ESTRO 38 Abstract book

S900 ESTRO 38

and United Kingdom currently provide a benign RT service. A project was undertaken at GenesisCare UK to review all aspects of the patient pathway and to standardise RT delivery for Dupuytren's Disease, Ledderhose's Disease and Plantar Fasciitis across 12 centres with postulated endpoints to improve access, increase awareness and optimise clinical practice of the service to prospective patient and potential referrers. Material and Methods The project team was formed from a multi-disciplinary group consisting of a Medical Oncologist, Radiographers, Medical Physicist, Patient Experience Coordinator and a Referrer/Marketing Liaison Officer. A literature review was to be performed, and a clinical analysis of current practice initiated to identify potential quality improvement and efficiency gains. The efficacy of a dedicated heel pain clinic hypothesising a joint consulting model of a Medical Oncologist and a Musculoskeletal (MSK) Consultant, with access to multi-modality imaging and treatment to diagnose and treat Plantar Fasciitis (PF) and Achilles Tendonitis was investigated. Results The evaluation demonstrated that clinical quality improvement and efficiencies were warranted to improve service delivery

Material and Methods 258 consecutive patients [male 56%, mean age 52 (7-87 yrs)] treated with CK in an Indian dedicated radiosurgery unit. Brain tumour, GI tumour, oligo-metastasis, lung cancer and GU tumour patients were 146 (56%), 43 (17%), 41 (16%), 9 (4%) and 8 (3%) respectively. In brain tumour, 36 (14%) was meningioma, 26 (10%) AN, 23 (9%) AVM and 34 (12%) brain metastasis. 36 (14%) was HCC, 9 (4%) glomus tumour and only 6 (2%) were prostate cancer patient. In rare tumours, 6 (2%) were brainstem cavernoma, 2 patient each eye tumours, cholangiocarcinoma and pancreatic cancer. AVM dose18-24Gy/1fr, meningioma & AN 12Gy/1fr. Lung cancer dose 45Gy/3fr, HCC 45Gy/5fr, prostate 36.25Gy/5fr. Four large AVM patients were treated in 'staged' SRS. Results Among 23 AVMs, 2 patient had acute oedema requiring admission and recovered with supportive care, 6 patients were on more than 1 month steriod after CK. Among 23 AN patients, 4 required steriod >3 months. One pituitary tumour patient had acute steriod insufficency. 4% (7/146) of brain tumour patients required admission after CK. No treatment related death or parmanent neurodeficit. Among 34 brain metastasis, 15 (44%) had controlled disease at last follow up [Estimated OS 284 days (95%CI: 234-328; SEM: 22.5); >6 month actuarial OS 89%].29.4% (10/34) had intra-cranial progression, 18% (6/34) patients had new lesions and 12% (4/34) had recurrence within high dose region. 27 HCC with PVT treated with CK [mean age 59 yrs, 94% male; CP A 63%; KPS>80: 81%]. 16% underwent TACE before SBRT. 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%) expired. 22% (6/27) had complete PVT response, 11% had stable disease with partial PVT response. 30% had local progression & 27% had metastasis. No death due RILD. Post-CK, 2 patient underwent TACE and 1 had TARE. Mild GI toxicities (Gr-1- II) in 40%, fatigue (Gr II-III) 28%. One (4%) patient had Gr III GI toxicity and one (4%) patient had decompensation (<4wk) after treatment. 36 patients (Male 92%, mean age 60.2 yrs, ECOG 0-1 92%, Child-Pugh A 89%) with HCCs underwent fiducial placement. Three patients (8%) had gross displacement (2 in lung, 1 in abdomen) immediate after placement. Poor post-fiducial pain score (3-4) was in 6% patients. 1/34(4%) patient expired after fiducial placement (<72 hours) with decompensation. Five patients (15%) had minor complications (pain abdomen 2, pneumothorax 2). Conclusion Early symptomatic toxicities after CK is less than 5%. Post- CK edema requiring long-term steroid is in 8%, procedure related mortality in 0.7% and admission required 4% patient. Recurrence rate after brain metastasis SRS is 29% at 6 month follow up. HCC with PVT response is in 27%. Acute toxicity and early outcome is acceptable with CK. EP-1675 Club100 (student organization of DEGRO e.V.) – Current activities and future perspectives L. Käsmann 1 , L. Bolm 2 , S. Knoedler 3 , T. Hoelscher 4 , F. Prott 5 1 LMU University Hospital Grosshadern, Department of Radiation Oncology, Munich, Germany ; 2 University Medical Center Schleswig-Holstein- Campus Luebeck, Department of Surgery, Luebeck, Germany ; 3 University Hospital Ulm, Department of Radiation Oncology, Ulm, Germany ; 4 University Hospital of Cologne, Department of Radiation Oncology, Cologne, Germany ; 5 St. Josefs- Hospital, Department of Radiation Oncology, Wiesbaden, Germany Purpose or Objective The Club 100 is an integral part of the German society of radiation oncology (DEGRO e.V.). The main goal of this subgroup is to actively support medical students as well as

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The patient pathway from consult to RT treatment was reduced from 10 to 14 days to 24 hours. A fully electronic workflow was introduced Evidence based clinical protocols were written for DD, LD, PF, AT. Improved and standardised patient stabilisation for RT and Surface Guidance Radiotherapy was implemented for all benign treatments. Introduction of a completed acrylic coated less toxic electron insert by sourcing an external supplier Tattoo-less treatment was implemented for all benign RT treatment across all 12 centres Extracorporeal Shockwave Treatments (EST) for newly diagnosed PF and AT and external beam for persistent and recurrent AT was introduced. The Heel Pain clinic was implemented with a Medical Oncologist consulting with multimodality imaging available at the time of consult

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Conclusion The project resulted in i service delivery efficiencies, in reducing consult to treatment start time, through a collaborative and coordinated approach. Initiating mechanisms to develop external relationships with prospective patients and referrers have been implemented. Further investigation will continue evaluating the Benign Service and collect metrics on all aspects of the patient pathway. A joint consulting model for the heel pain clinic is anticipated to start in early 2018. Future goals are to initiate a centralised data base with an automated data transfer system for patient recorded outcomes measures and to expand the service EP-1674 Early toxicity and outcome of 258 consecutive patients treated with CyberKnife in an Indian centre D. Dutta 1 , R. Das 1 , A. Gupta 1 , K. Kataki 1 , T. Tarani 1 , A. Krishnan 1 , C. Oc 2 , R. Holla 2 1 Amrita Institute of Medical Science- Kochi, Radiation Oncology, Kochi, India ; 2 Amrita Institute of Medical Science- Kochi, Medical Physics, Kochi, India Purpose or Objective Demographic profile, patient parameters, early toxicity and response to treatment assessment of all consecutive patients treated with CyberKnife radiosurgery.