ESTRO 36 Abstract Book

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S754 ESTRO 36
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feasible therapeutic option. Adjuvant chemotherapy, in
selected patients, can improve survival.
EP-1410 Role of PMRT in Elderly Patients with T1-2
and 1 to 3 Positive Nodes Breast Cancer
L. Cao1, M.Y. Kirova2, C. Xu1, K.W. Shen3, J.Y. Chen1
1 Ruijin Hospital- Shanghai Jiaotong University School of
Medicine, Department of Radiation Oncology, Shanghai,
China
2 Institut Curie, Department of Radiation Oncology, Paris,
France
3 Ruijin Hospital- Shanghai Jiaotong University School of
Medicine, Comprehensive Breast Health Center,
Shanghai, China
Purpose or Objective
Even if evidence of post-mastectomy radiotherapy (PMRT)
in patients with T1-2 and 1 to 3 positive nodes breast
cancer is increasing, controversies still exist, especially in
elderly patients because the risk of treatment-related
toxicity. The aim of this study is to evaluate the efficacy
and toxicity of PMRT in elderly as well as the place and
use of systemic treatment in this population of patients.
Material and Methods
We retrospectively reviewed records of consecutive
patients with T1-2 and 1 to 3 positive nodes treated with
mastectomy at our institution between June 2009 and
June 2014. Elderly patients were defined as 65 years or
above. Patients who had received neoadjuvant treatment
were excluded from the analysis. In total, we analyzed 73
patients, of them only 23 received PMRT. Locoregional
recurrence (LRR) was defined as any recurrence within the
ipsilateral chest wall, ipsilateral axillary, internal
mammary, infraclavicular or supraclavicular lymph nodes.
All recurrences at other sites were recorded as distant
disease recurrence (DDR). Disease-free survival (DFS) was
defined as the time from start of PMRT until recurrence of
tumor or death from any cause. Overall survival (OS) is
defined as the time from start of PMRT until death from
any cause.
Results
The median age was 72 years (range, 65-91 years). There
were 10 patients with HER2 positive tumors, of them100%
(n=4) received trastuzumab in the PMRT group and 2 of 6
patients in non-PMRT group. All patients with HR positive
tumor received endocrine therapy. The patients in the
PMRT group were younger (69 years vs. 75 years, P=0.005).
Higher number of patients in the PMRT group received
adjuvant chemotherapy (82.6 % vs 48 %, P=0.006). At a
median follow-up of 48 months (range, 25-85 months),
there were 2 LRR diagnosed concurrently with distant
metastasis, one in each group respectively. We observed
six distant metastases and 5 deaths. In the whole cohort,
the 5-year LRR, DDR, DFS and OS were respectively: 3.4%,
13.2%, 84.5% and 92.1%. In the PMRT group, the 5-year
LRR, DDR, DFS and OS were 4.5%, 14.1%, 85.9%, and 94.7%,
respectively. In the non-PMRT group, the 5-year LRR, DDR,
DFS and OS were 2.4%, 12.4%, 84.2% and 92.3%,
respectively. In these small single center series, there was
no difference in LRR, DDR, DFS and OS between the PMRT
and non-PMRT group. There was no significant impact of
comorbidity, T-stage, number of positive nodes, HR
status, HER2 status and adjuvant chemotherapy on the
effect of PMRT.
Conclusion
The benefit of PMRT might be limited in the unselected
elderly patients with T1-2 and 1 to 3 positive nodes. The
intensity of anti-cancer treatment including adjuvant
chemotherapy and PMRT tends to decrease in patients
with increased age at diagnosis. Larger study is needed to
identify elderly patients with relative higher risk of LRR
and metastasis, as well as the risk of toxicity to better
individualize treatment. Clear biomarkers are needed to
decide patients for whom radiotherapy can be avoided.
EP-1411 Chemo-IMRT in elderly head and neck cancer
patients
I. Ahmed1, S. Kotur1, D. Sahoo 2, D. Sougumarane3, R.
Bhise 4, K. Vinchurkar5, M. Kalloli5, A. Sanikoppa6
1Kle's belgaum cancer hospital, radiation oncology,
Belgaum, India
2Kle's belgaum cancer hospital, radiaiton oncology,
Belgaum, India
3kle's belgaum cancer hospital, radiation physics,
Belgaum, India
4Kle's belgaum cancer hospital, medical oncology,
Belgaum, India
5Kle's belgaum cancer hospital, surgical oncology,
Belgaum, India
6Kle's belgaum cancer hospital, pathology, belgaum,India
Purpose or Objective
Elderly patients have been underrepresented in
prospective clinical trials that have defined standards of
care for head and neck cancer. In the era of improved
radiation techniques, improved systemic therapy and
better supportive care can claim that chemoradiation
does, in fact, improve survival for a large segment of this
population and should not be denied for fear of poor
tolerance.
Material and Methods
21 patients with locally advanced head and neck cancer
treated with SIB-IMRT and concurrent weekly cisplatin
were prospectively evaluated. After written and informed
consent, all patients were immobilised with head and neck
thermoplastic mask followed by CT simulation. Critical
structures and Planning Target volumes – high risk
receiving 70Gy (PTVHR), intermediate risk receiving 63 or
59.4 Gy (PTVIR) and low risk receiving 56 or 54Gy (PTVLR)
in 33-35 fractions over 6.5-7 weeks were defined and
planned with Eclipse version 11 planning system using 7-9
field arrangements. Concurrent Chemotherapy was
administered using weekly cisplatin 40mg/m2 or
carboplatin AUC 2 for 6 cycles. All patients were evaluated
for treatment compliance and radiation toxicities weekly.
Outcomes were analysed in terms of clinical response
evaluation using RECIST criteria, acute toxicities
according to RTOG-EORTC and overall survival using
Kaplan Meir curve.
Results
Median age of presentation was 69 years (range 65-76)
with M: F ratio of 16:5. Primary site of presentation were
hypopharynx (10), oropharynx (5) and larynx (6). TNM
stage status were T1(2),T2(5), T3(11), T4(3); N1(4), N2(1),
N3(1); Stage III(10), IVA(10) and IVB(1). All patients
received 70 Gy. Median Overall treatment time was 53
days (range 46-65 days) with treatment interruption of 1-
9 days (median 3 days). All patients received 4-6 cycles of
cisplatin/carboplatin (median 6). Acute toxicities are
shown in table. Mean weight loss was 8% (range 4-
15%).With a median follow up of 9 months (range 3-15
months), ORR were 71.5% (15 patients) had complete
response and 28.5% (6 patients) had partial response. 7
(33%) patients had recurrence with 6 loco regional and 1
distant, out of which 3 expired and 4 are alive with
disease. The overall 15 month survival rate is 75.6%.
GRADE
1
GRADE
2
GRADE
3
GRADE
4
MUCOSITIS 1(5%) 17(80%) 3(14%) 0
DERMATITIS 17(80%) 3(14%) 1(5%) 0
LARYNGITIS 8(38%) 13(62%) 0 0
ANAEMIA 6(28%) 0 0 0
NEUTROPENIA 4(19%) 0 2(10%) 0
THROMBOCYTOPENIA 1(5%) 1(5%) 0 0