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Modern Outcomes of Inflammatory Breast Cancer: The Cleveland Clinic Experience
I. J. Radiation Oncology d Biology d Physics
S206
Volume 81, Number 2, Supplement, 2011
Materials/Methods: We retrospectively reviewed the charts of all 652 women who underwent mastectomy and were found to have pathologically LN+, non-inflammatory breast cancer between 2000 and 2007 at Cleveland Clinic. The decision to utilize post-mastectomy radiotherapy (PMRT) was at the discretion of the treating radiation oncologist, as was the decision to boost the chest wall. Rates of LRR and CWR were estimated by use of radiation therapy, radiation dose delivered, and lymph node status using Kaplan-Meier analysis and comparisons were made using the log-rank test. Results: The median age was 52 years and median follow-up was 63 months. Overall, 413, 169, and 70 patients were pathologically staged as N1, N2, and N3, respectively; 347 (53%) patients received PMRT, including 33% of 1 – 3 LN+ and 88% of 4+ LN+ patients. All but 2.6% received chemotherapy and/or hormonal therapy. For the 231 patients with radiation dose details available, 128 received 50 – 50.4 Gray (Gy) to the chest wall (of whom 34% had 1 – 3 LN+ and 66% had 4+ LN+) and 103 received ./= 60 Gy to the chest wall (of whom 41% had 1 – 3 LN+ and 59% had 4+ LN+). The 5-year rates of LRR and CWR for the entire cohort were 7.7% and 4.4%, respectively. The 5-year LRR was 5.6% in those treated with PMRT vs. 10.1% in those not receiving PMRT (p = 0.04), and this difference remained significant in women with 1 – 3 LN+ (LRR 1.7% vs. 8.4%, p = 0.0097) and with 4+ LN+ (8.2% vs. 28.0%, p = 0.0004). The 5-year LRR for those who received 50 – 50.4 Gy and ./= 60 Gy to the chest wall were 2.4% and 6.3%, respectively (p = 0.21), and the 5-year CWR were 2.4% and 3.2%, respectively (p = 0.71). There were no significant differences in LRR or CWR based on radiation dose for either the 1 – 3 LN+ subgroup or the 4+ LN+ subgroup. Conclusions: In the postmastectomy setting, failure to deliver radiation to LN+ patients leads to higher rates of LRR, particularly in patients with 4+ LN+. However, higher radiation doses delivered to the chest wall (./= 60 Gy compared to 50 – 50.4 Gy) do not significantly decrease the rates of LRR or CWR in this retrospective study. Author Disclosure: S. Rehman: None. C.A. Reddy: None. M.E. Shukla: None. R.D. Tendulkar: None.
1104
Modern Outcomes of Inflammatory Breast Cancer: The Cleveland Clinic Experience
S. Rehman, R. D. Tendulkar, C. A. Reddy Cleveland Clinic Foundation, Cleveland, OH Purpose/Objective(s): Inflammatory breast cancer (IBC) is associated with poor outcomes. The purpose of this study was to report recent outcomes for IBC patients treated at the Cleveland Clinic in the modern era of trastuzumab and taxane-based chemotherapy. Materials/Methods: We retrospectively reviewed the charts of non-metastatic IBC patients from January 2000 to December 2009 at the Cleveland Clinic. Patients that received chemotherapy, surgery, and radiation therapy were considered to have completed the intended therapy. Kaplan-Meier curves were generated to estimate locoregional control (LRC), distant metastases free survival (DMFS), and overall survival (OS). Results: A total of 104 patients met inclusion criteria. The median follow-up was 34 months; 57 (55%) were ER/PR negative, 34 (33%) were Her2/neu amplified, and 62 (60%) were pathologically lymph node (LN) positive. Seventy-five (72%) patients completed all of the intended therapy. Among patients that completed all therapy, 67 (89%) received a taxane and 18/28 (64%) of her2/neu amplified patients received trastuzumab. For the entire cohort, the 5-year OS rate was 46%. ER/PR negative patients had a 5-year DMFS of 39% vs. 52% for ER/PR positive patients (p = 0.03). Comparing pathologically LN negative to LN positive patients, the 5-year LRC was 100% vs. 80% (p = 0.03), and 5-year DMFS was 82% vs. 41% (p = 0.003), respectively. The 5-year DMFS for patients who achieved a pathologic complete response compared to those that did not was 83% vs. 44% (p = 0.006). Those patients who received .60.4 Gy (n = 15) to the chest wall had a 5-year LRC rate of 100% vs. 83% for those who received 45 – 60.4 Gy (n = 49; p = 0.048). On univariate analysis using Cox proportional hazards regression, significant predictors of DMFS included achieving a complete response to neoadjuvant chemotherapy (hazard ratio [HR], 5.8; 95% CI, 1.4 to 24.4; p = 0.02) and pathologically negative lymph nodes (HR, 4.1; 95% CI, 1.4 to 11.9; p = 0.008), but the difference was not significant on multivariate analysis. No significant predictors for LRC were identified. Conclusions: For IBC patients, the OS is still poor despite excellent 5-year local control rates, particularly for patients who received .60.4 Gy to the chest wall. Despite frequent use of taxanes and trastuzumab, outcomes remain poor, particularly for those with ER/PR-negative disease and those without a pathologic complete response. Author Disclosure: S. Rehman: None. R.D. Tendulkar: None. C.A. Reddy: None.
1105
Radiation-related Quality of Life Parameters after Targeted Intraoperative Radiotherapy vs. Whole Breast Radiotherapy in Patients with Breast Cancer: Results from the Randomized Phase III Trial TARGIT-A
G. Welzel1, A. Boch1, E. Blank1, U. Kraus-Tiefenbacher1, A. Keller1, B. Hermann1, M. S€utterlin2, F. Wenz1 1
Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany, Department of Obstetrics and Gynecology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany 2
Purpose/Objective(s): In the multicenter Phase III trial TARGIT-A women with early breast cancer were randomly treated either with targeted intraoperative radiotherapy (IORT, 20 Gy) during breast-conserving surgery or whole breast radiotherapy (WBRT, 56 Gy). In presence of risk factors, postoperative WBRT (46 – 50/2 Gy) was added after IORT. Initial results show non-inferiority of IORT and WBRT in terms of local recurrence and toxicity (Vaidya et al. Lancet 2010; 376: 91 – 102). Here, we assess radiationrelated quality of life parameters from 123 women of a single centre from the Phase III trial TARGIT-A. Materials/Methods: Radiation-related quality of life was collected using two validated questionnaires of the EORTC (QLQ-C30, QLQ-BR23). In addition, fatigue, anxiety, depression, self-esteem and body image parameters were controlled. The response rate was 72% (n = 88). Forty-six patients were randomized to IORT. Of them, 16 patients were postoperatively treated with additional WBRT, 5 patients did not receive IORT due to technical problems: 4 patients were treated with WBRT, 1 patient refused WBRT. The median age at the time of TARGIT-A entry was 65 years (range, 47 to 84). With a median follow-up time of 25 months (range, 9 to 94), all patients were disease-free at the time of the survey. Results: IORT patients reported less pain, breast and arm symptoms and better role functioning as compared to WBRT patients (mean ± SD: 21.3 ± 33.2 vs. 40.9 ± 32.3 points, p = 0.007; 7.0 ± 14.0 vs. 19.0 ± 20.0 points, p = 0.001; 15.1 ± 22.2 vs. 32.8 ± 28.6
S206
Volume 81, Number 2, Supplement, 2011
Materials/Methods: We retrospectively reviewed the charts of all 652 women who underwent mastectomy and were found to have pathologically LN+, non-inflammatory breast cancer between 2000 and 2007 at Cleveland Clinic. The decision to utilize post-mastectomy radiotherapy (PMRT) was at the discretion of the treating radiation oncologist, as was the decision to boost the chest wall. Rates of LRR and CWR were estimated by use of radiation therapy, radiation dose delivered, and lymph node status using Kaplan-Meier analysis and comparisons were made using the log-rank test. Results: The median age was 52 years and median follow-up was 63 months. Overall, 413, 169, and 70 patients were pathologically staged as N1, N2, and N3, respectively; 347 (53%) patients received PMRT, including 33% of 1 – 3 LN+ and 88% of 4+ LN+ patients. All but 2.6% received chemotherapy and/or hormonal therapy. For the 231 patients with radiation dose details available, 128 received 50 – 50.4 Gray (Gy) to the chest wall (of whom 34% had 1 – 3 LN+ and 66% had 4+ LN+) and 103 received ./= 60 Gy to the chest wall (of whom 41% had 1 – 3 LN+ and 59% had 4+ LN+). The 5-year rates of LRR and CWR for the entire cohort were 7.7% and 4.4%, respectively. The 5-year LRR was 5.6% in those treated with PMRT vs. 10.1% in those not receiving PMRT (p = 0.04), and this difference remained significant in women with 1 – 3 LN+ (LRR 1.7% vs. 8.4%, p = 0.0097) and with 4+ LN+ (8.2% vs. 28.0%, p = 0.0004). The 5-year LRR for those who received 50 – 50.4 Gy and ./= 60 Gy to the chest wall were 2.4% and 6.3%, respectively (p = 0.21), and the 5-year CWR were 2.4% and 3.2%, respectively (p = 0.71). There were no significant differences in LRR or CWR based on radiation dose for either the 1 – 3 LN+ subgroup or the 4+ LN+ subgroup. Conclusions: In the postmastectomy setting, failure to deliver radiation to LN+ patients leads to higher rates of LRR, particularly in patients with 4+ LN+. However, higher radiation doses delivered to the chest wall (./= 60 Gy compared to 50 – 50.4 Gy) do not significantly decrease the rates of LRR or CWR in this retrospective study. Author Disclosure: S. Rehman: None. C.A. Reddy: None. M.E. Shukla: None. R.D. Tendulkar: None.
1104
Modern Outcomes of Inflammatory Breast Cancer: The Cleveland Clinic Experience
S. Rehman, R. D. Tendulkar, C. A. Reddy Cleveland Clinic Foundation, Cleveland, OH Purpose/Objective(s): Inflammatory breast cancer (IBC) is associated with poor outcomes. The purpose of this study was to report recent outcomes for IBC patients treated at the Cleveland Clinic in the modern era of trastuzumab and taxane-based chemotherapy. Materials/Methods: We retrospectively reviewed the charts of non-metastatic IBC patients from January 2000 to December 2009 at the Cleveland Clinic. Patients that received chemotherapy, surgery, and radiation therapy were considered to have completed the intended therapy. Kaplan-Meier curves were generated to estimate locoregional control (LRC), distant metastases free survival (DMFS), and overall survival (OS). Results: A total of 104 patients met inclusion criteria. The median follow-up was 34 months; 57 (55%) were ER/PR negative, 34 (33%) were Her2/neu amplified, and 62 (60%) were pathologically lymph node (LN) positive. Seventy-five (72%) patients completed all of the intended therapy. Among patients that completed all therapy, 67 (89%) received a taxane and 18/28 (64%) of her2/neu amplified patients received trastuzumab. For the entire cohort, the 5-year OS rate was 46%. ER/PR negative patients had a 5-year DMFS of 39% vs. 52% for ER/PR positive patients (p = 0.03). Comparing pathologically LN negative to LN positive patients, the 5-year LRC was 100% vs. 80% (p = 0.03), and 5-year DMFS was 82% vs. 41% (p = 0.003), respectively. The 5-year DMFS for patients who achieved a pathologic complete response compared to those that did not was 83% vs. 44% (p = 0.006). Those patients who received .60.4 Gy (n = 15) to the chest wall had a 5-year LRC rate of 100% vs. 83% for those who received 45 – 60.4 Gy (n = 49; p = 0.048). On univariate analysis using Cox proportional hazards regression, significant predictors of DMFS included achieving a complete response to neoadjuvant chemotherapy (hazard ratio [HR], 5.8; 95% CI, 1.4 to 24.4; p = 0.02) and pathologically negative lymph nodes (HR, 4.1; 95% CI, 1.4 to 11.9; p = 0.008), but the difference was not significant on multivariate analysis. No significant predictors for LRC were identified. Conclusions: For IBC patients, the OS is still poor despite excellent 5-year local control rates, particularly for patients who received .60.4 Gy to the chest wall. Despite frequent use of taxanes and trastuzumab, outcomes remain poor, particularly for those with ER/PR-negative disease and those without a pathologic complete response. Author Disclosure: S. Rehman: None. R.D. Tendulkar: None. C.A. Reddy: None.
1105
Radiation-related Quality of Life Parameters after Targeted Intraoperative Radiotherapy vs. Whole Breast Radiotherapy in Patients with Breast Cancer: Results from the Randomized Phase III Trial TARGIT-A
G. Welzel1, A. Boch1, E. Blank1, U. Kraus-Tiefenbacher1, A. Keller1, B. Hermann1, M. S€utterlin2, F. Wenz1 1
Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany, Department of Obstetrics and Gynecology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany 2
Purpose/Objective(s): In the multicenter Phase III trial TARGIT-A women with early breast cancer were randomly treated either with targeted intraoperative radiotherapy (IORT, 20 Gy) during breast-conserving surgery or whole breast radiotherapy (WBRT, 56 Gy). In presence of risk factors, postoperative WBRT (46 – 50/2 Gy) was added after IORT. Initial results show non-inferiority of IORT and WBRT in terms of local recurrence and toxicity (Vaidya et al. Lancet 2010; 376: 91 – 102). Here, we assess radiationrelated quality of life parameters from 123 women of a single centre from the Phase III trial TARGIT-A. Materials/Methods: Radiation-related quality of life was collected using two validated questionnaires of the EORTC (QLQ-C30, QLQ-BR23). In addition, fatigue, anxiety, depression, self-esteem and body image parameters were controlled. The response rate was 72% (n = 88). Forty-six patients were randomized to IORT. Of them, 16 patients were postoperatively treated with additional WBRT, 5 patients did not receive IORT due to technical problems: 4 patients were treated with WBRT, 1 patient refused WBRT. The median age at the time of TARGIT-A entry was 65 years (range, 47 to 84). With a median follow-up time of 25 months (range, 9 to 94), all patients were disease-free at the time of the survey. Results: IORT patients reported less pain, breast and arm symptoms and better role functioning as compared to WBRT patients (mean ± SD: 21.3 ± 33.2 vs. 40.9 ± 32.3 points, p = 0.007; 7.0 ± 14.0 vs. 19.0 ± 20.0 points, p = 0.001; 15.1 ± 22.2 vs. 32.8 ± 28.6