ESTRO 36 Abstract Book

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S91 ESTRO 36 2017
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To examine 5-year rates of local control for breast cancer
patients with local relapses after second conservative
surgery and accelerated partial breast irradiation (APBI).
Material and Methods
Eligibility included local relapses of breast cancer <3 cm
in size after lumpectomy with negative surgical margins.
The APBI dose delivered was 34 Gy in 10 twice-daily
fractions over 5 days for high-dose-rate. This analysis
focuses on ipsilateral breast recurrence(LBR), regional
recurrence (RR), and distant metastases (DM), disease-
free and overall survival.
Results
The median follow-up was 49.6 months (5-98m). Fithty
two patients (p) were accrued from Sep 2008 to August
2015.
Histology: Intraductal carcinoma 15 p, Ductal carcinoma
31 p, Lobulillar carcinoma: 5 p; Papilar carcinoma : 1p; 50
p had T1 tumors and 2 p had T2. Seventy-five percent were
estrogen receptor and/or progesterone receptor positive.
There have been 4 local breast recurrences, 1 regional
recurrence (RR), and 1 distant metastases (DM), The 5-
year Local Recurrence Disease Free rate was 91.6%. The
5-year Disease Free Survival and Overall Survival rates are
87 % and 100%, respectively.
Conclusion
This prospective trial studying APBI in local relapses of
Breast Cancer show a high local control, so this treatment
is an real option to Mastectomy in these patients
OC-0181 Long-term clinical and cosmetic outcomes of
high-dose-rate brachytherapy for early breast cancer
F. Arcidiacono1, L. Chirico1, M. Italiani1, P. Anselmo1, M.
Casale 1, L. Draghini1, F. Trippa1, S. Fabiani1, M. Basagni1,
E. Maranzano1
1 "S.Maria" Hospital, Radiotherapy Oncology Centre,
Terni, Italy
Purpose or Objective
To report long-term clinical and cosmetic outcomes of
partial breast irradiation (PBI) with 192Ir high-dose-rate
brachytherapy (HDR-BRT) in early breast cancer patients.
Material and Methods
From May 2005 to February 2012, 124 patients undergoing
conservative surgery for early breast cancer were
recruited in a phase II trial of exclusive 192Ir HDR-BRT.
Inclusion criteria were: age >40, PS 0-2, unifocal invasive
ductal cancer, intraductal cancer component <25%,
negative axillary nodes and tumor size ≤2.5 cm. Treatment
schedule was 4 Gy twice a day for 4-5 days, up to a total
dose of 32 Gy in 8 fractions with a minimum interval
between daily fractions of at least 6 hours. Late toxicity
was graded at each follow-up visit according to
RTOG/EORTC scoring criteria and cosmetic outcomes
according to Harvard criteria and scored as excellent,
good, fair and poor.
Results
Median age was 67 years (range, 42-85). There were 10
(8%) pT1a, 38 (31%) pT1b, 68 (55%) pT1c and 8 (6%) pT2.
Estrogenic and progestinic receptors were positive in 113
(91%) and 104 (85%) cases, respectively. 110 (88%) and 15
(12%) patients received adjuvant hormonal therapy and
chemotherapy, respectively. Median follow-up was 77
months (range, 8-132). 1 (0,8%) isolated out-field breast
relapse occurred 109 months after HDR-BRT. 1 (0,8%)
patient developed contralateral breast cancer
and another one (0,8%) regional relapse in axillary node.
13 (10,5%) patients reported a second primary cancer. 5-
and 10-year overall survival and cancer specific free
survival were 95% and 88%, 100% and 98%,
respectively. At last follow-up, 114 (92%) patients were
alive without disease and 3 (2,5%) with systemic disease.
10 (8%) patients died: 1 (0,8%) for breast cancer, 2 (1,6%)
for other cancers and 7 (5%) for other causes. Cosmetic
outcomes were excellent in 102 (82%), good in 11 (9%), fair
in 8 (6%) and unknown in 3 (2,5%) patients. Late skin
toxicity was registered in 29 (23,4%) patients, grade 1-2 in
28 (22,5%), grade 3 in 1 (0,8%). Late toxicity was
significantly related to the skin administered doses (≤ 55%
vs. > 55%, P < 0.05).
Conclusion
PBI delivered with 192Ir HDR-BRT in selected breast cancer
patients was associated to high local control and survival
with excellent cosmetic outcomes. An appropriate
patient selection and skin dose ≤ 55% provided optimal
clinical outcomes.
OC-0182 2nd breast conserving therapy with
interstitial BT vs mastectomy for treatment of local
recurrences
V. Smanykó1, N. Mészáros1, M. Ujhelyi2, G. Stelczer1, T.
Major1, Z. Mátrai2, C. Polgár1
1National Institute of Oncology, Center of Radiotherapy,
Budapest, Hungary
2National Institute of Oncology, Center of Surgery,
Budapest, Hungary
Purpose or Objective
To compare the clinical outcomes of second breast
conserving therapy (BCT) with perioperative high-dose-
rate (HDR) interstitial brachytherapy (iBT) versus salvage
mastectomy (sMT) for the treatment of ipsilateral breast
tumor recurrences (IBTRs).
Material and Methods
Between 1999 and 2016, 92 patients who presented with
an IBTR after previous BCT were salvaged either with
reexcision and perioperative HDR multi-catheter iBT
(n=35) or sMT (n=57). In the BCT + HDR iBT group a median
of 7 (range: 4-23) catheters were implanted
intraoperatively. A total dose of 22 Gy in 5 fractions of 4.4
Gy was delivered to the tumor bed with a margin of 1-2
cm perioperatively on 3 consecutive days. Similar
proportion of patients received adjuvant chemotherapy in
the two groups (17% after BCT + HDR iBT vs 21% after sMT)
and/or hormonal treatments (71% vs 70%, respectively).
Five-year oncologic outcomes (including ultimate local
tumor control, regional tumor control, disease-free
survival [DFS], cancer specific survival [CSS], and overall
survival [OS]) were estimated by the Kaplan-Meier
method. Survival curves were compared with the log-rank
test.
Results
Mean follow up time was 63 months (range: 2-183) in the
BCT + HDR iBT group vs 30 months (range: 4-164) in the
sMT group. The mean diameter of IBTRs was 16.8 mm
(range: 2-70) vs 24.5 mm (range: 2-60), respectively.
There was no significant difference in any other patient
(e.g. age, menopausal status) or IBTR related (e.g. grade,
vascular invasion, margin status, receptor status)
parameters between the two groups. Three out of 35
(8.6%) and 7 out of 57 (12.3%) second local recurrences
occurred in the BCT + HDR iBT and the sMT group,
respectively. The 5-year actuarial rate of second local
recurrence was 7.4% after BCT + HDR iBT vs 17.5% after
sMT (p=0.11). The respective 5-year rates of regional
recurrence were 7.2% vs 5.3% (p=0.17). The 5-year
probability of DFS, CSS, and OS were 69.7% vs 73.5%
(p=0.79), 74.9% vs 80.5% (p=0.72), and 74.9% vs 69.6%
(p=0.73), respectively. At the time of analysis data on
cosmetic results were available for 31 patients (88.6%) in
the BCT + HDR iBT group. Among these, 3 (9.7%), 16
(51.6%), 5 (16.1%), and 7 (22.6 %) patients had excellent,
good, fair, and poor cosmetic results. Grade 2 and 3 late
skin toxicity occurred in 2 (5.7%) and 1 (2.9%) patients,
while grade 2 and 3 fibrosis developed in 9 (25.7%) and 1
(2.9%) patients. Asymptomatic fat necrosis was detected
in 11 (31.4%) women.
Conclusion
Second BCT + HDR iBT is a safe and feasible option for the
management of IBTRs resulting similar 5-year oncologic
outcomes compared to standard sMT. HDR iBT may