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Elderly patients with malignant glioma have a poorprognosis and the benefit of standard radical radiotherapyis equivocal. Twenty-two percent of the adult referralbase with malignant glioma at our centre isof age 70 years or greater. A phaseII study was undertaken to determine if ashorter course of therapy yields a comparable mediansurvival to radical radiotherapy and thus constitutes anappropriate investigational palliative regimen.25 patients were accrued between 1988–1995, all ofwhom had histologically proven malignant glioma, 23 glioblastomamultiforme and 2 anaplastic astrocytoma. The median agewas 73 (range 70–78) and median Karnofsky PerformanceStatus (KPS) was 70. 40% had a stereotacticbiopsy only for diagnosis. Radiotherapy was delivered tolimited fields to a dose of 37.5 Gyin 15 daily fractions over 3 weeks. Anintention-to-treat analysis was undertaken with survival determined fromdate of initial consultation. The median survival ofthe whole group was 8.0 months (95% CI4.8–9.6). Patients with good performance status (KPS >70) had a median survival of 10.4 months(95% CI 9.6–14.7).37.5 Gy in 15 daily fractions appears toyield comparable median survival to that of otherseries of radical radiotherapy. A phase III studyof this regimen is recommended in investigating optimalpalliation of elderly malignant glioma patients.

What percentage of anal canal cancer patients present with extrapelvic visceral metastasis?

Traditionally, there has been a high local recurrence rate after radical surgery in rectal cancer, and 10–40% of patients require a permanent stoma. Both short-course preoperative radiotherapy (SCPRT) and long-course preoperative chemoradiation (CRT) are advocated to reduce this risk of local recurrence and enable a curative resection. The role of preoperative radiotherapy to facilitate sphincter sparing surgery remains highly contentious.

PurposeThe aim of the study is to evaluate the effect of a conformal irradiation in short fractionation scheme of 49.5Gy in 15 fractions in an overall time of 3weeks, in terms of overall survival (OAS) and progression free survival (PFS) rates in brain glioma patients.Patients and methodsA prospective study was conducted on 54 brain glioma patients and was carried out in the Radiation Oncology Department, South Egypt Cancer Institute, Assiut University during the period from April 2006 till June 2009. Patients were treated by hypofractionated conformal irradiation (49.5Gy/15 fractions/3weeks).ResultsThe median follow up was 23months (range: 9–39months). Two-year OAS and PFS rates were 68% and 60%, respectively. In univariate analysis, age >50years, poor performance status [Karnofasky score of ⩾40–⩽70%], poor neuroperformance status of score III, high-grade tumor [glioblastoma multiforme], and biopsy were all associated with statistically significant reduction in OAS and PFS rates. Multivariate analysis, showed that age >50years and glioblastoma pathology were the only independent prognostic factors that were associated with poor OAS (p=0.003 and p=0.004, respectively), and PFS (p=0.027 and p=0.011, respectively).ConclusionHypofractionated conformal radiotherapy was as effective as the conventional radiotherapy, with time sparing for patients, and for radiation oncology centers. Hypofractionated radiotherapy may be considered the radiotherapy regimen of choice in clinical practice for patients with gliomas.

Introduction Lymph node metastases is a significant prognostic indicator for disease recurrence in colorectal cancer (CRC) patients. The aim of this study was to assess the impact of short course radiotherapy (SCRT) and long course chemo-radiotherapy (CRT) on the number of lymph nodes retrieved for rectal cancer surgery and its ultimate outcome on disease recurrence. Method Data for patients who underwent surgery alone or received SCRT or CRT followed by surgery for resectable primary rectal cancer from January 2005 till December 2010 were analysed. The primary outcomes measured were the number of lymph nodes retrieved, their status and disease recurrence. Patients with metastatic disease and palliative resections were excluded. Results There were 434 patients. Of these 166 had surgery alone, 104 had short course radiotherapy and 164 had long course chemo-radiotherapy followed by surgical resection. The patients who received neo-adjuvant treatment were relatively younger. CRT decreased the retrieval of more than 12 lymph nodes, the median number of lymph nodes and the median number of metastatic lymph nodes as tabulated below (P Conclusion Low lymph node count after CRT for rectal cancer surgery reflects the sensitivity to neo-adjuvant treatment and does not signify inadequate resection. This is the lymph node metastases and not the number of lymph nodes retrieved that is the prognostic factor for disease free survival. Disclosure of interest None Declared.

Purpose: To investigate the suitability of short-course radiotherapy (RT) for spinal cord compression (SCC) in myeloma patients. Methods and Materials: Data for 172 myeloma patients irradiated between January 1994 and December 2004 for SCC were retrospectively evaluated. Short-course RT (1 × 8 Gy, 5 × 4 Gy, n = 61) and long-course RT (10 × 3 Gy, 15 × 2.5 Gy, 20 × 2 Gy, n = 111) were compared for functional outcome up to 24 months after RT. In addition, 10 potential prognostic factors were investigated. Results: Improvement of motor function occurred in 90 patients (52%). Forty-seven percent of nonambulatory patients regained the ability to walk. Functional outcome was significantly influenced by the time of developing motor deficits before RT. Improvement of motor function was more frequent after long-course RT than after short-course RT: 59% vs. 39% ( p = 0.10) at 1 month, 67% vs. 43% ( p = 0.043) at 6 months, 76% vs. 40% ( p = 0.003) at 12 months, 78% vs. 43% ( p = 0.07) at 18 months, and 83% v 54% ( p = 0.33) at 24 months. A subgroup analysis of the long-course RT group demonstrated a similar functional outcome for 10 × 3 Gy when compared with 15 × 2.5 Gy and 20 × 2 Gy. Conclusions: Long-course RT is preferable for SCC in myeloma patients because it resulted in better functional outcome than short-course RT. Treatment with 10 × 3 Gy can be considered appropriate.

Purpose: To investigate the intra-fraction motion in patients with early stage rectal cancer using cine-MRI. Methods: Sixteen patient diagnosed with early stage rectal cancer underwent 1.5 T MR imaging prior to each treatment fraction of their short course radiotherapy (n=76). During each scan session, three 2D sagittal cine-MRIs were performed: at the beginning (Start), after 9:30 minutes (Mid), and after 18 minutes (End). Each cine-MRI has a duration of one minute at 2Hz temporal resolution, resulting in a total of 3:48 hours of cine-MRI. Additionally, standard T2-weighted (T2w) imaging was performed. Clinical target volume (CTV) an tumor (GTV) were delineated on the T2w scan and transferred to the first time-point of each cine-MRI scan. Within each cine-MRI, the first frame was registered to the remaining frames of the scan, using a non-rigid B-spline registration. To investigate potential drifts, a similar registration was performed between the first frame of the Start and End scans.To evaluate the motion, the distances by which the edge pixels of the delineations move in anterior-posterior (AP) and cranial-caudal (CC) direction, were determined using the deformation field of the registrations. The distance which incorporated 95% of these edge pixels (dist95%) was determined within each cine-MRI, and betweenmore » Start- End scans, respectively. Results: Within a cine-MRI, we observed an average dist95% for the CTV of 1.3mm/1.5mm (SD=0.7mm/0.6mm) and for the GTV of 1.2mm/1.5mm (SD=0.8mm/0.9mm), in respectively AP/CC. For the CTV motion between the Start and End scan, an average dist95% of 5.5mm/5.3mm (SD=3.1mm/2.5mm) was found, in respectively AP/CC. For the GTV motion, an average dist95% of 3.6mm/3.9mm (SD=2.2mm/2.5mm) was found in AP/CC, respectively. Conclusion: Although intra-fraction motion within a one minute cine-MRI is limited, substantial intra-fraction motion was observed within the 18 minute time period between the Start and End cine-MRI.« less

620 Background: One of the reasons for avoiding sphincter-preserving surgery for lower rectal cancer is difficulty in obtaining a sufficient distal margin. Short-course radiotherapy (SRT) with immediate surgery is not expected to reduce tumor volume, and currently available evidence suggests that it does not increase the sphincter-preservation rate. However, SRT with delayed surgery has been linked to downsizing of the primary tumor during the waiting period. We evaluated the feasibility of sphincter-preserving surgery for T3 lower rectal cancer after SRT with delayed surgery and examined whether a distal margin of ≤ 5 mm has an impact on oncologic outcomes. Methods: We retrospectively studied 161 consecutive patients with lower rectal cancer located below the peritoneum reflection who underwent radical surgery with total mesorectum resection (TME) 3 to 4 weeks after the completion of SRT. The median follow-up was 53.5 months. Results: Sphincter-preserving surgery was performed in 149 (92.5%) of the 161 patients. The procedures were as follows: double-stapling technique, 58 patients; intersphincteric resection, 91; abdominoperineal resection, 10; and Hartmann operation, 2. Among the patients who underwent sphincter-preserving surgery, the distal margin was ≤ 5 mm in 41 patients and > 5 mm in 108. The local recurrence rate was respectively 5.8% vs. 10.4% (p = 0.606), the recurrence-free survival 83.4% vs. 82.8% (p = 0.682), and the overall survival at 5 years 82.3% vs. 87.6% (p = 0.418). Our results suggested that there is no difference in long-term outcomes between a distal margin of ≤ 5 mm and > 5 mm. Conclusions: Sphincter-preserving surgery was performed in 92.5% of patients with T3 lower rectal cancer who received SRT with delayed surgery. Our results confirmed the long-term oncologic feasibility of sphincter-preserving surgery with a distal margin of ≤ 5 mm; there was no negative impact on long-term outcomes such as local recurrence, recurrence-free survival, and overall survival.

The management of patients with locally advanced rectal cancer (LARC) has evolved with the aim of reducing local recurrence and improving survival. Current practice has developed from refinements in surgical technique, the availability of different types of preoperative imaging, the selective or blanket use of neoadjuvant treatment (usually radiation) and sophisticated efforts exploring multimodality treatments to achieve organ preservation. Both short-course preoperative radiotherapy (SCPRT) and long-course chemoradiation (CRT) are considered standard neoadjuvant strategies, which are advocated in different parts of the world. New techniques in the delivery of radiotherapy, such as intensity-modulated radiotherapy (IMRT), may allow more precise dosing to the target volume (tumour and/or locoregional lymph nodes) and limit radiation doses to critical normal structures; however, current schedules of SCPRT and CRT impact on late function, and if they do not improve survival in resectable cancers, can they be omitted in selected cases?

Introduction Two schemes for pre-operative radiotherapy (RT) in locally advanced rectal carcinoma (RC) are possible: long-course irradiation (45 – 50.4 Gy / 25 – 28 fr) with chemotherapy (CHT), followed by surgery after 6 to 8 weeks; and short-course irradiation (25 Gy / 5 fr), followed by surgery usually 1 week after. Some studies have shown a downstaging effect with delayed surgery in short-course irradiation Goal: Compare results of different irradiation schemes for neoadjuvant treatment of RC in a Radiation Oncology Department. Methods Patients with RC treated pre-operatively between 2002 and 2012 were included. RT was performed according to 2 schemes: long-course scheme (GROUP 1) using only RT (GROUP 1A), with oral CHT (GROUP 1B) or infusion CHT (GROUP 1C); and short-course scheme (GROUP 2). Results 265 patients were included, 227 in GROUP 1. GROUP 1A were older than GROUP 1B and 1C (p 1 week) there were significant differences in locoregional response (28.6% vs 75.0%, p = 0.033), with 2 complete responses in those with greater time to surgery. Conclusions These results are according to literature: long-course scheme with concomitant CHT provided better locoregional response, although with some acute toxicity; a higher time to surgery in short-course scheme appears to have better results, with no increase in surgical complications. Short-course irradiation with surgery delay appears to be a useful alternative to long-course radiochemotherapy, namely in patients with advanced age and associated comorbidities. Disclosure All authors have declared no conflicts of interest.

Pre-operative radiotherapy is being used to reduce local recurrence and improve survival following surgery for rectal cancer. A report by Nagtegaal et al. analyses the histopathological effects in a large, randomized study employing short course radiotherapy. In future, changes in some of these tumour parameters will have to be considered when auditing rectal cancer resections and identifying prognostic factors.

e14093 Background: Conventional chemoradiotherapy (CRT) or short course radiotherapy are most frequent regimens in the preoperative treatment for rectal cancer. Debate is still going on which is mo...

3651 Background: Patients with rectal cancer may be offered preoperative therapy. Regimens differ and include short course radiotherapy (25Gy) or long course chemoradiotherapy (CRT). The response t...

Preoperative short-course radiotherapy in locally advanced rectal cancer : The attitude on how to use radiotherapy in rectal cancer is changing

3512 Background: The MRC CR07 trial compared routine short course pre-operative radiotherapy (PRE) with selective post-operative chemo-radiation if there was involvement of the circumferential resection margin (CRM) (POST) and included a prospective pathological assessment of the quality of resection of the surgical specimen. Methods: A total of 1350 patients were randomised from 52 centres between March 1998 and August 2005. Median follow-up is 3 years. Trial pathologists were trained in histopathological assessment and reporting of the involvement of the CRM and plane of surgery (PoS) according to pre-set criteria describing the plane of dissection (Grade 1-muscularis plane: 2-intramesorectal plane: 3-mesorectal plane). 1232 patients were prospectively assessed for CRM and 1119 for PoS. Results: The CRM was involved (tumour ≤1mm) in 139 (11%) of resected specimens, and for these patients the 3-year local recurrence (LR), disease-free survival (DFS) and overall survival rates were 18%, 50% and 57%. For the 1093 patients with CRM-ve the respective rates were 7%, 81% and 84%. LR and DFS rates were associated with PoS (log-rank test p=0.0019 and p=0.0506 respectively), and in addition there was clear evidence of a reduction in LR and improvement in DFS rates in favour of PRE for all grades of quality of surgical assessment as shown in the table . Conclusions: The results indicate a strong association between the quality of surgery and the rates of local recurrence and disease-free survival, as well as a clear benefit from the addition of PRE to all grades of surgical dissection. Thus for patients with rectal cancer short-course pre-operative radiotherapy and good quality surgery can almost completely eliminate local recurrence. [Table: see text] No significant financial relationships to disclose.