- Email: [email protected]
229 oral Ductal carcinoma in situ: University of Florida experience
$66 Friday, 2 February 2001
be used for further prognostic classification and risk-based therapeutic refinement. Our results also indicate the maximal multimodal adjuvant therapy is superior to any other combination for this high risk opulation. 228
era[
Outcome and prognostic factors in T3NOM0 Breast cancer patients treated by adjuvant radiotherapy: preliminary results I.L. Atahan, D. Ozturk, F. Yildiz, G. Ozyigit, M. GOrkaynak Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
Proffered papers
230
oral
IS cosmetic outcome or breast morbidity after radiotherapy in breast conservation affected by adjuvant systemic treatment w i t h C M F or tamoxifen ? J. Johansen 1, j. Overgaard2, M. Overgaard 3 1Dept. of Oncology, The Finsen Center, Rigshospitalet, Copenhagen 2Danish Cancer Society, Dept. of Experimental Clinical Oncology, Aarhus 3Dept. of Oncology, Aarhus University Hospital, Aarhus, Denmark On behalf of the Danish Breast Cancer Cooperative Group (DBCG), Denmark
Purpose: In this retrospective study we tried to evaluate the possible prognostic factors in pT3NOM0 breast cancer patients and to compare it with T3N1 M0 and T1-2NOM0 patients. Methods: Between December 1993 and December 1998, a total number of 474 patients with nonmetastatic breast cancer were referred to our department after modified radical mastectomy or breast conserving surgery. Of those, 40 (8%) were evaluated as pT3N0 whereas 148 (31.2%) were T3N1. The median age was 48 for the whole group and 47 for T3N0 patients. All patients received adjuvant radiotherapy to chest wall and/or regional lymphatics depending on the size of tumor, metastatic lymph nodes and type of surgery. Patients with T3 tumors were administered adjuvant chemotherapy in the form of CMF, C A r or CEF and in case of ER positivlty, tamoxifen was prescribed. Results: Median followup time is 32 months for whole group and 30 months for T3N0 subgroup. 3 year overall survival (OS) and disease free survival (DFS) for the whole group is 94% and 74% respectively. For T3N0 patients 3 year OS and DFS were found as 100% and 90% respectively. Family history, benign breast disease, receptor status, age at the time of diagnosis (< 40 years vs >40 years) were prognostic factors analyzed for T3N0 patients. Only age at the diagnosis was found as a statistically significant prognostic factor (p: 0.005) for DFS. There was no significance DFS and OS difference between T1-2NO and T3N0 patients. A significant DFS, distant metastases free survival (DMFS) advantage was observed in T3N0 subgroup when compared to T3N1 patients (p<0.05). Although not significant, there was a strong trend for OS in favour of T3N0 patients as well (p:- 0.09). For T3 patients the metastatic lymph node ratio (LNR:number of metastatic lymph nodes/total number of lymph nodes dissected, 0% vs <25% vs 26-50% vs >50%) significantly effected both DFS and DMFS. Similar 'p' values were found for DMFS. Conclusion: T3N0 breast cancer patients have relatively good outcome comparable to T1-2N0 breast cancer patients when adjuvant radiotherapy and chemotherapy is added. Since there is no significant survival difference in our study between NO and N1 patients with less than 25% LNR, we may conclude that a subgroup of T3N1 patients with less than 25% lymph node involvement may have the same prognosis as patients with T3N0.
Purpose: to study whether adjuvant treatment with CMF or tamoxifen predispose to an unfavourable cosmetic outcome (CO) and breast morbidity after postoperative radiotherapy in breast conservation. Patients and methods: 266 patients from a randomized breast conservation trial (DBCG-82TM protocol) were assessed. All the patients (pts) were treated with lumpectomy and axillary dissection followed by external beam radiotherapy to the residual breast. High-risk pts (n=94), as well as 31 lowrisk pts, received additional radiation to the regional lymph nodes. Adjuvant systemic treatment was given to all high-risk pts, i.e. premenopausal pts (n=67) had 8 cycles of CMF intravenously (600/40/600 mg per m2) every forth week, and postmenopausal pts (n=27) received 30 mg of tamoxifen daily for one year. CMF and irradiation were given sequentially. Outcome measures including CO, breast fibrosis, skin telangiectasia and dyspigmentation were scored on a 4-point categorical scale and used in multivariate logistic regression analysis. Results: in premenopausal pts, systemic treatment with CMF independently predicted a fair/poor cosmetic outcome, RR=2.3 (95%CI 1.2-4.6), increased skin telangiectasia, RR=3.3 (1.4-8.2), as well as breast fibrosis, RR=4.4 (1.8-10.3). In postmenopausale pts, endocrine treatment with tamoxifen exclusively exerted a significant effect on breast fibrosis, RR=5.3 (1.8-15.8), but this occurrence could possibly be linked to axillary irradiation which on the other hand did not exert an independent effect on CO or breast morbidity in premenopausal women. Conclusions: adjuvant systemic therapy with sequential CMF independently predicts an adverse cosmetic outcome as well as increased breast morbidity after postoperative radiotherapy in breast conservation while tamoxifen possibly increases the risk of breast fibrosis. This work is supported by the Danish Cancer Society.
229 oral D u c t a l c a r c i n o m a in
therapy based on psa doubling time, the change in histologic grade on rebiopsy, and the extent o f c l i n i c a l progression
situ: University of Florida experience
S. Chafe 1,2 N. Mendenhall 1, C. Hayes 1 1University of Florida College of Medicine, Radiation Oncology, Gainesville, Florida, USA 2University of Alberta, Cross Cancer Institute, Radiation Oncology, Edmonton, Alberta, Canada Purpose: To evaluate the outcome of patients with ductal carcinoma in situ (DCIS) treated by University of Florida faculty. Methods: Fifty-five patients with DICS were reviewed retrospectively to determine clinical outcome. The range of follow-up was 2.44 to 15.89 years. All patients were treated with medial and lateral tangential breast fields. The dose range was 45 - 50.5 Gy. Forty-five patients received a boost to the tumor bed with a dose range of 8 - 15 Gy. We evaluated the impact of histologic subtype, margin status, tumor size, and complications. Results: Eight patients developed an ipsilateral breast recurrence. Three patients had recurrent DCIS and 5 developed an invasive recurrence. One patient subsequently developed invasive disease. The time to recurrence ranged from 8.7 months to 8 years. Five patients developed a recurrence in the original tumor bed, one patient had a marginal recurrence, one patient developed a simultaneous recurrence in the tumor bed and separate quadrant, and one patient had a separate quadrant recurrence. The local control rate was 89% at 5 years and 83% at 10 years. The overall cause-specific survival rate was 100% at 5 and 10 years. Margin status and tumor size had no impact 9 n outcome. Seven of 8 patients with recurrence had a comedo component to their tumor at original diagnosis. Complications were acceptable with only 2% of patients developing severe late complications. Conclusions: Breast conservation is an appropriate management for patients with DCIS. Careful attention must be paid to the radiotherapeutic technique to ensure optimal local control and cosmesis.
UROLOGICAL TUMOURS 231
oral
Localized prostate cancer: watchful waiting vs. definitive
R. Choo 1, D. Danjoux 1, L. Klotz2, G. Morton 1, E. Rakovitch 1, N. Fleshnet2-, G. DeBoer 1, P. Bunting2 1Toronto-Sunnybrook Regional Cancer Centre, University of Toronto, Toronto, Canada 2Sunnybrook & Women's College Health Sciences Centre, University of Toronto, Toronto, Canada Purpose: To evaluate an observation protocol with selective delayed intervention, and PSA doubling time (Td) in localized, favorable grade, prostate cancer Methods: Prospective single-arm. Subjects with stage Tlb-2bNOM0, Gleason score (GS) < 7, and PSA < 15 ng/ml are managed with watchful observation as long as the arbitrarily defined disease progression criteria are not met. Disease progression requiring therapeutic intervention is defined: 1. PSA progression (PP): Td < 2 years (yr), based on at least 3 measurements over a minimum of 6 months (mn) and final PSA > 8, 2. Clinical progression (CP): more than twice increase in the size of prostate nodule, or symptoms requiring TURP, 3. Histologic progression (HP): GS > 8 in the rebiopsy at 18 mns. Td is estimated from a linear regression of In (PSA) on time, assuming a simple exponential relationship. Results: Since Nov. 1995, 174 patients have been accrued (median age: 70 yrs). The distribution of T stage, PSA at entry, and GS are as follows: TI: T2 = 106:68, PSA < 5: 5-9.9:10-14.9 = 57:83:34, GS 2-5: 6: 7: Gx = 40:93:39: 2. Median PSA at entry is 6.4 (range (r): 0.3-14.6). Median follow-up is 21 mns (r: 1-52). 125 remain on surveillance with no progression. 49 came off the study with the following reasons: 13:CP, 13:PP, 2:HP, 4:died of other causes, 13:patient's request, 4:protocol violations. Initial GS, T stage and PSA do not predict a higher progression rate. The actuarial probability of remaining on the surveillance protocol is 92% at 1 yr and
be used for further prognostic classification and risk-based therapeutic refinement. Our results also indicate the maximal multimodal adjuvant therapy is superior to any other combination for this high risk opulation. 228
era[
Outcome and prognostic factors in T3NOM0 Breast cancer patients treated by adjuvant radiotherapy: preliminary results I.L. Atahan, D. Ozturk, F. Yildiz, G. Ozyigit, M. GOrkaynak Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
Proffered papers
230
oral
IS cosmetic outcome or breast morbidity after radiotherapy in breast conservation affected by adjuvant systemic treatment w i t h C M F or tamoxifen ? J. Johansen 1, j. Overgaard2, M. Overgaard 3 1Dept. of Oncology, The Finsen Center, Rigshospitalet, Copenhagen 2Danish Cancer Society, Dept. of Experimental Clinical Oncology, Aarhus 3Dept. of Oncology, Aarhus University Hospital, Aarhus, Denmark On behalf of the Danish Breast Cancer Cooperative Group (DBCG), Denmark
Purpose: In this retrospective study we tried to evaluate the possible prognostic factors in pT3NOM0 breast cancer patients and to compare it with T3N1 M0 and T1-2NOM0 patients. Methods: Between December 1993 and December 1998, a total number of 474 patients with nonmetastatic breast cancer were referred to our department after modified radical mastectomy or breast conserving surgery. Of those, 40 (8%) were evaluated as pT3N0 whereas 148 (31.2%) were T3N1. The median age was 48 for the whole group and 47 for T3N0 patients. All patients received adjuvant radiotherapy to chest wall and/or regional lymphatics depending on the size of tumor, metastatic lymph nodes and type of surgery. Patients with T3 tumors were administered adjuvant chemotherapy in the form of CMF, C A r or CEF and in case of ER positivlty, tamoxifen was prescribed. Results: Median followup time is 32 months for whole group and 30 months for T3N0 subgroup. 3 year overall survival (OS) and disease free survival (DFS) for the whole group is 94% and 74% respectively. For T3N0 patients 3 year OS and DFS were found as 100% and 90% respectively. Family history, benign breast disease, receptor status, age at the time of diagnosis (< 40 years vs >40 years) were prognostic factors analyzed for T3N0 patients. Only age at the diagnosis was found as a statistically significant prognostic factor (p: 0.005) for DFS. There was no significance DFS and OS difference between T1-2NO and T3N0 patients. A significant DFS, distant metastases free survival (DMFS) advantage was observed in T3N0 subgroup when compared to T3N1 patients (p<0.05). Although not significant, there was a strong trend for OS in favour of T3N0 patients as well (p:- 0.09). For T3 patients the metastatic lymph node ratio (LNR:number of metastatic lymph nodes/total number of lymph nodes dissected, 0% vs <25% vs 26-50% vs >50%) significantly effected both DFS and DMFS. Similar 'p' values were found for DMFS. Conclusion: T3N0 breast cancer patients have relatively good outcome comparable to T1-2N0 breast cancer patients when adjuvant radiotherapy and chemotherapy is added. Since there is no significant survival difference in our study between NO and N1 patients with less than 25% LNR, we may conclude that a subgroup of T3N1 patients with less than 25% lymph node involvement may have the same prognosis as patients with T3N0.
Purpose: to study whether adjuvant treatment with CMF or tamoxifen predispose to an unfavourable cosmetic outcome (CO) and breast morbidity after postoperative radiotherapy in breast conservation. Patients and methods: 266 patients from a randomized breast conservation trial (DBCG-82TM protocol) were assessed. All the patients (pts) were treated with lumpectomy and axillary dissection followed by external beam radiotherapy to the residual breast. High-risk pts (n=94), as well as 31 lowrisk pts, received additional radiation to the regional lymph nodes. Adjuvant systemic treatment was given to all high-risk pts, i.e. premenopausal pts (n=67) had 8 cycles of CMF intravenously (600/40/600 mg per m2) every forth week, and postmenopausal pts (n=27) received 30 mg of tamoxifen daily for one year. CMF and irradiation were given sequentially. Outcome measures including CO, breast fibrosis, skin telangiectasia and dyspigmentation were scored on a 4-point categorical scale and used in multivariate logistic regression analysis. Results: in premenopausal pts, systemic treatment with CMF independently predicted a fair/poor cosmetic outcome, RR=2.3 (95%CI 1.2-4.6), increased skin telangiectasia, RR=3.3 (1.4-8.2), as well as breast fibrosis, RR=4.4 (1.8-10.3). In postmenopausale pts, endocrine treatment with tamoxifen exclusively exerted a significant effect on breast fibrosis, RR=5.3 (1.8-15.8), but this occurrence could possibly be linked to axillary irradiation which on the other hand did not exert an independent effect on CO or breast morbidity in premenopausal women. Conclusions: adjuvant systemic therapy with sequential CMF independently predicts an adverse cosmetic outcome as well as increased breast morbidity after postoperative radiotherapy in breast conservation while tamoxifen possibly increases the risk of breast fibrosis. This work is supported by the Danish Cancer Society.
229 oral D u c t a l c a r c i n o m a in
therapy based on psa doubling time, the change in histologic grade on rebiopsy, and the extent o f c l i n i c a l progression
situ: University of Florida experience
S. Chafe 1,2 N. Mendenhall 1, C. Hayes 1 1University of Florida College of Medicine, Radiation Oncology, Gainesville, Florida, USA 2University of Alberta, Cross Cancer Institute, Radiation Oncology, Edmonton, Alberta, Canada Purpose: To evaluate the outcome of patients with ductal carcinoma in situ (DCIS) treated by University of Florida faculty. Methods: Fifty-five patients with DICS were reviewed retrospectively to determine clinical outcome. The range of follow-up was 2.44 to 15.89 years. All patients were treated with medial and lateral tangential breast fields. The dose range was 45 - 50.5 Gy. Forty-five patients received a boost to the tumor bed with a dose range of 8 - 15 Gy. We evaluated the impact of histologic subtype, margin status, tumor size, and complications. Results: Eight patients developed an ipsilateral breast recurrence. Three patients had recurrent DCIS and 5 developed an invasive recurrence. One patient subsequently developed invasive disease. The time to recurrence ranged from 8.7 months to 8 years. Five patients developed a recurrence in the original tumor bed, one patient had a marginal recurrence, one patient developed a simultaneous recurrence in the tumor bed and separate quadrant, and one patient had a separate quadrant recurrence. The local control rate was 89% at 5 years and 83% at 10 years. The overall cause-specific survival rate was 100% at 5 and 10 years. Margin status and tumor size had no impact 9 n outcome. Seven of 8 patients with recurrence had a comedo component to their tumor at original diagnosis. Complications were acceptable with only 2% of patients developing severe late complications. Conclusions: Breast conservation is an appropriate management for patients with DCIS. Careful attention must be paid to the radiotherapeutic technique to ensure optimal local control and cosmesis.
UROLOGICAL TUMOURS 231
oral
Localized prostate cancer: watchful waiting vs. definitive
R. Choo 1, D. Danjoux 1, L. Klotz2, G. Morton 1, E. Rakovitch 1, N. Fleshnet2-, G. DeBoer 1, P. Bunting2 1Toronto-Sunnybrook Regional Cancer Centre, University of Toronto, Toronto, Canada 2Sunnybrook & Women's College Health Sciences Centre, University of Toronto, Toronto, Canada Purpose: To evaluate an observation protocol with selective delayed intervention, and PSA doubling time (Td) in localized, favorable grade, prostate cancer Methods: Prospective single-arm. Subjects with stage Tlb-2bNOM0, Gleason score (GS) < 7, and PSA < 15 ng/ml are managed with watchful observation as long as the arbitrarily defined disease progression criteria are not met. Disease progression requiring therapeutic intervention is defined: 1. PSA progression (PP): Td < 2 years (yr), based on at least 3 measurements over a minimum of 6 months (mn) and final PSA > 8, 2. Clinical progression (CP): more than twice increase in the size of prostate nodule, or symptoms requiring TURP, 3. Histologic progression (HP): GS > 8 in the rebiopsy at 18 mns. Td is estimated from a linear regression of In (PSA) on time, assuming a simple exponential relationship. Results: Since Nov. 1995, 174 patients have been accrued (median age: 70 yrs). The distribution of T stage, PSA at entry, and GS are as follows: TI: T2 = 106:68, PSA < 5: 5-9.9:10-14.9 = 57:83:34, GS 2-5: 6: 7: Gx = 40:93:39: 2. Median PSA at entry is 6.4 (range (r): 0.3-14.6). Median follow-up is 21 mns (r: 1-52). 125 remain on surveillance with no progression. 49 came off the study with the following reasons: 13:CP, 13:PP, 2:HP, 4:died of other causes, 13:patient's request, 4:protocol violations. Initial GS, T stage and PSA do not predict a higher progression rate. The actuarial probability of remaining on the surveillance protocol is 92% at 1 yr and