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S631
ESTRO 36
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Material and Methods
We had undertaken a retrospective study of T4 tumors
treated by radiotherapy in the departments of radiation
oncology in the Farhat Hached University Hospital and
Medical Centre Ibn Khaldoun
Results
250 patients classified as T4 tumors by our Committee for
Gynecologic Oncology were treated in our departments
between January 1995 and December 2013.
From these 250 patients, 79 were classified as T4d breast
tumors and 171 non inflammatory breast cancer. From
these, 11 cases the primary tumor size is unknown, 20
patients had small tumors under 3 cm at presentation, and
140 patients had tumors of 3cm in size or larger.
Seventeen were classified as T4a, 127 as T4b and 27 as
T4c.
148 patients had underwent neoadjuvant chemotherapy,
mastectomy, and adjuvant radiotherapy.
The median age was 50 years (ranging from 23 to 78). The
median size at presentation was 5 cm. the median follow-
up period was 42 months (ranging from 0 to 231).
The 5 years Disease free survival was 89% for small tumors
versus 59% for non-inflammatory larger tumors and 48% for
inflammatory breast cancer. With statistically significant
difference p = 0.037 (fig 1).
The overall survival was 89% versus 70% for non-
inflammatory larger tumors and 62% for inflammatory
breast (p = 0.28).
These finding support the fact that small T4 tumors had a
different behavior and better prognosis than other locally
advanced tumors, thus it should be considered as a
distinct entity. Indeed we propose that these tumors
should be classified T4”s” ('s” as small).
Although the actual T4 TNM subgrouping is lacking of
discriminative power, actually we did not find a significant
difference comparing the DFS (p = 0.34) or OS (p = 0.7)
according to the T4 TNM subgrouping (fig 2).
Fig 1: Disease free survival of the T4 s subgroup compared
with larger T4 non inflammatory breast cancer and T4d
Fig 2: Disease free survival according to TNM staging
system
Conclusion
Many authors are pointing the lack of uniformity and
discriminating power of the T4 subcategory of TNM
classification. The subgroup of T4 small tumors have a
better OS and DFS in our retrospective study.
We hope that adding the T4s subcategory to the TNM
classification, will encourage providing more data about
its
prognosis.
EP-1161 Hypofracionated Radiation Therapy in Breast
Cancer: retrospective analysis of late toxicity
P. Ferrazza
1
, F. De Renzi
1
, T. Iannone
1
1
Ospedale Civile San Martino, Radioterapia, Belluno,
Italy
Purpose or Objective
Various randomised trials have established the role of
hypofracionated radiotherapy (HRT) in breast cancer. The
aim of our retrospective analysis is to evaluate late toxicy
and cosmetic results in patients treated with
hypofracionated radiotherapy after breast conserving
surgery followed or not by chemoterapy.
Material and Methods
We included in this analysis patients (pts) treated with
breast conserving surgery and HRT with a follow-up of at
least 4 years. From january 2007 to september 2012, 239
pts with early breast cancer (TNM stage pTis pT1-2 and N0-
N1mic) were treated with adjuvant hypofractionated
radiation therapy. 40 pts underwent anthracycline-taxane
based chemotherapy befor HRT, 161 pts received only
hormone therapy and 38 pts received no other therapies.
Total dose delivered to whole breast was 45.66 Gy/16 fx
in 233 pts and 42.4 Gy/16 fx in only 6 pts. 36 pts received
a sequential boost on tumor bed (10 Gy/5 fx).
Late toxicity was recorded according RTOG/EORTC Late
Radiation Morbidity Scoring Schema.
Results
Median age was 61 years (range 36-86 years). 38/239 had
DCIS, 158/239 pts had stage I disease and 43/239 had stage
II disease. Median follow-up was 61 months. Most common
acute toxicity was skin grade 1 (56%) and grade 2 (36.8%).
Only 1 pts presented grade 3 skin toxicity.
112 pts present grade 1 skin late toxicity (58 pts grade 1
edema, 38 pts grade 1 pigmentation changes , 7 pts
telangiectasia , 9 pts grade 1 atrophy and 6 pts both
edema and pigmentation change ). No >grade 3 events
were reported. Only 3 grade 3 fibrosis occurred.
The cosmetic results were excellent in 76% pts, good in
19% pts and fair in 5% pts.