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Poster: Clinical track: Palliation PO-1256: Feasibility and initial results of Linac-based Stereotactic Body Radiotherapy in spinal metastases N. Giaj Levra, M. Niyazi, V. Figlia, G. Napoli, R. Mazzola, L. Nicosia, S. Corradini, R. Ruggieri, G. Minniti, F. Alongi. [Extracted from the article]

Poster: RTT track: Patient preparation, positioning and immobilisation PO-1841: Efficacy of a new dedicated immobilization device for treatment of Central Nervous disease N. Giaj Levra, V. Figlia, R. Mazzola, L. Nicosia, F. Ricchetti, M. Rigo, D. Tomasini, F. Cuccia, L. Agostinelli, R. Ruggieri, F. Alongi. [Extracted from the article]

To evaluate the efficacy of stereotactic body radiotherapy (SBRT) for spine oligometastases. This was a multicentre retrospective study of a series of patients who received SBRT for spine oligometastases. The efficacy of SBRT was evaluated in terms of local control as the primary endpoint. Survival outcomes were also analysed to identify predictive factors for clinical outcomes. Toxicity was assessed according to CTCAE v4.0. Between March 2018 and July 2022, 183 lesions in 177 patients were analysed. In most patients, SBRT was delivered to a single spine metastasis (82%) for a median total dose of 21 Gy (14–35 Gy) in three fractions (one to five fractions) and a median BED 10 = 119 Gy (57.7–152 Gy). Local control rates were 90.3% at 1 year, 84.3% at 2 years and 84.3% at 3 years. Distant progression-free survival rates were 33.1%, 18.5% and 12.4% at 1, 2 and 3 years, with prostate histology (P = 0.023), oligorecurrent disease (P = 0.04) and BED 10 > 100 Gy (P = 0.04) found to be predictive on univariate analysis. A further oligometastatic progression was observed in 33 patients (18.6%) treated with a second course of SBRT, reporting at univariate analysis improved overall survival rates (P = 0.01). Polymetastases-free survival rates were 57.8%, 43.4% and 32.4%; concurrent therapy was related to improved outcomes at multivariate analysis (P = 0.009). Overall survival rates were 91.8%, 79.6% and 65.9%, with prostate histology and non-cervical metastases related to better overall survival at multivariate analysis. Pain-flare after SBRT was recorded in 3.3%; five patients underwent surgical decompression after SBRT; there were no grade ≥3 adverse events. In our experience of only oligometastatic patients, spine SBRT gave excellent results in terms of safety and efficacy. Prostate histology and oligorecurrent disease were predictive factors for improved clinical outcomes; also, patients who experienced a further oligoprogression after SBRT maintained a survival advantage compared with polymetastatic progression. No severe adverse events were reported. • One of the largest series of spine SBRT oligometastases. • Spine SBRT impacts on oligometastatic disease. • Spine SBRT is safe with minimal toxicity. • Metabolic imaging can be helpful for spine SBRT. [ABSTRACT FROM AUTHOR]

Poster: Clinical track: Lung PO-1000: Multicentric restrospective analysis of safety of SBRT to centrally located lesion of the lung L. Frassinelli, P. Borghetti, N. Giaj-Levra, E. D'Angelo, M.L. Bonù, V. Salvestrini, G. Costantino, M. Mariotti, F. Alongi, F. Lohr, V. Scotti, A. Bruni. [Extracted from the article]

Purpose To investigate the feasibility and tolerance in the use of adjuvant intensity modulated radiation therapy (IMRT) and simultaneous integrated boost in patients with a diagnosis of breast cancer after breast-conserving surgery. Patients and methods Between September 2011 to February 2013, 112 women with a diagnosis of early breast cancer (T1-2, N0-1, M0) were treated with IMRT and simultaneous integrated boost after breast-conserving surgery in our institution. A dose of 50 Gy in 25 fractions was prescribed to the whole breast and an additional dose of radiation was prescribed on the tumour bed. A dose prescription of 60 Gy in 25 fractions to the tumour bed was used in patients with negative margins after surgery, whereas if the margins were close (< 1 mm) or positive (without a new surgical resection) a dose of 64 Gy was prescribed. All patients were followed with periodic clinical evaluation. Acute and late toxicity were scored using the EORTC/RTOG radiation morbidity score system. Both patient and physician recorded cosmetic outcome evaluation with a subjective judgment scale at the time of scheduled follow-up. Results The median follow-up was 28 months (range 24–40 months). The acute skin grade toxicity during the treatment was grade 0 in 8 patients (7%), grade 1 in 80 (72%), grade 2 in 24 cases (21%). No grade 3 or higher acute skin toxicity was observed. At 12 months, skin toxicity was grade 0 in 78 patients (70%), grade 1 in 34 patients (30%). No toxicity grade 2 or higher was registered. At 24 months, skin toxicity was grade 0 in 79 patients (71%), grade 1 in 33 patients (29%). No case of grade 2 toxicity or higher was registered. The pretreatment variables correlated with skin grade 2 acute toxicity were adjuvant chemotherapy ( P = 0.01) and breast volume ≥ 700 cm 3 ( P = 0.001). Patients with an acute skin toxicity grade 2 had a higher probability to develop late skin toxicity ( P < 0.0001). In the 98% of cases, patients were judged to have a good or excellent cosmetic outcome. The 2-year-overall survival and 2-year-local control were 100%. Conclusion These data support the feasibility and safety of IMRT with simultaneous integrated boost in patients with a diagnosis of early breast cancer following breast-conserving surgery with acceptable acute and late treatment-related toxicity. A longer follow-up is needed to define the efficacy on outcomes. [ABSTRACT FROM AUTHOR]

Objective: Dysphagia remains a side effect influencing the quality of life of patients with head and neck cancer (HNC) after radiotherapy. We evaluated the relationship between planned dose involvement and acute and late dysphagia in patients with HNC treated with intensity-modulated radiation therapy (IMRT), after a recontouring of constrictor muscles (PCs) and the cricopharyngeal muscle (CM). Methods: Between December 2011 and December 2013, 56 patients with histologically proven HNC were treated with IMRT or volumetric-modulated arc therapy. The PCs and CM were recontoured. Correlations between acute and late toxicity and dosimetric parameters were evaluated. End points were analysed using univariate logistic regression. Results: An increasing risk to develop acute dysphagia was observed when constraints to the middle PCs were not respected [mean dose (Dmean) ⩾50Gy, maximum dose (Dmax) >60Gy, V50 >70% with a p=0.05]. The superior PC was not correlated with acute toxicity but only with late dysphagia. The inferior PC was not correlated with dysphagia; for the CM only, Dmax >60Gy was correlated with acute dysphagia ⩾ grade 2. Conclusion: According to our analysis, the superior PC has a major role, being correlated with dysphagia at 3 and 6 months after treatments; the middle PC maintains this correlation only at 3 months from the beginning of radiotherapy, but it does not have influence on late dysphagia. The inferior PC and CM have a minimum impact on swallowing symptoms. Advances In Knowledge: We used recent guidelines to define dose constraints of the PCs and CM. Two results emerge in the present analysis: the superior PC influences late dysphagia, while the middle PC influences acute dysphagia. [ABSTRACT FROM AUTHOR]

Poster: Clinical track: Prostate PO-1193: 18F-CHOLINE PET/68Ga-PSMA PET SBRT in oligorecurrent prostate cancer: comparative analysis R. Mazzola, G. Napoli, G. Francolini, L. Triggiani, L. Nicosia, V. Figlia, N. Giaj-Levra, F. Ricchetti, M. Rigo, F. Cuccia, L. Livi, S.M. Magrini, M. Salgarello, F. Alongi. [Extracted from the article]

Poster: Clinical track: Upper GI (oesophagus, stomach, pancreas, liver) PO-1062: Stereotactic body radiotherapy can delay polymetastatic conversion in liver oligometastatic patients L. Nicosia, F. Cuccia, V. Figlia, N. Giaj-Levra, R. Mazzola, F. Ricchetti, M. Rigo, M. Bonù, F. Alongi. [Extracted from the article]

Poster discussion: CL: CNS PD-0175: TTIRS trial:a retrospective analysis of the association between TT or IT and RS for BM from NSCLC E. Olmetto, S. Scoccianti, R. Di Franco, P. Anselmo, G. Beltramo, C. Mantovani, M.F. Osti, V. Pinzi, N. Giaj-Levra, A. Bruni, P. Matteucci, S. Pedretti, E. Giudice, P. Tini, M. Krengli, P. Ciammella, F. Pasqualetti, M. Trignani, A. Merlotti, V. Borzillo, D. Franceschini, E. Maranzano, R. Umberto, N. Pierina, V. Scotti. [Extracted from the article]

Purpose/objective(s): MR-guided radiotherapy is a potential game changer in the field of radiation oncology, given the optimal visualization of the pelvic anatomy and the possibility to daily recalculate the plan based on real-time anatomy conditions. We report preliminary dosimetric data concerning the use of 1.5-T MR-guided daily-adaptive radiotherapy for abdomino-pelvic lymph-nodal oligometastases. We aimed to assess the impact of this technology on mitigating daily variations for both target coverage and organs-at-risk (OARs) sparing.Materials/methods: A total of 150 sessions for 30 oligometastases in 23 patients were analyzed. All patients were treated with MR-guided stereotactic body radiotherapy (SBRT) for a total dose of 35 Gy in 5 fractions. For each fraction, a quantitative analysis was performed for PTV volume, V35 Gy and Dmean. Similarly, for OARs we assessed daily variations of volume, Dmean, Dmax. Any potential statistically significant change between baseline planning and daily-adaptive sessions was assessed using the Mann-Whitney test, assuming a P-value < 0.05 as significant.Results: Median baseline PTV, bowel, bladder and single intestinal loop (in the case of targets very close to intestine) volumes were respectively 6.2cc (range, 0.7-41.2cc), 993cc (119-3654cc), 75cc (39.7-202.9cc), 15.7cc (9.1-37.7cc). No significant volume variations were detected for PTV (P = 0.17) bowel (P = 0.12), bladder (P = 0.14) and single intestinal loops (P = 0.21). Median baseline V35 Gy and Dmean for PTV were respectively 83.75% (72-98.8%) and 35.6 Gy (34.6-36.1 Gy). We recorded a positive trend in favor of daily-adaptive strategy vs baseline planning for improved target coverage (P = 0.06 and P = 0.07 for PTV-V35 Gy and PTV-Dmean). Concerning OARs, a significant difference was observed in favor of daily-adapted treatments in terms of single intestinal loop Dmax [26.9 Gy (13.2-26.9 Gy) at baseline vs 24 Gy (12.1-24 Gy); P = 0.014] and Dmean [16 Gy (6.518 Gy) at baseline vs 13.7 Gy (6.7-17.6 Gy); P = 0.0016]. For both bladder and bowel no significant differences were observed for Dmax and Dmean: for bladder, median Dmax was 15.3 Gy (0.4-34.3 Gy) at baseline vs 14.6 Gy (0.7-34.3 Gy), P = 0.24; median Dmean was 2.2 Gy (0.2-16.6 Gy) at baseline vs 2.2 Gy (0.2-16.4 Gy), P = 0.30. Similarly for bowel, no differences in terms of Dmax [28.7 Gy (7.7-34 Gy) vs 27.9 Gy (7.8-33.1 Gy); P = 0.06] and Dmean [4.3 Gy (1.3-10.9 Gy) vs 3.9 Gy (1.4-10.5 Gy); P = 0.25] were observed.Conclusion: Daily-adaptive MR-guided SBRT reported a significantly improved single intestinal loop sparing for lymph-nodal oligometastases. A minor advantage was also reported in terms of PTV coverage, although not statistically significant. The potentially improved safety profile of MR-guided SBRT may lead the way to propose ultra-hypofractionated schedules or single fraction treatments.Author Disclosure: F. Cuccia: None. M. Rigo: None. D. Gurrera: None. L. Nicosia: None. V. Figlia: None. N. Giaj-Levra: None. R. Mazzola: None. F. Ricchetti: None. G. Attinà: None. A. De Simone: None. S. Naccarato: None. G. Sicignano: None. R. Ruggieri: Honoraria; Elekta, Stockholm, Sweden. Consultant; Elekta, Stockholm, Sweden. F. Alongi: Honoraria; Elekta, Stockholm, Sweden. Consultant; Elekta, Stockholm, Sweden. [ABSTRACT FROM AUTHOR]