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(49.1%) pts received adjuvant chemotherapy. There were
43 (41%) pts with ECE and 43 (41%) with Grade 3 disease.
Complete patient characteristics are included in
Table 1
.
There were trends toward significance with use of a 3
rd
SCV field and pN1a disease (p=0.062), increased tumor
size (p=0.062), and positive ECE (p=0.077). The overall
rates of 2-year DFS and LRC were 95.1% and 98.9%,
respectively. One patient experienced an internal
mammary nodal recurrence, 1 contralateral breast tumor,
and 2 distant metastases. There were no axillary or
ipsilateral breast tumor recurrences. Factors associated
with decreased DFS on univariate analysis include Grade 3
disease (p=0.021) and use of a SCV field (p=0.008).
Conclusion
This retrospective analysis of pts undergoing BCS and SLN
biopsy with positive SLNs included pts who were
underrepresented or excluded from the Z11 trial yet
demonstrated comparable rates of LRC and DFS.
Nottingham Grade 3 disease and use of a 3
rd
SCV field were
associated with decreased DFS, though the apparent
detrimental effect of SCV treatment was likely due to
greater adverse risk factors causing pts to be selected for
more intensive treatment. The high rates of LRC and DFS
suggest that completion ALND may be safely omitted in
this patient population, though prospective data is needed
to
confirm this
finding.
EP-1150 Preliminary results of Intra-Operative
RadioTherapy in old women with good prognostic
features
S. Guillerm
1
, E. Bourstyn
2
, R. Itti
1
, I. Fumagalli
1
, V.
Martin
1
, L. Cahen-Doidy
2
, L. Quero
1
, S. Giacchetti
2
, C.
Cuvier
2
, M. Espié
2
, C. Hennequin
1
1
Hôpital Saint-Louis, Department of Radiation Oncolgy,
Paris, France
2
Hôpital Saint-Louis, Breast Cancer Unit, Paris, France
Purpose or Objective
In women > 65 yrs with good prognostic features (Isolated
tumour <3 cm, infiltrative ductal carcinoma (IDC),
presence of Estrogen Receptors ER+, pN0), adjuvant RT
increases the local control but do not improve overall
survival
1
. One possible alternative is to perform RT during
surgery to minimize patient’s travels and cost.
1
Hughes, JCO 2013; 31:2382-2387; Kunkler, Lancet Oncol
2015; 16: 266–73
Material and Methods
we reviewed our experience with Intra-Operative
RadioTherapy (IORT) for this population. All patients had
histologically confirmed breast cancer before surgery and
were judged eligible for IORT (Isolated IDC less than 3 cm,
ER+). Surgery consisted in sentinel lymph node dissection
(SNLD) with intraoperative touch imprint cytology and
lumpectomy. IORT was performed only in case of negative
SLND. It consisted in a radiation dose of 20 Gy delivered
with 50 kV photons (Intrabeam®, Zeiss).
Results
Between October 2012 and February 2015, 76 pts with pre-
operative good prognostic features were planned to have
IORT. Seven pts did not have it (positive SNLD: 4pts;
multifocality: 3pts). For the remaining 69 pts,
characteristics were: mean age: 78yrs [67-96]; mean pT
size: 15 mm [3-30]; OMS performance status 0-1: 65pts
(94%); Charlson Age-Comorbidity Index: Mean: 4.5 [2-9].
Mean duration of hospitalization was 2.5 days [0-6]. Grade
2 post-operative complications occurred in 19 pts (27%):
Abscess: 3pts; Hematoma: 3pts; Seroma: 2pts; Radiation
epithelitis: 10pts. Delay in healing was observed in 6 pts.
Adjuvant external beam RT after IORT was performed in 3
pts (SNLD+: 2pts; positive margins: 1pt). Hormonal
treatment was prescribed in 53 pts (77%). Minimal and
mean follow-up were 1 yr and 2 yr, respectively. No local
relapse occurred. Two pts died of intercurrent disease.
Cosmetic result was assessed in 60pts: excellent: 30pts;
good: 28pts; poor: 2pts. Cytosteatonecrosis and cutaneous
pigmentation were observed in 7 and 6 pts, respectively.
Conclusion
IORT in old women is feasible without increasing the rate
of post-operative complications. Preliminary results are
excellent in terms of local control and cosmesis.
EP-1151 Hypofractionated Radiotherapy in breast
cancer treatment: A comparison between 3-DCRT and
IMRT
A. Fiorentino
1
, R. Mazzola
1
, N. Giaj Levra
1
, G. Sicignano
1
,
G. Di Paola
1
, S. Naccarato
1
, S. Fersino
1
, U. Tebano
1
, F.
Ricchetti
1
, R. Ruggieri
1
, F. Alongi
1
1
Sacro Cuore Don Calabria Hospital, Radiation Oncology
Department, Negrar, Italy
Purpose or Objective
to compare 3-Dimensional Conformal RadioTherapy (3D-
CRT) and 4-fields Intensity Modulated RadiationTherapy
(IMRT) treatment plans, in terms of target dose coverage,
integral dose and dose to Organs at risk (OARs) in early
breast cancer (BC) hypofractionated RT.
Material and Methods
Twenty consecutive patients with early BC, after
lumpectomy, were selected for the present analysis. A
total dose of 40.5Gy in 15 fractions was prescribed to
Planning Target Volume (PTV
breast
) of the whole breast,
while a simultaneous total dose of 48Gy was prescribed to
the PTV of the surgical bed (PTV
boost
). For each patient
both a 3D-CRT plan with two couples of tangential-fields,
and a 4-fields sliding-window IMRT plan were generated.
Conformity and homogeneity indexes (CI, HI) were
calculated for PTVs. For evaluation of OARs and normal
tissue (NT), V
5Gy
, V
10Gy
and various organ specific V
xGy
values were analyzed.
Results
In terms of HI, IMRT (0.18 ± 0.02) was superior to 3D-CRT
(0.23 ± 0.02) for the PTV
breast
(p<0.0001). Both techniques
achieved the required dose for the PTV
boost
coverage, but
a significant difference for CI was observed in favour of
IMRT (0.9 ± 0.4) compared to 3D-CRT (3.7 ± 4.3)
(p<0.0001). With regards to the heart, IMRT improved both
mean and near-maximum doses. The inter-patients
average of the heart D
mean
was (1.9 ± 1) Gy for 3D-CRT,
and (1 ± 0.8) Gy for IMRT (p < 0.0001). For the analysis of
left BC, the inter-patients average of the heart D
mean
was
(2.9 ± 0.8) Gy for 3D-CRT, and (1.7 ± 0.6) Gy for IMRT (p =
0.0005). For the ipsilateral lung, the average of D
mean
for
overall patients was 6.3 ± 1.4 Gy with 3D-CRT, and 4.8 ±
1.3 Gy with IMRT (p<0.0001). The V
25Gy
value of the
ipsilateral lung was also lower with the use of IMRT
(p<0.0001). For the contralateral lung, the inter-patients
median of D
mean
to the contralateral lung was 0.4Gy for 3D-
CRT and 0.08Gy for IMRT (p<0.0001). For the contralateral
breast, both D
mean
and D
2%
were improved by the use of an
IMRT planning technique. The inter-patients average of
D
mean
was (0.3 ± 0.3) Gy for IMRT, while (1 ± 0.5) Gy for 3D-
CRT (p <0.0001). For NT
,
all DVH parameters are in favor
of IMRT, except the V
5Gy
for which the difference was not
statistically significant. The mean value of D
mean
was 2.2 ±
0.6 for 3D-CRT and 1.5 ± 0.4 for IMRT (p < 0.0001).
Conclusion
IMRT technique significantly reduced the dose to OARs and
NT, with a better target coverage compared to 3D-CRT.
Clinical evaluations are advocated.