ESTRO 38 Abstract book

S772 ESTRO 38

S. Bisello 1 , A. Palloni 2 , M. Buwenge 1 , R. Autorino 3 , F. Cellini 3 , L. Tagliaferri 3 , M. Gabriella 4 , F. Deodato 4 , V. Picardi 4 , S. Mignona 5 , S. Cilla 6 , V. Perri 7 , A. Tringali 7 , A. Galuppi 1 , G. Brandi 2 , A.G. Morganti 1 , S. Cammelli 1 , V. Valentini 3 , G.C. Mattiucci 3 1 S. Orsola-Malpighi Hospital, Department of Experimental- Diagnostic & Speciality Medicine DIMES- University of Bologna, Bologna, Italy ; 2 S. Orsola- Malpighi Hospital, Department of Medical and Surgical Sciences - DIMEC- University of Bologna, Bologna, Italy ; 3 Sacred Heart Catholic University, Radiation Oncology Department, Rome, Italy ; 4 “Giovanni Paolo II” Foundation- Catholic University of the Sacred Heart, Radiation Oncology Unit, Campobasso, Italy ; 5 “Giovanni Paolo II” Foundation- Catholic University of the Sacred Heart, Medical Oncology Unit, Campobasso, Italy ; 6 “Giovanni Paolo II” Foundation- Catholic University of the Sacred Heart, Medical Physics Unit, Campobasso, Italy ; 7 Gemelli University Hospital- Università Cattolica del Sacro Cuore, Digestive Endoscopic Unit, Rome, Italy Purpose or Objective To retrospectively evaluate the outcome of a combined modality treatment based on chemoradiation (CRT) +/- brachytherapy (BRT) in a pooled analysis of 3 series from different institutions of patients with unresectable biliary cholangiocarcinoma (CC). Material and Methods Data of patients with intrahepatic CC (ICC), Klatskin’s Tumor (KT), distal extrahepatic CC (ECC), and gallbladder cancer (GBC) diagnosed from 1991 to 2017 were retrospectively analyzed. The treatment was mainly based on concurrent chemotherapy (CT) plus external beam radiotherapy (EBRT), +/- BRT boost. The Kaplan-Meier method was used to calculate survival curves in terms of overall survival (OS). Log-rank test was used to compare survival curves. Results Seventy-eight patients were included in this analysis (59%: males; 41%: female; median age: 67 years). A minority of patients (7.7%) were treated for disease recurrence after surgery. According to TNM, 77.6% of patients had a T stage > 3 and 79% of patients were treated with CRT while 21% received EBRT followed by sequential CT. Median EBRT dose was 50 Gy (range: 16-75 Gy) delivered with conventional fractionation. CT was based on Gemcitabine or 5-Fluorouracil. BRT was prescribed to 50% of patient with a median dose of 7 Gy. Reported Grade ≥ 3 acute GI and hematological toxicity were 13.0% and 7.9%, respectively. No other severe acute toxicities were reported. One- and 2-year OS were 60.1 % and 29.2%, respectively (median: 15 months), while 1- and 2-year PFS were 42.4% and 7.8%, respectively. Analyzing the impact of BRT on OS, 24-month OS was 22.9% for the BRT group, and 36.2% for EBRT alone, while at 48-months, OS was 9.8% for the BRT group, and 0.0% for the group without BRT (p = 0.68). Conclusion Combined modality treatment (CRT + BRT) in unresectable biliary cancer was associated with acceptable toxicity and OS almost comparable to the actual standard (CT). Further prospective studies are needed to improve outcome by using advanced treatment techniques and innovative combined modality therapies. EP-1423 SBRT in locally advanced pancreatic cancer: a real-life study (PAULA-1) A. Arcelli 1 , G. Macchia 2 , A. Guido 1 , F. Dalla Torre 2 , S. Cilla 3 , V. Scotti 4 , M.E. Rosetto 5 , I. Djan 6 , S. Parisi 7 , G.C. Mattiucci 8 , M. Fiore 9 , P. Bonomo 10 , A. Bacigalupo 11 , R.M. Niespolo 12 , P. Gabriele 13 , D. Francesco 2 , N. Simoni 14 , R. Mazzarotto 14 , A.G. Morganti 1 1 Radiation Oncology Center- University of Bologna, Department of Experimental- Diagnostic and Specialty Medicine - DIMES, Bologna, Italy ; 2 Fondazione di Ricerca

value for the FIB-4 index was determined with the result from a receiver operating characteristic curve analysis. The effect of the FIB-4 index on overall and recurrence- free survival was retrospectively evaluated. Results Median age was 70 years old (range: 39-87). Median follow-up period was 64 months. Median tumor size was 30 (range: 12-50) mm. The cutoff value for the FIB-4 index was set to 3.5. The median FIB-4 index was 3.45 (range: 1.2-10.4) with 51% at ≤ 3.5 (low FIB-4 group) (n = 28) and 49% at grade >3.5 (high FIB-4 group) (n = 26). The PFS and OS rates for the entire cohort at 3 and 5 years were 57%, 45% and 85%, 66%, respectively. The PFS rate for the low FIB-4 group at 3 and 5 years were 59% and 50% and for high FIB-4 group 53% and 36%, respectively (p=0.259). The OS rate for the low FIB-4 group at 3 and 5 years were 89% and 76% and for high FIB-4 group 80% and 53%, respectively. A statistically significant difference was recognized between the groups (p=0.011). Conclusion The FIB4-index appears to be a promising predictor of long-term outcomes for HCC patients treated with PBT. EP-1421 Combined chemoembolization and radiotherapy for hepatocellular carcinoma with portal vein thrombosis K. Treewatthanawong 1 , N. Amornwichet 1 , A. Prayongra 1 , P. Alisanant 1 , C. Khorprasert 1 , K. Shotelersuk 1 1 King Chulalongkorn Memorial Hospital, Division of Therapeutic Radiation and Oncology- Department of Radiology, Bangkok, Thailand Purpose or Objective Patients with hepatocellular carcinoma with portal veins thrombosis have limited choice of therapy due to extensive disease and poor underlying liver function. We conducted a retrospective analysis of patients with hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) who underwent transarterial chemoembolization (TACE) and radiotherapy (RT) to evaluate the efficacy and toxicity. Material and Methods In this study, non-metastatic HCC with PVT patients treated with TACE and RT from March 2010 to December 2017 were retrospectively reviewed. Primary outcome was response of PVT. Secondary outcomes included response of tumor, overall survival (OS), acute toxicities and prognostic factors for OS. Results 80 patients were included for analysis. Median patient age was 61.71 years old (50.5-72.92). Mean of the tumor diameter was 7.12 cm (range, 1-20 cm). Fifty-nine (74.7%) patients had main or first branch PVT. Mean radiation dose was 41.35 Gy (range, 8-60 Gy) at 1.8-10 Gy per fraction. For PVT, the response rate was 32.4% and the complete response rate was 5.6%. For primary tumor, the response rate was 50% and the complete response rate was 2%. The median survival was 12 months (10.89-13.11). The 1, 2- and 3-year survival rates were 44.6%, 22.6% and 10%, respectively. On univariate analysis, age, Child-Pugh classification, MELD score, ECOG, serum level of AFP, HBV infection, tumor size, site of PVT and response of PVT were not significant prognostic factors for OS. The BED was insignificant associated with the response of PVT. Grade 3 and 4 hepatotoxicity occurred in 9.2% of patients. There was no treatment-related death. Conclusion TACE plus RT is a safe and practical treatment option for HCC with PVT. However, further prospective large-scale study is required to evaluate the optimal patient selection, dose/fractionation and prognostic factors related to response and toxicities. EP-1422 Unresectable biliary cancer: results of a pooled analysis of combined CHEMORADIOTHERAPY