Cancer is a major cause of morbidity and mortality in the LMIC of Africa. Prostate cancer specifically, despite the relative ease with which to diagnose and manage, is currently the commonest cause of cancer death in some African countries. Whilst such countries need to reflect on the infrastructure to improve outcomes, there are opportunities for relatively low-cost interventions to support professionals involved in the local care of such cancers through a program of site-specific training that includes the science of the disease and practical management. The IAEA is thus focusing on radiotherapy, both in the palliative and curative setting, with particular attention to practical experience in contouring of target volumes. We report here our experience. Three clinical experts from the UK and Canada in consultation with the IAEA and a continent specialty-lead agreed in advance on the learning objectives and clinical material to achieve this. Aside from pre-prepared seminar material, access to a web-based contouring platform for pre-course homework and contouring practicals were considered critical to the success of the teaching program. The course concluded in September 2019 and was evaluated by all the participants. Eleven countries were represented with 22 participants. 24 seminars of the 4½ day program were planned with 3 case-based discussions and 3 contouring workshops. Some sessions needed revision as the teaching faculty appreciated the local needs of the participants better once the course got underway. Most participants undertook the pre-contouring exercises of definitive prostate, post-operative prostate and nodal volumes. The contouring workshops were preceded by evidence-based guidelines. Examples were given by the clinical experts and where there was variation the rationale was explained. All attendees participated in the group sessions on contouring. Though the contours were anonymized, some participants requested and appreciated 1:1 tutorials to consolidate their learning. Contouring of target volumes and normal tissues were in some cases acceptable with minor revisions only required. The IAEA has been able to provide a bespoke training program on the science of prostate cancer management and practical skills specifically in the delineation of target volumes and normal tissues for radiotherapy planning. Though pre-planning of teaching material was essential there always needs to be scope to adapt a program to the learning objectives of individual participants once such an intensive course is underway. Practical contouring expertise was highly regarded. Access to a web-based platform for contouring obviated the need for bespoke contouring workstations and the logistical challenges that that brings. Expansion to other cancer sites of significance in LMIC are planned using the same methodology. Acknowledgement: Educase® for provision of its contouring platform.

We have performed a quality of life (QOL) substudy investigating change in patient reported outcomes (PROs) up to 5 years in the Conventional or Hypofractionated High Dose Intensity Modulated Radiotherapy in Prostate Cancer (CHHiP) trial. A total of 3213 men with localized prostate cancer were randomly assigned (1:1:1) to receive 74Gy in 37 fractions, 60Gy in 20 fractions or 57Gy in 19 fractions. A total of 2100 patients were recruited into the QOL substudy. UCLA Prostate Cancer Index (UCLA-PCI), Short Form (SF)-36 and Functional Assessment of Cancer Therapy-Prostate (FACT-P), or Expanded Prostate Cancer Index Composite (EPIC) and SF-12 quality-of-life questionnaires were completed at baseline and multiple time points up to 5 years post-radiotherapy. Analysis was on an intention-to-treat basis. Odds of change in symptoms (post-radiotherapy score at each time point minus baseline score) were compared between treatment arms using ordinal logistic regression; analysis of covariance was used to assess change over time for the domain scores, adjusting for baseline/pre-radiotherapy score. A total of 1138 (73%) of the expected 1557 forms were available at 5 years: 352 for 74Gy, 386 for 60Gy and 400 for 57Gy. There was no significant difference in the prevalence or cumulative incidence of patients with overall “moderate or big” bowel, urinary or sexual bother at 5-years between the three arms. There was no significant difference in the odds of "increase in score" from baseline to 5-years for overall bowel or urinary bother between the three arms (Table), and no evidence of an increase in bowel or urinary symptoms from 2 to 5-years. There was some evidence of a larger deterioration in overall sexual function in the 74 Gy arm compared to both hypofractionated arms, which was most marked for sexual bother (Table). Sexual function appeared to deteriorate across all arms between 2 and 5-years. There were no significant differences in general QOL domain scores between arms at 2 and 5 years. Change in bowel or urinary symptoms up to 5 years was similar between the treatment schedules in the CHHiP trial, but there was evidence of less decline in sexual function for the hypofractionated arms compared with the control arm. This supports the use of moderately hypofractionated radiotherapy for localized prostate cancer.Abstract 2; TableOrdinal logistic regression to show odds of "increase in score" from baseline to 5 years for each paired comparison of treatment groupsItemComparisonOdds ratio (99% CI)P-ValueOverall bowel bother60 Gy vs 74 Gy 57 Gy vs 74 Gy 57 Gy vs 60 Gy0.78 (0.52, 1.18) 0.75 (0.50, 1.12) 0.96 (0.64, 1.44)0.12 0.06 0.80Overall urinary bother60 Gy vs 74 Gy 57 Gy vs 74 Gy 57 Gy vs 60 Gy1.00 (0.67, 1.50) 1.08 (0.72, 1.61) 1.09 (0.73, 1.62)>0.99 0.62 0.58Overall sexual bother60 Gy vs 74 Gy 57 Gy vs 74 Gy 57 Gy vs 60 Gy0.55 (0.30, 0.99) 0.52 (0.29, 0.94) 0.95 (0.53, 1.70)0.009 0.004 0.82 Open table in a new tab

OBJECTIVE:A study of interobserver variation in the segmentation of the post-operative clinical target volume (CTV) and organs at risk (OARs) for parotid tumours was undertaken. The segmentation exercise was performed as a baseline, and repeated after 3 months using a segmentation protocol to assess whether CTV conformity improved.METHODS:Four head and neck oncologists independently segmented CTVs and OARs (contralateral parotid, spinal cord and brain stem) on CT data sets of five patients post parotidectomy. For each CTV or OAR delineation, total volume was calculated. The conformity level (CL) between different clinicians' outlines was measured using a validated outline analysis tool. The data for CTVs were re-analysed after using the cochlear sparing therapy and conventional radiation segmentation protocol.RESULTS:Significant differences in CTV morphology were observed at baseline, yielding a mean CL of 30% (range 25-39%). The CL improved after using the segmentation protocol with a mean CL of 54% (range 50-65%). For OARs, the mean CL was 60% (range 53-68%) for the contralateral parotid gland, 23% (range 13-27%) for the brain stem and 25% (range 22-31%) for the spinal cord.CONCLUSIONS:There was low conformity for CTVs and OARs between different clinicians. The CL for CTVs improved with use of a segmentation protocol, but the CLs remained lower than expected. This study supports the need for clear guidelines for segmentation of target and OARs to compare and interpret the results of head and neck cancer radiation studies.

LBA6006 The full, final text of this abstract will be available in Part II of the 2009 ASCO Annual Meeting Proceedings, distributed onsite at the Meeting on May 30, 2009, and as a supplement to the June 20, 2009, issue of the Journal of Clinical Oncology. [Table: see text]