ESTRO 37 Abstract book

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ESTRO 37

1 The Alfred Hospital, Alfred Health Radiation Oncology, Prahran, Australia 2 Istituto Nazionale dei Tumori, Prostate Cancer Program- Fondazione IRCCS-, Milan, Italy 3 Karolinska University Hospital, Medical Radiation Physics and Nuclear Medicine, Stockholm, Sweden 4 Sir Charles Gairdner Hospital, Radiation Oncology, Perth, Australia 5 University of Western Australia, School of Physics and Astrophysics, Perth, Australia 6 University of Newcastle, School of Medicine and Public Health, Newcastle, Australia 7 Monash University, Central Clinical School, Melbourne, Australia Purpose or Objective HDR brachytherapy (HDRB) in combination with external beam radiotherapy (EBRT) is an established technique shown to achieve effective dose escalation in the treatment of prostate cancer. Despite its wide use there is still large variability between centres in the choice of dose prescriptions and dose limits to the organs at risk. This is particularly true for the urethra for which large variability also exists among contouring protocols. The aim of this work was to understand the influence of urethra contouring on urethral stricture NTCP model parameters. Material and Methods The Lyman-Kutcher-Burman (LKB) model was used in the study. DVHs, clinical and toxicity data were prospectively collected for a first cohort of 262 patients from a single institution (PD= 18Gy in 3, 19Gy in 2 and 17Gy in 2 fractions) and used to fit LKB model parameters with maximum likelihood. DVHs were corrected for equieffective dose in 2Gy fractions, EQD2α/β =5Gy . The urethra was contoured around the external diameter of a 22 Fr gauge three-way indwelling urinary catheter as a solid structure, from typically 1 cm below the apex to the bladder base. The end-point was stricture requiring urethrotomy within 4 years after RT completion, with an average rate of 12.6%. The model was internally validated using bootstrapping. Data from a second cohort of 187 patients from another institution treated as part of the TROG03.04 RADAR trial were then collected. PD was 19.5Gy in 3 fractions and the stricture rate was 8.6%. Both cohorts had identical EBRT doses. For the second cohort urethras were initially contoured as the visible lumen of the urinary catheter (original) and, then for a subset of 100 patients, urethra contours were expanded 2mm in the AP and LR direction and limited in the SI direction to be similar to the first cohort’s contours (expanded). Both structures’ DVHs and associated clinical data were used to externally validate the LKB parameters obtained with the first cohort. Calibration was used to establish agreement between model estimated probabilities and observed stricture rates. Results

NTCP predictions of the LKB Model with the original DVHs showed poor calibration (Fig 1b), while for the subset of patients with the expanded urethra the calibration was considerably improved (Fig 1c). Conclusion In the treatment of prostate cancer with HDRB there are still no general recommendations for urethral dose constraints. This work shows that to understand the relationship between dose and toxicity consensus for the outlining of the urethral volume is needed. This in turn has implications for the application of urethral complication prediction in extreme hypofractionation OC-0322 Residual setup errors after IGRT are linked to overall survival in lung and oesophageal cancers C. Johnson 1 , G. Price 1 , C. Faivre-Finn 2 , M. Van Herk 2 1 The Christie NHS Foundation Trust- The University of Manchester, Manchester Cancer Research Centre, Manchester, United Kingdom 2 The University of Manchester, Division of Molecular and Clinical Cancer Sciences, Manchester, United Kingdom This abstract is part of the media programme and will be relased on the day of its presentation OC-0323 Patterns of recurrence in the randomised PORTEC-3 trial of chemoradiotherapy for endometrial cancer S.M. De Boer 1 , M.E. Powell 2 , L. Mileshkin 3 , D. Katsaros 4 , P. Bessette 5 , C. Haie-Meder 6 , P.B. Ottevanger 7 , J.A. Ledermann 8 , P. Khaw 9 , A. Colombo 10 , A. Fyles 11 , M.H. Baron 12 , I.M. Jürgenliemk-Schulz 13 , H.C. Kitchener 14 , H.W. Nijman 15 , G. Wilson 16 , I. Kolodziej 17 , S. Carinelli 18 , L.C.H.W. Lutgens 19 , V.T.H.B.M. Smit 20 , N. Singh 21 , R.A. Nout 1 , K.W. Verhoeven-Adema 22 , H. Putter 23 , C.L. Creutzberg 1 1 Leiden University Medical Center, Department of Radiation Oncology, Leiden, The Netherlands 2 Barts Health NHS Trust, Department of Clinical Oncology, London, United Kingdom 3 Peter MacCallum Cancer Centre, Division of Cancer Medicine, Melbourne, Australia 4 Città della Salute and S Anna Hospital- University of Torino, Department of Surgical Sciences- Gynecologic Oncology, Torino, Italy 5 University of Sherbrooke, CCTG- Department of Obstetrics and Gynaecology, Quebec, Canada 6 Institut Gustave Roussy, Department of Radiotherapy, Villejuif, France 7 Radboudumc, Department of Medical oncology, Nijmegen, The Netherlands 8 UCL Cancer Institute, Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom 9 Peter MacCallum Cancer Center, Division of Radiation Oncology, Melbourne, Australia 10 ASST-Lecco- Ospedale A.Manzoni, Division of Radiation Oncology, Lecco, Italy 11 Princess Margaret Cancer Centre, CCTG- Radiation Medicine Program, Toronto, Canada 12 Centre Hospitalier Régional Universitaire de Besançon, Department of Radiotherapy, Besançon, France 13 University Medical Center Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands 14 University of Manchester, Institute of Cancer Sciences, Manchester, United Kingdom 15 University Medical Center Groningen- University of Award Lecture: Donal Hollywood Award Proffered Papers: Highlights of proffered papers

For the first cohort of 262 patients the risk of urethra stricture was modelled by means of a sigmoid function of EUD (LKB Model: TD50=70.7Gy, n=0.3 and m=0.37). Boostrapping confirmed the parameters. The internal calibration is shown in Fig 1a. For the second cohort of 187 patients comparison between observed toxicity and