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Is There a Role for Stereotactic Body Radiation Therapy (SBRT) in Oligometastatic Breast Cancer? Results From an Observational Study
E12
International Journal of Radiation Oncology Biology Physics
2028
Materials/Methods: Between February 2002 and August 2011, 389 patients were treated with IORT. Following parameters were recorded: age, TNM status, grading, histology (lobular vs no special type), lymphangioinvasion, hormone receptor status, Luminal A/B/triple negative, uPA/PAI, number of resections, resection status, EIC, adjuvant therapy, localization of the tumor and recurrence. Four groups were analyzed (univariate analysis): local recurrence (< 2 cm of the tumor bed), ipsilateral recurrence (> 2 cm of the tumor bed), contralateral recurrence, and control group with no recurrence. A risk classification for recurrence of < 5%, 5-10%, 10-15% and > 15% was done. Results: Mean age was 64 years and the median follow-up was 44 months. A Tx/1/2/3/4 stadium was found in 8/295/94/0/1 patients and N0/1/2/3/x in 296/62/16/4/22 patients. Thirty-nine patients died. Local recurrence and contralateral recurrence occurred in 8 patients each (2%). Seven patients had an ipsilateral recurrence (1.8%). Risk factors for local recurrence were young age, therapy with bisphosphonates, medial tumor localization and resection margins < 1 mm and for ipsilateral recurrence triple negative tumors. A smaller number of resections were a risk factor for both local and ipsilateral recurrence. The combination of positive lymph nodes with lymphangioinvasion was a risk factor for all 3 recurrence types. High risk factors (> 15% probability of recurrence) were in particular positive lymph nodes with lymphangioinvasion and secondly triple negative tumors. Conclusion: Young age, lymphangioinvasion, medial tumor localization, triple negative tumors, and the resection status were confirmed as risk factors after IORT, too. Tumor size, positive lymph nodes without lymphangioinvasion and histology were not confirmed as risk factors. High risk factors were on the one hand a combination of positive lymph nodes and lymphangioinvasion and on the other hand triple negative tumors. Author Disclosure: E. Sperk: Honoraria; Carl Zeiss Meditec, Medtronic. Speaker’s Bureau; Carl Zeiss Meditec. Travel Expenses; Carl Zeiss Meditec, Merck. P. Teich: None. C. Weiß: None. M. Su¨tterlin: Honoraria; Carl Zeiss Meditec, Astra Zeneca, Pfizer, Roche. Speaker’s Bureau; Carl Zeiss Meditec. Advisory Board; CSL Behring. Travel Expenses; Carl Zeiss Meditec, Astra Zeneca, Roche, Pfizer. F. Wenz: Research Grant; Elekta, Carl Zeiss Meditec, opasca, IBA, Merck KGaA. Honoraria; Elekta, Carl Zeiss Meditec, Celgene, Roche, Lilly, Medtronic, Ipsen. Advisory Board; Elekta, Celgene. Travel Expenses; Elekta, Carl Zeiss Meditec, Celgene, Roche, Lilly, Sennewald GmbH. Co-development of IORT with Carl Zeiss Meditec; Carl Zeiss Meditec.
Is There a Role for Stereotactic Body Radiation Therapy (SBRT) in Oligometastatic Breast Cancer? Results From an Observational Study F. De Rose,1 D. Franceschini,1 L. Cozzi,2 T. Comito,2 G.R. D’Agostino,1 P. Navarria,2 A.M. Ascolese,2 A. Tozzi,1 C. Iftode,1 C. Franzese,2 E. Clerici,1 S. Tomatis,2 A. Fogliata,1 and M. Scorsetti2; 1Humanitas Clinical and Research Hospital, Rozzano, Italy, 2Humanitas Cancer Center and Research Hospital, Rozzano, Italy Purpose/Objective(s): There is increasing evidence that multidisciplinary management of oligometastatic breast cancer using local therapies could improve disease control and survival rate. The aim of this study is the evaluation of safety and efficacy of SBRT in a selected subset of patients. Materials/Methods: Oligometastatic patients from breast cancer were treated with SBRT for lung and liver lesions, in an observational study. Eligibility criteria were as follows: age >18 years, ECOG 0-2, diagnosis of breast cancer, controlled or absent extrapulmonary and/or extrahepatic disease, less than 5 lung and liver lesions (with maximum diameter <5 cm), chemotherapy completed at least 3 weeks before treatment, written informed consent. Prescription dose ranged between 48 and 75 Gy in 3 or 4 consecutive fractions. Primary end-point was local control (LC). Secondary end-points were toxicity, overall survival (OS) and progression-free survival (PFS). Local control was defined according to RECIST and PERCIST criteria. Toxicity was recorded according to the Common Toxicity Criteria Adverse Events (CTCAE) version 4.0. Results: From February 2010 to June 2015, 41 patients were irradiated for a total number of 58 lesions. Thirty patients for a total of 40 liver lesions and 11 patients for a total of 18 lung lesions were treated. Median followup was 28 months (range 6 - 71). One and two-three years actuarial LC rate was 96% and 88% respectively. Median overall survival (OS) was 45 months. Actuarial OS rate at 1 and 2 years was 90% and 63% respectively. Median progression-free survival (PFS) was 10 months, with a PFS rate at 1, and 2 years of 45% and 26% respectively. Univariate analysis showed a correlation between OS and DFI > 12 months, hormonal receptor positivity and medical therapies for metastatic disease after SBRT. No patients experienced radiation-induced liver disease (RILD) or any grade >3 toxicity. Conclusion: SBRT is a safe and feasible local treatment of liver and lung oligometastases from breast cancer, in selected patients not amenable to surgery, with promising local control and survival rate. We need for prospective trials to confirm these encouraging results and to identify the perfect candidate for SBRT. Author Disclosure: F. De Rose: None. D. Franceschini: None. L. Cozzi: None. T. Comito: None. G. D’Agostino: None. P. Navarria: None. A. Ascolese: None. A. Tozzi: None. C. Iftode: None. C. Franzese: None. E. Clerici: None. S. Tomatis: None. A. Fogliata: None. M. Scorsetti: None.
2029 Risk Factors for Breast Cancer Recurrence After Intraoperative Radiation Therapy (IORT) E. Sperk,1 P.C. Teich,1 C. Weiß,2 M. Su¨tterlin,3 and F. Wenz1; 1Department of Radiation Oncology, Universita¨tsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany, 2Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany, 3 Department of Gynecology and Obstetrics, Universita¨tsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, Germany Purpose/Objective(s): There are known risk factors for recurrence after breast cancer with breast conserving therapy. Up to date no special analysis of risk factors after intraoperative radiation therapy (IORT) for breast cancer are published. In this analysis we report risk factors for local recurrence, ipsilateral and contralateral recurrence after IORT and present a risk classification (probability of recurrence).
2030 The Impact of Re-Excision and Residual Disease on Local Recurrence Following Breast-Conserving Therapy S.A. Mihalcik,1 B. Rawal,2 L.Z. Braunstein,1 A. Capuco,3 J.S. Wong,3 R.S. Punglia,3 J.R. Bellon,3 and J.R. Harris3; 1Harvard Radiation Oncology Program, Boston, MA, 2Dana-Farber Cancer Institute, Boston, MA, 3Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA Purpose/Objective(s): Identifying risk factors for local recurrence (LR) following breast-conserving therapy (BCT) may inform the need for treatment intensification. Bodilsen et al. recently studied a Danish population-based cohort that identified the presence of residual disease on reexcision as an independent risk factor for LR (residual DCIS HR Z 2.58 (95% CI: 1.50 - 4.45); residual invasive carcinoma +/- DCIS HR Z 2.97 (95% CI: 1.57 e 5.62)), but the study was limited by incomplete data on biologic subtype. We sought to determine the risk for LR conferred by the presence of residual cancer on re-excision in an independent cohort of patients with clearly-defined biologic subtypes. Materials/Methods: The study population included 1073 consecutive patients with localized invasive breast cancer treated with BCT with one or zero re-excisions at one institution from 1998 to 2008. All patients had biologic subtype data as approximated by estrogen and progesterone receptor status, HER-2, and histologic grade. Cumulative incidence was calculated with competing risk analysis. Hazard ratios associated with LR were evaluated using Cox proportional hazards regression. Fisher’s exact and Wilcoxon rank sum tests were used to measure association.
International Journal of Radiation Oncology Biology Physics
2028
Materials/Methods: Between February 2002 and August 2011, 389 patients were treated with IORT. Following parameters were recorded: age, TNM status, grading, histology (lobular vs no special type), lymphangioinvasion, hormone receptor status, Luminal A/B/triple negative, uPA/PAI, number of resections, resection status, EIC, adjuvant therapy, localization of the tumor and recurrence. Four groups were analyzed (univariate analysis): local recurrence (< 2 cm of the tumor bed), ipsilateral recurrence (> 2 cm of the tumor bed), contralateral recurrence, and control group with no recurrence. A risk classification for recurrence of < 5%, 5-10%, 10-15% and > 15% was done. Results: Mean age was 64 years and the median follow-up was 44 months. A Tx/1/2/3/4 stadium was found in 8/295/94/0/1 patients and N0/1/2/3/x in 296/62/16/4/22 patients. Thirty-nine patients died. Local recurrence and contralateral recurrence occurred in 8 patients each (2%). Seven patients had an ipsilateral recurrence (1.8%). Risk factors for local recurrence were young age, therapy with bisphosphonates, medial tumor localization and resection margins < 1 mm and for ipsilateral recurrence triple negative tumors. A smaller number of resections were a risk factor for both local and ipsilateral recurrence. The combination of positive lymph nodes with lymphangioinvasion was a risk factor for all 3 recurrence types. High risk factors (> 15% probability of recurrence) were in particular positive lymph nodes with lymphangioinvasion and secondly triple negative tumors. Conclusion: Young age, lymphangioinvasion, medial tumor localization, triple negative tumors, and the resection status were confirmed as risk factors after IORT, too. Tumor size, positive lymph nodes without lymphangioinvasion and histology were not confirmed as risk factors. High risk factors were on the one hand a combination of positive lymph nodes and lymphangioinvasion and on the other hand triple negative tumors. Author Disclosure: E. Sperk: Honoraria; Carl Zeiss Meditec, Medtronic. Speaker’s Bureau; Carl Zeiss Meditec. Travel Expenses; Carl Zeiss Meditec, Merck. P. Teich: None. C. Weiß: None. M. Su¨tterlin: Honoraria; Carl Zeiss Meditec, Astra Zeneca, Pfizer, Roche. Speaker’s Bureau; Carl Zeiss Meditec. Advisory Board; CSL Behring. Travel Expenses; Carl Zeiss Meditec, Astra Zeneca, Roche, Pfizer. F. Wenz: Research Grant; Elekta, Carl Zeiss Meditec, opasca, IBA, Merck KGaA. Honoraria; Elekta, Carl Zeiss Meditec, Celgene, Roche, Lilly, Medtronic, Ipsen. Advisory Board; Elekta, Celgene. Travel Expenses; Elekta, Carl Zeiss Meditec, Celgene, Roche, Lilly, Sennewald GmbH. Co-development of IORT with Carl Zeiss Meditec; Carl Zeiss Meditec.
Is There a Role for Stereotactic Body Radiation Therapy (SBRT) in Oligometastatic Breast Cancer? Results From an Observational Study F. De Rose,1 D. Franceschini,1 L. Cozzi,2 T. Comito,2 G.R. D’Agostino,1 P. Navarria,2 A.M. Ascolese,2 A. Tozzi,1 C. Iftode,1 C. Franzese,2 E. Clerici,1 S. Tomatis,2 A. Fogliata,1 and M. Scorsetti2; 1Humanitas Clinical and Research Hospital, Rozzano, Italy, 2Humanitas Cancer Center and Research Hospital, Rozzano, Italy Purpose/Objective(s): There is increasing evidence that multidisciplinary management of oligometastatic breast cancer using local therapies could improve disease control and survival rate. The aim of this study is the evaluation of safety and efficacy of SBRT in a selected subset of patients. Materials/Methods: Oligometastatic patients from breast cancer were treated with SBRT for lung and liver lesions, in an observational study. Eligibility criteria were as follows: age >18 years, ECOG 0-2, diagnosis of breast cancer, controlled or absent extrapulmonary and/or extrahepatic disease, less than 5 lung and liver lesions (with maximum diameter <5 cm), chemotherapy completed at least 3 weeks before treatment, written informed consent. Prescription dose ranged between 48 and 75 Gy in 3 or 4 consecutive fractions. Primary end-point was local control (LC). Secondary end-points were toxicity, overall survival (OS) and progression-free survival (PFS). Local control was defined according to RECIST and PERCIST criteria. Toxicity was recorded according to the Common Toxicity Criteria Adverse Events (CTCAE) version 4.0. Results: From February 2010 to June 2015, 41 patients were irradiated for a total number of 58 lesions. Thirty patients for a total of 40 liver lesions and 11 patients for a total of 18 lung lesions were treated. Median followup was 28 months (range 6 - 71). One and two-three years actuarial LC rate was 96% and 88% respectively. Median overall survival (OS) was 45 months. Actuarial OS rate at 1 and 2 years was 90% and 63% respectively. Median progression-free survival (PFS) was 10 months, with a PFS rate at 1, and 2 years of 45% and 26% respectively. Univariate analysis showed a correlation between OS and DFI > 12 months, hormonal receptor positivity and medical therapies for metastatic disease after SBRT. No patients experienced radiation-induced liver disease (RILD) or any grade >3 toxicity. Conclusion: SBRT is a safe and feasible local treatment of liver and lung oligometastases from breast cancer, in selected patients not amenable to surgery, with promising local control and survival rate. We need for prospective trials to confirm these encouraging results and to identify the perfect candidate for SBRT. Author Disclosure: F. De Rose: None. D. Franceschini: None. L. Cozzi: None. T. Comito: None. G. D’Agostino: None. P. Navarria: None. A. Ascolese: None. A. Tozzi: None. C. Iftode: None. C. Franzese: None. E. Clerici: None. S. Tomatis: None. A. Fogliata: None. M. Scorsetti: None.
2029 Risk Factors for Breast Cancer Recurrence After Intraoperative Radiation Therapy (IORT) E. Sperk,1 P.C. Teich,1 C. Weiß,2 M. Su¨tterlin,3 and F. Wenz1; 1Department of Radiation Oncology, Universita¨tsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany, 2Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany, 3 Department of Gynecology and Obstetrics, Universita¨tsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, Germany Purpose/Objective(s): There are known risk factors for recurrence after breast cancer with breast conserving therapy. Up to date no special analysis of risk factors after intraoperative radiation therapy (IORT) for breast cancer are published. In this analysis we report risk factors for local recurrence, ipsilateral and contralateral recurrence after IORT and present a risk classification (probability of recurrence).
2030 The Impact of Re-Excision and Residual Disease on Local Recurrence Following Breast-Conserving Therapy S.A. Mihalcik,1 B. Rawal,2 L.Z. Braunstein,1 A. Capuco,3 J.S. Wong,3 R.S. Punglia,3 J.R. Bellon,3 and J.R. Harris3; 1Harvard Radiation Oncology Program, Boston, MA, 2Dana-Farber Cancer Institute, Boston, MA, 3Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA Purpose/Objective(s): Identifying risk factors for local recurrence (LR) following breast-conserving therapy (BCT) may inform the need for treatment intensification. Bodilsen et al. recently studied a Danish population-based cohort that identified the presence of residual disease on reexcision as an independent risk factor for LR (residual DCIS HR Z 2.58 (95% CI: 1.50 - 4.45); residual invasive carcinoma +/- DCIS HR Z 2.97 (95% CI: 1.57 e 5.62)), but the study was limited by incomplete data on biologic subtype. We sought to determine the risk for LR conferred by the presence of residual cancer on re-excision in an independent cohort of patients with clearly-defined biologic subtypes. Materials/Methods: The study population included 1073 consecutive patients with localized invasive breast cancer treated with BCT with one or zero re-excisions at one institution from 1998 to 2008. All patients had biologic subtype data as approximated by estrogen and progesterone receptor status, HER-2, and histologic grade. Cumulative incidence was calculated with competing risk analysis. Hazard ratios associated with LR were evaluated using Cox proportional hazards regression. Fisher’s exact and Wilcoxon rank sum tests were used to measure association.