1 1 University Hospital Düsseldorf, Radiation Oncology, Düsseldorf, Germany ; 2 Johns Hopkins University School of Medicine- Baltimore- USA, Division of Biostatistics and Bioinformatics- Department of Oncology, Düsseldorf, Germany Purpose or Objective Adding chemotherapy (CTx) simultaneously to primary radiation therapy (RT) results in improved overall survival in patients with locally advanced tumors of the head and neck region (HN). A comparable effect has likewise been reported for hyperfractionated radiotherapy (HFX+RT) without concurrent CTx. Yet, the addition of CTx to HFX- RT has also been investigated in multiple trials. However a clear effect on oncological outcomes and toxicity profile has not been established and reported. Material and Methods We performed a literature search for randomized controlled trials comparing HFX-RT alone to HFX-RT + concurrent CTx in patients with locally advanced cancer of the head and neck region undergoing definitive radiotherapy. A meta-analysis was performed using the event rates and effect-sizes for overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS) as well locoregional (LRC) and distant recurrence (DMR) as investigated endpoints. Additionally we compared selected acute and late toxicities in the included studies. Statistical analysis was performed using the Microsoft Excel add-in MetaXL 5.3 utilizing the inverse variance heterogeneity model. Results We identified six studies (n=1280 patients) randomizing between HFX-RT alone and the concurrent addition of CTx. OS was significantly improved in HFX-RT + CTx group (HR=0.77 CI95%=0.66-0.89; p=<0.001). We found similar results in CSS (HR=0.72 CI95%=0.60-0.88; p=0.001) and DFS (HR=0.74 CI95%=0.63-0.87; p<0.001). The analysis also revealed improvements in the rate of locoregional and distant recurrences with CTx. Acute toxicities (≥3°mucositis, ≥3°skin, ≥3° dysphagia) were not statistically different between both groups. Analysis of late adverse events included ≥3° xerostomia, ≥3° subcutaneous, ≥3° bone, ≥3°skin, ≥3°mucosal atrophy and

to 67 historical controls who received treatment as usual. The intervention is based on behaviour change counselling methods, including motivational interviewing to improve motivation to eat despite a range of barriers ( pain, mucositis, nausea, salivary toxicity , taste changes and appetite loss), and to provide patients with practical behaviour change strategies. Assessments will be conducted at 5 time points (first, third and final week of radiotherapy, 4 and 12 weeks postradiotherapy). The primary outcome was nutritional status at the end of RT as measured by the Patient Generated Subjective Global Assessment (PG-SGA). Secundary endpoints: quality of life (EORTC QLQ-C30) and anticancer treatment tolerance. Results Intervention patients resulted in smaller loss of body weight than control group (mean difference, 1.8 kg [95%CI, 0.65–2.5]; P = 0.005), and a clinically important reduction on the PG-SGA (34% of controls vs. 17% intervention; P = 0.04) in favor of the intervention condition. Secundary endpoints: reduced the need for changes in planned anti-cancer treatments (i.e. RT and/or systemic treatment dose reduction, interruptions or complete suspension) HR=0.38 [95%CI, 0.2–0.89], P = 0.03), and global QoL (P < 0.002) Conclusion HNC patients undergoing RT (+/- systemic treatment), receiving motivational and nutritional Intervention resulted in better weight maintenance, and was associated with better anti-cancer treatment tolerance and improved quality of life . PO-0716 Skull-base chordoma treated with proton and carbon ion radiotherapy : CNAO clinical experience A. Iannalfi 1 , E. D'Ippolito 1 , V. Vitolo 1 , B. Vischioni 1 , M.R. Fiore 1 , M. Bonora 1 , S. Ronchi 1 , A. Barcellini 1 , R. Petrucci 1 , S. Molinelli 1 , A. Mirandola 1 , S. Russo 1 , A. Facoetti 1 , A. Vai 1 , E. Mastella 1 , G. Viselner 2 , G. Magro 1 , M. Ciocca 1 , L. Preda 2 , F. Valvo 1 , R. Orecchia 1,3 1 National Center of Oncological Hadrontherapy, Radiotherapy Unit, Pavia, Italy ; 2 National Center of Oncological Hadrontherapy, Diagnostic Image Unit, Pavia, Italy ; 3 European Institute of Oncology, Radiation therapy Unit, Milan, Italy Purpose or Objective Skull-base chordomas are rare and malignant tumors that originate from remnants of the chorda dorsalis (notochord). Particle radiotherapy provides dosimetric advantages and higher biological effective dose especially for radioresistant tumors . The aim of the study was to evaluate local control (LC) and toxicity profile of patients (pts) with skull-base chordoma treated with exclusive or adjuvant particle therapy (proton therapy -PT- and carbon ion therapy -CIRT-) Material and Methods Between September 2011 and July 2017, a total of 134 pts (79 men and 55 women) with a median age of 57 years (range 14-86) with histologically proven skull-base chordoma were treated with particle therapy at National Center of Oncological Hadrontherapy -CNAO. One-hundred and two (76%) pts had previous surgery and complete macroscopic resection was achieved only in 15 pts (20%). Sixty-one pts were treated with PT and 73 with CIRT. The particle choice (proton or carbon ion) was made on personalized basis. Median prescribed total dose was 70,4 Gy RBE (range 35,2-70,4 Gy RBE) in 8-22 fractions (median 16 fractions) of 3-4,4 Gy RBE (median 4,4 Gy RBE) for CIRT, and 74 Gy RBE (range 70-74 Gy RBE) in 27-37 fractions (median 37 fractions) of 2 Gy RBE for PT. Clinical outcome (LC, 3 year local relapse free- LRFS and overall -survival - OS-) and toxicity profile in according with CTCAE criteria was evaluated Results