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S625
ESTRO 36 2017
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To report 5-year outcomes and toxicity in early breast
cancer pts treated with whole breast hypofractionated
adjuvant radiotherapy(HRT) and concomitant trastuzumab
after breast conservation surgery(BCS).
Material and Methods
From February 2009 to October2011, 442 pts with breast
cancer pTis-T2 pN0-N1(up to 3 positive lymph nodes)
underwent forward planned intensity modulated HRT to a
TD=40 Gy/15 fr at out institution, and reached 5 year
median follow up; 31/442 pts presented c-erb B2
overexpression and were treated with HRT and
concomitant trastuzumab. Acute toxicity during HRT was
evaluated using the RTOG scale, while late side effects
were assessed using SOMA-LENT score.
Results
Patients’ median age was 60,5(28-75)years; tumor breast
side: 20 left and 11 right. Histology: DCI: 24 pts; DCI+DCIs:
6 pts; DCI+ LCIs:1 patient; apocrine carcinoma: 1 patient.
With a median follow-up of 63,8 (42,5-79,2) mts 3/31 pts
(9,7%) presented a local relapse, 2/31 pts ( 6,5%) a lymph
nodal relapse and 4/31 pts (12,9%) a distant relapse,
confirming the higher propensity for loco-regional and
distant relapse of c-erb B2 positive tumors. All pts were
alive at the last follow up. Acute toxicity was G0 in 7 pts
(22,6%), G1 in 20 pts(64,5%) and G2 in 4 pts(12,9%) with
no G3 toxicity. Late G1 edema and hyperpigmentation
persisting up to 18 mts after HRT was observed in 7 pts
(22,6%). Two persistent late toxicities were registered
only in pts treated with FEC chemotherapy before HRT:
one G2 fibrosis, starting 36 months after the end of HRT,
with breast volume of 1812 cc (cut-off observed in our
series: 866 cc), and one G3 teleangiectasy with breast
volume of 596 cc. Two cardiac toxicities were registered,
both in left sided breast cancers, one in a patient treated
with AC x3 cycles+TXT x 12 weeks +trastuzumab x 12 mts,
another in a patient treated with FECx5 cycles+
trastuzumab x 12 mts, which presented a mediastinal
relapse, treated with salvage chemotherapy. The same
patient presented BPCO exacerbations, again after the
salvage chemotherapy. While chemotherapy and breast
volume were important predictors for acute toxicity,
the
association of trastuzumab was not statistically
significant for both acute and late toxicity at the
multivariate analysis.
Conclusion
HRT after BCS demonstrated good outcomes and low
toxicity. The association of hypofractionated radiotherapy
with trastuzumab does not increase acute and late
toxicity.
EP-1160 T4s for T4 small Breast cancer: a new TNM
classification subgroup proposal
W.S. Zrafi
1
, S. Tebra
1
, H. Ouaz
1
, N. Bouaouina
1
1
Farhat Hached University Hospital, Radiation oncology
departement, Sousse, Tunisia
Purpose or Objective
T4 breast cancer are tumors of any size with direct
extension to the chest wall and, or the skin, including
inflammatory breast cancer. Non inflammatory T4 breast
cancer are a considerably heterogeneous group of tumors
with a subgroup of small-sized tumors.
Our aim is to evaluate the prognosis of small sized (under
3 cm) non inflammatory T4 breast cancer, comparing them
with larger T4 tumors and inflammatory breast
cancer.
Material and Methods
We had undertaken a retrospective study of T4 tumors
treated by radiotherapy in the departments of radiation
oncology in the Farhat Hached University Hospital and
Medical Centre Ibn Khaldoun
Results
250 patients classified as T4 tumors by our Committee for
Gynecologic Oncology were treated in our departments
between January 1995 and December 2013.
From these 250 patients, 79 were classified as T4d breast
tumors and 171 non inflammatory breast cancer. From
these, 11 cases the primary tumor size is unknown, 20
patients had small tumors under 3 cm at presentation, and
140 patients had tumors of 3cm in size or larger.
Seventeen were classified as T4a, 127 as T4b and 27 as
T4c.
148 patients had underwent neoadjuvant chemotherapy,
mastectomy, and adjuvant radiotherapy.
The median age was 50 years (ranging from 23 to 78). The
median size at presentation was 5 cm. the median follow-
up period was 42 months (ranging from 0 to 231).
The 5 years Disease free survival was 89% for small tumors
versus 59% for non-inflammatory larger tumors and 48% for
inflammatory breast cancer. With statistically significant
difference p = 0.037 (fig 1).
The overall survival was 89% versus 70% for non-
inflammatory larger tumors and 62% for inflammatory
breast (p = 0.28).
These finding support the fact that small T4 tumors had a
different behavior and better prognosis than other locally
advanced tumors, thus it should be considered as a
distinct entity. Indeed we propose that these tumors
should be classified T4”s” ('s” as small).
Although the actual T4 TNM subgrouping is lacking of
discriminative power, actually we did not find a significant
difference comparing the DFS (p = 0.34) or OS (p = 0.7)
according to the T4 TNM subgrouping (fig 2).
Fig 1: Disease free survival of the T4 s subgroup compared
with larger T4 non inflammatory breast cancer and T4d