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and was described and graded according to the RTOG
classification. Relation to previous acute skin toxicity,
clinical and dosimetric factors was assessed by univariate
analysis.
Results
At a median follow up of 54 months (range 50-60), sixteen
patients (11%) developed late skin toxicity. Fifteen grade
G1-2 (dyschromia and telangiectasia), while 1 patients had
nipple necrosis (G4) at the the site of the surgical scar.
Interestingly, no significant relation with previous radio-
induced acute skin toxicity was found.
Conclusion
Our study suggests that late radioinduced skin toxicity
appears in a small but significant portion of patients
treated by BCT and seems to be unrelated to previous
acute skin toxicity.
EP-1178 Breast radiotherapy without nodal irradiation
in pT1-2 pN0-1 stage: prognostic factors and
outcomes.
C. Di Carlo
1
, M. Nuzzo
1
, L.A. Ursini
1
, M. Trignani
1
, L.
Caravatta
1
, G. Di Girolamo
1
, M. Di Nicola
2
, D. Genovesi
1
1
Ospedale Clinicizzato S.S. Annunziata, Radiotherapy,
Chieti, Italy
2
Biostatistic laboratory, Clinical Sciences, Chieti, Italy
Purpose or Objective
The aim of study was to evaluate loco-regional recurrence
(LRR), overall survival (OS), disease free survival (DFS),
prognostic influence of the number of positive lymph
nodes and others variables in treatment of early breast
cancer patients.
Material and Methods
From December 2005 to December 2013, 377 female
patients with pT1-T2 pN0-N1 were treated in our
Radiotherapy Institute and retrospectively evaluated. All
patients received conservative surgery with sentinel-
lymph node and/or axillary dissection followed by whole
breast radiotherapy. According to our institutional
protocol nodal region irradiation was not performed. Four
cohorts were analyzed according to the number of
involved lymph nodes: N0, N1
n1
(1 lymph node +), N1
n2
(2
lymph nodes +), N1
n3
(3 lymph nodes +). Actuarial rates of
total LRR, DFS and OS were calculated by the Kaplan-Meier
method. Comparisons of clinical and pathologic
characteristics between patients groups were calculated
using the log-rank test.
Results
From a total of 377 patients, 284 patients with pT1 tumors
and 93 with pT2 tumors were evaluated. The median age
was 58 years (range 31-82 years). The absence of involved
lymph nodes has been assessed in 276 patients while N1
was reported in 101 patients: 63 N1
n1
, 19 N1
n2
, and 19 N1
n3
.
The median follow-up was 4 years with a LRR rate of 3.4%
(13/377). In particular a nodal recurrence rate of 1.06%
(4/377) was observed: 2 occurred in the axillary region, 1
in supraclavicular region and 1 within internal mammary
chain. Estrogen receptor, menopausal status, adjuvant
chemotherapy, Her2neu, margin status and grading were
not significantly associated with OS and DFS, whereas
progesterone receptors were significantly correlated with
DFS and tumor size (T>2 cm) with DFS, LRR and OS.
Furthermore, a significant correlation between 3
metastatic lymph nodes and OS was found (N1
n3
p-value
0.024, N1
n1
p-value 0.175, N1
n2
p-value 0.369).
Conclusion
In our series, adjuvant radiotherapy after breast-
conserving surgery led to low rates of LRR and high rates
of OS and DFS in pT1-T2 pN0-N1 breast cancer patients.
Moreover, although the retrospective design, the limited
sample size and given the low rate of nodal recurrence,
the results observed from our study seem suggest that
nodal irradiation in patients presenting 1-3 positive
axillary nodes could be not necessary to improve outcome.
EP-1179 Target Volume Definition after Lumpectomy
for Accelerated Partial Breast Irradiation (APBI) or
Boost
I.F. Ciernik
1
, A.M. Greiß
2
1
Dessau City Hospital, Radiation Oncology, Dessau,
Germany
2
Deaconess Hospital, Department of Surgery, Dessau,
Germany
Purpose or Objective
After tumor resection and surgical manipulation during
lumpectomy or oncoplasty, the tumor cavity and the tissue
at risk for local relapse is often not clearly definable
during radiation therapy planning. Metal clips placed at
the thoracic fascia are used to better define the former
tumor location. Here we investigated the ability of a
liquid tissue marker (BioXmark®, Nanovi®, Copenhagen,
DK ) to define the local cavity for the purpose for defining
a boost volume or a target volume suitable for APBI.
Material and Methods
Preclinical investigations how to apply BioXMark® liquid
marker best for visualization by computer tomography
were performed. Subsequently, thirteen patients
underwent lumpectomy for limited stage breast cancer
disease and the tumor cavity was marked with the liquid
marker as well as a surgical clip. All patients were older
than 50 yrs, and all patients presented with hormone-
receptor positive disease less than 3 cm, pN0 and all were
potentially suitable for APBI. The tumor cavity was
marked immediately after resection with BioXmark® and
surgical clips. The liquid marker was placed before any
oncoplasty-manipulation was performed in three patients
analysed. A planning CT was performed 4-5 weeks after
surgery. The boost volume was defined, according to the
metal clips and the area marked by BioXmark.
Results
In preclincal studies a phantom was used to see that the
liquid marker sprayed over several square centimeters
achieved best Imaging qualities on comptuer
tomgraphy. Thus, applying a film of liqud marker over the
surface of interest was chosen for further clincal
investigations. Seven patients were analysed by the time
of submission. The tumor cavity was clearly marked for
the purpose of tumor cavity segmentation in six out
of seven cases. In one patient, the marker was not
reliabely discrimiated from the glandular tissue. The mean
volume or the tumor bed was 22,69 ml (range 8,1 - 40,96).
In respect to the metal clips placed on the thoracic wall
after lumpectomy, considerable displacement of the boost
target volume after oncoplasty was visualized.
Conclusion
Visualization of the tumor cavity can improve on the
accuracy of the target volume definition for APBI and may
allow optimizing PTV margins. Further investigation is
justified to reveal clinical utility of liquid-marker- based
target volume definition after lumpectomy.
EP-1180 Whole breast radiotherapy in Lateral
Decubitus position : efficacy and toxicity
E. Bronsart
1
, S. Dureau
2
, H. Xu
1
, F. Berger
2
, F. Campana
1
,
E. Costa
1
, A. Chilles
1
, A. Fourquet
1
, Y. Kirova
1
1
Institut Curie, Radiation therapy, Paris, France
2
Institut Curie, Biometrics, Paris, France
Purpose or Objective
To evaluate whole breast 3D conformal radiotherapy (RT)
delivered in lateral decubitus position (Isocentric Lateral
Dubitus ILD) and report the acute and the late cardiac and
pulmonary toxicity of a cohort of patients treated with
ILD.