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S624
ESTRO 36
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Purpose or Objective
To investigate if a relationship exists between the dose
volume parameters leading to moderate oesophagitis in
early breast cancer patients receiving radiotherapy to
both the breast and supraclavicular nodes (SCF).
Oesophagitis has been widely reported in treatment sites
such as lung and head and neck, however there is limited
data for breast cancer patients.
Material and Methods
Seventy-seven breast cancer patients receiving
radiotherapy to their breast and SCF were recruited for
the study. Patients were prescribed 50Gy to the breast or
chest wall and SCF +/- a simultaneous integrated boost to
the tumour bed of 57Gy. Analysis of the dose volume
histogram (DVH) data of the irradiated volume of the
oesophagus was performed. Patients were graded twice
weekly with a modified RTOG oesophagitis scale to
determine the onset, duration and severity of reported
oesophagitis. Patients who experienced a grade 1B or
worse by the end of their treatment were followed up
twice weekly until the symptoms of oesophagitis had
resolved.
Results
From the 77 patients analysed, 2 patients had no reaction,
22 patients reached a grade 1A reaction, 30 patients
reached grade 1B, 16 patients reached grade 2A and 7
patients reached grade 2B. The onset of each grade
reached throughout the treatment showed those who
reached a maximum grade of 1B, did so at an average of
13 fractions. Patients that reached a maximum grade of
2A, reached grade 1B at 10 fractions and 2A at 18
fractions. Patients that reached a maximum grade of 2B
reached the 1B grade at just 8.3 fractions, the 2A at 14
fractions and the 2B at 21.7 fractions suggesting the faster
the onset, the worse the outcome for the patient. The
average mean dose to the oesophagus for patients that
had a maximum grade of 0-1A was 31.95Gy, 1B was
32.46Gy, 2A was 34.22Gy and 2B was 34.64Gy. The
average maximum doses recorded for 0-1A was 49.86Gy,
1B 50.44Gy, 2A 50.36Gy and 2B 51.26Gy; maximum doses
did not seem to have an impact on the incidence of
oesophagitis, however the mean dose showed a steady
increase from grade 0-1A up to 2B. Also recorded was the
mean dose delivered at each grade, based on when the
patient reported the changes.
Figure 1 Difference in the average mean dose between
grades 1 and 2
The graph (Figure 1) shows between grades 1A-1B there
is almost a plateau and similarly between grade 2A-2B,
however there is a sharp increase between grade 1B-2A,
suggesting a potential limiting mean dose of 32Gy.
Conclusion
Moderate oesophagitis is prevalent in breast cancer
patients receiving radiotherapy to the SCF. Limiting the
mean oesophageal dose to 32Gy could decrease the
severity of oesophagitis in these patients.
EP-1148 Distress and self-awareness of disease severity
in early breast cancer: two Institutions comparison
I. Meattini
1
, T. Zagar
2
, G. Francolini
1
, A. Deal
2
, G. Carta
1
,
J. Camporeale
2
, L. Terzo
2
, L. Livi
1
, O. Kaidar-Person
2
1
Azienda Ospedaliero Universitaria Careggi - University
of Florence, Radiation Oncology Unit - Oncology
Department, Florence, Italy
2
University of North Carolina, Department of Radiation
Oncology, Chapel Hill, USA
Purpose or Objective
Coping with cancer, even in the curative setting, may lead
to emotional and psychological distress. However,
resilience is dependent on many factors including social
support and ethnic/cultural coping strategies. The aim of
this multicenter retrospective study is to evaluate the
distress among curative breast cancer (BC) patients in two
different continents: USA and Europe.
Material and Methods
We collected data from medical records of early BC
patients treated with curative intent at the Florence
University Hospital (FUH; Italy) and at the University of
North Carolina (UNC; USA) seen between November 2014
and December 2015. Data included demographics, stage,
BC subtype, treatment received, referral to supportive
services (SP), and use of mood/anxiety lytic and sleep
medications (meds). Patients with inoperable or
metastatic disease, known psychiatric disorder, or
recurrent/synchronous cancer were excluded from this
study. The use of SP and meds were compared between
the two cohorts using Wilcoxon, Fisher´s exact, and
Jonckheere–Terpstra
tests. Adjusted relative risks (RR)
were estimated using Poisson regression.
Results
In patients treated at FUH (n=110), rate of SP referral and
use of meds was not significantly influenced by adjuvant
or primary systemic therapy (PST), type of surgery
(mastectomy versus conservative surgery), regional nodal
irradiation (RNI) or use of boost, T or N stage. Patients
treated at UNC (n=121) who received mastectomy had
higher rates of SP vs BCT (62% vs 35%)p=0.02). The use of
meds was significantly higher in patients who received
adjuvant chemotherapy and RNI. Both SP referral and use
of meds were significantly associated with increasing T
stage (p=0.03 and p=0.003, respectively) and N stage
(p=0.03 and p=0.0004, respectively). Younger UNC
patients (age <60 years) had a significantly higher rate of
meds use (55% vs 33%, p=0.02). UNC patients had a
significantly higher rate of SP referral (41% vs 29%,
p=0.003), meds (44% vs 18%, p<0.0001), PST (p=0.03),
mastectomy (p=0.002), RNI (<0.0001), and tumor bed
boost administration (p=0.03) compared to FUH. After
adjusting for age, subtype, T stage, surgery, and PST: UNC
patients remained significantly more likely to refer to SP
(RR=1.7)
and
to
receive
meds
(RR=2.4).