ESTRO 38 Abstract book

S409 ESTRO 38

assessed the possible survival benefit of LMWHs in esophageal malignancies. Material and Methods This was a randomized, single blind, multi-center, phase II clinical trial on non-metastatic esophageal cancer candidate for neoadjuvant chemoradiotherapy. Patients were randomly assigned to the chemoradiotherapy-only arm (n=32) or chemoradiotherapy plus enoxaparin arm (n=37) using 1:1 allocation. Radiotherapy was delivered in 1.8-Gy daily fractions to a dose of 50.4 Gy in both groups. Paclitaxel 50 mg/m2 and carboplatin (AUC2) were administered weekly concurrent with radiotherapy. In the intervention group, patients received enoxaparin (40 mg) daily as well as chemoradiation. Four to six weeks after treatment, all patients underwent esophagectomy. Results Both groups were similar in term of age, gender, ECOG performance score, tumor grade, and location tumor (Table 1).

The Netherlands ; 3 Amsterdam UMC, Medical Oncology, Amsterdam, The Netherlands ; 4 Amsterdam UMC, Medical Libary, Amsterdam, The Netherlands ; 5 Erasmus MC, Surgery, Rotterdam, The Netherlands Purpose or Objective Current standard treatment for patients with (borderline) resectable pancreatic cancer is resection followed by adjuvant chemotherapy. Several retrospective studies have suggested a benefit of neoadjuvant treatment, but suffer from selection bias as they only report the outcome of patients who ultimately underwent a resection. Evidence from randomized controlled trials reaching full accrual is lacking and the final results of the Dutch Pancreatic Cancer Group multicenter randomized PREOPANC trial are still awaited. The aim of this meta- analysis is to report survival by intention to treat in a comparison of upfront surgery versus neoadjuvant treatment in (borderline) resectable pancreatic cancer. Material and Methods A systematic review of literature on Medline, EMBASE and the Cochrane Library was performed to identify studies reporting median overall survival (mOS) by intention to treat in patients with (borderline) resectable pancreatic cancer treated with or without neoadjuvant treatment. Two authors screened the articles independently for eligibility. Secondary outcomes included resection rate, reasons for no resection, R0 resection rate, positive lymph node rate and toxicity of the neoadjuvant treatment. Results Overall, 3484 patients with (borderline) resectable pancreatic cancer were included from 38 studies, of whom 1738 (49.9%) received neoadjuvant treatment. The weighted mOS by intention to treat was 18.8 months after neoadjuvant treatment versus 14.8 months after upfront surgery. In the subset analysis among patients that actually underwent resection, the difference was larger (26.1 versus 15.0 months respectively). The overall resection rate was 66.0% with neoadjuvant treatment compared with 81.3% after upfront surgery (P <0 ⋅ 001), but the R0 rate was higher in (86.8 versus 66.9%; P <0 ⋅ 001) with neoadjuvant treatment. Positive lymph nodes were seen in 43.8% after neoadjuvant treatment versus 64.8% in the upfront surgery group (P <0 ⋅ 001). Of the patients who had neoadjuvant treatment, 17.8% did not undergo exploratory surgery, mostly due to progression of disease. Toxicity (≥grade III) was reported in up to 64% of the patients receiving neoadjuvant therapy. Conclusion This meta-analysis of neoadjuvant treatment versus upfront surgery by intention to treat suggests improved survival, R0 resection and less lymph node positivity with neoadjuvant treatment in patients with (borderline) resectable pancreatic cancer. The lower resection rate after neoadjuvant treatment suggests that this treatment selects patients who might not benefit from harmful large surgery because of early progression. The final results of the randomized PREOPANC trial are awaited. PO-0792 A randomized clinical trial on radiosensitizer effects of LMWH in Chemoradiation of esophageal SCC S.A. Javadinia 1 , A. Taghizadeh Kermani 2 , S. Hosseini 2 , A. Fanipakdel 2 , M. Joudi Mashhad 2 , A. Gholami 2 1 Mashhad University of Medical Sciences, Student Research Committee, Mashhad, Iran Islamic Republic of ; 2 Mashhad University of Medical Sciences, Department of Radiation Oncology- Omid Hospital, Mashhad, Iran Islamic Republic of Purpose or Objective Current treatment approaches for esophageal cancer are associated with a poor survival, and there are ongoing efforts to find new and more effective therapeutic strategies. There are several reports on the anti-tumoral effects of low molecular weight heparin (LMWH). We have

A Pathologically complete response in intervention and control group was 64.8% and 62.5%, respectively (p=0.9) (Table 2).

After a median follow up of 7 months, estimated one year disease free survival in the intervention and control groups was 78.9% and 70% respectively (p=0.5). Toxicity from the experimental arm was minimal and there were no treatment-related deaths. Conclusion Overall, the results of this study showed that the clinical and pathological response of squamous cell carcinoma of esophagus to the neoadjuvant chemoradiation was improved by the addition of enoxaparin to the treatment, although the difference was not significant. Also, there was an insignificant improvement in one year disease free survival of chemoradiotherapy patients receiving enoxaparin. Data from our study indicate that concurrent enoxaparin with radiotherapy and weekly paclitaxel/carboplatin chemotherapy was associated with minimal toxicity. The effects of LMWHs on survival of cancer patients, is probably due to a combination of direct anti-tumoral effects, antiangiogenic and immunomodulatory effects, beside indirect effects on the coagulation system. Most of these direct and indirect effects may have clinical efficacy in the treatment of SCC and gasteroesophageal adenocarcinoma, although the