- Email: [email protected]
Analysis of Locally-Advanced Breast Cancer in Young Women
S238
International Journal of Radiation Oncology Biology Physics
thickening occurred during RT and up to 3 months post RT. The STR reaches the highest value between 3 and 6 months, and then started to recover. Skin thickness values correlated with clinical toxicity assessments based by RTOG grading scheme. The linear regression model indicates that the measurement during RT can predict measurements at 3-month, 6month, and 1-year post RT (p < 0.05). Conclusions: Our results based on ultrasound skin-thickness measurements suggest that early normal-tissue toxicity predicts for late toxicity (up to 1 year) following breast RT. Therefore, interventions designed to limit acute toxicity may improve long-term cosmetic outcome for breast-cancer survivors. Author Disclosure: T. Liu: None. X. Yang: None. Y. Liu: None. Y. Wang: None. W.J. Curran: None. M.A. Torres: None.
2089
2088 A Comparison of the Early Toxicities of Balloon Catheter HighDose-Rate Brachytherapy (BCHDRB) and Intraoperative Radiation Therapy N. Bhandare,1 C. Shaw,2 L. Spiguel,2 S.R. Grobmyer,3 and J.L. Lightsey1; 1 Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, FL, 2Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, 3Cleveland Clinic, Cleveland, OH Purpose/Objective(s): To evaluate and compare the early toxicities after intraoperative radiation therapy (IORT) to those of BCHDRB brachytherapy for the treatment of breast cancer. Materials/Methods: A retrospective review of a prospectively collected dataset of early-stage breast cancer patients treated between 2007 and 2012 was performed to evaluate the early toxicities related to IORT as compared to BCHDRB. Seventy-eight patients were treated with IORT and 15 patients were treated with BCHDRB. The prescribed dose for IORT patients was 20 Gy to the surface of the applicator with the radius of the applicator varying from 3.5 to 5.0 cm. The dose at 1 cm from the applicator varied from 5 to 7 Gy. BCHDRB patients received a total dose of 34 Gy delivered with twice-daily fractionation over 5 days. The cavity size varied between 30 to 50 cc. The dose was prescribed to 1.0 cm from the surface of the cavity. The median followup time for the IORT group was 12.5 months and that for the BCHDRB group was 36 months. Toxicities were evaluated using the Radiation Therapy Oncology Group (RTOG) toxicity scoring system based on the Common Terminology Criteria for Advanced Events version 3.0; posttreatment cosmesis was assessed using the Harvard breast cosmesis score. Results: Early postoperative seromas (grades I and II) developed in 26 (32.5%) patients in the IORT group with a majority of the seromas being asymptomatic and resolving in 4 to 6 months. Four (5%) of the patients required a single aspiration for symptomatic seroma. Of the BCHDRB group 5 (33%) patients developed seromas (grades I and II). Symptomatic seroma was observed in 2 (13.3%) patients and 1 patient required a single aspiration. Other observed toxicities in the IORT and BCHDRB groups, respectively, were as follows: dermatitis, 4 patients (5.1%) and 2 patients (13.3%); fibrosis, 1 patient (1%) and 3 patients (20.0%); and breast infection, 4 patients (5.0%) and 2 patients (13.3%). In the IORT group, breast cellulitis was managed by antibiotics in 3 (4%) patients. In the BCHDRB group, fat necrosis occurred in 2 (13.3%) patients. In the IORT group, at the12-month follow-up, 92% of patients had excellent or good cosmesis and 8% of patients had fair or poor cosmesis. In the BCHDRB group, at 26 months of follow-up 83% of patients had excellent or good cosmesis and 17% had fair or poor cosmesis. Conclusions: IORT has been shown to be an equivalent treatment in earlystage breast cancer as whole-breast irradiation. The benefits of IORT include a shorter treatment time, less dermatitis, fewer infections, and improved cosmesis over BCHDRB. Author Disclosure: N. Bhandare: None. C. Shaw: None. L. Spiguel: None. S.R. Grobmyer: None. J.L. Lightsey: None.
Analysis of Locally-Advanced Breast Cancer in Young Women S.S. Khwaja, L. Ochoa, S. Badiyan, T. Dewees, M. Thomas, and I. Zoberi; Washington University School of Medicine, St. Louis, MO Purpose/Objective(s): Younger age at diagnosis of breast cancer has been shown to be a predictor of adverse outcome. Here, we evaluate patient-, tumor-, and treatment-related prognostic factors in women 40 years of age with locally advanced breast cancer (LABC). Materials/Methods: A single institution retrospective chart-based review of 83 patients age 40 diagnosed with LABC treated with surgery, comprehensive radiation therapy (RT) +/- chemotherapy from 2003 to 2011. LABC was operationally defined as any node positive cancer or T34N0 cancer. Patient, tumor, treatment, and surgical factors that may predict overall survival (OS), local/regional failure (LR), distant metastasis (DM), or recurrence-free survival (RFS) were evaluated. RFS was defined as any local/regional or distant failure. Results: Median age at diagnosis was 36 years (range, 24-40 years) with a follow-up time of 48 months (range, 5-116 months). The majority of women were white (60%) or African American (28%). Breast conserving surgery was performed in 31%. Negative margins were achieved in 84%. Axillary lymph node dissections (ALND) were performed in 89% of patients. Ninety-six percent of patients received chemotherapy with 58% (n Z 46) as neoadjuvant. Of these 46 patients, 52% (n Z 24) also received adjuvant chemotherapy. Six patients (7%) received neoadjuvant hormones. Four of those patients also received neoadjuvant chemotherapy. Triple negative (TN) status was seen in 30% (n Z 25). Pathologic lymph node positivity was present in 77% and lymphovascular space invasion (LVSI) in 37%. OS at 2 and 4 years was 95% and 90%, respectively. RFS at 2 and 4 years was 88% and 77%, respectively. Fouryear OS for non-TN patients was 94% vs 78% for TN patients (p Z 0.02). Four-year RFS for patients with no LVSI was 85% vs 62% for those with LVSI (p Z 0.01). LR recurrences were observed in 11% (n Z 9), all of whom eventually developed distant metastases. Twenty-two patients (26%) in total developed DM. Univariate analysis for OS revealed ER positivity, TN, ALND, adjuvant hormones, and number of involved nodes as significant. Only ALND, number of involved nodes, and TN were significant on multivariate analysis. Univariate analysis for RFS revealed African American race and LVSI as significant. Only LVSI was significant on multivariate analysis. Conclusions: With high risks of local recurrence and inferior overall survival compared to older women, breast cancers in young women can be difficult to treat. We identify TN as significant for OS and LVSI as significant for RFS with significantly decreased RFS at 4 years. Author Disclosure: S.S. Khwaja: None. L. Ochoa: None. S. Badiyan: None. T. Dewees: None. M. Thomas: None. I. Zoberi: None.
2090 Accelerated Partial Breast Irradiation for Ductal Carcinoma In Situ: Single Institution Experience With Median Follow-up Time of Over 5 Years B.M. Anderson,1 R.K. Das,1 H.M. Geye,1 K.A. Bradley,1 R.R. Patel,2 and R.R. Kuske3; 1University of Wisconsin, Madison, WI, 2Targeted Radiation Institute at VMOC, Pleasanton, CA, 3Arizona Breast Cancer Specialists, Scottsdale, AZ
Poster Viewing Abstract 2090; Table Follow-up time (years) <2 2-3.9 4-5.9 6-7.9 8-9.9 10 or more
Follow-up time by 2-year increments Number of patients (%) 12 9 25 13 8 12
(15.2%) (11.4%) (31.6%) (16.5%) (10.1%) (15.2%)
International Journal of Radiation Oncology Biology Physics
thickening occurred during RT and up to 3 months post RT. The STR reaches the highest value between 3 and 6 months, and then started to recover. Skin thickness values correlated with clinical toxicity assessments based by RTOG grading scheme. The linear regression model indicates that the measurement during RT can predict measurements at 3-month, 6month, and 1-year post RT (p < 0.05). Conclusions: Our results based on ultrasound skin-thickness measurements suggest that early normal-tissue toxicity predicts for late toxicity (up to 1 year) following breast RT. Therefore, interventions designed to limit acute toxicity may improve long-term cosmetic outcome for breast-cancer survivors. Author Disclosure: T. Liu: None. X. Yang: None. Y. Liu: None. Y. Wang: None. W.J. Curran: None. M.A. Torres: None.
2089
2088 A Comparison of the Early Toxicities of Balloon Catheter HighDose-Rate Brachytherapy (BCHDRB) and Intraoperative Radiation Therapy N. Bhandare,1 C. Shaw,2 L. Spiguel,2 S.R. Grobmyer,3 and J.L. Lightsey1; 1 Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, FL, 2Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, 3Cleveland Clinic, Cleveland, OH Purpose/Objective(s): To evaluate and compare the early toxicities after intraoperative radiation therapy (IORT) to those of BCHDRB brachytherapy for the treatment of breast cancer. Materials/Methods: A retrospective review of a prospectively collected dataset of early-stage breast cancer patients treated between 2007 and 2012 was performed to evaluate the early toxicities related to IORT as compared to BCHDRB. Seventy-eight patients were treated with IORT and 15 patients were treated with BCHDRB. The prescribed dose for IORT patients was 20 Gy to the surface of the applicator with the radius of the applicator varying from 3.5 to 5.0 cm. The dose at 1 cm from the applicator varied from 5 to 7 Gy. BCHDRB patients received a total dose of 34 Gy delivered with twice-daily fractionation over 5 days. The cavity size varied between 30 to 50 cc. The dose was prescribed to 1.0 cm from the surface of the cavity. The median followup time for the IORT group was 12.5 months and that for the BCHDRB group was 36 months. Toxicities were evaluated using the Radiation Therapy Oncology Group (RTOG) toxicity scoring system based on the Common Terminology Criteria for Advanced Events version 3.0; posttreatment cosmesis was assessed using the Harvard breast cosmesis score. Results: Early postoperative seromas (grades I and II) developed in 26 (32.5%) patients in the IORT group with a majority of the seromas being asymptomatic and resolving in 4 to 6 months. Four (5%) of the patients required a single aspiration for symptomatic seroma. Of the BCHDRB group 5 (33%) patients developed seromas (grades I and II). Symptomatic seroma was observed in 2 (13.3%) patients and 1 patient required a single aspiration. Other observed toxicities in the IORT and BCHDRB groups, respectively, were as follows: dermatitis, 4 patients (5.1%) and 2 patients (13.3%); fibrosis, 1 patient (1%) and 3 patients (20.0%); and breast infection, 4 patients (5.0%) and 2 patients (13.3%). In the IORT group, breast cellulitis was managed by antibiotics in 3 (4%) patients. In the BCHDRB group, fat necrosis occurred in 2 (13.3%) patients. In the IORT group, at the12-month follow-up, 92% of patients had excellent or good cosmesis and 8% of patients had fair or poor cosmesis. In the BCHDRB group, at 26 months of follow-up 83% of patients had excellent or good cosmesis and 17% had fair or poor cosmesis. Conclusions: IORT has been shown to be an equivalent treatment in earlystage breast cancer as whole-breast irradiation. The benefits of IORT include a shorter treatment time, less dermatitis, fewer infections, and improved cosmesis over BCHDRB. Author Disclosure: N. Bhandare: None. C. Shaw: None. L. Spiguel: None. S.R. Grobmyer: None. J.L. Lightsey: None.
Analysis of Locally-Advanced Breast Cancer in Young Women S.S. Khwaja, L. Ochoa, S. Badiyan, T. Dewees, M. Thomas, and I. Zoberi; Washington University School of Medicine, St. Louis, MO Purpose/Objective(s): Younger age at diagnosis of breast cancer has been shown to be a predictor of adverse outcome. Here, we evaluate patient-, tumor-, and treatment-related prognostic factors in women 40 years of age with locally advanced breast cancer (LABC). Materials/Methods: A single institution retrospective chart-based review of 83 patients age 40 diagnosed with LABC treated with surgery, comprehensive radiation therapy (RT) +/- chemotherapy from 2003 to 2011. LABC was operationally defined as any node positive cancer or T34N0 cancer. Patient, tumor, treatment, and surgical factors that may predict overall survival (OS), local/regional failure (LR), distant metastasis (DM), or recurrence-free survival (RFS) were evaluated. RFS was defined as any local/regional or distant failure. Results: Median age at diagnosis was 36 years (range, 24-40 years) with a follow-up time of 48 months (range, 5-116 months). The majority of women were white (60%) or African American (28%). Breast conserving surgery was performed in 31%. Negative margins were achieved in 84%. Axillary lymph node dissections (ALND) were performed in 89% of patients. Ninety-six percent of patients received chemotherapy with 58% (n Z 46) as neoadjuvant. Of these 46 patients, 52% (n Z 24) also received adjuvant chemotherapy. Six patients (7%) received neoadjuvant hormones. Four of those patients also received neoadjuvant chemotherapy. Triple negative (TN) status was seen in 30% (n Z 25). Pathologic lymph node positivity was present in 77% and lymphovascular space invasion (LVSI) in 37%. OS at 2 and 4 years was 95% and 90%, respectively. RFS at 2 and 4 years was 88% and 77%, respectively. Fouryear OS for non-TN patients was 94% vs 78% for TN patients (p Z 0.02). Four-year RFS for patients with no LVSI was 85% vs 62% for those with LVSI (p Z 0.01). LR recurrences were observed in 11% (n Z 9), all of whom eventually developed distant metastases. Twenty-two patients (26%) in total developed DM. Univariate analysis for OS revealed ER positivity, TN, ALND, adjuvant hormones, and number of involved nodes as significant. Only ALND, number of involved nodes, and TN were significant on multivariate analysis. Univariate analysis for RFS revealed African American race and LVSI as significant. Only LVSI was significant on multivariate analysis. Conclusions: With high risks of local recurrence and inferior overall survival compared to older women, breast cancers in young women can be difficult to treat. We identify TN as significant for OS and LVSI as significant for RFS with significantly decreased RFS at 4 years. Author Disclosure: S.S. Khwaja: None. L. Ochoa: None. S. Badiyan: None. T. Dewees: None. M. Thomas: None. I. Zoberi: None.
2090 Accelerated Partial Breast Irradiation for Ductal Carcinoma In Situ: Single Institution Experience With Median Follow-up Time of Over 5 Years B.M. Anderson,1 R.K. Das,1 H.M. Geye,1 K.A. Bradley,1 R.R. Patel,2 and R.R. Kuske3; 1University of Wisconsin, Madison, WI, 2Targeted Radiation Institute at VMOC, Pleasanton, CA, 3Arizona Breast Cancer Specialists, Scottsdale, AZ
Poster Viewing Abstract 2090; Table Follow-up time (years) <2 2-3.9 4-5.9 6-7.9 8-9.9 10 or more
Follow-up time by 2-year increments Number of patients (%) 12 9 25 13 8 12
(15.2%) (11.4%) (31.6%) (16.5%) (10.1%) (15.2%)