ESTRO 38 Abstract book

S685 ESTRO 38

D. Amelio 1 , D. Scartoni 1 , S. Lorentini 1 , L. Widesott 1 , R. Righetto 1 , I. Giacomelli 1 , M. Schwarz 1 , M. Amichetti 1 1 Centro di Protonterapia, U.O. Protonterapia- Azienda Provinciale per i Servizi Sanitari - Trento, Trento, Italy Purpose or Objective To report preliminary results of active beam scanning proton therapy (PT) for large skull base benign Thirty-three patients (pts) with LSBM were treated with PT between January 2015 and June 2018. Median age was 53 years (range, 28-82) while KPS ranged between 60 and 100 (median 90); 26 were female (79%), and 7 were male (21%). Twelve pts (36%) had histologically proven World Health Organization (WHO) Grade I tumors. In remaining pts diagnosis was based on the typical imaging appearance of benign meningioma. All patients received PT for residual, progressive or non-operable lesions. Newly diagnosed tumors received total dose of 50 GyRBE (RBE: relative biologic effectiveness) while progressing meningiomas 54 GyRBE. All the treatments were delivered at 2 GyRBE per fraction. Treatment planning was based on morphological magnetic resonance imaging (MRI) with contrast enhancement medium administration and 68-Ga- DOTATOC-PET. GTV ranged from 21 to 107 cc. Toxicity was assessed according to Common Terminology Criteria for Adverse Events version 4.0. Health-related (HR) quality of life (QoL) was assessed by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)––C30 and EORTC Quality of Life Questionnaire Brain Cancer Module (QLQ-BN20). Median follow-up (FU) time was 12 months (range, 3-41) Results All pts completed the treatment without breaks. Registered acute side effects include grade 1 (12%) and grade 2 (9%) skin erythema, grade 1 (9%) and grade 2 (9%) alopecia, grade 1 (48%) fatigue, grade 1 (6%) and grade 2 (15%) conjunctivitis, grade 1 (15%) pain, grade 1 (15%) blurred vision, grade 1 (15%) headache, and grade 2 (9%) skin hyperpigmentation. One pts experienced grade 3 pain. There were no further grade 3 or higher acute toxicities. Registered late side effects include grade 1 (9%) and grade 2 (9%) alopecia, grade 1 (12%) fatigue, grade 1 (9%) and grade 2 (6%) headache, grade 1 (6%) dizziness, grade 1 (6%) blurred vision, grade 1 (6%) and grade 2 (6%) pain, grade 1 (6%) dry eye, and grade 1 (9%) skin hyperpigmentation. One pts experienced grade 3 pain. There were no further grade 3 or higher late toxicities. During follow-up one pts (3%) with cavernous sinus meningioma experienced complete obstruction of intracavernous carotid artery with mild transient symptoms that resolved in few days and brain tissue ischemia detected at MRI (grade 2). Before irradiation this pts already had a meningioma-related near-complete obstruction of the intracavernous carotid artery and received a vascular surgery evaluation. Currently, absolute tumor control is 100%. Moreover, relief of symptoms recorded before irradiation occurred in 27% of pts. The treatment was associated with improvement or stability in most of the preselected HRQoL domains Conclusion PT is feasible and safe treatment for pts with LSBM with a favorable effect on HRQoL. Longer FU is necessary to assess definitive efficacy EP-1247 The patterns of care and management of brain metastases In a large Oncology centre M. O'Cathail 1 , R. Bentley 1 , V. Crosby 2 , L. Aznar-Garcia 1 , A. Wilcock 2 , J. Christian 1 1 Nottingham University Hospital, Oncology and radiotherapy, Nottingham, United Kingdom ; 2 Nottingham University Hospital, Palliative care, Nottingham, United Kingdom meningiomas (LSBM) Material and Methods

Conclusion Almost all respondents indicated that these meetings were "very beneficial" to their own practice and these data emphasizes the fact that in a relevant number of cases the initial treatment strategy could be modified after a multidisciplinary discussion. The retrospective phase allows us to elaborate case report form for data collection in order to prospective analyze the adherence to guidelines, the reduction of diagnostic work-up and the patients related outcomes. We are using the new schedule for data collection in our multidisciplinary clinical practice. EP-1245 Evolution of non functioning pituitary adenoma after first surgery : long follow-up of 256 patients. T. Charleux 1 , V. Vendrely 1 , A. Huchet 1 , R. Trouette 1 , A. Tabarin 2 , V. Jecko 3 , H. Loiseau 3 , C. Dupin 1 1 Bordeaux University Hospital, Radiation Oncology, Bordeaux, France ; 2 Bordeaux University Hospital, Endocrinology and Metabolism, Bordeaux, France ; 3 Bordeaux University Hospital, Neurosurgery, Bordeaux, France Purpose or Objective Pituitary adenomas account for 14 to 18% of all primary brain tumours. Our objective was to evaluate therapeutic outcome after the first surgery in non functioning pituitary adenomas (NFPA). Material and Methods Between january 1978 and 2018 all patients treated by surgery for NPFA with at least 2 MRI in the follow-up and an endocrinologic follow-up in our hospital were included in this retrospective study. Evaluation concerned patients and tumor characteristics, radiation therapy data, time between each surgical procedure. Analysis of survival was done according to Kaplan Meier method. Results Between 1978 and january 2018, 256 patients were treated by surgery for NPFA at our institution. Mean age at surgery was 55 [18 – 86] with 59% male. Mean tumor size was 29 mm [12 – 60] and post-operative MRI found residual tumor in 87 % of patients. Mean follow up was 10,2 years [0,6 - 40,1]. Median time to second treatment (second surgery or radiation therapy) was 10.3 years and only 32% did not need second treatment at 15 years. First event at 5, 10 and 15 years, was second surgery for 11%, 18% and 32% of patients and radiation therapy for 26%, 32% and 36%. After a second surgery, half of the patients were irradiated within 1,8 years and only 27% of patients did not receive radiotherapy within 5 years. All together, 32%, 43% and 61% of patients recevied radiation therapy within 5, 10 and 15 years after surgery for NFPA. After radiation therapy, 7% of patients had another surgery at 5 years and 9% at 10 and 15 years. Patients treated by radiation therapy following surgery have a risk to suffer from gonadotropic, corticotropic and/or thyrotropic deficencies in 65%, 66% and 73% of the cases. At least 14 to 38% of these are induced by the RT. Two patients had cerebral tumors : 1 meningioma present at first surgery, and a glioblastoma appeared after 13 years after radiation therapy. Six pourcents of patients had stroke both in the group treated with radiation therapy (6/107) or than without radiation therapy (9/149) Conclusion After a first surgery for NFPA, most of patients needed another treatment (surgery or radiotherapy). In case of a second surgical resection, 73% of them received radiation therapy within the next 5 years, whereas in case of radiation therapy as second treatment, 8% needed surgery within the next 5 years. EP-1246 Outcomes and health-related quality of life in large skull base meningiomas treated with protons