ESTRO 38 Abstract book

S759 ESTRO 38

8%, 19%, 72% respectively. Correlation between RT & RD score was satisfactory (Pearson correlation test: 0.001). Placement time of 10-20 min, 20-45 min and more than 45 min were in 55%, 36% and 8% patients respectively. Poor pain score (3/4) was in 6% only. Good RT Score, good RD Score and poor pain score, in seg VII-VIII (n=12) and other segments (n=24) were 83% & 67% (p-value: 0.484); 83% & 79% (p-value: 0.186); nil & 8% (p-value: 0.69) respectively. In Child Pugh A (n=32) and B&C (n=4) were 78% & 25% (p- value:0.08); 87% & 25% (p-value: 0.029) and 6% & 75% (p- value: 0.024) respectively. PS also influenced RT score (p- value: 0.014), RD score (p-value: 0.003), pain score (p- value: 0.016). Fiducial placement score improved from 30% in 1st 10 patients to 93% in last patient cohort (p- value: 0.023). Fiducial placement time reduced from 42.2 min to 14.3 min (p-value: 0.069) in the same cohort. Interfiducial distance, angle and distance from centre max and min are 4.7 & 2.4 cm; 82.7 & 28.5 degree and 5.1 & 2.1 cm respectively Conclusion Fiducial placement is safe and in experienced hands, quality of placement is 'good' in majority. Major complications and admission after fiducial placement is rare. Patients with poor Child Pugh Score, extensive liver involvement, poor PS have higher probability of complications. Segment of liver involved, BCLC stage do not influence fiducial placement quality. EP-1394 Prognostication of HCC with PVT treated with SBRT: Early results from a prospective study in India T. Tatineni 1 , K. Kataki 1 , R. Madhavan 1 , S. G 2 , R. Das 1 , D. Dutta 1 1 Amrita institute of medical sciences, Radiation oncology, Kochi, India ; 2 Amrita institute of medical sciences, Radiologist, Kochi, India Purpose or Objective Present prospective study evaluating role of Radiosurgery (CK) in Indian patients and analyzed prognostic factors Material and Methods Inoperable HCC with PVT with good performance status, liver function were accrued after radiological diagnosis for CK (M6). Fiducial placement (3 number) done as per protocol. Triple phase contrast CT scan done, planning done with Multiplan. PVT categorized as Chen classification. GTV is gross contrast enhancing mass within the main portal vein, its tributaries and adjacent parynchymal disease. PTV margin was 2-3 mm. Dose as per established risk stratification protocol. Mean liver dose <15Gy & 800 cc liver <8Gy. Dosage was 22-50Gy/5fr. Prognostication done with Chen, Child Pugh (CP), AFP, CLIP score, GRETCH, BCLC classification and response to treatment, dosage Results : 27 HCC with PVT accrued in the study [mean age 59.1 yrs, 94% male; Child Pugh A 63%, B 30%; BCLC C 93% & D 7%; PS0-1: 89%, KPS>80: 81%; co-morbidities 40%; infective 15%, Alcohol intake 26%]. Patients presented with abdomenal pain (44%), fatigue (30%), ascitis (15%) and melena (11%). CP Score 5,6,7 & 8 was in 37%,26%,19% & 19% respectively. 40% patients presented with abdominal pain, 30% with fatigue. 15% patients had focal disease with PVT, liver involvement >50% &<50% in 44% and 40%. 16% underwent TACE before SBRT. 56% received sorafinib after SBRT. PVT Chen classification VP2, VP3 & VP4 were in 22%, 33%, 41% respectively. CLIP score 1, 2, 3, 4, 5 was in 4%, 26%, 30%, 33% and 7% respectively. Mean follow up was 7 months (range 1.7-17.6 months). Mean actuarial OS was 10.8 months (SEM: 1.48; 95%CI: 7.8-13.7). At last follow up, 16/27(59%) were alive and 11/27(41%) were dead. 6(22%) had complete PVT response, 3(11%) had stable disease with partial PVT response, 7 (30%) have local progression, 3 (27%) had metastatic disease (1 lung, 2 spine) and 8 (73%) expired with local progression. No death due RILD. 6/27 (22%) patients had radiologically confirmed

advanced esophageal cancer - of which at least 130 patients with adenocarcinoma and at least 61 patients with squamous cell carcinoma - scheduled to receive nCRT followed by esophagectomy will be included. The primary modalities to be incorporated in the prediction model are quantitative parameters derived from MRI and 18 F-FDG PET-CT scans, which will be acquired at fixed intervals before, during and after nCRT. Secondary modalities include blood samples for analysis of the presence of circulating tumor DNA (ctDNA) at 3 time-points (before, during and after nCRT), and an endoscopy with (random) bite-on-bite biopsies of the primary tumor site and other suspected lesions in the esophagus as well as an endoscopic ultrasonography (EUS) with fine needle aspiration of suspected lymph nodes after finishing nCRT. The main study endpoint is the performance of the model for pCR prediction. Secondary endpoints include progression-free and overall survival. Results If the multimodal PRIDE concept provides high predictive performance for pCR, the results of this study will play an important role in the accurate identification of esophageal cancer patients with a pCR to nCRT. These patients might benefit from a patient-tailored approach with omission of surgery in the future. Vice versa, patients with non-pCR might benefit from additional neoadjuvant treatment. Conclusion Trial registration : The article reports on a health care intervention on human participants and was prospectively registered on March 22, 2018 under ClinicalTrials.gov Identifier: NCT03474341 EP-1393 Prospective fiducial placement in liver tumours: Effectiveness, placement 'quality' and toxicities K. Kataki 1 , S. G 2 , R. Madhavan 1 , T. Tatineni 1 , S. P g 3 , J. J 3 , D. Dutta 1 1 Amrita Institute of Medical Sciences- Kochi, Radiation Oncology, Kochi, India ; 2 Amrita Institute of Medical Sciences- Kochi, Radiology, Kochi, India ; 3 Amrita Institute of Medical Sciences- Kochi, Radiation therapy, Kochi, India Purpose or Objective Fiducial placement in liver tumours (HCC) for Robotic Radiosurgery (Cyberknife, CK) treatment is considered crucial step of treatment and also associated with morbidity. Present prospective study evaluating the associated effectiveness, quality of fiducial placement and toxicities. Material and Methods Between Mar 2017-Mar 2018, 36 HCCs accrued in the ethical & scientific committee approved prospective study for CK treatment. Three fiducials were placed in liver (CT/USG guided) for tracking. Fiducials placed by radiologist (RD) with ideal fiducials will be equidistant from each other (max distance 5 cm, min distance 2 cm). Quality of fiducial placement as RD and radiation oncologist (RT) were assessed by "institution" defined scale.Placement time, pain score, complications, recovery time and factors influencing fiducial placement were analysed Results Thirty six patients (Male 92%, mean age 60.2 yrs, ECOG 0- 1 92%, Child-Pugh A 89%, B&C 11%, majority in seg II & VI, PVT disease 64%) with HCCs underwent fiducial placement under guidance (CT scan 69%). 5, 4 & 3 fractions were in 29 (80%), 16% & 4%. Time for placement <20 min, within 45 min and >45 min were in 55%, 36% and 8% respectively. Three patients (8%) had gross displacement (2 in lung, 1 in abdomen) immediately after placement. One patient (4%) expired after fiducial placement (<72 hours) with decompensation. Five patients (15%) had minor complications (pain abdomen 2, pneumothorax 2). RD & RT Score values of poor, fair, good are 6%, 14%, 80% and