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IMRT-SIB for locally advanced inoperable breast cancer patients – update
15th St.Gallen International Breast Cancer Conference / The Breast 32S1 (2017) S22–S77
P126 Synchronous malignant tumors of different genesis in axillary lymph nodes E. Dimonitsas1, G. Charitos2, K. Fragia-Tsivou3, K. Dritsakos4, F. Fostira5, E. Christodoulaki1, N. Kentepozidis6, I. Stefanaki7, A. Stratigos7, I. Kapiris1,8*. 1Second Department of Surgery, 251 General Airforce Hospital, Athens, Greece, 2Department of Plastic and Reconstructive Surgery, 251 General Airforce Hospital, Athens, Greece, 3 Private Laboratory of Pathological Anatomy, HistoBio Diagnosis, Athens, Greece, 4Pathological Anatomy Department, 251 General Airforce Hospital, Athens, Greece, 5Μolecular Diagnostics Laboratory, National Centre for Scientific Research “Demokritos”, Athens, Greece, 6 Department of Oncology, 251 General Airforce Hospital, Athens, Greece, 7 First Department of Dermatology and Venereology, “A. Sygros” Hospital, Athens Medical School, Athens, Greece, 8Breast Center, 251 General Airforce Hospital, Athens, Greece Aim: Multiple Primary Malignant Tumors (MPMT) are described as an independent appearance and development of two or more neoplasms in one patient. These tumors should be of different position and different histological type with common metastases area. According to this, many studies have suggested an increased risk for breast cancer in patients diagnosed with melanoma and vice versa, though a lack of consensus regarding the degree and nature of the association persists. Specifically, females with BRCA2 gene mutations are in an increased risk of melanoma. At a similar way studies found that patients with mutation of CDKN2a melanoma susceptibility gene exhibit a higher than expected risk of breast cancer. Case Report: An 80-year-old female presented with a suspicious pigmented lesion on right arm. Histology showed a pT4a superficial spreading melanoma with vertical growth phase (7,95 mm Breslow’s thickness, Clark’s level V). Sentinel lymph node biopsy was positive and the patient had a radical axillary lymph node dissection. Lymph node histology revealed metastatic melanocytes, but also infiltration from an invasive breast ductal adenocarcinoma (ER+, PR+, Cerb-B2+, Ki-67+). According to this finding, further breast imaging revealed a malignant tumor of right breast (IDC grade II), followed by surgical removal of the right breast. Although the patient had no significant family history, the patient was refereed for genetic testing, where 41 cancer predisposing genes were analyzed by NGS (Next Generation Sequencing). Results: A BRCA2 missense mutation ( p.Y3035S) was identified through panel testing and is classified as a variant of unknown clinical significance. This variant is currently assessed centrally by collecting additional carriers and family members, as well as through tumor testing. Conclusion: This case describes the implementation of genetic testing in an individual with multiple primary cancers without family history and can lead the way for analyzing large numbers of such patients. Disclosure of Interest: No significant relationships. P127 IMRT-SIB for locally advanced inoperable breast cancer patients – update K. Trela-Janus1 *, R. Kulik2, A. Namysl-Kaletka1, I. Wzietek1, D. Gabrys1. Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland, 2Radiotherapy and Brachytherapy Planning Department, Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
1
This, ethics approved, prospective study was designed to evaluate the technical feasibility, toxicity and early results of simultaneous integrated boost (SIB) for locally advanced, breast cancer patients. Thirty five (14 right; 18 left-sided) received radiotherapy with SIB applying various dose levels in 30 fractions. Doses were individualized according to the stage of the disease. The regional lymph nodes
S65
received 49.8–60 Gy, df 1.66–2 Gy, metastatic lymph nodes received 66–69.9 Gy, df 2.2–2.33 Gy, breast with chest wall was irradiated with a dose 49,8–60 Gy, the whole breast to 60 Gy, and the highest dose was delivered to the breast tumour 69.9 Gy. Early toxicity and results were prospectively recorded using CTCAE 4.03, QLQ 30, QLQ Br23, and Lent Soma scale. All patients underwent planning CT or FDG PET-CT. The majority (26 patients) were treated with the use of Clinac IMRT-SIB, 6 patients were treated with Tomo-SIB. The median age was 61 years (range 37–82). Median tumor size was 6 cm (range 1–15 cm). Majority (24) patients presented with clinical stage IIIB of the disease, one patient with IIIA, three with IIIC. Two patients in stage IIA were not qualified to surgery, one was not suitable for resection due to medical conditions, the second did not agree for a surgery. All patients received chemotherapy, 14 patients FAC only, remaining various combinations with taxanes. Twenty patients were treated with hormonal therapy, the majority of them (15 patients) were treated with Tamoxifen. The mean dose to the ipsilateral lung was 16.6 Gy (range12.5–20.7). The percentage of lung receiving >5 Gy was 77.8 >10 Gy – 52.2, >20 Gy – 24.8. The mean heart dose was 9.9 Gy (range 4.3–21.5) and V5Gy was 65.4, V10Gy – 28.4, V30Gy – 4.4. There was significant decrease in WBC (median 6.9 vs. 4.9 10^3/μl; p-0.03), PLT (264 vs. 199 10^3/μl; p-0.01) before and after radiotherapy. RBC and Hb did not significantly decrease. The maximum Grade 3 early skin toxicity by the end of treatment was present only in two patients. No Grade 4 toxicities were observed. The maximum Grade 2 fatigue, Grade 1 dysphagia, Grade 1 pain with swallowing were recorded. The early skin toxicity resolved in all patients evaluated one month after finishing the treatment. This 6-week course of definitive radiotherapy using SIB technique showed to be feasible and was associated with acceptable early skin toxicity. Long-term follow-up data are needed to assess late toxicity and clinical outcomes. Disclosure of Interest: No significant relationships. P128 Prospective cohort study of lung oligometastasis of breast cancer M. Hatono*, T. Shien, K. Kawada, Y. Takahashi, T. Tsukioki, T. Nogami, T. Iwamoto, T. Motoki, N. Taira, H. Doihara. Okayama University Hospital, Okayama City, Japan Background: For the treatment of metastatic breast cancer, systemic therapies are used to prolong survival and palliate symptoms, and surgery is useful to only locoregional treatment. Recently, by the development of the new drugs such as the molecular target drug and immune checkpoint inhibitor, and the progress of the radiological examination, the treatment strategy of MBC is changing. The prognostic effect of surgical resection for the oligo metastasis which are small and few metastases to a single organ is reported. Aims: We start the prospective cohort study to evaluate the diagnostic and prognostic efficacy and safety of surgery for lung oligometastasis of breast cancer. Methods: We prospectively analyse lung oligometastasis of breast cancer diagnosed by CT, PET-CT. Oligometastasis is defined one to three metastases limited to the lung. Primary outcome is overall survival and secondary outcomes are rate of concordance of the expression statuses of ER, PR, HER2, Ki-67 between primary and metastatic breast cancer lesions and safety of surgery for lung oligometastasis. Target sample size is 80, accrual period is 5 years from October 2014, and follow-up duration is 5 years after final registration. Conclusions: About lung oligometastasis of breast cancer, there is only the retrospective study and it is unclear about the usefulness of the surgical resection. We perform a prospective cohort study to discuss treatment strategy for lung oligometastasis of breast cancer. Disclosure of Interest: No significant relationships.
P126 Synchronous malignant tumors of different genesis in axillary lymph nodes E. Dimonitsas1, G. Charitos2, K. Fragia-Tsivou3, K. Dritsakos4, F. Fostira5, E. Christodoulaki1, N. Kentepozidis6, I. Stefanaki7, A. Stratigos7, I. Kapiris1,8*. 1Second Department of Surgery, 251 General Airforce Hospital, Athens, Greece, 2Department of Plastic and Reconstructive Surgery, 251 General Airforce Hospital, Athens, Greece, 3 Private Laboratory of Pathological Anatomy, HistoBio Diagnosis, Athens, Greece, 4Pathological Anatomy Department, 251 General Airforce Hospital, Athens, Greece, 5Μolecular Diagnostics Laboratory, National Centre for Scientific Research “Demokritos”, Athens, Greece, 6 Department of Oncology, 251 General Airforce Hospital, Athens, Greece, 7 First Department of Dermatology and Venereology, “A. Sygros” Hospital, Athens Medical School, Athens, Greece, 8Breast Center, 251 General Airforce Hospital, Athens, Greece Aim: Multiple Primary Malignant Tumors (MPMT) are described as an independent appearance and development of two or more neoplasms in one patient. These tumors should be of different position and different histological type with common metastases area. According to this, many studies have suggested an increased risk for breast cancer in patients diagnosed with melanoma and vice versa, though a lack of consensus regarding the degree and nature of the association persists. Specifically, females with BRCA2 gene mutations are in an increased risk of melanoma. At a similar way studies found that patients with mutation of CDKN2a melanoma susceptibility gene exhibit a higher than expected risk of breast cancer. Case Report: An 80-year-old female presented with a suspicious pigmented lesion on right arm. Histology showed a pT4a superficial spreading melanoma with vertical growth phase (7,95 mm Breslow’s thickness, Clark’s level V). Sentinel lymph node biopsy was positive and the patient had a radical axillary lymph node dissection. Lymph node histology revealed metastatic melanocytes, but also infiltration from an invasive breast ductal adenocarcinoma (ER+, PR+, Cerb-B2+, Ki-67+). According to this finding, further breast imaging revealed a malignant tumor of right breast (IDC grade II), followed by surgical removal of the right breast. Although the patient had no significant family history, the patient was refereed for genetic testing, where 41 cancer predisposing genes were analyzed by NGS (Next Generation Sequencing). Results: A BRCA2 missense mutation ( p.Y3035S) was identified through panel testing and is classified as a variant of unknown clinical significance. This variant is currently assessed centrally by collecting additional carriers and family members, as well as through tumor testing. Conclusion: This case describes the implementation of genetic testing in an individual with multiple primary cancers without family history and can lead the way for analyzing large numbers of such patients. Disclosure of Interest: No significant relationships. P127 IMRT-SIB for locally advanced inoperable breast cancer patients – update K. Trela-Janus1 *, R. Kulik2, A. Namysl-Kaletka1, I. Wzietek1, D. Gabrys1. Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland, 2Radiotherapy and Brachytherapy Planning Department, Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
1
This, ethics approved, prospective study was designed to evaluate the technical feasibility, toxicity and early results of simultaneous integrated boost (SIB) for locally advanced, breast cancer patients. Thirty five (14 right; 18 left-sided) received radiotherapy with SIB applying various dose levels in 30 fractions. Doses were individualized according to the stage of the disease. The regional lymph nodes
S65
received 49.8–60 Gy, df 1.66–2 Gy, metastatic lymph nodes received 66–69.9 Gy, df 2.2–2.33 Gy, breast with chest wall was irradiated with a dose 49,8–60 Gy, the whole breast to 60 Gy, and the highest dose was delivered to the breast tumour 69.9 Gy. Early toxicity and results were prospectively recorded using CTCAE 4.03, QLQ 30, QLQ Br23, and Lent Soma scale. All patients underwent planning CT or FDG PET-CT. The majority (26 patients) were treated with the use of Clinac IMRT-SIB, 6 patients were treated with Tomo-SIB. The median age was 61 years (range 37–82). Median tumor size was 6 cm (range 1–15 cm). Majority (24) patients presented with clinical stage IIIB of the disease, one patient with IIIA, three with IIIC. Two patients in stage IIA were not qualified to surgery, one was not suitable for resection due to medical conditions, the second did not agree for a surgery. All patients received chemotherapy, 14 patients FAC only, remaining various combinations with taxanes. Twenty patients were treated with hormonal therapy, the majority of them (15 patients) were treated with Tamoxifen. The mean dose to the ipsilateral lung was 16.6 Gy (range12.5–20.7). The percentage of lung receiving >5 Gy was 77.8 >10 Gy – 52.2, >20 Gy – 24.8. The mean heart dose was 9.9 Gy (range 4.3–21.5) and V5Gy was 65.4, V10Gy – 28.4, V30Gy – 4.4. There was significant decrease in WBC (median 6.9 vs. 4.9 10^3/μl; p-0.03), PLT (264 vs. 199 10^3/μl; p-0.01) before and after radiotherapy. RBC and Hb did not significantly decrease. The maximum Grade 3 early skin toxicity by the end of treatment was present only in two patients. No Grade 4 toxicities were observed. The maximum Grade 2 fatigue, Grade 1 dysphagia, Grade 1 pain with swallowing were recorded. The early skin toxicity resolved in all patients evaluated one month after finishing the treatment. This 6-week course of definitive radiotherapy using SIB technique showed to be feasible and was associated with acceptable early skin toxicity. Long-term follow-up data are needed to assess late toxicity and clinical outcomes. Disclosure of Interest: No significant relationships. P128 Prospective cohort study of lung oligometastasis of breast cancer M. Hatono*, T. Shien, K. Kawada, Y. Takahashi, T. Tsukioki, T. Nogami, T. Iwamoto, T. Motoki, N. Taira, H. Doihara. Okayama University Hospital, Okayama City, Japan Background: For the treatment of metastatic breast cancer, systemic therapies are used to prolong survival and palliate symptoms, and surgery is useful to only locoregional treatment. Recently, by the development of the new drugs such as the molecular target drug and immune checkpoint inhibitor, and the progress of the radiological examination, the treatment strategy of MBC is changing. The prognostic effect of surgical resection for the oligo metastasis which are small and few metastases to a single organ is reported. Aims: We start the prospective cohort study to evaluate the diagnostic and prognostic efficacy and safety of surgery for lung oligometastasis of breast cancer. Methods: We prospectively analyse lung oligometastasis of breast cancer diagnosed by CT, PET-CT. Oligometastasis is defined one to three metastases limited to the lung. Primary outcome is overall survival and secondary outcomes are rate of concordance of the expression statuses of ER, PR, HER2, Ki-67 between primary and metastatic breast cancer lesions and safety of surgery for lung oligometastasis. Target sample size is 80, accrual period is 5 years from October 2014, and follow-up duration is 5 years after final registration. Conclusions: About lung oligometastasis of breast cancer, there is only the retrospective study and it is unclear about the usefulness of the surgical resection. We perform a prospective cohort study to discuss treatment strategy for lung oligometastasis of breast cancer. Disclosure of Interest: No significant relationships.