ESTRO 37 Abstract book

S114

ESTRO 37

SP-0213 Oesophagus cancer A. Rovirosa Hospital Clinic I Provincal, Barcelona, Spain

HRQOL. In many countries, government policy statements and national guidelines reflect broad scientific and societal support for an integrated approach to supportive care in cancer patients, including rehabilitation, psychosocial care, and lifestyle interventions. Using patient reported outcome measures (PROMs) in clinical practice is recommended to monitor HRQOL and to facilitate adequate referral to supportive care. Currently, much effort is undertaken to use the concept of value based health care to optimize (head and neck cancer) care, which can be translated into three components: tailoring of care to the needs of the individual patient (patient-centered care), offering effective care (quality care), and offering cost-effective care (affordable care). An important aspect in this type of care is patient’s self- management. There are six core self-management skills: problem solving, decision making, resource utilization, forming of a patient/health care provider partnership, taking action, and self-tailoring. E-health applications including PROMs to monitor HRQOL, computerized decision support, and self-help interventions facilitate supportive care. However, the diversity and unconnectedness of available supportive care options (online and face-to-face) remains a problem and many cancer patients have unmet needs. This presentation provides an overview of evidence of (cost)effectiveness of supportive care with a special focus on self- management and eHealth. Abstract text Anal squamous cell carcinomas (ASCC) are increasing in frequency across the developed world, and 70-90% of all cases originate from infection with human papilloma viruses (HPV). Primary chemoradiotherapy (CRT) with 5- fluorouracil and mitomycin C remains the standard treatment for ASCC, but local and/or distant failure still occurs in up to 30% of patients. In the present lecture, the epidemiology and pathophysiology of ASCC in the context of HPV will be discussed. The evidence from randomized clinical trials, and the definitions of clinical primary and secondary endpoints will be presented. Although largely effective, especially in early-stage tumors, CRT is associated with significant late side effects. The latter underlines the importance of using modern radiotherapy techniques such as intensity- modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) to facilitate highly conformal plans, but the need to possibly consider reduction of tumor volume margins and/or the radiation dose to organs at risk. Furthermore, although promising, early-phase trials using targeted agents such as cetuximab in combination with CRT failed to improve the clinical outcome, whereas higher toxicity was observed in ASCC patients. Hence, there is an unmet need to develop develop accurate predictive biomarkers to guide therapeutic decisions. Finally, novel approaches, including immunotherapy, and new clinical trials, also with RT dose stratification according to clinical stage will be summarized. Teaching Lecture: Anal cancer: Can we individualise treatment? SP-0212 Anal cancer: Can we individualise treatment? E. Fokas 1 1 Klinikum der Johann Wolfgang Goethe Univ, Department of Radiotherapy and Oncology, Frankfurt, Germany

Abstract not received

Teaching Lecture: Clinical implementation of adaptive radiotherapy

SP-0214 Clinical implementation of adaptive radiotherapy D. Moeller 1 , U.V. Elstrøm 1 , M.S. Assenholt 1 , L. Hoffmann 1 1 Aarhus University Hospital, Department of Medical Physics, Aarhus C, Denmark Abstract text When anatomical changes occur during the course of radiotherapy they can affect the dose to both tumour and normal tissues. The planned dose distribution can then be restored with the concept of adaptive radiotherapy. Strategies for treatment adaptation lead to more precise treatment delivery, in some cases even allowing for margin reduction. This in turn has been shown to reduce dose to organs at risk with the possibility to minimize toxicity, for example in the lung [1,2], bowel and rectum [3] and parotic glands [4]. Strategies for treatment adaptation can be geared towards either systematic or random changes. The choice of adaptation strategy should be based on clinically relevant trigger criteria which should be verified in a large scale clinical setting. The lecture outlines how to implement adaptive radiotherapy in clinical practice focussing on: * Selection of patients for adaptation. What evidence do we need? * What are the clinical relevant time points for adaptation? * How do we identify/define clinically relevant trigger criteria? * How do we adjust margins, treatment planning and setup to comply with the adaptive strategy? * How do we ensure consistent and efficient evaluation and clinical compliance? * Automation of an adaptive workflow. What tests are needed? [1] Tvilum M et al. Clinical outcome of image-guided adaptive radiotherapy in the treatment of lung cancer patients. Acta Oncol. 54:1430-7 (2015). [2] Møller DS et al. Adaptive radiotherapy for advanced lung cancer ensures target coverage and decreases lung dose. Radiother Oncol.121:32-38 (2016). [3] Thörnqvist S et al. Adaptive radiotherapy strategies for pelvic tumors - a systematic review of clinical implementations. Acta Oncol. 5:943-58 (2016). [4] Hvid CA et al. Cone-beam computed tomography (CBCT) for adaptive image guided head and neck radiation therapy. Acta Oncol. 10:1-5 (2017)

Teaching Lecture: Oesophagus cancer