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EP-1207: Inmediate reconstruction and postmastectomy radiotherapy
S58 EP-1207 Inmediate reconstruction and postmastectomy radiotherapy V. Díaz Díaz1, L. De Ingunza1, I. Villanego1, E. Gonzalez1, L. Diaz1, L. Gutierrez1, C. Salas1, J. Jaen1 1 Hospital Universitario Puerta del Mar, Radiation Oncology, Cadiz, Spain Purpose/Objective: Postmastectomy radiotherapy has an important role in terms of survival and quality of life in breast cancer. It has demostrate superior locoregional control. Women who required RTPM represent a great reconstructive challenge. Optimal management of women who have undergone RTPM and reconstruction for breast cancer requires a multimodality approach. Breast reconstruction can be carried out inmmediate or delayed. The adecquate decision is based in optimize outcomes and minimize complications. Despite patients who need radiation are more suitable for delayed reconstruction, in this study we analize a serie of patients treated with RT in our center who undergone inmediate reconstruction.
ESTRO 33, 2014 and PTVCTV. The mean V95 of all IMB plans was 100% and 99.1% of the GTV and CTV, respectively. Delivering an ablative dose to the GTV with IMB was readily achievable with 2-3 catheters, however for appropriate CTV coverage, additional 5-12 catheters were required. This resulted in multiple hotspots throughout the CTV. In addition, for the IMB approach, the percentage (PTV)CTV volume receiving more than 19 Gy (95% of the prescribed dose to the GTV) was substantial, with a median of 80%. The OAR dose was acceptable in both plans.
Materials and Methods: We studied twenty pati: nts treated with postmastectomy radioteherapy who underwent inmediate reconstructio and twenty patients whithout reconstruction from 2007 to 2012. The prescribed dose was 50 Gy in 25 fractions and them who received also boost was16 Gy in 8 fr. The implant used was tissue expander and one was directly a prosthesis.. The staging most frequently was III. The type of procedure was in all cases modified radical mastectomy and one simple mastectomy. Results: The acute toxicity (1 month) was dermitis Grade I and no toxicity at 6 months in the inmediate reconstruction group and dermatitis G1 and G2 in the PMRT without reconstruction group , based in the toxicity criteria of the Radiation Oncology Therapy Group. There was nor infection neither deflation. In one of them was developed capsular contractured that required the replacement of the tissue expander with a prosthesis after finishing radiotherapy (5%). Tissue expansion was performed before the treatment in all cases. Pulmonary irradiation was inferior in reconstruction group based in V20 lung doses. Aesthetic satisfaction is similar in both but psychological impact and qualitiy of life was better in the inmediate reconstruction group. Conclusions: Inmediate reconstruction has shown to be safe and has advantages compared difered reconstruction in patients with postmastectomy radiotherapy, it has similar complication rates and general satisfaction with controls, but increased lung irradiation sparing, esthetic satisfaction and quality of life EP-1208 Single fraction ablative radiotherapy for early stage breast cancer: A brachytherapy versus IMRT planning study K.R. Charaghvandi1, M.D. Den Hartogh1, J.H.W. De Vries1, V. Scholten1, M.A. Moerland1, M.E.P. Philippens1, M. Van Vulpen1, B. Van Asselen1, H.J.G.D. Van den Bongard1 1 University Medical Center Utrecht, Radiotherapy, Utrecht, The Netherlands Purpose/Objective: A part of the elderly early stage breast cancer patients is not treated with breast conserving therapy due to surgery or multiple radiotherapy sessions. Consequently, these patients receive only endocrine monotherapy or are treated with mastectomy. In order to attain optimal treatment for elderly patients, we investigated the potential for a single fraction ablative radiotherapy treatment to the tumor. In this planning study we compared two modalities for a single fraction ablative dose delivery, namely an interstitial multicatheter brachytherapy (IMB) - versus an intensity-modulated radiation therapy (IMRT) based stereotactic treatment approach. Materials and Methods: The gross tumor volume (GTV) was delineated for 19 patients on the planning CT-scan, coregistered with a contrast enhanced MRI, both in radiotherapy supine position. Until now, 1 right sided and 4 left sided breast tumors with a maximal diameter of 2 cm were evaluated. The clinical target volume (CTV) was created by expanding the GTV with 2 cm, excluding skin (defined as the first 5 mm from the body surface) and chest wall. For IMRT, the GTV and CTV were expanded by 3 mm to obtain the planning target volumes PTVGTV and PTVCTV. A 15 Gy dose was prescribed to the (PTV)CTV and a simultaneous integrated boost of 20Gy to the (PTV)GTV. For IMRT, a maximum dose of 120% was allowed within the PTVGTV. IMB scenarios were generated using OncentraBrachy 4.3® (Elekta/Nucletron,The Netherlands) whereas IMRT plans using 9 beam angles were created using Monaco 3.2 ® (Elekta, The Netherlands). The skin, breasts, chest wall, lungs and heart were delineated as organs at risk. The plans were evaluated on target coverage, overdosage in the CTV and dose to OARs. Results: In Table 1, the V95 of all IMRT plans was above 99% of the PTVGTV
Conclusions: Our preliminary findings show that IMRT is suitable for treatment with a single ablative radiotherapy dose on small breast tumors (≤ 2 cm), also when a CTV is taken into account. IMB treatment seems thus far not suitable for clinical implementation due to the necessity of numerous catheters resulting in multiple hotspots and overdosage in the CTV. We are currently extending our study with 14 additional patients, and expect to complete this planning study within the next three months. EP-1209 Management parameters in the launching of intraoperative electron radiotherapy in a University Hospital I. Valduvieco1, R. Llorente2, D. Lambisto1, J. Morales2, P.L. Fernandez3, M. Velasco4, J. Pahisa5, F. Carmona5, B. Farrus6, A. Biete6 1 Hospital Clinic, Radiation Oncology / Fundacio Clinic, Barcelona, Spain 2 Hospital Clinic, Radiation Oncology, Barcelona, Spain 3 Hospital Clinic, Pathology, Barcelona, Spain 4 Hospital Clinic, Radiology, Barcelona, Spain 5 Hospital Clinic, Ginaecology, Barcelona, Spain 6 Hospital Clinic / IDIBAPS, Radiation Oncology, Barcelona, Spain Purpose/Objective: Analyze the repercussion of launching intraoperative electron radiotherapy (ELIOT) with a dedicated Linear Accelerator (SORDINA) in a Radiation Oncology Department of a University Hospital with limited equipment, great health care demand and a needed for freed spots in Conventional Linear Accelerator (CLA) for introducing new technologies. Materials and Methods: From July to October 2013 candidates to conservative surgery for infiltrating breast cancer were included in the protocol. Those fulfilling criteria of low risk defined by ASTRO and GECESTRO were treated exclusively with ELIOT while the intermediate and high risk received ELIOT-boost. ELIOT was performed within the context of a cohort study with the hypothesis of no inferiority related to standard treatment. The ELIOT technique allows precise application of irradiation and provides exclusive treatment during surgery in a selected group. In exclusive-ELIOT a dose of 20 Gy is administered and in boost-ELIOT 10 Gy, both in isodose of 90 % (R90). ELIOT requires close teamwork (surgery, anaesthesiology, radiology, pathology and radiation oncology) and thus a multidisciplinary training program and quality control were designed for participation and knowledge of the technique in all the settings involved. We measured the time saved with ELIOT in terms of CLA spaces and qualified personnel time consumption.
ESTRO 33, 2014 and PTVCTV. The mean V95 of all IMB plans was 100% and 99.1% of the GTV and CTV, respectively. Delivering an ablative dose to the GTV with IMB was readily achievable with 2-3 catheters, however for appropriate CTV coverage, additional 5-12 catheters were required. This resulted in multiple hotspots throughout the CTV. In addition, for the IMB approach, the percentage (PTV)CTV volume receiving more than 19 Gy (95% of the prescribed dose to the GTV) was substantial, with a median of 80%. The OAR dose was acceptable in both plans.
Materials and Methods: We studied twenty pati: nts treated with postmastectomy radioteherapy who underwent inmediate reconstructio and twenty patients whithout reconstruction from 2007 to 2012. The prescribed dose was 50 Gy in 25 fractions and them who received also boost was16 Gy in 8 fr. The implant used was tissue expander and one was directly a prosthesis.. The staging most frequently was III. The type of procedure was in all cases modified radical mastectomy and one simple mastectomy. Results: The acute toxicity (1 month) was dermitis Grade I and no toxicity at 6 months in the inmediate reconstruction group and dermatitis G1 and G2 in the PMRT without reconstruction group , based in the toxicity criteria of the Radiation Oncology Therapy Group. There was nor infection neither deflation. In one of them was developed capsular contractured that required the replacement of the tissue expander with a prosthesis after finishing radiotherapy (5%). Tissue expansion was performed before the treatment in all cases. Pulmonary irradiation was inferior in reconstruction group based in V20 lung doses. Aesthetic satisfaction is similar in both but psychological impact and qualitiy of life was better in the inmediate reconstruction group. Conclusions: Inmediate reconstruction has shown to be safe and has advantages compared difered reconstruction in patients with postmastectomy radiotherapy, it has similar complication rates and general satisfaction with controls, but increased lung irradiation sparing, esthetic satisfaction and quality of life EP-1208 Single fraction ablative radiotherapy for early stage breast cancer: A brachytherapy versus IMRT planning study K.R. Charaghvandi1, M.D. Den Hartogh1, J.H.W. De Vries1, V. Scholten1, M.A. Moerland1, M.E.P. Philippens1, M. Van Vulpen1, B. Van Asselen1, H.J.G.D. Van den Bongard1 1 University Medical Center Utrecht, Radiotherapy, Utrecht, The Netherlands Purpose/Objective: A part of the elderly early stage breast cancer patients is not treated with breast conserving therapy due to surgery or multiple radiotherapy sessions. Consequently, these patients receive only endocrine monotherapy or are treated with mastectomy. In order to attain optimal treatment for elderly patients, we investigated the potential for a single fraction ablative radiotherapy treatment to the tumor. In this planning study we compared two modalities for a single fraction ablative dose delivery, namely an interstitial multicatheter brachytherapy (IMB) - versus an intensity-modulated radiation therapy (IMRT) based stereotactic treatment approach. Materials and Methods: The gross tumor volume (GTV) was delineated for 19 patients on the planning CT-scan, coregistered with a contrast enhanced MRI, both in radiotherapy supine position. Until now, 1 right sided and 4 left sided breast tumors with a maximal diameter of 2 cm were evaluated. The clinical target volume (CTV) was created by expanding the GTV with 2 cm, excluding skin (defined as the first 5 mm from the body surface) and chest wall. For IMRT, the GTV and CTV were expanded by 3 mm to obtain the planning target volumes PTVGTV and PTVCTV. A 15 Gy dose was prescribed to the (PTV)CTV and a simultaneous integrated boost of 20Gy to the (PTV)GTV. For IMRT, a maximum dose of 120% was allowed within the PTVGTV. IMB scenarios were generated using OncentraBrachy 4.3® (Elekta/Nucletron,The Netherlands) whereas IMRT plans using 9 beam angles were created using Monaco 3.2 ® (Elekta, The Netherlands). The skin, breasts, chest wall, lungs and heart were delineated as organs at risk. The plans were evaluated on target coverage, overdosage in the CTV and dose to OARs. Results: In Table 1, the V95 of all IMRT plans was above 99% of the PTVGTV
Conclusions: Our preliminary findings show that IMRT is suitable for treatment with a single ablative radiotherapy dose on small breast tumors (≤ 2 cm), also when a CTV is taken into account. IMB treatment seems thus far not suitable for clinical implementation due to the necessity of numerous catheters resulting in multiple hotspots and overdosage in the CTV. We are currently extending our study with 14 additional patients, and expect to complete this planning study within the next three months. EP-1209 Management parameters in the launching of intraoperative electron radiotherapy in a University Hospital I. Valduvieco1, R. Llorente2, D. Lambisto1, J. Morales2, P.L. Fernandez3, M. Velasco4, J. Pahisa5, F. Carmona5, B. Farrus6, A. Biete6 1 Hospital Clinic, Radiation Oncology / Fundacio Clinic, Barcelona, Spain 2 Hospital Clinic, Radiation Oncology, Barcelona, Spain 3 Hospital Clinic, Pathology, Barcelona, Spain 4 Hospital Clinic, Radiology, Barcelona, Spain 5 Hospital Clinic, Ginaecology, Barcelona, Spain 6 Hospital Clinic / IDIBAPS, Radiation Oncology, Barcelona, Spain Purpose/Objective: Analyze the repercussion of launching intraoperative electron radiotherapy (ELIOT) with a dedicated Linear Accelerator (SORDINA) in a Radiation Oncology Department of a University Hospital with limited equipment, great health care demand and a needed for freed spots in Conventional Linear Accelerator (CLA) for introducing new technologies. Materials and Methods: From July to October 2013 candidates to conservative surgery for infiltrating breast cancer were included in the protocol. Those fulfilling criteria of low risk defined by ASTRO and GECESTRO were treated exclusively with ELIOT while the intermediate and high risk received ELIOT-boost. ELIOT was performed within the context of a cohort study with the hypothesis of no inferiority related to standard treatment. The ELIOT technique allows precise application of irradiation and provides exclusive treatment during surgery in a selected group. In exclusive-ELIOT a dose of 20 Gy is administered and in boost-ELIOT 10 Gy, both in isodose of 90 % (R90). ELIOT requires close teamwork (surgery, anaesthesiology, radiology, pathology and radiation oncology) and thus a multidisciplinary training program and quality control were designed for participation and knowledge of the technique in all the settings involved. We measured the time saved with ELIOT in terms of CLA spaces and qualified personnel time consumption.