ESTRO 38 Abstract book

S1215 ESTRO 38

the breast. 56 patients (27%) reported acute G2/G3 toxicity; 35 pts. in the ipsilateral axillary area and submammary line, 21 patients recorded (10% of total) G2 toxicity but affecting the whole breast. In any case, the presence of hot areas only in some points did not allow us to understand the onset of toxicity on the whole mammary area. From these data for this group of patients it was necessary to use a more aggressive topical therapy. No patient discontinued treatment. The post-treatment cosmetic result at a median follow-up of 8 months showed no permanent damage. Conclusion The possibility of having an instrument such as DVH to predict acute toxicity also allows to put in action for selected patients those actions useful to avoid the toxicity onset, first of all with the use of new treatment methods able to limit the number of hot spots. The combination of clinical and radiotherapy techniques knowledges allows the identification of new methodological approaches to avoid functional imperfections and limitations, limited to the duration of treatment. The 3D conformational technique used by us has allowed a decrease in toxicity compared to the data reported in the literature, but does not always allow homogeneity of the treatment. Even the continuous use of topical supportive therapy should not be underestimated. EP-2204 The impact of breast irradiation using thermoplastic mask on quality of life A. DINU 1 , T. Flonta 1 , L. Marcu 2 1 County Hospital "Gavril Curteanu", Radiotherapy, Oradea, Romania; 2 Faculty of Science- University of Oradea- Romania School of Physical Sciences- University of Adelaide- Australia, Medical Physics, Oradea- Adelaide, Romania Purpose or Objective The critical role of thermoplastic mask in patient immobilization during breast irradiation is well known. However, these immobilizing casts can have a buildup effect which augments the skin dose, thus leading to unwanted adverse events. The purpose of this study is to evaluate these adverse events and their impact on patient’s quality of life (QoL). Material and Methods For patients with large and pendulous breasts the prone setup represents the ideal solution for an accurate immobilization, which can be achieved either with a designated board or using thermoplastic masks. The study included 42 patients, between the ages of 32-60, where 21 patients were irradiated with the mask, while the other 21 underwent breast irradiation without mask. Dose prescription for both groups was 50Gy in 25 fractions to the whole breast CTV and boost dose to the tumour bed of 60 Gy in 25 fractions. At the start of therapy all patients were informed about possible adverse events, particularly of radiodermatitis, as well as other risk factors (sun exposure, smoking, the use of inadequate ointments on the lesion). During the course of treatment, the radiation therapists used both verbal questioners and physical examination of the irradiated skin to be assured that the physicians’ recommendations were followed. The main targeted aspects were: (1) the grade and time interval to radiodermatitis, (2) the impact of radiodermatitis on patient’s quality of life. Radiodermatitis was visually evaluated using the RTOG criteria Results Without thermoplastic mask, skin erythema developed after 10-14 days from the start of treatment, all patients developing grade 1/2 radiodermatitis by the end of therapy. When irradiated with the thermoplastic mask, skin erythema was installed after the 7 th day of treatment, grade 1 radiodermatitis after 26-30Gy, while by the 4 th treatment week grade 2 radiodermatitis was present in all patients. By the end of treatment, 3 patients (14.3%)

couples and sexuality, 3) impact of treatment on sexuality, 4) relationship doctor-patient before BRT. Results Evaluable 199 pts.; median follow up 44 months (range 8- 93); median age 62 years (40-88). Histological examination resulted 5 squamous and 194 adenocarcinoma; grading G1 for 15%, G2 for 65% and G3 for 20% of cases; all stage pT1B; lymph node status Negative in 149 (75%) and NX in other 50 (25%). Diameter of the cylinder used in 168 (84%) pts. it was 3-4 cm the remaining 31 (26%) diameter 1-2. Only 3 (1.5%) pts. disease progression. Psychological evaluation performed on 142 pts. (median age 61, range 44-71) the rest 57 not interested because not sexual active. Two groups: 69 CBRT vs 73 pts. SuBRT. First area the change of social activity recorded as "very, very much" was 33 of CBRT vs 22% of SuBRT, in the emotional state we found 42 of CBRT vs 29 % SuBRT. Second area: intimacy of couple; 71 vs 49% said they had undergone change; with repercussions on her relationship 49 vs 32 % and 81 vs 48 % of women reported decreased sexual desire. Third area impact on sexuality: BRT changed your sex life? 46 vs 21% of SuBRT "very, very much”. With sexual intercourse painful for 73 vs 48 % of the interviewees and to the question "Are sexual relations satisfactory?" 91 vs 60 % of respondents answered “NO”. Fourth area when we asked "Have you been informed that BRT could have an impact on sexuality?" 58 vs 80% of the patients answered "YES" while at the question "Did they advise you to have sex with your partner?" 71% vs 81 of the women received these indications. Unexpectedly, 13 vs 1 % SuBRTof patients explicitly requested psychological support. Conclusion Regardless of grading and lymph node depletion, BRT is effective in preventing disease recurrence. Although cylinders with larger diameter are used, the problem of post BRT toxicity management remains. Introduction of supportive therapy during treatment and best patient doctor relationship reduced the impact on quality of life of these patients. EP-2203 DVH as predictor of acute skin toxicity, its clinical application in breast cancer radiotherapy F. Piro 1 , D. Cosentino 1 , A. Martilotta 1 , A. Massenzo 1 , U. Piro 1 , G. Tocci 1 , L. Marafioti 1 1 Ospedale Mariano Santo, Radiotherapy Center, Cosenza, Italy Purpose or Objective The correlation between acute cutaneous toxicity and homogeneous dosimetry in breast cancer radiotherapy is now certain. For this reason, using the 3D conformational technique, we reviewed the dosimetry and DVH of each patient and recorded during the treatment the possible onset of acute cutaneous toxicity. Material and Methods from September 2017 to April 2018, 204 patients with breast cancer underwent 3D conformal radiotherapy on the breast. Tangential latero-medial technique, 6 MV photons, also using dynamic filters, two treatment schedules: single dose. 2.65 up to 42.40 Gy or single dose 2 to 50 Gy plus boost with electrons single dose 2.5 up to 10 Gy. So we evaluated the DVHs of each treated patient. Both during and after treatment, the onset, the location, and the degree of cutaneous toxicity were recorded. Results The evaluation of the DVH and of the dosimetry of each patient, regardless of the fractionation used, showed the presence of hot spots with respect to the prescribed dose for 51 of the 204 aforesaid patients even in the presence of normal dosimetrics for the remaining parameters that usually are considered. Reviewing the outlines made it was possible to highlight that the presence of such dose peaks may be due to various factors such as the size or shape of