ESTRO 38 Abstract book

S686 ESTRO 38

more consistent decision making as which was established this year in our centre. We will reassess the patterns of care after a year. EP-1248 Stereotactic radiotherapy for brain metastasis and systemic therapies: a safe combination? M. Manicone 1 , M. Galaverni 1 , I. Renna 1 , P. Ciammella 1 , L. Giaccherini 1 , F. Bellafiore 1 , G. Timon 1 , F. Vigo 1 , A. Rosca 1 , D. Ramundo 1 , M. Galeandro 1 , M.P. Ruggieri 1 , T. Palmieri 1 , A. Botti 2 , R. Sghedoni 2 , E. Cagni 2 , M. Orlandi 2 , M. Russo 3 , C. Bonelli 4 , M. Pagano 4 , C. Iotti 1 1 Azienda USL-IRCCS di Reggio Emilia, Radiation Oncology Unit, Reggio Emilia, Italy ; 2 Azienda USL-IRCCS di Reggio Emilia, Medical Physics Unit, Reggio Emilia, Italy ; 3 Azienda USL-IRCCS di Reggio Emilia, Clinical Neurology, Reggio Emilia, Italy ; 4 Azienda USL-IRCCS di Reggio Emilia, Medical Oncology Unit, Reggio Emilia, Italy Purpose or Objective Stereotactic Radiotherapy (SRT) is an effective treatment for brain metastases (BM) and is generally safe. Aim of this retrospective study was to compare toxicities and efficacy of SRT alone and in combination with systemic therapies in patients with BM. Material and Methods We analyzed all patients treated between 2010 and 2017 at our institution with SRT for BM, with or without concurrent systemic therapy (defined as administered within four weeks of SRT). We evaluated in this cohort of patients the haematological and neurological toxicities, brain progression free survival (bPFS) and overall survival, stratifying patients for yes/no systemic therapy. Results Data on 45 patients were obtained. Median age at diagnosis of BM was 66 years (range 37-90 yrs). At the time of initial presentation, the majority of patients had ECOG perfomance status of 0-2. The most common primary tumors were lung, breast, melanoma and kidney. Sixty percent of SRT treatments were delivered concurrently with systemic therapy, of which 56% were with conventional chemotherapy and 44% with targeted and immunotherapy agents. Patients were divided in two groups: SRT alone and SRT/systemic therapy. No differences between the two groups in terms of clinical and treatments characteristics were found. Median follow up was 10 months (range 1-65). Myelosuppression was minimal after treatment, with 9% grade 2-4 toxicity; grade ≥ 2 neurological symptoms were reported in 11% of patients, with one grade 5 neurological toxicity. There was no difference in haematological (p=0.79) and neurological (p=0.96) toxicities between the two groups. Histologically confirmed radionecrosis was reported in 2 patients (one in SRT alone and one in SRT/systemic therapy group) and radiologically suspected radionecrosis in 2 patients both in the group of concurrent therapy (one with chemotherapy and one with target therapy). Median bPFS was 12.1 months, without any significant difference between the two groups (p=0.49). To date 29 patients have died, of which 3 for brain progression, 13 for systemic progression and two for both systemic and brain progression. Nine patients were died for no tumor related causes and 2 patients for unknown causes. Median OS for entire group was 8.13 months without any difference between the two groups of patients. (p=0.37). Conclusion SRT for BM can be safely delivered concurrently with systemic therapy without significant increase in toxicity. EP-1249 Impact of retreatment or chemiotherapy on survival in patients affected by a recurrent Glioblastoma C. Mazzarella 1 , S. Chiesa 1 , S. Bracci 2 , T. Zinicola 2 , S. Longo 2 , F. Beghella Bartoli 2 , S. Luzi 2 , G. Sabatino 3 , A.

Purpose or Objective Brain metastases (BM) affect up to 40% of patients with metastatic disease. Recent advances in systemic therapy means patients are living longer whilst the widespread availability of stereotactic radiosurgery (SRS) for brain metastases provides a realistic expectation of local control in suitable patients. The is a lack of data on the prevalence of treatment modalities used and the patterns of care these patients experience. We aim to quantify the proportion of patients receiving SRS, Whole brain radiotherapy (WBRT), neurosurgery and best supportive care (BSC) in a tertiary oncology centre. Material and Methods Over a two year period (1 st Jan 2016 – 31 st Dec 2017), adult patients with a new radiologically confirmed diagnosis of BM were identified by retrieving all MRI and CT head scans that contained the words ‘metastases’, ‘metastasis’ or ‘met’ in the report. Only patients with a confirmed primary cancer were included. Patients who underwent SRS, WBRT or surgery were considered to have received ‘treatment’ for their BM. Receiving systemic anticancer treatment or steroids were not considered to be ‘treatment’. Patients who did not receive ‘treatment’ for their BM were identified as BSC. Results Of 2,422 scans, reviewed, there were 236 cases of newly diagnosed BM. The median age at diagnosis was 65 years (range 30-87). The median survival across all groups was 115 days (range 1-829). There were more females (58%) than males (42%). Lung cancer was the most common primary site (49%), followed by breast (20%) and melanoma (13%). At the time of diagnosis, 47% had controlled extracranial disease. Lung primaries carried the worst prognosis ( median survival 95 days) with breast (202 days) the best. Half of the cases received some form of treatment for their BM with the other half receiving BSC. There were 127 treatments delivered to 118 patients. WBRT (39.5%) and SRS (39.5%) were the most common with surgery used in 21%. Treatment modality varied according to primary tumour site. In breast WBRT (54%) was the most common treatment followed by SRS (15%). In lung and melanoma, this was reversed with SRS (21% & 53% respectively) more commonly used than WBRT (14% & 6% respectively). Patients who received SRS lived the longest; their median survival was not reached at assessment, compared to surgery (210 days) and WBRT (202 days). We identified 7 cases who received WBRT where an opportunity to give SRS may have been missed. Of the 50% of patients who did not receive any treatment; median survival was 55 days. Of these, 62% had contact with palliative care services. Amongst treated patients, 54% were seen by palliative care.

Conclusion Half of all patients receive no brain directed therapy. Radiotherapy is the most common treatment though SRS may have been to 7 others who WBRT. We suggest a well resourced and dedicated dedicated BM MDT would provide