ESTRO 36 Abstract Book

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S617 ESTRO 36 2017
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Hypofractionated radiotherapy for post-operative breast
cancer has consolidated as the standard treatment for
breast cancer due to similar results compared with
mastectomy in terms of local relapse, disease recurrence
and survival rates. On clinical trials, Multiples fractionated
schemes have been tested in the past years,
demonstrating that hypofractionated whole-breast
irradiation was not inferior to standard radiation
treatment in women who had undergone breast-
conserving surgery for invasive breast cancer with clear
surgical margins and negative axillary nodes. The purpose
of this study was to compare the economic outcomes in
our institution resulting from an hypofractionated
treatment in selected patients.
Material and Methods
A retrospective review from January 1º 2010 to December
31º 2015 of hypofractionated whole-breast irradiation was
performed. Inclusion criteria was: Early breast cancer (I,
II) Breast-conserving surgery, Age >18 years and absence
of previous RT treatment at the same area. Pregnancy,
breastfeeding and axillary nodes involvement were
excluded. 3D conformal radiotherapy was delivered with
6-15 MV photons: 40 Gy in 15 fractions, 5 fractions per
week. Additionally, boost doses to the tumor bed in
patients <50 years, close margins of IDC or positive
margins on DCIS with an equivalent dose in 2Gy fractions
(EQD2) of 10-20 Gy. The estimated cost by treatment was
obtained multiplying the number of sessions received by
the stipulated cost of each session according to the law in
force. Additionally we calculated an estimated cost of the
treatment as if it has been performed with conventionally
fractionated schedule, comparing the total amount
between treatments.
Results
361 patients who fitted the inclusion criteria were treated
in our institution using hypofractionated schemes. The
cost by session was estimated in 285,53€ according with
the law in force provided by the Economic department of
our institution. 75,6% (n273) of patients received 15
fractions with an estimated cost by treatment of
1.169.245,35€ and the remain 24,4% of patients (n88)
received 18 fractions with an estimated cost of
452.279,52€. Comparing a standard irradiation in 25
fractions with hypofractionated irradiation in 15 fractions,
a total saving estimated on 779.496,9€ was obtained.
Likewise in patients who underwent boost doses to the
tumor bed receiving 18 fractions, a total saving of
301.519,68€ was calculated compared to a conventional
treatment of 30 fractions.
Conclusion
The increasing demand of treatments in health care
institutions makes necessary the implementation of cost-
efficacy strategies, in attendance of each patients needs
without letting a side the importance of optimization of
health resources. Hypofractionated schedules reduces the
total time of treatments which translates in a reduction of
sanitary personnel costs, time machine, waiting lists,
transportation and patient discomfort among others.
EP-1144 Old age impact on radiotherapy omission in
breast cancer patients
S. Cima1, B. Muoio1, P. Fanti1, A. Richetti1, C. Azinwi1, F.
Martucci1, K. Yordanov1, G. Pesce1, M. Valli1
1 Istituto Oncologico della Svizzera Italiana, Radiation
Oncology, Bellinzona, Switzerland
Purpose or Objective
Increasing life expectancy and overall aging in the western
countries will improve the impact of breast cancer
treatment in old women. The aim of this study was to
analyse the impact of age on post-operative radiotherapy
(RT) omission in breast cancer patients, older than 69
years.
Material and Methods
We analysed retrospectively 384 women, treated from
January 2007 to June 2015, dividing them into three
subgroups: 70 to 79 years, 80 to 89 years and 90 years and
older.
Results
A total of 280 patients (72.9%) were treated with
conservative surgery. The adjuvant RT was given to 135
patients (71.4%) aged 70-79 years, 27 patients (34.2%)
aged 80-89 years and 3 patients (25%) older than 90 years.
RT was omitted in 115 (41.1%) cases. A significant
correlation was observed between age and RT omission,
comparing younger subgroup to the others (p<0.001 and
p=0.002), with a smaller number of older patients treated
with RT. The 2 and 5 year DFS of patients treated with
conservative surgery was 94.5% and 82.7% without
significant difference between age subgroups (p=0.36). No
significant difference in 2 and 5 years DFS was detected
(p=0.12) between patients treated with adjuvant RT and
conservative surgery alone (p 0.12). The 5 year OS was 81%
in patients aged 70-79 years; 71% in patients aged 80-89
years and 65% in patients older than 90 years, with a
significant difference (p=0.009). The 5 year OS in patients
treated with adjuvant RT was 79% while it was 75 % in
patients treated with conservative surgery alone, without
significant difference (p=0.11). Mastectomy was
performed in 124 patients: 17 patients (13.7%) received
RT while 107 (86.3%) no further RT, with omission in 22
patients (17.7%).The adjuvant RT was given to 13 patients
(16.7%) aged between 70-79 years, 4 patients (10.3%) aged
between 80 and 89 years, while no patients older than 90
years was treated with post-mastectomy RT. No
statistically significant difference in term of RT omission
was observed between age subgroups, comparing younger
subgroup to the others (p=0.40 and p=0.60). The 2 and 5
year DFS of patients treated with mastectomy was 90% and
81.7% without significant difference between age
subgroups (p=0.51). The 2 year DFS in patients treated
with adjuvant RT was 91% and 89% in patients treated with
mastectomy alone. The 5 year DFS in patients treated with
adjuvant RT was 86% and 65% in patients treated with
mastectomy alone. No significant difference was detected
(p=0.26). The 5 year OS was 70% in patients aged 70-79
years; 55% in patients aged 80-89 years and 14% in patients
older than 90 years, with a significant difference
(p<0.001). The 5 year OS was 64% and 52% in patients
treated with or without adjuvant RT respectively, without
significant difference (p=0.12).
Conclusion
An higher percentage of patients aged between 70-79
years received RT after conservative surgery if compared
with the older subgroups. No difference was detected in
RT omission after mastectomy.
EP-1145 Troponin I for the detection of cardiac
toxicity in adjuvant breast cancer radiotherapy
K. Boudaoud 1, H. Allioueche2, O. Haderbeche2, K. Sifi3, S.
Taleb4, C. Kourteli5, K. Benmebarek3, M. Setta6, S.
Serradj6, T. Filali 7, A. Djemaa4, N. Abadi3
1Scientific research laboratory of molecular biology and
genetics- Faculty of Medicine- UC3, Radiation oncology,
Constantine, Algeria
2CHUC, Radiation oncology, Constantine, Algeria
3Scientific research laboratory of molecular biology and
genetics- Faculty of Medicine- UC3, Laboratory of
biochemistry, Constantine, Algeria
4Faculty of medicine- UC3, Radiation oncology,
Constantine, Algeria
5University Constantine 1, Radiation oncology,
Constantine, Algeria
6Faculty of Natural and Life Sciences- UC1, Department
of animal biology, Constantine, Algeria
7Scientific research laboratory of molecular biology and
genetics- Faculty of Medicine- UC3, Medical oncology,
Constantine, Algeria