ESTRO 36 Abstract Book

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S635 ESTRO 36
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Purpose or Objective
Male breast carcinoma (MBC) is rare, and the incidence
varies worldwide. It accounts for about 1% of all breast
cancers.
Due to the rarity of this disease, there is a lack of
prospective clinical trials to define its optimum
treatment. Current data consists mostly of small
retrospective studies, hence treatment generally follows
the principles established for that of female breast
cancer.
The purpose of this study was to review and analyse breast
cancer in men managed from 2004 to 2013.
Material and Methods
Men with histologically confirmed breast cancer from
2004–2013 were studied. Information regarding patient
demographics, presenting symptoms, tumor
characteristics, treatment and outcomes were analysed.
Results
Over the 10 year period, 41 patients were studied, making
1.6% of all breast cancer cases managed. Median age at
diagnosis was 66 years, ranging 36-89.
Majority, 87.8%, self-detected a lump in the breast. The
median time from onset of symptoms to diagnosis was 12
months, ranging 3–48.
The commonest histology was invasive ductal carcinoma
,70.7%.
Stage III disease represented 47.58%, while stage I, II and
IV disease made up 7.32%, 19.61% and 25.49% respectively
Hormone receptor (HR) status was unknown in 63.4%,
14.6% were estrogen receptor (ER) only positive, 7.3%
were progesterone receptor (PR) only positive, 4.9% were
ER and PR positive, and 9.8% were ER and PR negative.
Of those who had their HR status checked, 73.2% were HR
positive.
Modified radical mastectomy was the most common
surgical procedure, 46.3%, mastectomy only in 14.6% and
breast conservation in 7.3%. 46.3% of patients
received adjuvant radiotherapy. 48.8% did not receive
adjuvant radiotherapy because they were metastatic,
defaulted or presented late after the surgery. 40.3%
received chemotherapy in adjuvant, neoadjuvant or
metastatic setting.
Hormone receptor positive patients had Tamoxifen.
Median follow up duration was 7 months, ranging 0-64.
Median survival was 13 months and 5 year overall survival
of 2%.
Conclusion
MBC makes up 1.6% of all breast cancer presenting to our
centre, consistent with worldwide findings of about 1%.
Majority presented with locally advanced or metastatic
disease. Outcomes are poor and could be due to late
presentation. Screening programs may translate into
better outcomes.
MBC is frequently hormone receptor positive and may
be more sensitive to hormonal therapy, hence receptor
status testing is recommended.
Low survival and poor follow up made disease free survival
difficult to determine.
EP-1169 Preoperative CT scan in tumor bed
delineation after breast conserving surgery and
oncoplasty
T. Saxena1, V. Goel 1, G. Kadyaprath2, D. Arora3, A.K.
Verma1, P. Agarwal 1, P. Kumar1, J. Jain1, R. Shukla1, P.
Kumar3, A. Masanta3, T.R. Singh4, R. Kaur4, A.K. Anand1
1 Max Hospital- Delhi- India, Radiation Oncology, Delhi,
India
2 Max Hospital- Delhi- India, Surgical Oncology, Delhi,
India
3 Max Hospital- Delhi- India, Medical Physics, Delhi, India
4 Max Hospital- Delhi- India, Radiation Therapy
Technologist, Delhi, India
Purpose or Objective
Background: Tumor bed (TB) boost, in addition to whole
breast radiation therapy (WBRT) improves local control
rates as compared to WBRT alone after breast conserving
surgery (BCS). There are several pitfalls in localizing TB
accurately. Surgical clips are generally placed over
pectoralis muscle, even if the tumor is superficial and
hence not truly representative and there is always a
concern of clip migration. Mammogram and MR
mammogram are not quite useful as they are done in a
non-anatomic position. Problem of accurate TB
identification is further compounded in patients with
oncoplastic reconstruction. In oncoplastic surgeries (OPS),
scar is often not representative of tumor location. Seroma
cavity is generally obliterated by tissue repositioning.
Hence, TB delineation is sum total of information from
surgical notes, surgical clips, postoperative changes on
radiation therapy (RT) planning scans, histopathology
report and some calculated guess work.
Objective: To determine utility of preoperative CT scan
in TB delineation after BCS.
Material and Methods
This pilot study was conducted in Department of Radiation
Oncology, Max Hospital, Delhi, India, on 21 breast cancer
patients in whom prior to BCS, preoperative CT scan was
done in treatment position on a flat couch, in CT
simulator. A radio opaque fiducial was also placed at the
centre of palpable lump. After BCS & chemotherapy (if
any), RT planning CT scan was taken with similar set up as
pre-operative CT scan. Both the scans were co-registered
using non-deformable registration on Eclipse Version 10.0.
TB was contoured on RT planning CT using surgical clips
(TB1) and also on preoperative CT scan (TB2). Tumor bed
on all RT planning scans were scored for Cavity
Visualization Score (CVS). Relative shift in position of TB
on both the scans was compared in all three [lateral (RL),
cranio caudal (CC) and Antero-posterior (AP)] directions.
Results
In our patients, median age was 59 years (Range 42-71).
Median of maximum tumor size was 2.5 cm (Range 1.0-
5.0). All patients underwent BCS with oncolplastic
reconstruction. Median time between preoperative and RT
planning scan was 4.6 months. CVS 1 and 5 was observed
in 6 patients each and rest patients were having CVS 2, 3
or 4. Mean preoperative, postoperative and combined
tumor volume were 10.9cc, 10.9cc and 23.4cc
respectively. On evaluating relative positions of tumor bed
on pre-operative vs RT planning scan, mean (± SD) RL shift
was 2.8 cm (± 1.8), which was larger than for the other
directions (CC shift 1.2 cm, SD ± 0.9; AP shift 1.6 cm, SD
± 1.1). When relative shifts of TB were co-related with
tumor location, RL & CC shifts were more in outer
quadrant tumors (p=0.0005 & 0.016 respectively), while in
AP direction, p value (0.26) was not statistically
significant.
Conclusion
Preoperative CT scan in treatment position is an additional
useful tool in calculated guess work of TB delineation and
helps in improving the accuracy of target volume
delineation for TB boost.
EP-1170 Hypofractionated radiotherapy for ductal
carcinoma in situ using VMAT: acute toxicity and
cosmesis
F. De Rose1, A. Fogliata1, D. Franceschini1, C. Iftode1,
A.M. Ascolese1, T. Comito1, L. Di Brina 1, A. Tozzi1, C.
Franzese1, E. Clerici1, G.R. D'Agostino1, P. Navarria1, F.
Lobefalo 1, M. Scorsetti1
1Istituto Clinico Humanitas, Radiotherapy and
Radiosurgery, Rozzano Milan, Italy