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Background Salvage radiotherapy (SRT) is a potentially curative option for patients with rising PSA (biochemical recurrence) after radical prostatectomy. Recently, success rates of SRT were significantly improved through the use of concomitant anti-androgen (AAT) or androgen-deprivation (ADT) therapy. In RTOG 96-01, 2 years of bicalutamide 150 mg resulted in a 5% OS benefit at 12-years. In GETUG-AFU 16, 5-year progression-free survival was significantly improved when SRT was combined with 6 months of an LHRH agonist. Based on GETUG-AFU 16, most European urologists and (radiation) oncologists now combine SRT with at least 6 months of ADT. However, ADT comes with several serious side-effects, both physical (cardiovascular, metabolic, musculoskeletal) and psychological (sexual, emotional and cognitive). Considering RTOG 96-01, and in view of new AAT options, it appears worthwhile to look for alternatives. In that respect, apalutamide (ERLEADA®), a next-generation anti-androgen, is an interesting candidate. Trial design This is a phase II randomized, open-label study comparing SRT in combination with 6 months of LHRH (ant)agonist (arm A) versus 6 cycles of apalutamide 240 mg daily (each cycle is 28 +/- 2 days) (arm B) in hormone-naive patients with biochemical recurrence (PSA > 0.1 µg/L at least 8 weeks after radical prostatectomy). Patients with severe erectile dysfunction are excluded. All subjects will receive SRT as standard of care and will be randomly assigned in a 1:1 ratio to arm A or B. Primary objective is to compare sexual function, based on the EPIC-26 sexual domain score, at 9 months (i.e. 3 months after the end of hormonal treatment). Secondary endpoints include general quality of life (EPIC-26, EORTC QLQ C30 and PR25, FACT-P), acute as well as late toxicity (CTCAE version 5.0), and PSA (complete) response rates (i.e. decline from baseline in PSA level of 80% (90%) or greater). The trial was approved by the local ethics committee on April 2nd 2019 and started recruiting immediately thereafter. Clinical trial identification NCT03899077; 2018-004365-13. Legal entity responsible for the study GZA Hospitals. Funding Janssen. Disclosure All authors have declared no conflicts of interest.

Purpose/objective To report on toxicity, resection rate and outcome after IMAT ± cisplatin for primary irresectable cervical cancer. Material/methods Fourty one patients with Figo IIB-IVA cervix carcinoma were treated with IMAT ± cisplatin pre-operatively. Pre-treatment work-up included clinical examination and imaging (18FDG-PET/CT and MRI). IMAT dose prescription was as follows: 62 Gy and 60 Gy (Dmed) to the primary tumour and PET/CT-positive lymph nodes respectively; 58 Gy and 56 Gy (Dmed) to CTV (uterus, cervix, upper vaginal 1/3 to 1/2 and parametria) and its PTV; minimal dose of 45 Gy to pelvic lymph nodes. IMAT was delivered in 25 fractions, resulting in a SIB. Within 4 weeks after IMAT, tumour resectability was assessed clinically and radiologically. Wertheim-Meigs hysterectomy was performed within 6-8 weeks after end of IMAT. If irresectable, brachytherapy (BT) was performed. Acute toxicity was scored weekly during IMAT and 1 and 3 months thereafter. Late toxicity scoring started ≥ 6 months after ending IMAT and was scored 3 monthly during the first 2 years, and 6 monthly thereafter. Disease control was evaluated clinically (3-monthly) and with imaging (6-monthly). Results 7/41(17%) were inoperable because of progression (2/7), insufficient response (4/7) or reduced general condition (1/7. Pathology revealed complete response in 14/34 (41%). Surgical margins were free of disease in all cases. There was no postoperative mortality and no excess in morbidity. One patient needed a re-intervention due to large lymphocoeles. At 3 years OS and DFS were 81% and 91% respectively in the wertheim group. Non of patients in the brachytherapy group survived 3 years. Conclusion Wertheim surgery following IMAT ± cisplatin is associated with no mortality and acceptable morbidity IMAT has low toxicity and is excellent in rendering irresectable cervical cancer resectable. Disclosure All authors have declared no conflicts of interest.

Background and aims To asses the palliative effect of WAPRT using IMAT for patients with chemotherapy-resistant ovarian cancer. Methods Forty-two patients were treated (33Gy; 22 daily fractions). At referral, median [range] age and Karnofsky performance score (KPS) was 59y [31 -76] and 80 [40-90]. Disease-related symptoms were: intestinal (sub)-obstruction (n = 22), minor gastro-intestinal symptoms (n = 2), pain (n = 20), ascites (n = 11), and vaginal bleeding (n = 2). Median [range] CA125 serum level was 421 U/ml [6-13796]. All patients were heavily pre-treated. The actuarial overall survival (OS) and abdominal progression free survival (aPFS) were calculated from the start, response duration from the end of treatment. Results Response rates (completed treatments; n = 30): The median [range] response duration (all symptoms) was 16 weeks [0-139]. For the whole population median [range] OS and aPFS was 4 months [0-32] and 11 weeks [0-142]. For those patients who completed treatment median [range] OS and aPFS was 8 months [2-32] and 17 weeks [4-142]. Patients with a KPS ≥70 ended the treatment significantly more (p Conclusion WAPRT offers important palliation for peritoneal metastasized /platinum resistant ovarian cancer patients. It can resolve intestinal obstruction for a substantial period. Carefull patient selection is mandatory (KPS ≥ 70). Disclosure All authors have declared no conflicts of interest.