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PR AND HER2 EXPRESSION IN PAKISTANI WOMEN
ESTRO 31
Materials and Methods: 20 patients with left-sided breast cancer and at least one cardiovascular risk factors (diabetes mellitus, high blood pressure, elevated serum cholesterol, smoking, adiposity, positive family disposition) had a 3-dimensional planned LINAC radiation therapy to a total dose of generally 50 Gy whole breast irradiation, in a single fraction of 2 Gy, 5x/week, plus 10 Gy electron boost (5 x 2 Gy/week). They received a myocardial rest/stress perfusion two to five years after radiation therapy. The 99mTc-MIBI-SPECT/CT images were matched with the planning-CT images and evaluated for DVHbased dose-response relations of radiation-induced defects in myocardial perfusion. Results: In 40 % of the patients (8/20) mild to moderately reduced perfusion was seen in the stress and rest images. All abnormalities were confined to the cardiac apex. In this area the heart received the highest dose. No correlation between the myocardial perfusion defects and the dose to the left anterior descending artery was observed, myocardial perfusion defects were not associated with cardiovascular risk factors in this small group of patients. Conclusions: Mild myocardial perfusion abnormalities are common in patients treated for left sided breast cancer. It is therefore justified to study this phenomenon in a larger prospective study in order to better evaluate its clinical significance together with advanced dose dependence evaluations and a more detailed investigation of the time course and the influence of cardiovascular risk factors. EP-0992 COVERAGE OF AXILLARY LYMPH NODES IN PRONE VERSUS SUPINE 3D TECHNIQUE FOR WHOLE BREAST RADIOTHERAPY V. Reyes Lopez1, J. Saez2, L. Arbelaez1, M. Molla1, M. Altabas1, S. Madirolas2, M. Sancho2, J. Giralt1 1 Hospital Universitario Vall d'Hebron, Radiation Oncology, Barcelona, Spain 2 Hospital Universitario Vall d'Hebron, Physics Department, Barcelona, Spain Purpose/Objective: Introduction: Earlystage breast cancer patients are treated with adjuvant radiotherapy afterbreast conservative surgery usually delivered in a supine position. Thispositioning is the most commonly used set-up for this treatment because of itsreproducibility and its acceptable acute and chronic complications. In order tominimize dose at the organs at risk and improve dose homogeneity, treatment inthe prone position has been proposed as a viable alternative to theconventional supine position. Althoughextensively studied in the supine position, the coverage of the axillary levelnodes in the prone position has only been addressed in few publications. Purpose: Theaim of this study is to compare the axillary coverage in a group of 10 earlystage breast cancer patients who had undergone a CT simulation in the supineand prone positions to assess whether a better coverage of PTV or a bettersparing of organs at risk was feasible. Materials and Methods: Ten patients with early stage breast cancer (AJCC Stage 0, I or II) were selected for the analysis. Six patients had left-sided tumors and four had right-sided tumors. All patients had undergone breast-conserving surgery and nodal assessment with sentinel node biopsy. A simulation CT was performed for each patient in both the prone and supine positions with 5mm slice thickness. For supine position patients were placed on a breast board with both arms elevated. For the prone position a custom-made mattress was used. All patients were planned in both positions. The axillary lymph nodes regions (level I-III), breast tissue, heart and bilateral lungs were manually contoured. PTV was the whole index breast. The prescribed daily dose was 2 Gy, 5 days a week, to a total of 50Gy to the breast. Dosimetric analysis was performed comparing PTV coverage and doses to axillary lymph nodes region (level I-II), ipsilateral lung and heart. Results: As shown in Table 1. the mean dose to the nodal regions for levels I-III was inferior in the prone as compared with the supine position. Aditionaly, Lung dose was reduced in the prone position (p< 0.001). There were no differences regarding PTV homogeneity (p=0.92).
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Axillary Level Mean Dose (Gy) p-value Level I 34.9 p<0.01 Supine 18.6 Prone Level II Supine 13.8 p=0.3 Prone 11.5 Level III Supine 3.2 p=0.10 Prone 1.6 Conclusions: Coverage of axillary nodes was found inadequate in either position but further reduced in the prone set-up. Treatment in the prone position significantly improves the dose to the ipsilateral lung while offers and adequate coverage of the breast tissue. In order to fully characterize this data we are currently accruing more patients. EP-0993 BREAST CANCER SUBTYPES BASED ON ER/PR AND HER2 EXPRESSION IN PAKISTANI WOMEN M. Bukhari1, U. Masood2, T. Mehmood2, A. Masood2, I. Haider2, A. Khan1, H. Majeed1, N. Siddiqui3 1 Shaukat Khanum Memorial Cancer hospital and Research Centre, Surgical Oncology, Lahore, Pakistan 2 Shaukat Khanum Memorial Cancer hospital and Research Centre, Radiation Oncology, Lahore, Pakistan 3 Shaukat Khanum Memorial Cancer hospital and Research Centre, Medical Oncology, Lahore, Pakistan Purpose/Objective: we classified Pakistani breast cancer patients based on of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (Her2) expression by immunohistochemistry (IHC) in four subtypes and then compare the clinicopathologic features and survival in these subtypes. Materials and Methods: The hospital cancer registry identified 830 patients with confirmed receptor status treated between 2007 and 2008 at our institution who were assigned to groups as follows:luminal A(ER/PR+,Her2- ; n=129 ; 16%),luminal B (ER/PR+,Her2+ ;n=340; 41%),luminal C (ER/PR-,Her2+;n=144;17 %) ,luminal D (ER/PR- ,Her2;n=217;26%) also called Basal like breast cancer or Triple Negative (TN). Demographics, clinical, pathological and treatment variables were extracted from the medical records and compared among groups. Results: The median follow up for all groups was 38 months. Most common subtype turned to be luminal B followed by luminal D (TN) Breast Cancer. There were no differences among the groups regarding to median age, histological subtypes, pathological size of tumour and lymphovascular invasion. Subtypes with positive Her2 receptors i.e. luminal A and C showed high axillary metastasis than other groups. Luminal D group had least metastasis to axillary LN. Most poorly differentiated cancers with Grade III were of luminal D (TN) i.e. 78% followed by Luminal C (65%). Again H2n+ subtypes (luminal A and Luminal C) showed highest rates of locoregional recurrence. while systemic metastasis was seen most common in luminal C (37%) followed by Luminal D (21).The 3 - years and 5 - years overall survival rate (OS) were significantly lower in luminal C patients ( 72%,70%) and Luminal D (75%,70%) as compared to luminal A (85%,82%) and luminal B(88%,85). The 3 –years and 5-years Disease free survival (DFS) was also worst in luminal C (58%, 38%) followed by luminal D (70% and 48%) as compared to other subtypes. Conclusions: This study shows in Pakistani women most aggressive Breast cancers with poorest prognosis are those with ER/PR- ,Her2+ receptors (also known as H2N subtype internationally) and Triple negative breast cancer(ER/PR-,Her2-). It is important to further categorize female breast cancer on basis of receptors in Pakistani women for proper management and good follow up. We suggest every breast cancer must be analyzed for its receptors and for this purpose facilities must be provided everywhere in Pakistan. EP-0994 IMPACT OF DELAY IN STARTING RADIOTHERAPY IN LOCAL FAILURE IN CONSERVATIVE BREAST CANCER WITHOUT CHEMOTHERAPY J. Munoz Garcia1, J. Quiros Rivero1, O. Zoleto Camacho1, Y. Rios Kavadoy1, F. Ropero Carmona1, E. Capelo Medina1, A. Corbacho Campos1, J. Cabrera Rodriguez1 1 Hospital Infanta Cristina, Radiation Oncology, Badajoz, Spain
Materials and Methods: 20 patients with left-sided breast cancer and at least one cardiovascular risk factors (diabetes mellitus, high blood pressure, elevated serum cholesterol, smoking, adiposity, positive family disposition) had a 3-dimensional planned LINAC radiation therapy to a total dose of generally 50 Gy whole breast irradiation, in a single fraction of 2 Gy, 5x/week, plus 10 Gy electron boost (5 x 2 Gy/week). They received a myocardial rest/stress perfusion two to five years after radiation therapy. The 99mTc-MIBI-SPECT/CT images were matched with the planning-CT images and evaluated for DVHbased dose-response relations of radiation-induced defects in myocardial perfusion. Results: In 40 % of the patients (8/20) mild to moderately reduced perfusion was seen in the stress and rest images. All abnormalities were confined to the cardiac apex. In this area the heart received the highest dose. No correlation between the myocardial perfusion defects and the dose to the left anterior descending artery was observed, myocardial perfusion defects were not associated with cardiovascular risk factors in this small group of patients. Conclusions: Mild myocardial perfusion abnormalities are common in patients treated for left sided breast cancer. It is therefore justified to study this phenomenon in a larger prospective study in order to better evaluate its clinical significance together with advanced dose dependence evaluations and a more detailed investigation of the time course and the influence of cardiovascular risk factors. EP-0992 COVERAGE OF AXILLARY LYMPH NODES IN PRONE VERSUS SUPINE 3D TECHNIQUE FOR WHOLE BREAST RADIOTHERAPY V. Reyes Lopez1, J. Saez2, L. Arbelaez1, M. Molla1, M. Altabas1, S. Madirolas2, M. Sancho2, J. Giralt1 1 Hospital Universitario Vall d'Hebron, Radiation Oncology, Barcelona, Spain 2 Hospital Universitario Vall d'Hebron, Physics Department, Barcelona, Spain Purpose/Objective: Introduction: Earlystage breast cancer patients are treated with adjuvant radiotherapy afterbreast conservative surgery usually delivered in a supine position. Thispositioning is the most commonly used set-up for this treatment because of itsreproducibility and its acceptable acute and chronic complications. In order tominimize dose at the organs at risk and improve dose homogeneity, treatment inthe prone position has been proposed as a viable alternative to theconventional supine position. Althoughextensively studied in the supine position, the coverage of the axillary levelnodes in the prone position has only been addressed in few publications. Purpose: Theaim of this study is to compare the axillary coverage in a group of 10 earlystage breast cancer patients who had undergone a CT simulation in the supineand prone positions to assess whether a better coverage of PTV or a bettersparing of organs at risk was feasible. Materials and Methods: Ten patients with early stage breast cancer (AJCC Stage 0, I or II) were selected for the analysis. Six patients had left-sided tumors and four had right-sided tumors. All patients had undergone breast-conserving surgery and nodal assessment with sentinel node biopsy. A simulation CT was performed for each patient in both the prone and supine positions with 5mm slice thickness. For supine position patients were placed on a breast board with both arms elevated. For the prone position a custom-made mattress was used. All patients were planned in both positions. The axillary lymph nodes regions (level I-III), breast tissue, heart and bilateral lungs were manually contoured. PTV was the whole index breast. The prescribed daily dose was 2 Gy, 5 days a week, to a total of 50Gy to the breast. Dosimetric analysis was performed comparing PTV coverage and doses to axillary lymph nodes region (level I-II), ipsilateral lung and heart. Results: As shown in Table 1. the mean dose to the nodal regions for levels I-III was inferior in the prone as compared with the supine position. Aditionaly, Lung dose was reduced in the prone position (p< 0.001). There were no differences regarding PTV homogeneity (p=0.92).
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Axillary Level Mean Dose (Gy) p-value Level I 34.9 p<0.01 Supine 18.6 Prone Level II Supine 13.8 p=0.3 Prone 11.5 Level III Supine 3.2 p=0.10 Prone 1.6 Conclusions: Coverage of axillary nodes was found inadequate in either position but further reduced in the prone set-up. Treatment in the prone position significantly improves the dose to the ipsilateral lung while offers and adequate coverage of the breast tissue. In order to fully characterize this data we are currently accruing more patients. EP-0993 BREAST CANCER SUBTYPES BASED ON ER/PR AND HER2 EXPRESSION IN PAKISTANI WOMEN M. Bukhari1, U. Masood2, T. Mehmood2, A. Masood2, I. Haider2, A. Khan1, H. Majeed1, N. Siddiqui3 1 Shaukat Khanum Memorial Cancer hospital and Research Centre, Surgical Oncology, Lahore, Pakistan 2 Shaukat Khanum Memorial Cancer hospital and Research Centre, Radiation Oncology, Lahore, Pakistan 3 Shaukat Khanum Memorial Cancer hospital and Research Centre, Medical Oncology, Lahore, Pakistan Purpose/Objective: we classified Pakistani breast cancer patients based on of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (Her2) expression by immunohistochemistry (IHC) in four subtypes and then compare the clinicopathologic features and survival in these subtypes. Materials and Methods: The hospital cancer registry identified 830 patients with confirmed receptor status treated between 2007 and 2008 at our institution who were assigned to groups as follows:luminal A(ER/PR+,Her2- ; n=129 ; 16%),luminal B (ER/PR+,Her2+ ;n=340; 41%),luminal C (ER/PR-,Her2+;n=144;17 %) ,luminal D (ER/PR- ,Her2;n=217;26%) also called Basal like breast cancer or Triple Negative (TN). Demographics, clinical, pathological and treatment variables were extracted from the medical records and compared among groups. Results: The median follow up for all groups was 38 months. Most common subtype turned to be luminal B followed by luminal D (TN) Breast Cancer. There were no differences among the groups regarding to median age, histological subtypes, pathological size of tumour and lymphovascular invasion. Subtypes with positive Her2 receptors i.e. luminal A and C showed high axillary metastasis than other groups. Luminal D group had least metastasis to axillary LN. Most poorly differentiated cancers with Grade III were of luminal D (TN) i.e. 78% followed by Luminal C (65%). Again H2n+ subtypes (luminal A and Luminal C) showed highest rates of locoregional recurrence. while systemic metastasis was seen most common in luminal C (37%) followed by Luminal D (21).The 3 - years and 5 - years overall survival rate (OS) were significantly lower in luminal C patients ( 72%,70%) and Luminal D (75%,70%) as compared to luminal A (85%,82%) and luminal B(88%,85). The 3 –years and 5-years Disease free survival (DFS) was also worst in luminal C (58%, 38%) followed by luminal D (70% and 48%) as compared to other subtypes. Conclusions: This study shows in Pakistani women most aggressive Breast cancers with poorest prognosis are those with ER/PR- ,Her2+ receptors (also known as H2N subtype internationally) and Triple negative breast cancer(ER/PR-,Her2-). It is important to further categorize female breast cancer on basis of receptors in Pakistani women for proper management and good follow up. We suggest every breast cancer must be analyzed for its receptors and for this purpose facilities must be provided everywhere in Pakistan. EP-0994 IMPACT OF DELAY IN STARTING RADIOTHERAPY IN LOCAL FAILURE IN CONSERVATIVE BREAST CANCER WITHOUT CHEMOTHERAPY J. Munoz Garcia1, J. Quiros Rivero1, O. Zoleto Camacho1, Y. Rios Kavadoy1, F. Ropero Carmona1, E. Capelo Medina1, A. Corbacho Campos1, J. Cabrera Rodriguez1 1 Hospital Infanta Cristina, Radiation Oncology, Badajoz, Spain