22nd Annual SASRO Meeting
Strahlentherapie und Onkologie (Print)
Aims: To evaluate the impact of pre-operative multidisciplinary discussion on reconstruction modalities in breast cancer pts, planned for mastectomy and adjuvant RT. Methods: In our Breast Unit all pts are discussed primarily during a pre-operative multidisciplinary meeting for optimizing the treatment schedule. If mastectomy and adjuvant RT are required, the proper reconstruction technique is arranged by the plastic surgeon and the radiation oncologist, taking into account the patient's
... nce. The records of 46 pts, treated with mastectomy in 2017, have been reviewed. Results: 226 pts underwent a breast operation in 2017: 180 (80%) conservative surgery and 46 (20%) radical or skin/nipple sparing mastectomy. Immediate breast reconstruction has been performed in 28 pts: 19 with expander, 5 with autologous tissue and 4 with definitive prosthesis. Five of them have been treated with adjuvant RT according to stage: 4 have been reconstructed with expander (one had bilateral breast cancer) and 1 with autologous tissue. All pts, except one, have been treated on chest wall plus SC/IM chain with VMAT/RapidArc technique and respiratory gating if left or bilateral chest wall. Conclusion: The lack of clear guidelines on the best reconstruction technique, if post-op RT is required, reinforce the duty of a pre-operative multidisciplinary discussion. Our actual policy consists in RT on completely inflated expander and definitive placement of permanent implant at least six months after the end of RT. The pre-operative discussion allowed us to avoid definitive prosthesis reconstruction in patients candidates to RT. We moreover ask for checking clinically the pts together with the plastic surgeon for a clear and shared explanation of the pros and contra of the different reconstruction modalities, if post-operative RT is prescribed. Poster Mobile health technologies for palliative care patients Aims: Discharge from hospital is a vulnerable phase in palliative patients' trajectories resulting in frequent unplanned readmissions. We examined the feasibility of remote monitoring of palliative patients, aiming to detect deterioration of health status early and to prevent emergency readmissions. Methods: Patients treated with palliative intent in an inpatient setting were recruited for this prospective single-center observational study. Inclusion criteria were age >18, a severe medical condition (metastatic cancer or severe cardiac/pulmonary disease), ECOG ≤2/KPS ≥50%, no relevant cognitive impairment and good knowledge of German language. Patients were provided with wearables in form of a smartphone and a bracelet collecting vital data. These data as well as questionnaires about symptoms were collected over 12 weeks. The study was conducted in an exploratory and descriptive design. Results: Between 02/17-02/18 71 patients were eligible, of which 31 patients between 39-85 y (median 62, SD 11.4) agreed to participate. 25/31 patients completed the whole study period, 4 died in between, 2 discontinued. Completion rate of questionnaires was 75%. On average, the bracelet was worn at 53% of the days. Wearing time for these days was on average 63% (8.00-20.00). Smartphone was worn at 85% of the days and wearing time was 50% (08.00-20.00). Heart rate variability (HRV) while resting (Root Mean Square of the Successive Differences) and resting heart rate differed between groups of patients (readmission vs no readmission). Differences were nominally significant (p = .011, p = .036, resp.). Due to explorative design involving multiple testing, these results have to be confirmed by an independent study. Conclusion: Monitoring of palliative patients using wearables and smartphone technology over 12 weeks is feasible. First results indicate that resting HRV and heart rate might predict readmission. Poster Sexual function after prostate seeds brachytherapy-a longterm single center experience Daniel Taussky radio-oncologie, université de Montréal, Montréal, Canada Purpose: Prostate brachytherapy (PB) with radioactive seeds has been shown to have a favorable outcome in preserving erections. In this present study we analyze its long-term effect on erectile function (EF) and other influencing factors. Material and methods: We included all patients treated with seed-PB as monotherapy who were prospectively followed and EF evaluated and recorded at our center. All patients had to have recorded pretreatment EF and at least one post-PB evaluation. EF was graded with the Common Terminology Criteria for Adverse Events (CTCAE), Version 4.0: 0 = no dysfunction; 1 = decrease, but no intervention needed; 2 = decrease, intervention indicated; 3 = decrease but erectile intervention not helpful. Only potent patients were included (CTCAE ≤2). Binary logistic regression analysis was used to predict factors associated with preserved EF after PB, defined as having sufficient EF for sexual activity with or without the help of medication (CTCAE ≤2). Results: Median age was 64 years (IQR 60-68), 12% had diabetes, 44% hypertension, 10% a previous cardiac event. In general, of patients potent (grade 0-2) at baseline from the time of the first evaluation throughout the last evaluation (8-65 months) 11-16% were unable to have intercourse (grade 3 toxicity). Of the patient who did not need any medical or mechanical help at baseline, only 10-24% latter needed help (grade 2 dysfunction) and 9-14% became important (grade 3). Erectile dysfunction plateaued at 26 months. On multivariate analysis diabetes (HR 3.9, 95%CI 1.8-8.1, p < 0.001) age >65 years (HR 2.4, 1.2-4.8, p = 0.009) and EF at baseline (HR per point increase 2.43, 1.6-6.4, p < 0.001) remained significant, but not hypertension (p = 0.1). Conclusion: Preservation of EF after PB in potent patients is excellent. Only 14% lose their EF at a maximum of 65 months of follow-up. Known risk-factors for arteriosclerosis as well as age and baseline EF determine whether a patient will be able to remain sexually active after PB. Poster Aims: Treatment options in locally advanced cancer cervix (LACC) (stages IIB-IVA) have evolved around radiotherapy (RT) and/or chemotherapy (CT), hypoxic cell sensitizers (HypCS), immunotherapy (Imm) and loco-regional moderate hyperthermia (HT). A systematic review and network meta-analysis (NMA) was conducted to synthesize the clinical evidence for efficacy and safety of these approaches for Strahlenther Onkol (2019) 195:579-606 long-term loco-regional control (LRC), overall survival (OS), grade III+ acute (AM) and late morbidity (LM). Methods: Five major databases were searched as per the PRISMA guidelines and 6285 articles screened. 60 randomized trials in LACC published during 1974-2018 without surgical interventions were selected. These used 13 different interventions-RT alone or/with neoadjuvant CT (NACT), adjuvant CT (ACT), concurrent CTRT (weekly CDDP/3-weekly CDDP/combination CT with CDDP/non-CDDP based CT), HypCS, Imm and HT. Random effects NMA were performed and odds ratios (ORs) estimated. Interventions for each endpoint were ranked as per their corresponding cumulative ranking curve (SUCRA) values. Quality of the evidence was evaluated according to the GRADE Working Group recommendations. Results: Of the 9895 patients evaluated, 97.4% were LACC. Total events reported for LRC, OS, AM and LM were 5431/8197, 4482/7958, 1710/7183 and 441/6333 respectively. The strategies with best ORs and 95% credit intervals for LRC, OS, AM and LM were HT+RT (1.23,), concurrent CTRT (3-weekly CDDP) (1.14, 0.35-3.65), RT+ACT (0.01, 0.00-1.04) and NACT+RT+ACT (0.42, 0.02-7.39) respectively. The three highest ranked comprehensive SU-CRA values for all four endpoints taken together were HT+RT, HT+C-TRT and CTRT (3-weekly CDDP). Further, two-step cluster analysis grouped these three interventions into a single distinctive cluster. Conclusion: Using NMA, the greatest panoptic impact on key clinical endpoints in LACC was evident for HT+RT, HT+CTRT and CTRT (3-weekly CDDP). A phase III randomized trial between these shortlisted therapeutic strategies is thus warranted for a direct head-to-head comparison. Posterwalk Aims: To evaluate the alignment with the international guidelines in the adjuvant treatment of endometrial cancer patients after Multidisciplinary Discussion Meeting (MDM). Methods: From 2015 to 2017 133 new cases of endometrial cancer were recorded in Ticino and 117 cases (88%) were discussed at weekly MDM of the Ente Ospedaliero Cantonale (EOC). During MDM gynecologists, medical oncologists, radiation oncologists, radiologists and pathologists discussed together for a shared therapeutic proposal. Ninety patients with endometrioid carcinoma were selected and divided into risk groups according to ESMO-ESGO-ESTRO recommendations, considered as reference. Results: The 84% of pts, presented at MDM by reference gynecologist, underwent surgery in a single center. Risk group was: low or intermediate, 45 pts (50%); high intermediate N0, 16 pts (18%); high intermediate N x, 2 pts (2%); high stage I-II, 7 pts (8%); high stage III, 17 pts (19%); high stage IV, 3 pts (3%). The RT and CT were performed in two different hospitals by the same dedicated staff. For all the cases, the relevance of adjuvant treatment to the guidelines was 91%: 100% for low and intermediate risk pts; 94% for high intermediate risk N0 pts; 50% for high intermediate risk N x pts; 86% for high risk stage I-II pts; 71% for high risk stage III pts and 100% for high risk stage IV pts. The reasons of treatment omission were: old age in 2 cases, refusal in 2 cases, disease progression and development of a second tumor in 2 and 1 case, respectively. In 1 pts with high intermediate risk (N0) the RT on pelvis was prescribed due to isolated tumor cells in one of the sentinel lymph nodes analyzed and lymph-vascular space invasion. Two pts with stage IV disease were treated with chemotherapy and one with hormonal therapy. Conclusion: ESMO-ESGO-ESTRO recommendations were applied in 91% of cases. The MDM allowed a better centralization of the oncologic gynecologic cases, especially for complex surgical procedures and following adjuvant treatments. Poster Hypo-vs. normofractionated irradiation in early-stage breast cancer-A patterns of care analysis in German speaking countries Objective: Adjuvant radiotherapy (RT) plays an important role in early breast cancer management but the dose and fractionation schedules used are variable. A whole breast irradiation of 50 Gy in 25 daily fractions delivered over 5 weeks, usually followed by a boost is often considered the "standard" adjuvant RT prescription. Studies indicate that hypofractionated regimes such as 40.05 Gy in 15 daily fractions WBI are equally effective and achieve similar or better cosmetic and normal tissue outcomes. Thus, the 2017 German guidelines recommend hypofractionated RT (HF-RT) as a new standard of treatment for early breast cancer. However, there are limitations to the HF-RT studies such as the length of follow up. To understand the patterns of care in German-speaking countries a survey was conducted regarding the use of normo-and hypofractionated radiotherapy techniques.