ESTRO 38 Abstract book

S883 ESTRO 38

Purpose or Objective We hypothesized that lower socioeconomic status (SES) was associated with higher all-cause mortality in patients newly diagnosed with cancer, particularly with respect to the elderly (age ³ 60 years). There are no previous studies evaluating the relationship between individual/regional- level SES and all-cause mortality in cancer patients more than 60 years in the context of national health care coverage. Material and Methods We collected study patients from the stratified random sample of Korean National Health Insurance Elderly Cohort (2002-2015). Patients who were newly diagnosed with cancer between 2003 and 2015 were included. Those living in a newly created city (‘Sejong’ city) or with other/ill- defined/sex-specific cancer at diagnosis were excluded. A total of 108,626 patients were collected. Cox’s proportional hazard regression model was used to investigate risk factors of mortality. Individual SES position (insurance type, income level) and regional-level SES from composite deprivation index (CDI) 2010 were derived. The comorbidities were measured using Charlson Comorbidity Index score. Results Patients with disability or residing in a deprived region were found more in the low-income level group. In patients ≤80 years, multivariate Cox hazard regression model revealed that low-income status was associated with higher risk of mortality compared to high-income status (HR 1.08, 95% CI 1.05-1.11, P<0.001). Contrary to patients > 80 years, those ≤80 years and living in a deprived region at diagnosis showed worse survival (HR 1.10, 95% CI 1.08-1.12, P<0.001). Male, lowest insurance Conclusion Low individual/regional SES at the time of cancer diagnosis is associated with increased mortality in elderly patients. Further understanding causes of the phenomena and accordingly providing support for elderly cancer patients with low SES or residing in deprived regions would be necessary. EP-1640 Radical radiotherapy in elderly prostate cancer patients: a monoinstitutional experience C.L. Deantoni 1 , A. Fodor 1 , C. Fiorino 2 , C. Cozzarini 1 , F. Zerbetto 1 , P. Mangili 2 , C. Calandrino 2 , N.G. Di Muzio 1 1 San Raffaele Scientific Institute- Milano- Italy, Department of Radiotherapy, Milano, Italy ; 2 San Raffaele Scientific Institute- Milano- Italy, Medical Physics, Milano, Italy Purpose or Objective Continuous or intermittent androgen deprivation therapy (ADT) is generally prescribed in elderly prostate cancer (PCa) patients (pts) with under 10 years life expectancy. Unfortunately, 18-24 months later many pts become castration resistant and only palliative therapies are available. Here we report toxicity and outcomes obtained in elderly (≥80 years old at diagnosis) PCa (pts) treated with radical radiotherapy in a monoinstitutional experience Material and Methods From December 2006 to July 2014, 34 elderly PCa pts underwent radiotherapy with radical intent. Three pts, affected by a low risk cancer, were treated on prostate and seminal vesicles only, to 71.4 Gy in 28 fractions (EQD2 80.8 Gy, considering α/β=1.5 for prostate cancer). Intermediate and high-risk PCa pts underwent prophylactic irradiation on pelvic nodes to 51.8 Gy in 28 fractions (EQD2 52.2 Gy), with simultaneous integrated boost to seminal vescicles up to 65.5 Gy (77.7 Gy EQD2) and to prostate up to 74.2 Gy (88 Gy EQD2). Neoadjuvant and/or adjuvant androgen deprivation therapy (ADT) was prescribed in 25/34 pts for a median of 27.9 months (2-79 months). All patients were treated with helical IMRT

Association of Radiation Oncology-Young Members Working Group., University and Spedali Civili - Radiation Oncology, Brescia, Italy ; 9 AIROGiovani Italian Association of Radiation Oncology-Young Members Working Group., General Regional Hospital " F. Miulli" - Radiation Oncology, Acquaviva delle Fonti Bari, Italy Purpose or Objective In USA 53% of new cancer cases are diagnosed in people over 65 years, and in the next decade the incidence of cancer in elderly people will continue to grow up. Radiotherapy (RT), chemotherapy and more recently immunotherapy have favorably changed the outcome of various cancers. Nevertheless, elderly people are under- represented in clinical trials. Aim of the present review is to assess the present data about the use of the association of Radiotherapy and immunotherapy in elderly people. Material and Methods PubMed database was searched for English literature published up to December 2017 using keywords “radiotherapy” combined with “immunotherapy” and “ipilimumab” or “pembrolizumab” or “nivolumab”. Studies performing radiotherapy and immunotherapy in people aged > 65 years were evaluated focusing on safety, toxicity and, if possible, efficacy. Studies eligible for inclusion in this review were: (a) case reports, retrospective or prospective studies in which RT and new drugs were used concomitantly or sequentially; (b) studies in which the evaluation of elderly sub-group was reported. Results The systematic search identified 363 records from PubMed. After exclusion of duplicates, full-text review, cross-referencing and paper that do not respect the inclusion criteria, 20 studies were included in this review. As regard Ipilimumab, data seems to indicate a longer OS in patients with metastatic melanoma treated with ipilimumab +RT vs those treated with Ipilimumab alone, suggesting a possible RT role in enhancing ipilimumab- induced immune response (Stokes WA et al 2017, Tazi K et al 2015). In NSCLC a prospective phase II trial of neoadjuvant ipilimumab followed by radical or post operative surgery demonstrated excellent tolerance with no observed G3 or more side effects (Boyer MJ et al 2016) and in prostate cancer Ipilimumab + palliative RT seems to improve OS in subgroups of pts (high risk) (Kwon ED et al 2015). As regards Pembrolizumab it seems to improve PFS and OS in NSCLC previous treated with RT without increasing in side effects (Shaverdian N et al 2017). On the other hand there are some data on immunotherapy related pneumonitis during anti PD1 treatment combined to RT, reported both for pembrolizumab and for nivolumab with development also later after RT end (Lu CS et al 2017, Manapov F et al 2018, Yoshida Tet al 2017). Conclusion Immunotherapies in association of RT seems to be safe, but in elderly patients data concerning safety and toxicity are limited. The tolerance of combined RT and immunotherapy seems similar among older and younger people. To date many data underline the immune stimulation of RT, so it might be interesting evaluate if the two combined treatment might improve the response also in elderly patients. Specific clinical trials on this population are encouraged. EP-1639 Socioeconomic Status and Mortality in Elderly Cancer Patients:A National Elderly Sample Cohort Study B. Jang 1 , J.H. Chang 2 1 Seoul National University Hospital, Radiation Oncology, Seoul, Korea Republic of ; 2 SNU-SMG Boramae Medical Center, Radiation Oncology, Seoul, Korea Republic of