635 / 1082
S619
ESTRO 36 2017
_______________________________________________________________________________________________
Figure 1 Difference in the average mean dose between
grades 1 and 2
The graph (Figure 1) shows between grades 1A-1B there
is almost a plateau and similarly between grade 2A-2B,
however there is a sharp increase between grade 1B-2A,
suggesting a potential limiting mean dose of 32Gy.
Conclusion
Moderate oesophagitis is prevalent in breast cancer
patients receiving radiotherapy to the SCF. Limiting the
mean oesophageal dose to 32Gy could decrease the
severity of oesophagitis in these patients.
EP-1148 Distress and self-awareness of disease severity
in early breast cancer: two Institutions comparison
I. Meattini
1
, T. Zagar
2
, G. Francolini
1
, A. Deal
2
, G. Carta
1
,
J. Camporeale
2
, L. Terzo
2
, L. Livi
1
, O. Kaidar-Person
2
1
Azienda Ospedaliero Universitaria Careggi - University
of Florence, Radiation Oncology Unit - Oncology
Department, Florence, Italy
2
University of North Carolina, Department of Radiation
Oncology, Chapel Hill, USA
Purpose or Objective
Coping with cancer, even in the curative setting, may lead
to emotional and psychological distress. However,
resilience is dependent on many factors including social
support and ethnic/cultural coping strategies. The aim of
this multicenter retrospective study is to evaluate the
distress among curative breast cancer (BC) patients in two
different continents: USA and Europe.
Material and Methods
We collected data from medical records of early BC
patients treated with curative intent at the Florence
University Hospital (FUH; Italy) and at the University of
North Carolina (UNC; USA) seen between November 2014
and December 2015. Data included demographics, stage,
BC subtype, treatment received, referral to supportive
services (SP), and use of mood/anxiety lytic and sleep
medications (meds). Patients with inoperable or
metastatic disease, known psychiatric disorder, or
recurrent/synchronous cancer were excluded from this
study. The use of SP and meds were compared between
the two cohorts using Wilcoxon, Fisher´s exact, and
Jonckheere–Terpstra
tests. Adjusted relative risks (RR)
were estimated using Poisson regression.
Results
In patients treated at FUH (n=110), rate of SP referral and
use of meds was not significantly influenced by adjuvant
or primary systemic therapy (PST), type of surgery
(mastectomy versus conservative surgery), regional nodal
irradiation (RNI) or use of boost, T or N stage. Patients
treated at UNC (n=121) who received mastectomy had
higher rates of SP vs BCT (62% vs 35%)p=0.02). The use of
meds was significantly higher in patients who received
adjuvant chemotherapy and RNI. Both SP referral and use
of meds were significantly associated with increasing T
stage (p=0.03 and p=0.003, respectively) and N stage
(p=0.03 and p=0.0004, respectively). Younger UNC
patients (age <60 years) had a significantly higher rate of
meds use (55% vs 33%, p=0.02). UNC patients had a
significantly higher rate of SP referral (41% vs 29%,
p=0.003), meds (44% vs 18%, p<0.0001), PST (p=0.03),
mastectomy (p=0.002), RNI (<0.0001), and tumor bed
boost administration (p=0.03) compared to FUH. After
adjusting for age, subtype, T stage, surgery, and PST: UNC
patients remained significantly more likely to refer to SP
(RR=1.7)
and
to
receive
meds
(RR=2.4).
Conclusion
The
rate of SP referral and the use of meds were higher in
USA cohort versus the cohort from south of Europe. The
reasons for these differences might be related to social
and cultural differences, rather than availability of
medications.
EP-1149 Omission of completion axillary lymph node
dissection in patients underrepresented in ACOSOG
Z11
B. Gebhardt
1
, Z. Horne
1
, G. Ahrendt
2
, E. Diego
2
, S.
Beriwal
1
1
University of Pittsburgh Cancer Institute, Radiation
Oncology, Pittsburgh, USA
2
University of Pittsburgh Cancer Institute, Surgical
Oncology, Pittsburgh, USA
Purpose or Objective
ACOSOG Z0011 demonstrated that axillary lymph node
dissection (ALND) can be omitted in patients (pts)
managed with breast conserving surgery (BCS) and 1-2
positive sentinel nodes (SLN) without adverse effects on
loco-regional control (LRC) or survival. Adjuvant
radiotherapy (RT) fields in this trial were heterogeneous
and included high tangents in half of pts and a 3
rd
nodal-
directed field in one-third of pts. Most pts enrolled in Z11
were post-menopausal with hormone receptor positive
breast cancer and axillary micrometastases. We
investigated breast cancer ptswith clinicopathologic
features underrepresented Z11 and analyzed RT patterns
and clinical outcomes.
Material and Methods
We retrospectively reviewed the records of pts who
underwent BCS with positive SLNS but not undergoing
ALND and who completed adjuvant RT. Eligible patients
had T3 tumors, >2 positive SLNs, invasive lobular
carcinoma, triple negative receptor status, extracapsular
extension (ECE), positive surgical margins, Nottingham
Grade 3, or age <50 years. Binary logistic regression was
used to examine association of pt characteristics with
delivered RT fields. Disease-free survival (DFS) and LRC
were assessed using the Kaplan-Meier method and log-rank
test for association with risk factors.
Results
We identified 106 pts treated from July 2011 to July 2016.
The median follow-up among living pts was 28 (range, 1-
62) months. Nineteen (17.9%) pts were treated with
whole-breast irradiation only, and 87 (82.1%) were treated
with modified tangential fields covering axillary level I/II.
Thirty-four (32.1%) pts received comprehensive nodal RT
including a 3
rd
supraclavicular (SCV) field. Fifty-two