ESTRO 38 Abstract book

S805 ESTRO 38

patient was put on best supportive care. Median follow up period was 11 months (Range 3-29 months).Median SUVmax was 5.8 (range 2.9-56.2) and median MTV was 43 cm 3 (range 7.8-212).The cumulative PFS for all patients was 30% at 24 months. The one year PFS was 26 % for patients with SUVmax value of >5.8 versus 47 % for those with SUVmax value of <5.8 (P value 0.02).The one year PFS was 41% for patients with MTV of >43cm 3 versus 43% for those with MTV of <43 cm 3 (P value 0.8) Conclusion Post irradiated recurrent cervical carcinoma patients with SUVmax of <5.8 have a favourable outcome compared with those with SUVmax of >5.8 and should be selected for aggressive salvage therapy. Further prospective studies are needed to validate the findings of our study. EP-1486 Role of HPV DNA testing and its influence on clinical outcomes in Cervical Cancer P. Jayaprakash 1 , G. Narayanan 1 1 Vydehi Institute of Medical Sciences and Research Centre, Radiation Oncology, Bengaluru, India Purpose or Objective Persistent infection with Human Papillomavirus (HPV) is the major etiological factor for development of cervical cancer. Although the standard treatment of locally advanced cervical cancer includes Definitive Chemo Radiation, little is known about the impact of HPV on the response to chemo radiation and on the clinical outcome.Primary objective was to compare treatment response of cervical carcinoma patients infected with HPV 16 and HPV 18 who are treated with Definitive Chemo Radiation. Secondary Objectives was to find out the HPV positivity rate in diagnosed cervical cancer cases, to estimate the number of HPV high risk genotypes and to compare response between positive and negative cases of HPV in the same study group Material and Methods 96 patients who presented to our institute were included for the study. Inclusion criteria were patients with biopsy proven carcinoma of the uterine cervix considered suitable for curative treatment with definitive radio- chemotherapy with Performance Status 0-2 (ECOG) and International Federation of Gynecology and Obstetrics (FIGO) Stages IB2 to IIIB. HPV testing was done using TRUPCR® HPV 16&18 Real-Time PCR kit. All the patients received External Beam Radiation therapy (EBRT) on Linear Accelerator with 3 Dimensional Conformal Radiotherapy (3DCRT) to a dose of 4600cGy in 23 fractions, 5 fractions per week and weekly Chemotherapy regimen consisted of Cisplatin 40 mg/m2 during EBRT. Three fractions of High-dose rate Intracavitary Brachytherapy was delivered after completion of EBRT with a fraction dose of 7 Gy at point A. Treatment response assessment was done using Response evaluation criteria in solid tumors (RECIST) criteria. Clinical examination was performed at completion of EBRT and at 3rd month follow up. Radiological response was assessed using MRI at 3rd month follow up Results 96 patients of Cervical Cancer were tested for HPV DNA, of which 79 (82.3%) patients were positive . 73 patients showed HPV genotype 16 and 6 patients were positive for genotype 18. The response was correlated with HPV genotype. There was a significant increase in radiological complete response in HPV16 compared to HPV 18 and HPV negative groups at 3 months,80.8%, 50% and 52.9% respectively (χ2=36.5, p<0.001). There was also a significant increase in clinical response at 3 months in HPV 16 group compared to HPV 18 and HPV negative groups,87.5%, 50% and 50% respectively (χ2=29.9, p<0.001). The age of the patient, volume of the disease, overall treatment time, and average Hemoglobin level and number of blood transfusions did not have any correlation.

related deaths. During CCRT 4% of patients had grade 3/4 hematological while 7% non hematological. With median follow-up of 21 months (Q1-Q3: 15-24 months) the 1 year progression free survival, distant disease survival and overall survival were 80%, 79% and 87% respectively. The global health score showed moderate increment after treatment and at 6 months follow up (FU)suggesting an improvement in QOL post therapy. In general for both functional and symptom scales, QOL improved during FU from baseline but difference was not significant. Overall symptom experience declined significantly following completion of NACT and CCRT as compared to baseline score. There was trend towards significant difference in sexual activity score over four time period but sexual enjoyment and vaginal function scores could not be analyzed reliably as majority of patients chose not to answer the questions which highlights social stigma related to sex prevalent in society. There was a significant difference in financial difficulty as faced by patient during treatment period as compared to FU period. Conclusion 2 cycles of 3 weekly NACT followed by CCRT in locally advanced cervical cancer had a good response and outcome with acceptable toxicities and without much impact on quality of life EP-1485 Role of PET-CT in patients of recurrent carcinoma cervix treated with definitive chemoradiotherapy M. Rastogi 1 , A.K. Gandhi 1 , R. Khurana 1 , S.S. Nanda 1 , H.B. Singh 1 , S. Rath 1 , P.C. Rai 1 , S. Kumar 1 , A. Bharati 1 , A.K. Srivastava 1 , S.P. Mishra 1 1 Dr. Ram Manohar Lohia Institute of Medical Sciences, Radiation Oncology, Lucknow, India Purpose or Objective We did this retrospective study to evaluate the role of positron emission tomography (PET-CT) in predicting the clinical outcome of patients with recurrent cervical carcinoma following definitive radiation therapy. Material and Methods Between July 2015 and June 2017, 40 histo-pathologically proven patients of carcinoma cervix treated with definitive radiotherapy or chemoradiotherapy and declared cured after the completion of their treatment were included. Patients were required to have a diagnosis of recurrent cervical cancer established by histopathology (biopsy or cytology) or clinically evident recurrent disease with a minimum of three months gap between recurrence and completion of radiotherapy. Patients with persistent residual disease and those having distant metastatic disease on conventional imaging (Abdominal CT scan or chest X-ray) were excluded from the study.18- fluorodeoxyglucose (FDG) PET imaging was performed in each patient before the salvage therapy but was not used for guiding treatment decisions. The maximum standardized uptake value (SUV max) and metabolic tumor volume (MTV) were measured and correlated with cumulative progression free survival (PFS).The MTV was calculated as 60% of the volume covered by the SUV max. SPSS version 20.0 was used for statistical analysis. Results Median age of the patient was 47 years (Range 30-66 years).22 patients had stage IIIB, 13 had stage II B, 3 patients had stage III A disease and 2 patients had stage IV disease in the pre-salvage workup. The median recurrence free period was 11 months (Range 3.5-36). 25 patients were treated with Re-irradiation (with EBRT doses of 20- 36 Gy ± HDR interstitial brachytherapy of 10-20 Gy in 1-2 sessions), 4 patients underwent surgery (2 Radical hysterectomy and 2 Pelvic exenteration),6 patients received palliative radiotherapy alone (Dose 5-20 Gray),4 patient received palliative chemotherapy (with regimen consisting of Paclitaxel and Carboplatin,3-6 cycles) and 1