ESTRO 38 Abstract book

S766 ESTRO 38

Martin’s definition, 64 pts (61.5%) had sarcopenia. 3-year overall survival (OS) was 34.6%. Prognostic factors for OS in univariate analysis were initial PS and surgery. Sarcopenia, using international or Martin’s definition, was not significantly associated with OS. However, when using the median SMI for each sex as a cut-off (a lower level than the other definitions), sarcopenia is associated with OS (at 3 years: 43.3% vs 26.2%; p=0.02). However, in multivariate analysis, only PS remains statistically associated with OS. There was no correlation between fat measurements and OS. Conclusion High level of sarcopenia is associated with OS in patients with EC treated with up-front CRT; but its prognostic value is low and disappears in multivariate analysis. EP-1408 Cardiac dose and treatment-elicited inflammation are related to poor survival in esophageal cancer Y. Ho 1 , J. Lin 1 , T. Chou 1 , L. Hung 1 , C. Huang 1 , C. Pi 1 , T. Chang 1 , M. Liu 1 1 Changhua Christian Hospital, Radiation Oncology, Changhua City, Taiwan Purpose or Objective Definitive concurrent chemoradiation (CCRT) is the standard treatment for esophageal cancer with cervical location or non-surgical candidate and able to tolerate chemoradiation. Studies have correlated cancer-related inflammatory response and treatment-related toxicities with worsening survival. The purpose of this study was to evaluate the prognostic factors and normal tissue dosimetric parameters affecting overall survival (OS), as well as the predictive values on OS of the levels of neutrophil to lymphocyte ratio (NLR) at baseline, during- CCRT and post-CCRT periods. Material and Methods Between 2010 and 2015, 110 newly diagnosed stage II and III patients, with the majority of squamous cell carcinoma, were identified from our institution. Patients' clinical, dosimetric, and laboratory data at baseline, during and post-CCRT were collected by review of medical records. The Cox proportional hazard model was used to identify the potential risk factors for OS. Thresholds were chosen to increase specificity and to dichotomize continuous variables, as the median for heart mean dose and baseline NLR, and the upper quartile for increased NLR during- CCRT. Results Median follow up was 21.0 months (range 3-95 months) and overall survival was 20.6 months. A total of 75% of patients had stage III disease and all patients completed definitive CCRT. Two-year OS and five-year OS were 27% and 16%. Univariate analysis showed that male gender (p = 0.035), stage (II vs. III, p = 0.058), ECOG performance status (0 vs. ≥ 1, p = 0.031), mean heart dose (>2070.5 vs. ≤2070.5 cGy, p = 0.017), baseline NLR (>3.56 vs. ≤3.56, p = 0.005) and increased NLR during-CCRT (>27.46 vs. ≤27.46, p = 0.022) were significantly associated with poor OS. On multivariate analysis, stage (Hazard Ratio [HR] 1.71; 95% CI 1–2.9, p = 0.048), performance status (HR 5.89; 95% CI 2.21–15.67, p < 0.001), mean heart dose (HR 1.71; 95% CI 1.09–2.68, p = 0.02), baseline NLR (HR 1.9; 95% CI 1.19–3.04, p = 0.007) and increased NLR during- CCRT (HR 2.58; 95% CI 1.52–4.39, p < 0.001) remained significantly associations with reduced OS. Conclusion Mean heart dose > 2070.5 cGy, baseline NLR > 3.56 and increased NLR during-CCRT > 27.46 were poor prognostic markers for OS in esophageal cancer patients receiving definitive CCRT. Minimal cardiac dose during radiotherapy and novel therapy targeting tumor or treatment-elicited inflammatory response might improve survival for patients with esophageal cancer underwent definitive CCRT.

Table 1. Patient characteristics Variable

Value

Age (y), median (range)

56 (44-80)

Sex Male Female

60 (87.0%)9 (13.0%)

Surgical

type McKeown

15 (21.7%) 41 (59.4%)13 (18.9%)

Ivor-Lewis Sweet

Location

Upper

11 (15.9%) 31 (44.9%)27 (39.2%)

Middle Low

Grade

Well Median Poor Undifferentiated

8

(11.6%) (46.4%) (34.8%)

32 24

5 (7.2%)

Stage

I II III

12 19

(17.4%)

(27.5%) 30 (43.5%)8 (11.6%)

IVa

Adjuvant chemotherapy Yes No

17 (24.6%)52 (75.4%)

Conclusion A modified target from the upper border of C7 to the lower border of the carina of the trachea could cover the high- risk area of TESCC. UAR seems to be an elective irradiation target for lower TESCC at pathological IIIB stage or above. EP-1407 Sarcopenia is a weak prognostic factor before chemoradiotherapy of esophageal carcinomas B. Bethsabee 1 , Q. Laurent 1 , C. Pierre 2 , H. Valerie 1 , G. Sophie 1 , A. Thomas 3 , L. Nelson 3 , G. Jean-Marc 3 , C. Hennequin 1 1 Hôpital Saint-Louis, Radiation Oncology, Paris, France ; 2 Hôpital Saint-Louis, Surgery, Paris, France ; 3 Hôpital Saint-Louis, Gastro-enterology, Paris, France Purpose or Objective Sarcopenia seems to be an important prognostic factor of esophageal carcinoma (EC) before surgery. Data are less convincing before chemoradiotherapy (CRT) and this prompt us to review our experience in a recent cohort study. Material and Methods Between 2010 and 2015, all patients with a locally advanced EC treated with upfront CRT and a CT-scanner at the time of CRT available were included. All patients had an 18-FDG-PET-CT to eliminate distant metastases. Decision of surgery was performed after CRT (40-50 Gy) according to tumor extension, performance status (PS), comorbidities and response to CRT. To evaluate sarcopenia, a single slice at the L3 level was identified and total skeletal muscle (TMA) and subcutaneous and visceral fat were measured. The skeletal muscle index (SMI) is calculated as follows: TMA/height 2 (m 2 ). Sarcopenia was internationally defined as a SMI of ≤39 cm 2 /m 2 for women and ≤55 cm 2 /m 2 for men. We used also the definition given by Martin el al. (JCO, 2013): for patients with a body mass index (BMI) < 25, SMI <41 cm 2 /m 2 for women and <43 cm 2 /m 2 for men; if BMI≥25, SMI < 41 cm 2 /m 2 for women and <53 cm 2 /m 2 for men. Results 104 patients were included: Mean age: 63 yrs. Men: n=72. PS 0: 32; PS 1: 59; PS 2: 13. T-stage: T2: 4; T3: 95; T4: 5. N stage: N1-2: 76. Weight loss >5%: n=74. Surgery after CRT: 39. Histology: Squamous cell cancer (SCC): 69. Mean SMI was 35 cm 2 /m 2 for women and 46 cm 2 /m 2 for men. According to the international definition, sarcopenia was found in 84 pts (81%). It was correlated to initial BMI, but not to age, weight loss, PS or T stage. According to the