ESTRO 37 Abstract book

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ESTRO 37

2011 12. Efstathiou JA, Spiegel DY, Shipley WU, et al: Long- term outcomes of selective bladder preservation by combined-modality therapy for invasive bladder cancer: the MGH experience. European urology 61:705-11, 2012 SP-0021 Technical aspects of radiation therapy for muscle-invasive bladder cancer. V. Fonteyne 1 1 Ghent University Hospital, Radiation-Oncology, Ghent, Belgium Nowadays, the standard treatment of patients with muscle invasive bladder cancer (MIBC) is a radical cystectomy with extended pelvic lymph node dissection. Peri-operative mortality rate is ± 2% and major toxicity such as ileus, atelectasis, thrombosis and blood loss is reported in up to 30% of the patients. A re-intervention is required in 15% of the patients. In order to reduce toxicity and increase quality of life of MIBC patients, bladder-preserving therapies, combining external beam radiotherapy (EBRT) and chemotherapy, are gaining interest. Results Beside a proper patient selection many factors play an important role in improving the clinical outcome of MIBC patients treated with EBRT. Among them, there are many technical considerations: 1) So is EBRT only a valuable alternative if sufficiently high doses are delivered. With modern radiation techniques and imaging, dose escalation with simultaneous integrated boost to the initial tumor region becomes feasible while sparing intestinal loops and rectal mucosa. So far many treatment regimens have been proposed but the optimal treatment schedule is unknown. 2) Also the optimal treatment volume remains a matter of debate. 3) Another major problem of EBRT for MIBC patients is bladder displacement due to different daily bladder filling and this despite fixed protocols to control for bladder volume. Target displacements have led to large planning margins to compensate for positioning misses. Adaptive planning, with selection of a plan of the day, can help to overcome this problem. An overview of the current literature addressing these issues will be presented. Conclusion The implementation of modern radiotherapy techniques in a bladder preserving strategy could induce a paradigm shift towards a more widespread use of bladder- conserving treatment. To obtain this goal, research on proper patient selection, modern imaging to improve target volume delineation, defining the optimal treatment schedule (dose per day, total treatment duration) and technique as well as correct positioning is mandatory. SP-0022 When should we give radiotherapy following cystectomy and how? P. Sargos 1 1 Institut Bergonié, radiotherapie, BORDEAUX CEDEX, France Abstract text Local-regional recurrence after radical cystectomy is a significant problem for a subset of patients. Chemotherapy has not been shown to reduce the risk of local-regional recurrences in randomized prospective trials, and salvage therapies for local-regional failure are rarely successful. There is promising evidence that radiation therapy plus chemotherapy can significantly reduce local recurrences Abstract text Background

compared to chemotherapy alone, and that this improvement in local-regional control may translate to meaningful improvements in disease-free and overall survival with acceptable toxicity. In light of the high rates of local failure following cystectomy for locally advanced disease and the progress that has been made in identifying patients at high risk of failure and the patterns of failure in the pelvis, post-operative radiotherapy could be an option to consider for patients with ≥pT3 disease. Despite advances in our understanding of the problem of local-regional failure after cystectomy and the potential role of adjuvant radiotherapy, the question of whether adjuvant radiotherapy should have a defined role for patients with locally advanced urothelial carcinoma has not yet been determined. The results of the NRG, European, Indian, and Egyptian trials on adjuvant radiotherapy are eagerly awaited. While none of these trials on their own may provide definitive conclusions, their aggregate outcomes will help clarify whether this treatment should have a role in the management of patients with locally advanced bladder cancer. Abstract text In Denmark postoperative radiotherapy was omitted in 1986 for low-risk stage I endometrial cancer, in 1998 for intermediate-risk stage I and for high-risk stage I in 2010. Instead pelvic lymph node resection was introduced in 2010 for intermediate- and high-risk patients to tailor the postoperative therapy after lymph node status. Since 2010 almost no Danish patients have received postoperative radiotherapy. Only postoperative chemotherapy has been offered to patients with disseminated disease. The Danish endometrial cancer group (DEMCA) has published two prospective nationwide studies and demonstrated that postoperative radiotherapy (RT) could be omitted in low- and intermediate-risk stage I patients without loss of survival when evaluated after 5 years. The group also demonstrated that omitting radiotherapy seems to increase the rate of local recurrence in the intermediate group, but not in the low-risk stage I group. The explanation for the survival results was that local vaginal recurrences could be treated with radiotherapy at time of recurrences. Since then all Danish patients have been registered in the Danish Gynecological Cancer Database (DGCD) and data from 2005-2012 have now been evaluated. I will demonstrate recurrence rate, location of recurrences (vaginal, pelvic, abdominal and distant) for low-, intermediate- and high-risk stage I patients not given postoperative radiotherapy and give an estimate of number needed to treat if vaginal recurrences should be prevented by brachytherapy. SP-0024 Yes, in selected patients. - The US experience M. Harkenrider 1 1 Loyola University Chicago, Department of Radiation Oncology, Maywood, USA Abstract text The primary management of endometrial cancer is TH- BSO with or without pelvic and paraaortic lymph node dissection. Adjuvant radiation therapy for endometrial cancer may be recommended based upon presence of known adverse risk factors. Adjuvant radiotherapy can Symposium: Do we need adjuvant vaginal BT in endometrial cancer? SP-0023 No, not necessary, the Danish experience G. Ørtoft 1 1 Rigshospitalet, Department of Gynecology- Copenhagen University Hospital, Copenhagen, Denmark