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Intraoperative electron boost radiotherapy (IORT) versus postoperative external electron beam boost radiation in breast cancer patients — A sequential intervention study on local recurrence rates
s33
Poster Session II
FRIDAY,
14 MARCH
2003
Local treatment
I P62
lntraoperative electron boost radiotherapy (IORT) versus postoperative external electron beam boost radiation in breast cancer patients - A sequential intervention study on local recurrence rates
Fi. Reitsamer’ F. , Peintinger*.
F. Sedlmaye?, M. Kopp3, C. Menzel’. ’General Hospital Salzburg, Department of Senologl: Salzburg, Austria,. 2 General Hospital Leoben, Department ot Gynecology Leoben, Austria, 3 General Hospital Salzburg, Depanment of Radiooncology and Radiotherapy Sai’burg, Austria Introduction: The purpose of this sequential intervention study was to determine the rate of local recurrences and the rate of distant metastases in patients with invasive breast cancer, who had been treated with breast conserving surgery and postoperative radiation to the whole breast either with postoperative electron boost in group 1 or with intraoperative electron boost in group 2. Methods: After breast conserving surgery 378 women with invasive breast cancer of tumor sizes Tl and T2 received 51 to 56.1 Gy of postoperative radiation to the whde breast in 1.7 Gy fractions. 188 of those patients additionally received postoperative boost radiation of 12 Gy in group 1 from January 1996 to October 1998. Consecutively from October 1998 to March 2001 190 patients additionally received a single intraoperative electron boost radiation of 9 Gy to the tumor bed in group 2. Both groups are comparable looking at age, menopausal status, tumor size, grading and lymph node status. All statistical tests were two-sided. Results: During a median follow up period of 55.3 months in group 1 and a median follow up period of 25.8 months in group 2, local recurrences were observed in 8 of the 188 patients (4.3%) in group 1 and no local recurrence was observed in group 2 (P=O.O82). Distant metastases occurred in 15 of the 188 patients (8.0%) in group 1 and in 2 of the 190 patients (1 .I%) in group 2 (P=O.O9). The four-year actuarial rates of local recurrence were 4.3% (95% confidence interval, 1.8 to 8.2 percent) and 0.0% (95% confidence interval, 0.0 to 1.9%) and the four-year actuarial rates of distant metastasis were 7.9% (95% confidence interval, 4.5 to 12.8 percent) and 1 .l% (95% confidence interval, 0.1 to 3.8 percent). Conclusion: IORT boost appears to be superior to conventional postoperative boost according to local recurrence rates.
P63
czl
Partial breast irradiation with 19Biridium implants after breast conserving surgery: perioperative morbidity, toxicity and cosmetic results
0. Ott’, V. Stmad’, R. Poetter2. J. Hammer3, A. Resch2, G. Kovacs’, M.W. Beckmann5, Ft. Sauer’ ’University of Edangen, Department of Radiation Oncology Ertangen, Germany; *University of Vienna, Department of Radiation Oncokqy Vienna, Austna; 3 Hospital Bamherzige Schwestern, Department of Radiation Oncology Linz, Austria; 4 University of Kiel, Department of Radiation Oncology Kiet, Germany; s Universitv of Erangen, Department of Gynecology Erlangen, Germany Purpose: To evaluate perioperative morbidity, toxicity and cosmetic outcome in patients treated with interstitial brachytherapy to the tumor bed as the sole radiation modality after breast conserving surgery. Patients and Methods: From 1 November 2000 through 36 November 2002, 80 women with early stage breast cancer were entered into a pDepartment of Radiation Oncologyrotccol of tumor bed irradiation alone using PDR or HDR interstitial implants. Patients were eligible if their tumor was an infiltrating carcinoma ??3 cm in diameter, surgical margins were clear by at least 2 mm, the axilla was surgically staged node negative, the tumor was hormone receptor positive and well or moderately differentiated, the tumor did not contain an extensive intraductal component and the patients age was I 35 years. Implants were positioned using a template guide delivering either 49.80 Gy in 83 hours (PDR) or 32.00 Gy in two daily fractions over 4 days (HDR). Perioperalive morbidity, toxicity and cosmetic outcome were
assessed. We present interim findings of the first 40 patients after a median follow-up of 15 months treated in this multicenter trial. Results: No perioperative complications, for example bleeding, hematoma or bacterial infection of the implant, were observed. Acute toxicity was low: 5% of the patients (2/40) experienced a mild radiodermatitis. Late toxicity: hypersensatiotimild pain 25% (10/40), mild hyperpigmentation 10% (4/40), moderate hyperpigmentation 2,5% (l/40), mild fibrosis 125% (5/40) and mild teleangiectasia 7.5% (3/40). Good-to-excellent cosmetic results have been observed in 93% of the evaluated patients. Conclusions: This interim analysis shows that partial breast irradiation with interstitial implants is feasible without significant perioperative morbidity, low acute and mild late toxicity and does not significantly affect cosmetic results.
I
P64
Short fractionation schedule in breast irradiation: Preliminary results
A. Kuten’,* , L Leitzin’ ,E. Rosenblatt’ , A. Tamir*, M. Schnaidman*, ’Rambam Medical Center Oncology Department, Haifa, Israel; * The Technion, Faculty of Medicine, Hai& tsmel Purpose: To evaluate the results of a short radiation fractionation schedule in terms of local control, survival, disease free survival (DFS), cosmetic outcome and cardiac and pulmonary toxicity in patients with primary breast cancer receiving breast conserving therapy. Patients and methods: Between July 1998 -April2001, 201 patients with stage O-IIB. who underwent breast conserving surgery, received 40Gy/16fx to the whole breast follwved by a “boost” dose of 12.5Gy/5fx to the tumor bed. At the time of analysis, 201 patients are available for survival and local control evaluation and 144 patients are available for radiotherapy related toxicity and cosmetic outcome evaluation. These 144 patients were seen by an oncologist at 3 month intervals during the first 3 years following the completion of radiotherapy. Results: With a median follow up of 3.3 years, the local control rate is lOO%, the overall survival 95% and the DFS 93%. Cosmetic outcome is excellent/good in 68%. Cardiac related mortality rate is 1%; decreased LVEF was detected in 4 patients (2.8%). Chest x-ray revealed pulmonary fibrosis in 21/79 patients (26.6%). Conclusion: Early results of short fractionation schedule in breast irradiation are comparable to those of standard therapy. Further follow up is needed to assess long term effectiveness and toxicity.
I
P65
Long-term cardiac side effects of post operative irradiation studied with myocardial scintigraphy
U. Blom-Goldman, T Fornander. Karolinska Institute, Dep ofOncolog)s Stockholm, Sweden
Goals: Assessment of long term cardiac side effects after postoperative
radiotherapy in patients with left-sided breast cancer. Methods: We recruited patients where the computer tomography-based 3D-dose planning showed that a part of the hearts left ventricle would be included in the 85% &-dose curve. Tangential opposed photon fields were given to the breast tissue in partially mastectomized patients, while electrons were given to the thoracic wall in patients operated on with modified radical mastectomy. Echocardiography and myocardial perfusion scintigraphy with stress test were performed before and after radiotherapy. Six patients with scintigrafic changes before radiotherapy were excluded. Other patients were excluded because of bad condition, withdrawn consent or lost to follow up. Nineteen out of 33 patients were thus eligible for the short-term follow with reexamination 5-23 months after irradiation. New fixed scintigraphic defects indicating regional myocardial hypoperfusion after radiotherapy were detected in 13 patients. To assess if these defects are reversible or progressive in the long term we have started a long time follow up with re-examination after five to eight years. Results:. The localization of the defects seems to correspond with the irradiation volume of the left ventricle. Initially patient with new perfusion-defects at first follow-up are examined. Currently three patients with previous defects have been examined. In one of these patients the previous scintigrafic defect persists. This patient suffers from coronary heart disease. Examination of other patients with and without previous defects are ongoing and will be reported.
Poster Session II
FRIDAY,
14 MARCH
2003
Local treatment
I P62
lntraoperative electron boost radiotherapy (IORT) versus postoperative external electron beam boost radiation in breast cancer patients - A sequential intervention study on local recurrence rates
Fi. Reitsamer’ F. , Peintinger*.
F. Sedlmaye?, M. Kopp3, C. Menzel’. ’General Hospital Salzburg, Department of Senologl: Salzburg, Austria,. 2 General Hospital Leoben, Department ot Gynecology Leoben, Austria, 3 General Hospital Salzburg, Depanment of Radiooncology and Radiotherapy Sai’burg, Austria Introduction: The purpose of this sequential intervention study was to determine the rate of local recurrences and the rate of distant metastases in patients with invasive breast cancer, who had been treated with breast conserving surgery and postoperative radiation to the whole breast either with postoperative electron boost in group 1 or with intraoperative electron boost in group 2. Methods: After breast conserving surgery 378 women with invasive breast cancer of tumor sizes Tl and T2 received 51 to 56.1 Gy of postoperative radiation to the whde breast in 1.7 Gy fractions. 188 of those patients additionally received postoperative boost radiation of 12 Gy in group 1 from January 1996 to October 1998. Consecutively from October 1998 to March 2001 190 patients additionally received a single intraoperative electron boost radiation of 9 Gy to the tumor bed in group 2. Both groups are comparable looking at age, menopausal status, tumor size, grading and lymph node status. All statistical tests were two-sided. Results: During a median follow up period of 55.3 months in group 1 and a median follow up period of 25.8 months in group 2, local recurrences were observed in 8 of the 188 patients (4.3%) in group 1 and no local recurrence was observed in group 2 (P=O.O82). Distant metastases occurred in 15 of the 188 patients (8.0%) in group 1 and in 2 of the 190 patients (1 .I%) in group 2 (P=O.O9). The four-year actuarial rates of local recurrence were 4.3% (95% confidence interval, 1.8 to 8.2 percent) and 0.0% (95% confidence interval, 0.0 to 1.9%) and the four-year actuarial rates of distant metastasis were 7.9% (95% confidence interval, 4.5 to 12.8 percent) and 1 .l% (95% confidence interval, 0.1 to 3.8 percent). Conclusion: IORT boost appears to be superior to conventional postoperative boost according to local recurrence rates.
P63
czl
Partial breast irradiation with 19Biridium implants after breast conserving surgery: perioperative morbidity, toxicity and cosmetic results
0. Ott’, V. Stmad’, R. Poetter2. J. Hammer3, A. Resch2, G. Kovacs’, M.W. Beckmann5, Ft. Sauer’ ’University of Edangen, Department of Radiation Oncology Ertangen, Germany; *University of Vienna, Department of Radiation Oncokqy Vienna, Austna; 3 Hospital Bamherzige Schwestern, Department of Radiation Oncology Linz, Austria; 4 University of Kiel, Department of Radiation Oncology Kiet, Germany; s Universitv of Erangen, Department of Gynecology Erlangen, Germany Purpose: To evaluate perioperative morbidity, toxicity and cosmetic outcome in patients treated with interstitial brachytherapy to the tumor bed as the sole radiation modality after breast conserving surgery. Patients and Methods: From 1 November 2000 through 36 November 2002, 80 women with early stage breast cancer were entered into a pDepartment of Radiation Oncologyrotccol of tumor bed irradiation alone using PDR or HDR interstitial implants. Patients were eligible if their tumor was an infiltrating carcinoma ??3 cm in diameter, surgical margins were clear by at least 2 mm, the axilla was surgically staged node negative, the tumor was hormone receptor positive and well or moderately differentiated, the tumor did not contain an extensive intraductal component and the patients age was I 35 years. Implants were positioned using a template guide delivering either 49.80 Gy in 83 hours (PDR) or 32.00 Gy in two daily fractions over 4 days (HDR). Perioperalive morbidity, toxicity and cosmetic outcome were
assessed. We present interim findings of the first 40 patients after a median follow-up of 15 months treated in this multicenter trial. Results: No perioperative complications, for example bleeding, hematoma or bacterial infection of the implant, were observed. Acute toxicity was low: 5% of the patients (2/40) experienced a mild radiodermatitis. Late toxicity: hypersensatiotimild pain 25% (10/40), mild hyperpigmentation 10% (4/40), moderate hyperpigmentation 2,5% (l/40), mild fibrosis 125% (5/40) and mild teleangiectasia 7.5% (3/40). Good-to-excellent cosmetic results have been observed in 93% of the evaluated patients. Conclusions: This interim analysis shows that partial breast irradiation with interstitial implants is feasible without significant perioperative morbidity, low acute and mild late toxicity and does not significantly affect cosmetic results.
I
P64
Short fractionation schedule in breast irradiation: Preliminary results
A. Kuten’,* , L Leitzin’ ,E. Rosenblatt’ , A. Tamir*, M. Schnaidman*, ’Rambam Medical Center Oncology Department, Haifa, Israel; * The Technion, Faculty of Medicine, Hai& tsmel Purpose: To evaluate the results of a short radiation fractionation schedule in terms of local control, survival, disease free survival (DFS), cosmetic outcome and cardiac and pulmonary toxicity in patients with primary breast cancer receiving breast conserving therapy. Patients and methods: Between July 1998 -April2001, 201 patients with stage O-IIB. who underwent breast conserving surgery, received 40Gy/16fx to the whole breast follwved by a “boost” dose of 12.5Gy/5fx to the tumor bed. At the time of analysis, 201 patients are available for survival and local control evaluation and 144 patients are available for radiotherapy related toxicity and cosmetic outcome evaluation. These 144 patients were seen by an oncologist at 3 month intervals during the first 3 years following the completion of radiotherapy. Results: With a median follow up of 3.3 years, the local control rate is lOO%, the overall survival 95% and the DFS 93%. Cosmetic outcome is excellent/good in 68%. Cardiac related mortality rate is 1%; decreased LVEF was detected in 4 patients (2.8%). Chest x-ray revealed pulmonary fibrosis in 21/79 patients (26.6%). Conclusion: Early results of short fractionation schedule in breast irradiation are comparable to those of standard therapy. Further follow up is needed to assess long term effectiveness and toxicity.
I
P65
Long-term cardiac side effects of post operative irradiation studied with myocardial scintigraphy
U. Blom-Goldman, T Fornander. Karolinska Institute, Dep ofOncolog)s Stockholm, Sweden
Goals: Assessment of long term cardiac side effects after postoperative
radiotherapy in patients with left-sided breast cancer. Methods: We recruited patients where the computer tomography-based 3D-dose planning showed that a part of the hearts left ventricle would be included in the 85% &-dose curve. Tangential opposed photon fields were given to the breast tissue in partially mastectomized patients, while electrons were given to the thoracic wall in patients operated on with modified radical mastectomy. Echocardiography and myocardial perfusion scintigraphy with stress test were performed before and after radiotherapy. Six patients with scintigrafic changes before radiotherapy were excluded. Other patients were excluded because of bad condition, withdrawn consent or lost to follow up. Nineteen out of 33 patients were thus eligible for the short-term follow with reexamination 5-23 months after irradiation. New fixed scintigraphic defects indicating regional myocardial hypoperfusion after radiotherapy were detected in 13 patients. To assess if these defects are reversible or progressive in the long term we have started a long time follow up with re-examination after five to eight years. Results:. The localization of the defects seems to correspond with the irradiation volume of the left ventricle. Initially patient with new perfusion-defects at first follow-up are examined. Currently three patients with previous defects have been examined. In one of these patients the previous scintigrafic defect persists. This patient suffers from coronary heart disease. Examination of other patients with and without previous defects are ongoing and will be reported.