Gynecological Cancer

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TU_17_3482 - Bone Marrow-Sparing IMRT Cannot Compensate for Hematologic Toxicity after Neoadjuvant Chemotherapy for Advanced Cervical Cancer

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Bone Marrow-Sparing IMRT Cannot Compensate for Hematologic Toxicity after Neoadjuvant Chemotherapy for Advanced Cervical Cancer
D. Portik1, T. Popescu1, A. Sipos2, N. Schultes2, A. Eva2, D. Dordai2, C. Iacob2, and G. Kacso2,3; 1'Prof. Dr. Ion Chiricuta' Institute of Oncology, Cluj-Napoca, Romania, 2RTC Amethyst Cluj, Cluj-Napoca, Romania, 3Iuliu Hatieganu Medical University of Cluj, Cluj-Napoca, Romania

Purpose/Objective(s): Although it is not standard of care, neoadjuvant chemotherapy for cervical cancer is gaining ground, being widely used either in early stages before surgery to avoid radiotherapy or in advanced stages to obtain downsizing for subsequent concomitant chemoradiation (CRT). Bone marrow-sparing radiotherapy (BMS-RT) decreased the acute hematologic toxicity in a recent phase II clinical trial. We analyzed whether BMS-RT can improve the number of concomitant Cisplatin cycles, after initial neoadjuvant chemotherapy.

Materials/Methods: During 2017, 16 consecutive patients, with stages IIB-IVA cervix cancer, underwent concomitant CRT, 45-50.4Gy/25-28 fractions, with weekly Cisplatin 40mg/m2and HDR brachytherapy, 4 fractions of 7Gy, to a total dose of EQD2Gy=85-90Gy with curative intent. Among them, 9 patients received neoadjuvant chemotherapy, Paclitaxel + Cisplatin, and 7 didn’t. The mean number of neoadjuvant chemotherapy cycles was 3.67 ± 0.9, (min=2, Max=5). All patients’ plans respected bone marrow dose constraints, according to our protocol: V10Gy<90%; V20Gy<75%.

Results: Mean number of concomitant Cisplatin cycles was 3.06 ± 0.37. Patients with neoadjuvant chemotherapy had a lower number of completed Cisplatin cycles, 2.22 ± 1.2, compared with patients who did not undergo neoadjuvant treatment 4.14 ± 1.1. This difference was statistically significant (p=0.005).

Conclusion: In our experience, despite BMS-RT, the delivery of CRT is dramatically compromised by the neoadjuvant chemotherapy, with possible relevant suboptimal concomitant CRT. This observation needs to be prospectively explored, with longer follow-up.

Author Disclosure: D. Portik: None. T. Popescu: None. A. Sipos: None. N. Schultes: None. A. Eva: None.

Daniel Portik, MD

Biography:
Daniel Portik, MD, Radiation Oncology Resident, Prof. Dr. Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania

I have completed my medical training in 2015 at the University of Medicine and Pharmacy of Targu Mures, Transylvania, Romania. During my student years I was an active member of the Romanian Students' Surgical Society as a volunteer. Likewise, I had the honour of participating on several exchanges abroad - Indonesia, Denmark, Hungary and Sweden. On one of these trips I discovered radiation oncology and the multidisciplinary world of oncological care. This lead me to a residency in Radiation Oncology, so with the start of 2016 I joined the Prof. Dr. 'Ion Chiricuta' Institute of Oncology as an in-training radiation oncologist. During my residency so far I have managed patients with H&N, gynecological, breast, lung, GI cancers and sarcomas. I have actively sought out to complement my training with participation on national and international radiation oncology courses, workshops, conferences. Since October 1st 2018 I have started my doctoral studies, with a focus on the combination of radiotherapy and immunotherapy.

I have an interest in constantly upgrading my skills, whether that is bridging the gap from 3D-CRT to IMRT or the implementation of new techniques such as SBRT and SRS.

I am a member of: ESTRO, ASTRO, ESMO, ASCO.

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