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P178 Carbon-Ion radiotherapy for malignant gynecological melanoma
  1. A Barcellini1,
  2. V Vitolo1,
  3. R Lazzari2,
  4. F Consoli3,
  5. A Ditto4,
  6. A Facoetti5,
  7. P Fossati1,
  8. MR Fiore1,
  9. B Vischioni1,
  10. A Iannalfi1,
  11. C Laliscia6,
  12. A Mirandola7,
  13. A Vai7,
  14. E Mastella7,
  15. A Gadducci8,
  16. F Raspagliesi4,
  17. L Preda9,10,
  18. R Orecchia1,11 and
  19. F Valvo1
  1. 1Radiation Oncology, National Center of Oncological Hadrontherapy (CNAO), Pavia
  2. 2Radiation Oncology, European Institute of Oncology, Milan
  3. 3Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia
  4. 4Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan
  5. 5Radiobiology, National Center of Oncological Hadrontherapy (CNAO), Pavia
  6. 6Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Pisa
  7. 7Medical Physics, National Center of Oncological Hadrontherapy (CNAO), Pavia
  8. 8Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa
  9. 9Radiology, National Center of Oncological Hadrontherapy (CNAO)
  10. 10Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia
  11. 11European Institute of Oncology, Milan, Italy


Introduction/Background We analyzed early clinical outcomes of carbon ion radiotherapy (CIRT) in the first patients with gynecological malignant mucosal melanoma(g-MMM) treated at CNAO.

Methodology Between 2016 and 2018, 9 patients(pts) with g-MMM were treated with CIRT after surgery or in exclusive settings (table 1) . They had 7 vaginal(VaM),1 cervical(CM) and 1 vulvar(VuM)MMM. One pt with VaM had been previously irradiated with photons;8 pts are considered inoperable and 1 pt underwent adjuvant CIRT on the small pelvic space after radical surgery without lymphadenectomy. Two pts underwent neoadjuvant and sequential anti-PD-1 immunotherapy. Because of the large volume of macroscopic disease,CM and VuM patients were irradiated with up to a total dose of 28 GyRBE(3 fractions) and 68.8 GyRBE(16 fractions), respectively, to the Clinical Target Volume (CTV) defined as the Gross Tumor Volume (GTV)+uterine cervix and corpus for the CM and GTV+vulva for the VuM. For inoperable VaM, small pelvic space including GTV was irradiated with up to a total dose of 38.7-43 GyRBE followed by a GTV boost of up to a total dose of 68.8 GyRBE in 16 fractions (figure 1). All patients were treated with synchrotron-based scanning carbon ion beams. Early clinical and toxicity profile(according to CTCAE V4.03) were evaluated.

Results Treatment was well tolerated and no interruption was needed. For the evaluable pts, toxicity profile was favorable and no G≥2 acute/late toxicities were observed. Overall,for pts with a follow-up≥3 months,median LC ranged from 3 to 13 months( <for VuM and CM), median MFS and median OS was 6.5 (range: 3–23) and 9 months (range: 3–29.5) respectively. Data are still ongoing.

Conclusion Because of the high rate of distant metastasis and unsatisfactory survival benefit, a more conservative treatment approach, instead of extensive surgery, may be warranted. We think that CIRT may serve as a definitive treatment choice for patients with g-MMM.

Disclosure Nothing to disclose.

Abstract P178 Figure 1

Case of vaginal MMM received CIRT and dose distribution

Abstract P178 Table 1

Patient, tumor and treatment characteristics

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