ESTRO 36 Abstract Book

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S625 ESTRO 36
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Conclusion
The rate of SP referral and the use of meds were higher in
USA cohort versus the cohort from south of Europe. The
reasons for these differences might be related to social
and cultural differences, rather than availability of
medications.
EP-1149 Omission of completion axillary lymph node
dissection in patients underrepresented in ACOSOG
Z11
B. Gebhardt1, Z. Horne1 , G. Ahrendt2, E. Diego2, S.
Beriwal1
1 University of Pittsburgh Cancer Institute, Radiation
Oncology, Pittsburgh, USA
2 University of Pittsburgh Cancer Institute, Surgical
Oncology, Pittsburgh, USA
Purpose or Objective
ACOSOG Z0011 demonstrated that axillary lymph node
dissection (ALND) can be omitted in patients (pts)
managed with breast conserving surgery (BCS) and 1-2
positive sentinel nodes (SLN) without adverse effects on
loco-regional control (LRC) or survival. Adjuvant
radiotherapy (RT) fields in this trial were heterogeneous
and included high tangents in half of pts and a 3rd nodal-
directed field in one-third of pts. Most pts enrolled in Z11
were post-menopausal with hormone receptor positive
breast cancer and axillary micrometastases. We
investigated breast cancer ptswith clinicopathologic
features underrepresented Z11 and analyzed RT patterns
and clinical outcomes.
Material and Methods
We retrospectively reviewed the records of pts who
underwent BCS with positive SLNS but not undergoing
ALND and who completed adjuvant RT. Eligible patients
had T3 tumors, >2 positive SLNs, invasive lobular
carcinoma, triple negative receptor status, extracapsular
extension (ECE), positive surgical margins, Nottingham
Grade 3, or age <50 years. Binary logistic regression was
used to examine association of pt characteristics with
delivered RT fields. Disease-free survival (DFS) and LRC
were assessed using the Kaplan-Meier method and log-rank
test for association with risk factors.
Results
We identified 106 pts treated from July 2011 to July 2016.
The median follow-up among living pts was 28 (range, 1-
62) months. Nineteen (17.9%) pts were treated with
whole-breast irradiation only, and 87 (82.1%) were treated
with modified tangential fields covering axillary level I/II.
Thirty-four (32.1%) pts received comprehensive nodal RT
including a 3rd supraclavicular (SCV) field. Fifty-two
(49.1%) pts received adjuvant chemotherapy. There were
43 (41%) pts with ECE and 43 (41%) with Grade 3 disease.
Complete patient characteristics are included in Table 1 .
There were trends toward significance with use of a 3 rd
SCV field and pN1a disease (p=0.062), increased tumor
size (p=0.062), and positive ECE (p=0.077). The overall
rates of 2-year DFS and LRC were 95.1% and 98.9%,
respectively. One patient experienced an internal
mammary nodal recurrence, 1 contralateral breast tumor,
and 2 distant metastases. There were no axillary or
ipsilateral breast tumor recurrences. Factors associated
with decreased DFS on univariate analysis include Grade 3
disease (p=0.021) and use of a SCV field (p=0.008).
Conclusion
This retrospective analysis of pts undergoing BCS and SLN
biopsy with positive SLNs included pts who were
underrepresented or excluded from the Z11 trial yet
demonstrated comparable rates of LRC and DFS.
Nottingham Grade 3 disease and use of a 3 rd SCV field were
associated with decreased DFS, though the apparent
detrimental effect of SCV treatment was likely due to
greater adverse risk factors causing pts to be selected for
more intensive treatment. The high rates of LRC and DFS
suggest that completion ALND may be safely omitted in
this patient population, though prospective data is needed
to confirm this finding.
EP-1150 Preliminary results of Intra-Operative
RadioTherapy in old women with good prognostic
features
S. Guillerm 1, E. Bourstyn2, R. Itti1, I. Fumagalli1, V.
Martin 1, L. Cahen-Doidy2, L. Quero 1, S. Giacchetti2, C.
Cuvier 2, M. Espié2, C. Hennequin1
1Hôpital Saint-Louis, Department of Radiation Oncolgy,
Paris, France
2Hôpital Saint-Louis, Breast Cancer Unit, Paris, France
Purpose or Objective
In women > 65 yrs with good prognostic features (Isolated
tumour <3 cm, infiltrative ductal carcinoma (IDC),
presence of Estrogen Receptors ER+, pN0), adjuvant RT
increases the local control but do not improve overall
survival1. One possible alternative is to perform RT during
surgery to minimize patient’s travels and cost.
1 Hughes, JCO 2013; 31:2382-2387; Kunkler, Lancet Oncol
2015; 16: 266–73
Material and Methods
we reviewed our experience with Intra-Operative
RadioTherapy (IORT) for this population. All patients had
histologically confirmed breast cancer before surgery and
were judged eligible for IORT (Isolated IDC less than 3 cm,
ER+). Surgery consisted in sentinel lymph node dissection
(SNLD) with intraoperative touch imprint cytology and
lumpectomy. IORT was performed only in case of negative
SLND. It consisted in a radiation dose of 20 Gy delivered
with 50 kV photons (Intrabeam®, Zeiss).
Results
Between October 2012 and February 2015, 76 pts with pre-
operative good prognostic features were planned to have
IORT. Seven pts did not have it (positive SNLD: 4pts;
multifocality: 3pts). For the remaining 69 pts,
characteristics were: mean age: 78yrs [67-96]; mean pT
size: 15 mm [3-30]; OMS performance status 0-1: 65pts
(94%); Charlson Age-Comorbidity Index: Mean: 4.5 [2-9].
Mean duration of hospitalization was 2.5 days [0-6]. Grade
2 post-operative complications occurred in 19 pts (27%):
Abscess: 3pts; Hematoma: 3pts; Seroma: 2pts; Radiation
epithelitis: 10pts. Delay in healing was observed in 6 pts.
Adjuvant external beam RT after IORT was performed in 3
pts (SNLD+: 2pts; positive margins: 1pt). Hormonal
treatment was prescribed in 53 pts (77%). Minimal and
mean follow-up were 1 yr and 2 yr, respectively. No local
relapse occurred. Two pts died of intercurrent disease.
Cosmetic result was assessed in 60pts: excellent: 30pts;
good: 28pts; poor: 2pts. Cytosteatonecrosis and cutaneous
pigmentation were observed in 7 and 6 pts, respectively.
Conclusion
IORT in old women is feasible without increasing the rate
of post-operative complications. Preliminary results are
excellent in terms of local control and cosmesis.