ESTRO 36 Abstract Book

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S646 ESTRO 36
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results of such comparisons as reported by the authors of
the studies.
Results
The search strategy retrieved 2224 references. Of these,
271 publications, corresponding to 182 trials fulfilled the
eligibility criteria and were the subject of this analysis.
HRQOL was considered as endpoint in 38 (20.8%) of the
included studies and it was used as primary endpoint in
10.9% of them. Most trials (84.0%) focused on biomedical
intervention. Of 22 trials that had a positive primary
endpoint, 18 had a significant benefit in HRQOL, in favor
of the experimental arm. Of 13 trials that had a negative
primary endpoint, there were no differences in HRQOL
among the study groups. In regards of HRQOL assessment,
statistical methods and definition of timing of evaluation
were described 32 (84.2%) and 36 (94.7%) trials,
respectively. The European Organization for the Research
and Treatment of Cancer Quality-of-Life Questionnaire
(EORTC-QLQ) (C-30 with or without BR23) alone or plus
additional measures was the most frequently used tool in
17 (44.7%) of 38 studies. Eighteen trials (47.4%) used two
or more HRQOL assessment tools. The Functional
Assessment of Cancer Therapy (global or breast) with or
without additional measures were used in 9 (23.6%) of 38
trials.
Conclusion
This analysis shown that HRQOL has been infrequently
investigated in phase III trials of radiation therapy in
breast cancer. Statistical methods and timing of
evaluation were not always described with sufficient
detail. Significant benefit in HRQOL was frequently
reported in those trials that reported a positive primary
endpoint.
EP-1193 Hypofractionated external beam radiation
therapy for breast cancer. The new standard?
I. Nobre Góis1, A. Ponte 1, J. Casalta-Lopes1, T. Teixeira1,
P. Vicente 1, M. Borrego1
1 Hospitais da Universidade de Coimbra, Servico de
Radioterapia, Coimbra, Portugal
Purpose or Objective
Hypofractionated external beam radiation therapy (HRT)
consists in the administration of higher than conventional
dose per fraction, leading to reduced overall treatment
time and increased compliance to treatment, at lower
costs for hospital and patient. Several randomized phase
III trials show HRT as an alternative to conventional
fractionation in the adjuvant setting after breast
conserving surgery, with similar outcomes regarding local
control and side effects. The most commonly used HRT
schedules include 42.6 Gy / 16 fractions or 40 Gy / 15
fractions, as stated in international recommendations.
In this study we aim to assess toxicity after conservative
surgery followed by HRT in breast cancer patients.
Material and Methods
Prospective inclusion of patients with invasive breast
cancer submitted to breast conserving surgery, treated in
our Radiation Oncology department between March 2014
and June 2016, aged over 60 years, hormone receptor-
positive, HER2-negative, tumor histological grade G1-G2,
margins exceeding 1 mm, staged pT1-T2 pN0 cM0, with an
adequate dosimetric study. A dose of 40 Gy was delivered
in 15 fractions (2.67 Gy / fraction), followed by a boost to
the tumor bed of 10 to 16 Gy in 5 to 8 fractions (2.0 Gy /
fraction). Acute toxicity (CTCAE4.0 scale) and heart and
lung dosimetric parameters were recorded.
Results
Of the 74 patients accepted for HRT, 2 were excluded due
to failure on dosimetric assessment or the presence of
complex sclerosing lesion. 72 included patients with a
median age of 65 years (60-79 years), tumors mainly
located on the left breast (58.3%) and upper quadrants
(65.3%). Invasive carcinoma not otherwise specified (NOS)
was present in 91.7%, staged pT1b in 37.5% and pT1c in
52.8%. Boost was prescribed with a dose of 10Gy in 63.9%
of patients.The median values of the dosimetric
parameters evaluated were Heart V25 of 3.10% (0%-
16.68%) and Lung V20 of 11.13% (2.5%-24.38%).All patients
completed the originally planned schedule, 97.2%
presenting acute cutaneous toxicity (any grade), grade 3
in only 5 patients (6.9%). No other complications were
registered during treatment.Median follow-up was 10
months (3-25 months). In the first follow-up visit toxicity
was observed in 55.6% patients, with
erythema/pigmentation (grade 1-2) in 29.2%, breast
edema in 23.5% and fibrosis in 8.3%. One patient had
symptomatic radiation related pneumonitis, with full
resolution after the 47 patients already
observed in subsequent follow-up appointments, there
was visible fibrosis in 11 patients, edema in 7 patients,
breast shrinkage in one patient and telangiectasia in
another patient.
Conclusion
Hypofractionated radiation therapy schedules allow for
excellent treatment compliance with an acceptable
toxicity profile and a good cosmetic result. A longer
follow-up will allow increased accuracy in late side effects
evaluation.
EP-1194 Dose-volume relationship for acute skin
erythema in patients undergoing breast irradiation
F. Badenchini1, F. Bonfantini2, M. De Santis 3, S. Gay1, F.
Palorini1, A. Cicchetti1, T. Rancati1, M. Carrara2, T.
Giandini2, E. Pignoli2, R. Valdagni 3, L. Lozza3
1Fondazione IRCCS Istituto Nazionale dei Tumori,
Prostate Cancer Program, Milan, Italy
2Fondazione IRCCS Istituto Nazionale dei Tumori, Medical
Physics, Milan, Italy
3Fondazione IRCCS Istituto Nazionale dei Tumori,
Radiation Oncology 1, Milan, Italy
Purpose or Objective
Standard 3DCRT after breast conserving surgery (BCS) may
cause skin toxicity with a wide range of intensity including
acute effects like erythema or late effects. In order to
reduce these side effects it is advisable to identify
potential factors of influence in breast cancer patients
undergoing 3DCRT of the breast and modern systemic
therapy
Material and Methods
breast cancer patients consecutively treated in our
institution with 3D-CRT after BCS (50 Gy whole breast
photon radiotherapy followed in same cases by 10 OR 16
Gy photon OR electron boost to the tumor bed) were
evaluated with special focus on documented skin toxicity
during RT course.
Acute skin erythema (AE) was visually assessed and
recorded using the RTOG scoring system, before RT and
every 5 fractions. In this study, grade 2-3 AE during RT was
considered as the primary endpoint.
A number of relevant clinical risk factors was
prospectively recorded: age, skin phototype, smoking
habits, use of drugs, neoadjuvant chemotherapy with
anthracyclines and/or taxanes and/or trastuzumab,
hormone therapy with tamoxifen or aromatase inhibitors,
comorbidities and related drugs, T stage, location of
breast surgery.
Dosimetric feature were extracted from the skin dose-
volume histogram for the whole treatment (DVH, absolute
volume in cc), with skin defined as the difference between
the body contour and a 5mm inner isotropic contour from
the body.
Dosimetric and clinical variables were included into
multivariable logistic regression. Goodness-of-fit was