2061 Feasibility of concurrent radiation therapy and paclitaxel or docetaxel chemotherapy in the management of locally advanced breast cancer

Proceedings

of the 41st Annual

ASTRO

Meeting

309

of 4 years (87.9% and 77.6% vs. 98.1% and 95.6%, respectively (p=O.OOS). Compared to unilateral patients, bilateral breast cancer patients have an odds-ratio of 1.9 for developing distant metastasis. Median time to distant metastasis was 63 months for synchronous patients and 96 months for metachronous breast cancer patients. Cosmesis was excellent in 93% of bilateral patients. There was no difference when comparing metachronous to unilateral breast cancer patients with respect to local control and overall survival. Conclusions: We conclude that bilateral breast cancer patients who present with synchronous disease are at greater risk for distant metastases than women with unilateral or metachronous breast tumors. There was a trend towards decreased overall survival and local control for synchronous bilateral breast cancer patients when compared to either metachronous or unilateral breast cancer patients.

206 1 Bellon

FEASIBILITY CHEMOTHERAPY

JR, Lindsley

KL, Ellis GK,

of Washington,

liniversiiy

OF CONCURRENT RADIATION IN THE MANAGEMENT

Seattle,

Gralow

JR, Livingston

THERAPY OF LOCALLY

AND PACLITAXEL OR DOCETAXEL ADVANCED BREAST CANCER

RB, Austin-Seymour

MN

WA, USA

Purpose: Evidence supporting the inclusion of the taxanes in the treatment regimen of locally advanced breast cancer continues to increase. In vitro and in vivo studies have demonstrated a biological benefit of concurrent administration with radiation therapy. Both additive, and supraadditive or synergistic models have been proposed. In addition, a recent randomized trial has shown an overall survival advantage to the addition of paclitaxel to a control arm of adriamycin and cyclophosphamide in node positive breast cancer patients, Moreover, several studies have shown diminished local control with delay in the initiation of radiation therapy. For these reasons, we began in 1995 to administer radiation therapy concurrently with the taxanes, initially with paclitaxel, and later with docetaxel, in patients with locally advanced breast cancer. This retrospective review examines the tolerance of such treatment. Methods and Materials: The records of 44 patients consecutively treated with concurrent radiation and either paclitaxel or docetaxel from January 1995 through March 1999 were reviewed. Radiation consisted of either tangential beams to the breast or chest wall, or chest wall electrons, with or without regional nodal irradiation. Doses ranged from 32.4 Gy to 50.4 Gy. with the majority of patients subsequently receiving an electron boost to the mastectomy incision or lumpectomy site. Eighteen patients were treated for recurrent disease, including 9 women who were retreated to sites that had been previously irradiated. Twenty-nine patients received concurrent paclitaxel. Treatment was typically given either by protracted continuous infusion (20-35 mg/m*/d x 4 days; median dose 35 mg/m2/d) every three weeks, or by rapid infusion every three weeks (135.175 mg/m2 over 3 hours; median dose 175 mg/m’). Sixteen patients received concurrent docetaxel every three weeks by one hour infusion (50-100 mg/m’; median dose 60 mgim’). One patient, initially treated with paclitaxel, was subsequently treated to the contralateral chest with concurrent docetaxel for a second primary cancer. Toxicity was assessed by the RTOG scale for acute and late effects. Fisher’s exact test was used to compare the odds ratio of toxicity between regimens. Concurrent radiation and taxane chemotherapy was well tolerated, with 10 patients (22%) experiencing RTOG grade 3 acute skin toxicity. This was more likely with concurrent docetaxel than with paclitaxel (p=.O4). Not surprisingly, prior radiation was also associated with increased grade 3 skin toxicity (p= .04). Among the patients undergoing breast conservation, there were no grade 3 skin reactions. No significant differences were identified between the two paclitaxel regimens. One patient (treated with docetaxel) experienced an incisional dehiscence during treatment. Five patients required a delay or dose reduction in their chemotherapy secondary to skin toxicity, and 18 patients a break in radiation due to toxicity, with a median hiatus of 8.5 days. With a median follow-up of 41 weeks, one patient (the patient with a wound dehiscence) has developed soft tissue fibrosis and permanent skin changes, including telangiectasias.

Results:

Conclusion: Both docetaxel and paclitaxel resulted in acceptable toxicity when given concurrently with radiation. Overall; docetaxel resulted in greater acute skin toxicity. It is unclear whether this finding reflects inherent differences in taxane induced potentiation of radiation skin reaction, since differences in chemotherapy dose intensity or schedule may also be a factor. However, among patients undergoing breast conservation with or without regional nodal radiation, the taxanes were both very well tolerated with no grade 3 acute skin toxicities. Further study is necessary to assess the impact of concurrent treatment on long-term outcome.

2062 Doyle

LONG TERM FOR INVASIVE

TH’,

University

Schultz

DJ’,

of Pennsylvania

RESULTS BREAST Peters

CA’,

School

OF LOCAL CANCER

RECURRENCE

AFTER

BREAST

CONSERVATION

THERAPY

Solin LJ’

of Medicine,

Philadelphia

, PA, USA’;

Millersville

University,

Millersville,

Purpose: The outcome for women with a local failure after breast conservation therapy is not well described Because local recurrence is a potentially salvageable event, this study was performed to evaluate the outcome local recurrence after breast conservation surgery and definitive radiation therapy.

PA, USA’ in the literature. of patients with

Materials and Methods: The study population consisted of 112 patients with ipsilateral breast tumor recurrence detected during 1977 to 1997. There were 101 isolated local recurrences and 11 local plus regional recurrences. Not included were patients with concurrent metastatic disease (n= 12) or with regional only failures (n= 1). Local recurrences were detected by physical examination alone in 42 patients, mammography alone in 47 patients, and both modalities in 23 patients. All patients were initially treated with breast conservation therapy with or without systemic therapy and subsequently treated at the time of local recurrence with salvage mastectomy with or without systemic therapy. The mean and median followup times after local recurrence were 4.2 and 4.8 years respectively. Results: survival

For the entire group of 112 patients, the overall is 71%. There are 3 second locoregional failures

survival at 10 years after recurrence on the chest wall (3%). Pathologic

is 69% and the cause specific size of recurrence (51 cm, > 1