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Objectives: To characterize chest radiographic interpretations in a large population of patients who have received a diagnosis of acute pulmonary embolism and to estimate the sensitivity and specificity of chest radiographic abnormalities for right ventricular hypokinesis that has been diagnosed by echocardiography.Design: A prospective observational study at 52 hospitals in seven countries.Patients: A total of 2,454 consecutive patients who had received a diagnosis of acute pulmonary embolism between January 1995 and November 1996.Results: Chest radiographs were available for 2,322 patients (95%). The most common chest radiographic interpretations were cardiac enlargement (27%), normal (24%), pleural effusion (23%), elevated hemidiaphragm (20%), pulmonary artery enlargement (19%), atelectasis (18%), and parenchymal pulmonary infiltrates (17%). The results of chest radiographs were abnormal for 509 of 655 patients (78%) who had undergone a major surgical procedure within 2 months of the diagnosis of pulmonary embolism: normal results for chest radiograph often accompanied pulmonary embolism after genitourinary procedures (37%), orthopedic surgery (29%), or gynecologic surgery (28%), whereas they rarely accompanied pulmonary emboli associated with thoracic procedures (4%). Chest radiographs were interpreted to show cardiac enlargement for 149 of 309 patients with right ventricular hypokinesis that was detected by echocardiography (sensitivity, 0.48) and for 178 of 485 patients without right ventricular hypokinesis (specificity, 0.63). Chest radiographs were interpreted to show pulmonary artery enlargement for 118 of 309 patients with right ventricular hypokinesis (sensitivity, 0.38) and for 117 of 483 patients without right ventricular hypokinesis (specificity, 0.76).Conclusions: Cardiomegaly is the most common chest radiographic abnormality associated with acute pulmonary embolism. Neither pulmonary artery enlargement nor cardiomegaly appears sensitive or specific for the echocardiographic finding of right ventricular hypokinesis, an important predictor of mortality associated with acute pulmonary embolism. [ABSTRACT FROM AUTHOR]

Background: Pulmonary embolism (PE) remains poorly understood. Rates of clinical outcomes such as death and recurrence vary widely among trials. We therefore established the International Cooperative Pulmonary Embolism Registry (ICOPER), with the aim of identifying factors associated with death.Methods: 2454 consecutive eligible patients with acute PE were registered from 52 hospitals in seven countries in Europe and North America. The primary outcome measure was all-cause mortality at 3 months. The prognostic effect of baseline factors on survival was assessed with multivariate analyses.Findings: 2110 (86.0%) patients had PE proven by necropsy, high-probability lung scan, pulmonary angiography, or venous ultrasonography plus high clinical suspicion; ICOPER accepted without independent review diagnoses and interpretation of imaging provided by participating centres; 3-month follow-up was completed in 98.0% of patients. The overall crude mortality rate at 3 months was 17.4% (426 of 2454 deaths, including 52 patients lost to follow-up): 179 of 397 (45.1%) deaths were ascribed to PE and 70 of 397 (17.6%) to cancer, and no information on the cause of death was available for 29 patients. After exclusion of 61 patients in whom PE was first discovered at necropsy, the mortality rate at 3 months was 15.3% (365 of 2393 deaths). On multiple-regression modelling, age over 70 years (hazard ratio 1.6 [95% CI 1.1-2.3]), cancer (2.3 [1.5-3.5]), congestive heart failure (2.4 [1.5-3.7]), chronic obstructive pulmonary disease (1.8 [1.2-2.7]), systolic arterial hypotension (2.9 [1.7-5.0]), tachypnoea (2.0 [1.2-3.2]), and right-ventricular hypokinesis on echocardiography (2.0 [1.3-2.9]) were identified as significant prognostic factors.Interpretation: PE remains an important clinical problem with a high mortality rate. Data from ICOPER provide rates and highlight adverse prognostic categories that will help in planning of future trials of high-risk PE patients. [ABSTRACT FROM AUTHOR]

Poster: Physics track: Intra-fraction motion management PO-1658: Online-adaptive SRT with automated Organ At Risk contouring for abdominal oligometastases: Results J. Nuyttens, L. Visani, P. Granton, M. Milder. [Extracted from the article]

Poster: Clinical track: Haematology PO-0928: Safety and efficacy of concomitant RT and CDK4/6 inhibitors in metastatic breast cancer patients. L. Visani, C. Saieva, I. Desideri, V. Scotti, L. Dominici, E. Scoccimarro, M. Aquilano, C. Cerbai, V.E. Palmieri, V. Maragna, C. Becherini, M. Bernini, L. Sanchez, L. Orzalesi, J. Nori, L. Antonuzzo, S. Bianchi, I. Meattini, L. Livi. [Extracted from the article]

Proffered Papers: Proffered papers 17: GI OC-0336: Evaluation of bowel for online adaptive stereotactic radiotherapy of abdominal oligometastases J. Nuyttens, L. Visani, P. Granton, M. Milder. [Extracted from the article]

Deals with a study which examined the use of periduroscopy for diagnostic and therapeutic purposes. Background on the periduroscope; Methodology; Results and discussion.

Presents information on two experiments which investigated the precipitation phenomenon that occurs in clinical practice between two medicinal drugs, ketorolac thrometamine and morphine hydrochloride, used for treatment of cancer pain. Advantages of the use of continuous subcutaneous infusion for the therapeutic efficacy of medicinal drugs and for patients; Methodology; Results and discussion.

A phase II trial was conducted to assess the feasibility, safety, and activity of a single 21 Gy preoperative robotic radiosurgery (prRS) in early breast cancer patients, 50+ years old, hormonal receptors positive/human epidermal growth factor receptor 2 negative (HR+/HER2-), sized up to 25 mm. Breast surgery was performed 2 to 4 weeks after radiosurgery. A translational study was carried out to explore the modulation of tumor-immune microenvironment before and after irradiation and the transcriptome on tumor samples before irradiation. Among the 70 patients recruited, 22 patients were successfully treated with prRS. Fresh pre-treatment tumor biopsies and fresh post-radiosurgery and post-operative tumor samples were retrieved. For immunohistochemistry analysis, pre-radiosurgery biopsies and post-operative tumors were stained with specific antibodies to evaluate the expression of different immune-related biomarkers. For the transcriptome analysis, total RNA was extracted from frozen pre-treatment samples and RNA sequencing was performed by using a total of 10 ng/uL. The statistical analyses aiming at detecting differences in gene expression according to tumor downstaging were conducted by fitting age-adjusted linear regression models, and applying the false discovery rate (FDR) method for correcting for multiple tests. As clinical output, we considered tumor downstaging according to pTNM and patients were classified as Radio-Responders (R-R = 8) and non-Radio-Responders (nR-R = 13) after prRS. IHC was performed on available 19 pairs of pre- and post-irradiation tissues for evaluation of CD68, CD163, CD4, CD8, CD56 and CD16: preliminary analysis showed a marked increase in CD68, CD163 and CD4 staining after tumor prRS. RNAseq results showed 170 differentially expressed genes between R-R and nR-R. Statistical analysis identify CCDC97 and MDIFC as genes that were significantly up- and down-regulated respectively in R-R patients. CCD97 is an orphan gene previously described as part of a nuclear interactome with functional role in DNA damage repair, while MDFIC is reported to be associated with pro- or anti-tumoral functions as chemoresistance induction or cell proliferation inhibition. The phase II trial enrolled 22 patients; this little number limits the statistical power of results obtained in the translational analysis. Based on the preliminary results, IHC analysis showed that prRS modulates the immune microenvironment composition in early breast cancer patients. Furthermore, we hypothesized that the differential expression of CCDC97 and MDFIC may play a role in prRS response. The role of orphan genes CCDC97 and MDFIC in response to radiation and to hypofractionation makes worthy further pre- and clinical investigations. [ABSTRACT FROM AUTHOR]

Poster: Clinical track: Lower GI (colon, rectum, anus) PO-1107: Impact of fractionation on the treatment of squamous cell anal cancer: a dual-institution experience M. Vernaleone, P. Bonomo, B. Meduri, G. Caramia, G. Aluisio, L. Visani, I. Desideri, C. Becherini, E. D'Angelo, L. Livi, F. Lohr. [Extracted from the article]

Les effets secondaires liés à la radiothérapie sont habituellement rapportés par les médecins à la place des patients. Les patient-reported outcomes (PROs) s'utilisent de plus en plus en clinique et dans des essais. Dans le cadre de développement d'une application pour évaluer des PROs électroniques (ePROs), le young Radiation Oncology Group (yROG) de l'European Organization for the Research and Treatment of Cancer (EORTC) a mené une enquête pour évaluer l'utilisation, l'acceptation et les bénéfices ressentis des PROs et quantifier ses caractéristiques souhaitables. L'enquête a été adressée à des médecins, des manipulateurs en électroradiologie et des infirmiers de 26 pays qui traitent des patients par irradiation. Cette enquête d'accès publique en ligne incluait 40 questions qui cotaient les caractéristiques des ePROs sur une une échelle Likert bipolaire à 5 points, allant de 1 (peu important) à 5 (très important). Les sous-groupes ont été comparés par le test de Mann-Whitney-Wilcoxon. L'enquête était promue par les newsletters du réseau l'EORTC et les sociétés savantes nationales de radiothérapie. Entre juillet et décembre 2018, 367 réponses ont été recues, dont 354 éligibles comportant 4,5 % réponses francaises, le sixième pays le plus participatif après l'Allemagne (24,3 %), l'Italie (13,3 %), la Chine (12,2 %), le Danemark (11,6 %), et Israël (9,9 %). En France les PROs étaient utilisés dans un quart des réponses (contre 42,4 % des réponses des autres pays ; p < 0.001). Cent pour cent des français ayant répondu utiliseraient des ePROs en routine clinique si elles étaient disponibles (autres pays : 96,9 %). Les ePROs étaient considérés plus avantageux pour des traitements curatifs avec une moyenne de 4,53 points. La France est le pays qui a le mieux valorisé la cotation des effets secondaires aigus (en moyenne : 4,87 points ; autres pays : 4,44 ; p = 0,08), mais parmi les pays, elle valorise moins le rappel aux patients de remplir les ePROs, sans différence significative (moyenne 3,60 points ; autres pays :3,99 ; p = 0,39). L'utilisation des PROs en France est significativement moins importante qu'internationalement. Tous les répondeurs français utiliseraient un ePRO en routine s'ils y avaient accès. [ABSTRACT FROM AUTHOR]

Poster discussion: Radiobiology PD-0067: An ex vivo assay to detect radiosensitization by PARP-inhibitors in soft tissue sarcomas M. Mangoni, G. Salvatore, D. Greto, M. Sottili, C. Talamonti, V. Lorenzetti, M. Aquilano, A. Peruzzi, V. Salvestrini, L. Visani, P. Bonomo, M. Scorianz, F. Muratori, G. Scoccianti, D.A. Campanacci, L. Livi. [Extracted from the article]