649 / 1082
S633
ESTRO 36 2017
_______________________________________________________________________________________________
tumoral bed. Dose constraints were defined by an internal
protocol following the QUANTEC directive and more
recent
reports.HTtreatment plans were generated using
Tomotherapy HD System commercial planning software
(TomoTherapy Inc., Madison, WI). Daily set-up corrections
were performed for all patients.Toxicity was reported
following CTCAE 4.0. Statistical analysis: The Chi-square
and the Mann–Whitney's U-tests compared continuous
(age and body mass index) and categorical variables
(comorbidity,
chemotherapy,
hormonotherapy,
trastuzumab and chest wall/breast and lymph nodes
volumes).
Results
All patients completed treatment. HT provided good
target-coverage for the breast, chest wall and lymph
nodes, with respectively mean D90% 47.8Gy and 48.55Gy,
mean D95% 46.64Gy and 47.99Gy,mean D98% 45.20Gy and
47.3Gy, and mean V107% 0.65Gy and 0.315Gy. All
constraints for OARs were respected (i.e ipsilateral lung:
median V5: 70.93 Gy, V20: 24.2Gy and V30: 11.89Gy;
contralateral lung: V5: 24.17Gy and V15: 2.15Gy; heart:
Dmean 6.6 Gy). G1-G2 acute toxicity developed in 42
patients patients and G3 acute toxicity in only 1 (Table 2).
The only risk factor for desquamation and oedema
was chest wall/breast volume (p=0.003 and
p=0.011respectively). At a median follow-up of 12.5
months (range 2-29), all patients were alive and 41/43
(95.3%) patients were disease-free.
Conclusion
HT is associated with low acute toxicity and appears
suitable for treating the chest wall or breast plus level III
and IV draining nodes in patients with breast cancer.
EP-1177 Late radiation skin effects after breast
conserving surgery: possible predictive clinical factors.
A. Romano
1
, A. Rese
1
, E. Toska
1
, L. Faraci
1
, M. Conson
1
,
A. Farella
1
, R. Solla
2
, R. Liuzzi
2
, L. Cella
2
, R. Pacelli
1
1
University of Napoli Federico II, Section of Radiation
Oncology, Napoli, Italy
2
National Council of Research, Institute of Biostructure
and Bioimage, Napoli, Italy
Purpose or Objective
Previously we have shown that dose to surface and
psoriasis were predictive factors for radio-induced acute
skin toxicity in patients affected by breast cancer treated
with breast conserving therapy (BCT). In this study we
assessed in the same group of patients the late skin
toxicity, evaluating possible relation with acute skin
toxicity, dosimetric and clinical factors.
Material and Methods
One Hundred Forty patients treated with BCT between
2011 and 2012 in our department were considered for the
study. Median age was 57 year (range 32-85). All patients
were treated after surgery with 50 Gy to the whole breast
delivered with 25 daily fractions in 5 weeks. A boost dose
of 10 Gy in 5 days was delivered by electrons to the
tumoral bed. Late skin toxicity was assessed by physical
inspection during the oncological follow up of the patients
and was described and graded according to the RTOG
classification. Relation to previous acute skin toxicity,
clinical and dosimetric factors was assessed by univariate
analysis.
Results
At a median follow up of 54 months (range 50-60), sixteen
patients (11%) developed late skin toxicity. Fifteen grade
G1-2 (dyschromia and telangiectasia), while 1 patients had
nipple necrosis (G4) at the the site of the surgical scar.
Interestingly, no significant relation with previous radio-
induced acute skin toxicity was found.
Conclusion
Our study suggests that late radioinduced skin toxicity
appears in a small but significant portion of patients
treated by BCT and seems to be unrelated to previous
acute skin toxicity.
EP-1178 Breast radiotherapy without nodal irradiation
in pT1-2 pN0-1 stage: prognostic factors and
outcomes.
C. Di Carlo
1
, M. Nuzzo
1
, L.A. Ursini
1
, M. Trignani
1
, L.
Caravatta
1
, G. Di Girolamo
1
, M. Di Nicola
2
, D. Genovesi
1
1
Ospedale Clinicizzato S.S. Annunziata, Radiotherapy,
Chieti, Italy
2
Biostatistic laboratory, Clinical Sciences, Chieti, Italy
Purpose or Objective
The aim of study was to evaluate loco-regional recurrence
(LRR), overall survival (OS), disease free survival (DFS),
prognostic influence of the number of positive lymph
nodes and others variables in treatment of early breast
cancer patients.
Material and Methods
From December 2005 to December 2013, 377 female
patients with pT1-T2 pN0-N1 were treated in our
Radiotherapy Institute and retrospectively evaluated. All
patients received conservative surgery with sentinel-
lymph node and/or axillary dissection followed by whole
breast radiotherapy. According to our institutional
protocol nodal region irradiation was not performed. Four
cohorts were analyzed according to the number of
involved lymph nodes: N0, N1
n1
(1 lymph node +), N1
n2
(2
lymph nodes +), N1
n3
(3 lymph nodes +). Actuarial rates of
total LRR, DFS and OS were calculated by the Kaplan-Meier
method. Comparisons of clinical and pathologic
characteristics between patients groups were calculated
using the log-rank test.
Results
From a total of 377 patients, 284 patients with pT1 tumors
and 93 with pT2 tumors were evaluated. The median age
was 58 years (range 31-82 years). The absence of involved
lymph nodes has been assessed in 276 patients while N1
was reported in 101 patients: 63 N1
n1
, 19 N1
n2
, and 19 N1
n3
.
The median follow-up was 4 years with a LRR rate of 3.4%
(13/377). In particular a nodal recurrence rate of 1.06%
(4/377) was observed: 2 occurred in the axillary region, 1
in supraclavicular region and 1 within internal mammary
chain. Estrogen receptor, menopausal status, adjuvant
chemotherapy, Her2neu, margin status and grading were
not significantly associated with OS and DFS, whereas
progesterone receptors were significantly correlated with
DFS and tumor size (T>2 cm) with DFS, LRR and OS.
Furthermore, a significant correlation between 3
metastatic lymph nodes and OS was found (N1
n3
p-value
0.024, N1
n1
p-value 0.175, N1
n2
p-value 0.369).
Conclusion
In our series, adjuvant radiotherapy after breast-
conserving surgery led to low rates of LRR and high rates
of OS and DFS in pT1-T2 pN0-N1 breast cancer patients.
Moreover, although the retrospective design, the limited
sample size and given the low rate of nodal recurrence,
the results observed from our study seem suggest that
nodal irradiation in patients presenting 1-3 positive
axillary nodes could be not necessary to improve outcome.
EP-1179 Target Volume Definition after Lumpectomy
for Accelerated Partial Breast Irradiation (APBI) or
Boost
I.F. Ciernik
1
, A.M. Greiß
2
1
Dessau City Hospital, Radiation Oncology, Dessau,
Germany
2
Deaconess Hospital, Department of Surgery, Dessau,
Germany
Purpose or Objective
After tumor resection and surgical manipulation during
lumpectomy or oncoplasty, the tumor cavity and the tissue
at risk for local relapse is often not clearly definable
during radiation therapy planning. Metal clips placed at
the thoracic fascia are used to better define the former
tumor location. Here we investigated the ability of a