ESTRO 36 Abstract Book

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S618 ESTRO 36 2017
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Purpose or Objective
Chemotherapy, targeted agents, hormone therapy and
radiation therapy improve survival for women with locally
advanced breast cancer but increases the risk for heart
failure and cardiomyopathy. Radiation induced heart
disease generally occurs with a latent period of 5–10 years.
Cardiac troponin I (cTnI) is highly sensitive and specific
biomarker of cardiac damage. Our aim was to evaluate the
early effect of breast cancer radiotherapy on serum high
sensitivity troponin I levels.
Material and Methods
A total of 28 patients with breast cancer who received
adjuvant 3D conformal radiation therapy (RT) were
included in a prospective, study. High sensitivity cardiac
troponin I (µg/ml) was analyzed from serum samples taken
before, during and after two or three radiation therapy
weeks. According to cTnI value (≤0.009 or >0.009 µg/ml),
patients were allocated into two groups; group A (>0.009
µg/ml) and group B (≤0.009 µg/ml) All patients underwent
left ventricular ejection fraction (LVEF, Echo)
examination before and after radiation therapy. Dose-
volume-histograms (DVH) for the heart were also
calculated.
Results
In the whole study population, cTnI was detectable
(>0.009 µg/ml) in 6 (21.42 %) patients before RT, in 5
(17.85 %) during RT and in 6 (21.42 %) patients after RT.
Patients with increased cTnI values (group A, N = 6) had
higher radiation doses for the heart (5.14 vs, 4.06 Gy). This
increase in the cTnI level was more marked in patients
with high blood pressure (33% vs, 4.54%), left-sided breast
cancer (66.66% vs, 50%), and those who had received
lymph nodes RT; (internal mammary chain (50 vs, 27.27%),
supra clavicular and infraclavicular lymph nodes (83.33 vs,
22.72%).
Conclusion
In spite of the limited patient number, our study shows
that circulating cTnI confirms subclinical myocardial
damage during and after breast cancer radiation therapy.
The role of cTnI as biomarker in predicting future
cardiovascular events in patients undergoing adjuvant
radiation therapy remains to be determined in large
studies and could become a useful research tool.
EP-1146 Acute toxicity of hypofractionation with SIB
in the radiation therapy for breast cancer
J. Fernandez-Ibiza1, J. Calvo1, O. Coronil1, S. San José1,
E. Puertas 1, R. Robaina1 , J. Casals1
1 Hospital Quiron Barcelona, Radiation Oncology,
Barcelona, Spain
Purpose or Objective
The aim of our study is to evaluate the tolerance and
acute/immediate toxicity of a ‘mild’ hypofractionation
with simultaneous integrated boost in the radiation
therapy after breast conserving surgery in women with
diagnosis of early breast cancer.
Material and Methods
Between January 2015 to October 2016, 100 women with
breast cancer diagnosis (Tis-T2, N0-1) were treated with a
hypofractionated simultaneous integrated boost (SIB)
after breast-conserving surgery, using IMRT, field-in-field
technique (FIF) or a mixed technique. Dose prescribed was
45,57 Gy (2, 17 Gy/fr.) in 21 fractions to the breast (+
supraclavicular fossa in 25p), and a simultaneous
integrated boost to the surgical bed to achieve 55, 86 Gy
(2, 66 Gy/fr.). All patients were treated with
chemotherapy (27, 9% were neoadjuvant), except 6 cases
of intraductal carcinoma. We registered the acute toxicity
at the end of the treatment, one week after and 6 weeks
after, prospectively, using the NCI-CTCAE v4.0 scale.
Results
The acute toxicity at the end of the treatment was grade
1 in 62% of patients, grade 2 in 38% of patients, and grade
3 in 1 patient. One week after the treatment, we observed
grade 0 in 2 patients, grade 1 in 54 patients , and grade 2
in 44%. Hence, we detected an increase of gradation
toxicity, only in 10 patients (10%), when the toxicity was
registered a week later. Finally, 6 weeks after the
radiation therapy; 67 % of the patients had recovered their
skin’s normal appearance, and 33 % of them persisted with
faint erythema (G1) or pigmentation. We collect other
parameters of acute toxicity as desquamation, observing
no desquamation in 51 % of the patients, dry desquamation
in 43% and moist desquamation in 6%.
Conclusion
This scheme of ‘mild’ hypofractionation with SIB, in the
postoperative radiation treatment of early breast cancer
after conserving-surgery, showed to be well tolerated and
feasible, and is associated with acceptable
immediate/acute skin toxicity. Longer follow up is needed
to demonstrate acceptable subacute and late toxicity.
EP-1147 Radiation induced oesophagitis in breast
cancer patients
K. West1, N. Coburn1, R. Beldham-Collins1,2, K. Tiver1, K.
Stuart2, V. Gebski2
1Nepean Cancer Care Centre, Nepean Hospital, Penrith,
Australia
2Crown Princess Mary Cancer Centre, Westmead
Hospital, Westmead, Australia
Purpose or Objective
To investigate if a relationship exists between the dose
volume parameters leading to moderate oesophagitis in
early breast cancer patients receiving radiotherapy to
both the breast and supraclavicular nodes (SCF).
Oesophagitis has been widely reported in treatment sites
such as lung and head and neck, however there is limited
data for breast cancer patients.
Material and Methods
Seventy-seven breast cancer patients receiving
radiotherapy to their breast and SCF were recruited for
the study. Patients were prescribed 50Gy to the breast or
chest wall and SCF +/- a simultaneous integrated boost to
the tumour bed of 57Gy. Analysis of the dose volume
histogram (DVH) data of the irradiated volume of the
oesophagus was performed. Patients were graded twice
weekly with a modified RTOG oesophagitis scale to
determine the onset, duration and severity of reported
oesophagitis. Patients who experienced a grade 1B or
worse by the end of their treatment were followed up
twice weekly until the symptoms of oesophagitis had
resolved.
Results
From the 77 patients analysed, 2 patients had no reaction,
22 patients reached a grade 1A reaction, 30 patients
reached grade 1B, 16 patients reached grade 2A and 7
patients reached grade 2B. The onset of each grade
reached throughout the treatment showed those who
reached a maximum grade of 1B, did so at an average of
13 fractions. Patients that reached a maximum grade of
2A, reached grade 1B at 10 fractions and 2A at 18
fractions. Patients that reached a maximum grade of 2B
reached the 1B grade at just 8.3 fractions, the 2A at 14
fractions and the 2B at 21.7 fractions suggesting the faster
the onset, the worse the outcome for the patient. The
average mean dose to the oesophagus for patients that
had a maximum grade of 0-1A was 31.95Gy, 1B was
32.46Gy, 2A was 34.22Gy and 2B was 34.64Gy. The
average maximum doses recorded for 0-1A was 49.86Gy,
1B 50.44Gy, 2A 50.36Gy and 2B 51.26Gy; maximum doses
did not seem to have an impact on the incidence of
oesophagitis, however the mean dose showed a steady
increase from grade 0-1A up to 2B. Also recorded was the
mean dose delivered at each grade, based on when the
patient reported the changes.