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Dosimetric and Clinical Predictors of the Development of Moist Desquamation in Breast Cancer Irradiation
S210
International Journal of Radiation Oncology Biology Physics
cCR, and another 2 pts showed cPR. The pts did not show any severe complications (with the exception of mild dermatitis for all 18 pts and telangiectasias for 1 pt), and cosmetic results as rated by the physician were excellent/good for 14 pts and fair for another 4 pts. The mean duration of follow-up at the end of December 2012 was 43.0 months, at which time only 1 pt who had shown cPR had died, 1 was alive with controlling-lung metastasis, 1 was alive with controlling-local relapse, and another 15 were alive without any evidence of disease. Conclusions: PET-CT-guided non-surgical care for LABC can be performed with KORTUC II chemo-radiosensitizing tmt. This tmt has 4 major characteristics: image-guided by PET-CT and US studies; employment of enzyme-targeting peroxidase/catalase; enhanced therapeutic effects of EC CT; and targeting of breast cancer stem cells via CD44. KORTUC II has great potential as a viable non-invasive replacement for surgery and offers a valuable method of radiosensitization for almost all relatively large neoplasms. Author Disclosure: Y. Ogawa: None. K. Kubota: None. N. Aoyama: None. K. Ohgi: None. M. Tadokoro: None. T. Yamanishi: None. S. Kariya: None. M. Nogami: None. A. Nishioka: None. M. Miyamura: None.
Purpose/Objective(s): To compare the displacement of surgical cavity center delineated by metal clips and seroma based on the four-dimensional computed tomography (4DCT) in the free-breathing (FB) state for external-beam partial breast irradiation (EB-PBI) after breast conserving surgery. Materials/Methods: Fourteen breast cancer patients after breastconserving surgery were recruited for EB-PBI. All of the metal clips in the cavity were delineated on each of the 10 respiratory phases. All of the metal clips were marked as the geometry. The gross tumor volume formed by the clips and the seroma were defined as GTVc and GTVs, respectively. The centra displacements of the geometry, GTVc, GTVs and the selected boundary metal clips in the left-right (LR), anterior-posterior (AP) and superior-inferior (SI) were measured and compared. Three dimensional displacement vectors of the geometry, GTVc and GTVs were calculated. Results: The displacements in the LR, AP and SI directions were 2.20 mm, 1.80 mm and 2.70 mm for geometry center; 0.90 mm, 1.05 mm and 1.20 mm for GTVc center; 0.80 mm, 1.05 mm and 0.80 mm for GTVs center. For every center the displacements in the LR, AP and SI directions do not have significant difference (X2 Z 3.837, 2.051, 3.647, p Z 0.147, 0.359, 0.161). In the three-dimensional directions, the displacements of the geometry were larger than GTVc and GTVs (p < 0.05). The displacement of GTVc was larger than the GTVs center in SI direction (Z Z 2.048, p Z 0.041). The displacement of the three cavities was larger than the four selected clips. Conclusions: In the FB state, the centra displacements of the geometry resulted from the respiration movement were larger than GTVc and GTVs, and also larger than the four selected boundary metal clips in three directions, but there was no significant difference between GTVc and GTVs. Author Disclosure: Y. Ding: None. J.B. Li: None. W. Wang: None. T.Y. Fan: None. M. Xu: None. Q. Shao: None. Z.F. Ma: None. S.Z. Wang: None.
2015 Final Result of Phase 1 Clinical Trial of Stereotactic Body Radiation Therapy Concomitant With Neoadjuvant Chemotherapy for Breast Cancer P. Bondiau, A. Courdi, C. Chapellier, E. Chamorey, I. Birtwisle, B. Flipo, and J. Ferrero; Centre A. Lacassagne, Nice, France Purpose/Objective(s): Stereotactic body radiation therapy (SBRT) allows stereotactic irradiation of thoracic tumors. It may have a real impact for patients who may not otherwise qualify for breast-conserving surgery. We conducted a Phase I trial that tested five dose levels of SBRT, concomitantly with neoadjuvant chemotherapy (NACT) prior to surgery. The purpose of the current dose-escalation study is to determine the maximum tolerated dose of SBRT in the treatment of breast cancer. Materials/Methods: To define toxicity, we performed dermatologic examinations (DE) that included clinical examinations by two separate physicians and technical evaluations using colorimetry, dermoscopy, and skin ultrasound. First DE was performed before NACT, then 36 days after, and 56 days after NACT onset, and finally prior to surgery. Surgery was performed 4-8 weeks after the last chemotherapy session. Efficacy, the primary endpoint, was determined by the pathological complete response rate. Results: Maximum tolerable dose was not reached. Only one case of doselimiting toxicity was reported (grade III dermatologic toxicity) and SBRT was overall well tolerated. Pathologic complete response (pCR) rate was 36%, with no pCR being observed in the first two levels, and the highest rate being obtained at dose level 3 (25.5 Gy delivered in three fractions). Conservative breast surgery rate was up to 92% compared with an 8% radical mastectomy rate. No surgical complications were reported. Conclusions: Regarding the efficacy endpoints, this trial showed promising results in terms of pCR rate (36%), as well as breast-conserving rate (92%). The findings provide a strong rationale for extending the study into a phase II trial. In view of the absence of correlation between dose and pCR. Author Disclosure: P. Bondiau: None. A. Courdi: None. C. Chapellier: None. E. Chamorey: None. I. Birtwisle: None. B. Flipo: None. J. Ferrero: None.
2016 Comparative Study on the Displacement of Surgical Cavity Center Defined Separately by Clips and Seroma Based on 4DCT Scan for External Beam Partial Breast Irradiation After Breast Conserving Surgery Y. Ding, J.B. Li, W. Wang, T.Y. Fan, M. Xu, Q. Shao, Z.F. Ma, and S.Z. Wang; Shandong Cancer Hospital, Jinan, China
2017 Dosimetric and Clinical Predictors of the Development of Moist Desquamation in Breast Cancer Irradiation C.E. Rutter, L. Qin, S.A. Higgins, M. Moran, and S.B. Evans; Yale New Haven Hospital, New Haven, CT Purpose/Objective(s): To evaluate the impact of patient and treatment factors on the incidence and timing of moist desquamation (MD) during adjuvant whole breast radiation therapy (RT) utilizing tangents only. Materials/Methods: Sixty-nine consecutive patients treated with lumpectomy and tangential-field whole breast RT to 50 Gy in 2 Gy fractions between August 2011 and August 2012 were reviewed. A contour was generated for the skin and subcutaneous structures (“Skin”), as well as the entire irradiated breast (“Breast”). Patient factors and dosimetric data for breast and skin contours were assessed using univariate and multivariate analyses to determine significant predictors of moist desquamation during RT. Kaplan-Meier analyses assessed the influence of these factors on timeto-development of MD. Results: Twenty-three patients (33.3%) developed MD at a median dose of 46 Gy. Median age and body mass index (BMI) were 54 years and 29.9, respectively. Seventeen patients (24.6%) received chemotherapy prior to RT. MD occurred earlier for patients with a BMI above 30, greater than 45 cubic centimeters (cc) of skin receiving 45 Gy or 15 cc receiving 50 Gy, and greater than 1,300 cc breast receiving 50 Gy (p < 0.0001, < 0.0001, 0.041, and < 0.0001, resp). In multivariate analyses, only BMI remained as a statistically significant predictor of MD (p < 0.05), as BMI was correlated with higher volumes of breast and skin receiving at least 50 Gy (p < 0.0001, 0.06, resp). Conclusions: In tangential field breast RT, dose-volume relationships influence the development and timing of MD. It appears that fine differences in dose delivered to skin and subcutaneous structures significantly alters the time-course of MD development. Author Disclosure: C.E. Rutter: None. L. Qin: None. S.A. Higgins: None. M. Moran: None. S.B. Evans: None.
International Journal of Radiation Oncology Biology Physics
cCR, and another 2 pts showed cPR. The pts did not show any severe complications (with the exception of mild dermatitis for all 18 pts and telangiectasias for 1 pt), and cosmetic results as rated by the physician were excellent/good for 14 pts and fair for another 4 pts. The mean duration of follow-up at the end of December 2012 was 43.0 months, at which time only 1 pt who had shown cPR had died, 1 was alive with controlling-lung metastasis, 1 was alive with controlling-local relapse, and another 15 were alive without any evidence of disease. Conclusions: PET-CT-guided non-surgical care for LABC can be performed with KORTUC II chemo-radiosensitizing tmt. This tmt has 4 major characteristics: image-guided by PET-CT and US studies; employment of enzyme-targeting peroxidase/catalase; enhanced therapeutic effects of EC CT; and targeting of breast cancer stem cells via CD44. KORTUC II has great potential as a viable non-invasive replacement for surgery and offers a valuable method of radiosensitization for almost all relatively large neoplasms. Author Disclosure: Y. Ogawa: None. K. Kubota: None. N. Aoyama: None. K. Ohgi: None. M. Tadokoro: None. T. Yamanishi: None. S. Kariya: None. M. Nogami: None. A. Nishioka: None. M. Miyamura: None.
Purpose/Objective(s): To compare the displacement of surgical cavity center delineated by metal clips and seroma based on the four-dimensional computed tomography (4DCT) in the free-breathing (FB) state for external-beam partial breast irradiation (EB-PBI) after breast conserving surgery. Materials/Methods: Fourteen breast cancer patients after breastconserving surgery were recruited for EB-PBI. All of the metal clips in the cavity were delineated on each of the 10 respiratory phases. All of the metal clips were marked as the geometry. The gross tumor volume formed by the clips and the seroma were defined as GTVc and GTVs, respectively. The centra displacements of the geometry, GTVc, GTVs and the selected boundary metal clips in the left-right (LR), anterior-posterior (AP) and superior-inferior (SI) were measured and compared. Three dimensional displacement vectors of the geometry, GTVc and GTVs were calculated. Results: The displacements in the LR, AP and SI directions were 2.20 mm, 1.80 mm and 2.70 mm for geometry center; 0.90 mm, 1.05 mm and 1.20 mm for GTVc center; 0.80 mm, 1.05 mm and 0.80 mm for GTVs center. For every center the displacements in the LR, AP and SI directions do not have significant difference (X2 Z 3.837, 2.051, 3.647, p Z 0.147, 0.359, 0.161). In the three-dimensional directions, the displacements of the geometry were larger than GTVc and GTVs (p < 0.05). The displacement of GTVc was larger than the GTVs center in SI direction (Z Z 2.048, p Z 0.041). The displacement of the three cavities was larger than the four selected clips. Conclusions: In the FB state, the centra displacements of the geometry resulted from the respiration movement were larger than GTVc and GTVs, and also larger than the four selected boundary metal clips in three directions, but there was no significant difference between GTVc and GTVs. Author Disclosure: Y. Ding: None. J.B. Li: None. W. Wang: None. T.Y. Fan: None. M. Xu: None. Q. Shao: None. Z.F. Ma: None. S.Z. Wang: None.
2015 Final Result of Phase 1 Clinical Trial of Stereotactic Body Radiation Therapy Concomitant With Neoadjuvant Chemotherapy for Breast Cancer P. Bondiau, A. Courdi, C. Chapellier, E. Chamorey, I. Birtwisle, B. Flipo, and J. Ferrero; Centre A. Lacassagne, Nice, France Purpose/Objective(s): Stereotactic body radiation therapy (SBRT) allows stereotactic irradiation of thoracic tumors. It may have a real impact for patients who may not otherwise qualify for breast-conserving surgery. We conducted a Phase I trial that tested five dose levels of SBRT, concomitantly with neoadjuvant chemotherapy (NACT) prior to surgery. The purpose of the current dose-escalation study is to determine the maximum tolerated dose of SBRT in the treatment of breast cancer. Materials/Methods: To define toxicity, we performed dermatologic examinations (DE) that included clinical examinations by two separate physicians and technical evaluations using colorimetry, dermoscopy, and skin ultrasound. First DE was performed before NACT, then 36 days after, and 56 days after NACT onset, and finally prior to surgery. Surgery was performed 4-8 weeks after the last chemotherapy session. Efficacy, the primary endpoint, was determined by the pathological complete response rate. Results: Maximum tolerable dose was not reached. Only one case of doselimiting toxicity was reported (grade III dermatologic toxicity) and SBRT was overall well tolerated. Pathologic complete response (pCR) rate was 36%, with no pCR being observed in the first two levels, and the highest rate being obtained at dose level 3 (25.5 Gy delivered in three fractions). Conservative breast surgery rate was up to 92% compared with an 8% radical mastectomy rate. No surgical complications were reported. Conclusions: Regarding the efficacy endpoints, this trial showed promising results in terms of pCR rate (36%), as well as breast-conserving rate (92%). The findings provide a strong rationale for extending the study into a phase II trial. In view of the absence of correlation between dose and pCR. Author Disclosure: P. Bondiau: None. A. Courdi: None. C. Chapellier: None. E. Chamorey: None. I. Birtwisle: None. B. Flipo: None. J. Ferrero: None.
2016 Comparative Study on the Displacement of Surgical Cavity Center Defined Separately by Clips and Seroma Based on 4DCT Scan for External Beam Partial Breast Irradiation After Breast Conserving Surgery Y. Ding, J.B. Li, W. Wang, T.Y. Fan, M. Xu, Q. Shao, Z.F. Ma, and S.Z. Wang; Shandong Cancer Hospital, Jinan, China
2017 Dosimetric and Clinical Predictors of the Development of Moist Desquamation in Breast Cancer Irradiation C.E. Rutter, L. Qin, S.A. Higgins, M. Moran, and S.B. Evans; Yale New Haven Hospital, New Haven, CT Purpose/Objective(s): To evaluate the impact of patient and treatment factors on the incidence and timing of moist desquamation (MD) during adjuvant whole breast radiation therapy (RT) utilizing tangents only. Materials/Methods: Sixty-nine consecutive patients treated with lumpectomy and tangential-field whole breast RT to 50 Gy in 2 Gy fractions between August 2011 and August 2012 were reviewed. A contour was generated for the skin and subcutaneous structures (“Skin”), as well as the entire irradiated breast (“Breast”). Patient factors and dosimetric data for breast and skin contours were assessed using univariate and multivariate analyses to determine significant predictors of moist desquamation during RT. Kaplan-Meier analyses assessed the influence of these factors on timeto-development of MD. Results: Twenty-three patients (33.3%) developed MD at a median dose of 46 Gy. Median age and body mass index (BMI) were 54 years and 29.9, respectively. Seventeen patients (24.6%) received chemotherapy prior to RT. MD occurred earlier for patients with a BMI above 30, greater than 45 cubic centimeters (cc) of skin receiving 45 Gy or 15 cc receiving 50 Gy, and greater than 1,300 cc breast receiving 50 Gy (p < 0.0001, < 0.0001, 0.041, and < 0.0001, resp). In multivariate analyses, only BMI remained as a statistically significant predictor of MD (p < 0.05), as BMI was correlated with higher volumes of breast and skin receiving at least 50 Gy (p < 0.0001, 0.06, resp). Conclusions: In tangential field breast RT, dose-volume relationships influence the development and timing of MD. It appears that fine differences in dose delivered to skin and subcutaneous structures significantly alters the time-course of MD development. Author Disclosure: C.E. Rutter: None. L. Qin: None. S.A. Higgins: None. M. Moran: None. S.B. Evans: None.