- Email: [email protected]
P294 Breast biopsies during follow up after intraoperative radiotherapy in early breast cancer patients
S128
Poster Abstracts II / The Breast 24S1 (2015) S87–S150
P293 PFT change during adjuvant hypofractionated radiation with simultaneous integrated boost for EBC
P294 Breast biopsies during follow up after intraoperative radiotherapy in early breast cancer patients
D. Mondal1 *, P.K. Julka1 , M. Jana2 , M.A. Laviraj3 , R. Guleria4 , S.V.S. Deo5 , S. Roy1 , K.P. Haresh1 , D.N. Sharma1 , G.K. Rath1 . 1 Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India, 2 Department of Radiology, All India Institute of Medical Sciences, New Delhi, India, 3 Department of Medical Physics, Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India, 4 Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India, 5 Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
N. Sikorsky1 *, V. Schneider2 , J. Goldman2 , M. Leviov2 , L. Leitzin3 , S. Keren4 , M. Steiner3 . 1 Oncology Department, Linn Medical Center, Haifa, Israel, 2 Radiology, Lin Medical Center, Haifa, Israel, 3 Oncology Department, Lin Medical Center, Haifa, Israel, 4 Linn Medical Center, Haifa, Israel
Introduction: An early report of PFT changes during the course of radiation in patients with early breast cancer (EBC) receiving hypofractionated whole breast radiotherapy (WBRT) with simultaneous integrated boost (SIB) is being presented. Aims and objectives: To prospectively assess radiation pneumonitis in patients undergoing hypofractionated WBRT with SIB technique and to correlate with various dosimetric parameters. Methods: Patients with EBC undergoing breast conserving surgery requiring WBRT were enrolled in a prospective phase I study. Radiotherapy was planned with SIB. Whole breast and tumor cavity was treated to a dose of 40.5 Gy and 48 Gy respectively in 15 fractions over 3 weeks. Planning was done using Monaco® planning software (Elekta, Sweden). Treatment was delivered with 6 MV photon from Elekta Synergy-S machine. PFT was done every week during radiation, at 1 month and 3 months. Toxicity was scored as per RTOG toxicity criteria. Mann–Whitney U test was used for comparative analysis of the means of PFT parameters. Time trend of PFT parameter changes were analysed. P value of 0.05 or less was considered to be statistically significant. Results: Data of five patients are being presented. None of them showed any clinical feature of radiation pneumonitis till 3 month after radiation. Mean conformity index of whole breast was 0.96 and that of the boost volume was 0.97. Mean Dmean , Dmax , V20 and V5 for ipsilateral lung were 12.4 Gy, 48.9 Gy, 21% and 61.2% respectively. On statistical analysis, a significant correlation was noted between change of FVC from first week to second week of radiation and ipsilateral lung V5 . Patients with V5 >61.2% showed a mean 15% reduction of FVC whereas those with V5 <61.2% showed a mean 11% increment of FVC (p = 0.022). The mean change of FEV1/FVC from first week to second week of radiation was significantly associated with ipsilateral lung Dmean , Dmax and V20 . Patients with Dmean >12.6 Gy, Dmax >48 Gy and V20 >21% showed a mean 6% increase in FEV1/FVC and those with Dmean <12.6 Gy, Dmax <48 Gy and V20 <21% showed a mean 9% reduction of FEV1/FVC (p = 0.049). Ipsilateral lung V5 showed only a borderline significance with change in FEV1/FVC from first week to second week of radiation. The pattern of change in FEV1/FVC during early period may be attributed to a reduction of FVC, which may be due to a larger volume of lung being irradiated to a low dose, causing more alveolar damage and gradual stabilization over later period of radiation. Conclusion: Though radiation pneumonitis is a well known complication after breast radiotherapy, clinical data after 3DRT, IMRT or arc therapy is largely unavailable. The present study throws light on the clinical lung function parameters and their association with dosimetric variables, in absence of symptomatic acute pneumonitis. As the study is ongoing, further follow up with more patients will definitely be meaningful to correlate the changes in PFT parameters and long term toxicity if any. Disclosure of Interest: No significant relationships.
Goals: Intraoperative breast irradiation (IORT) is becoming a new treatment alternative to the standard adjuvant whole breast irradiation in low risk early breast cancer patients. From 2006 we offer IORT to a well selected population of breast cancer patients. A single dose of 20 Gy is administered to the tumor bed by low energy X-ray generating system (IntraBeam, Zeiss). This relatively high single radiation dose may cause significant and unusual post surgery changes in breast tissue that could complicate the radiologic follow up and lead to additive diagnostic procedures. Methods: We analyzed the first consecutive 300 patients treated by IORT. During median follow up period 56 months (1–96) 38 patients (13%) underwent core biopsy due to clinical or imaging findings in the treated breast. Results: In 12/38 patients (32%) breast tumor recurrence was diagnosed. In 26/38 patients (68%) the pathology showed benign tissue. In this subgroup of 26 patients the reasons for biopsy were ultrasound findings at the lumpectomy scar in 13 (50%) mammography findings (usually calcifications) around the surgical bed in 8 (19%) and clinical palpable masses in 5 patients (19%). The median time between surgery and core biopsy seems to be shorter in patients with mammography findings (25 months, 16–34) than in patients with palpable findings (38 months, 16–51) or ultrasound lesions (69 months, 14–83). This difference is probably due to the fact that post lumpectomy with IORT mammography calcifications represent fat necrosis and appear earlier while ultrasound and palpatory findings represent fibrotic changes which appear later. Conclusion: Single high dose irradiation dose administered to the breast tissue is causing unusual clinical and imaging findings. These findings, which represent benign lesions in 68% of patients, lead to increased need for invasive diagnostic procedures like breast core biopsy. Disclosure of Interest: No significant relationships. P295 Comparison of complication, cosmetic outcome with or without irradiation after breast reconstruction J. Ishiguro1 *, M. Sawaki1 , M. Hattori1 , N. Kondou1 , A. Yoshimura1 , H. Kotani1 , Y. Adachi1 , T. Hisada1 , S. Okumura2 , H. Iwata1 . 1 Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan, 2 Department of Plastic and Reconstructive Surgery, Aichi Cancer Center, Nagoya, Japan Goals: To study complications of irradiation following immediate breast reconstruction using autologous tissue in patients compared with those having no irradiation, and to find predictive factors for complications. Irradiation for chest wall is recommended to improve the outcome in high-risk cases with mastectomy by guidelines of all over the world. However, the safety of irradiation after reconstruction with autologous tissue is still unclear. Methods: 125 patients who received mastectomy for primary breast cancer and breast reconstruction using autologous tissue with or without radiation therapy between January of 2011 and September of 2014 were included in the study. 106 patients were evaluated, excluding 3 patients with prereconstruction irradiation for metachronous breast cancer, and 16 patients without data of cosmetic outcome. We compared the irradiated group (RT) to the non-irradiated group (OP) after breast reconstruction for cosmetic
Poster Abstracts II / The Breast 24S1 (2015) S87–S150
P293 PFT change during adjuvant hypofractionated radiation with simultaneous integrated boost for EBC
P294 Breast biopsies during follow up after intraoperative radiotherapy in early breast cancer patients
D. Mondal1 *, P.K. Julka1 , M. Jana2 , M.A. Laviraj3 , R. Guleria4 , S.V.S. Deo5 , S. Roy1 , K.P. Haresh1 , D.N. Sharma1 , G.K. Rath1 . 1 Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India, 2 Department of Radiology, All India Institute of Medical Sciences, New Delhi, India, 3 Department of Medical Physics, Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India, 4 Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India, 5 Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
N. Sikorsky1 *, V. Schneider2 , J. Goldman2 , M. Leviov2 , L. Leitzin3 , S. Keren4 , M. Steiner3 . 1 Oncology Department, Linn Medical Center, Haifa, Israel, 2 Radiology, Lin Medical Center, Haifa, Israel, 3 Oncology Department, Lin Medical Center, Haifa, Israel, 4 Linn Medical Center, Haifa, Israel
Introduction: An early report of PFT changes during the course of radiation in patients with early breast cancer (EBC) receiving hypofractionated whole breast radiotherapy (WBRT) with simultaneous integrated boost (SIB) is being presented. Aims and objectives: To prospectively assess radiation pneumonitis in patients undergoing hypofractionated WBRT with SIB technique and to correlate with various dosimetric parameters. Methods: Patients with EBC undergoing breast conserving surgery requiring WBRT were enrolled in a prospective phase I study. Radiotherapy was planned with SIB. Whole breast and tumor cavity was treated to a dose of 40.5 Gy and 48 Gy respectively in 15 fractions over 3 weeks. Planning was done using Monaco® planning software (Elekta, Sweden). Treatment was delivered with 6 MV photon from Elekta Synergy-S machine. PFT was done every week during radiation, at 1 month and 3 months. Toxicity was scored as per RTOG toxicity criteria. Mann–Whitney U test was used for comparative analysis of the means of PFT parameters. Time trend of PFT parameter changes were analysed. P value of 0.05 or less was considered to be statistically significant. Results: Data of five patients are being presented. None of them showed any clinical feature of radiation pneumonitis till 3 month after radiation. Mean conformity index of whole breast was 0.96 and that of the boost volume was 0.97. Mean Dmean , Dmax , V20 and V5 for ipsilateral lung were 12.4 Gy, 48.9 Gy, 21% and 61.2% respectively. On statistical analysis, a significant correlation was noted between change of FVC from first week to second week of radiation and ipsilateral lung V5 . Patients with V5 >61.2% showed a mean 15% reduction of FVC whereas those with V5 <61.2% showed a mean 11% increment of FVC (p = 0.022). The mean change of FEV1/FVC from first week to second week of radiation was significantly associated with ipsilateral lung Dmean , Dmax and V20 . Patients with Dmean >12.6 Gy, Dmax >48 Gy and V20 >21% showed a mean 6% increase in FEV1/FVC and those with Dmean <12.6 Gy, Dmax <48 Gy and V20 <21% showed a mean 9% reduction of FEV1/FVC (p = 0.049). Ipsilateral lung V5 showed only a borderline significance with change in FEV1/FVC from first week to second week of radiation. The pattern of change in FEV1/FVC during early period may be attributed to a reduction of FVC, which may be due to a larger volume of lung being irradiated to a low dose, causing more alveolar damage and gradual stabilization over later period of radiation. Conclusion: Though radiation pneumonitis is a well known complication after breast radiotherapy, clinical data after 3DRT, IMRT or arc therapy is largely unavailable. The present study throws light on the clinical lung function parameters and their association with dosimetric variables, in absence of symptomatic acute pneumonitis. As the study is ongoing, further follow up with more patients will definitely be meaningful to correlate the changes in PFT parameters and long term toxicity if any. Disclosure of Interest: No significant relationships.
Goals: Intraoperative breast irradiation (IORT) is becoming a new treatment alternative to the standard adjuvant whole breast irradiation in low risk early breast cancer patients. From 2006 we offer IORT to a well selected population of breast cancer patients. A single dose of 20 Gy is administered to the tumor bed by low energy X-ray generating system (IntraBeam, Zeiss). This relatively high single radiation dose may cause significant and unusual post surgery changes in breast tissue that could complicate the radiologic follow up and lead to additive diagnostic procedures. Methods: We analyzed the first consecutive 300 patients treated by IORT. During median follow up period 56 months (1–96) 38 patients (13%) underwent core biopsy due to clinical or imaging findings in the treated breast. Results: In 12/38 patients (32%) breast tumor recurrence was diagnosed. In 26/38 patients (68%) the pathology showed benign tissue. In this subgroup of 26 patients the reasons for biopsy were ultrasound findings at the lumpectomy scar in 13 (50%) mammography findings (usually calcifications) around the surgical bed in 8 (19%) and clinical palpable masses in 5 patients (19%). The median time between surgery and core biopsy seems to be shorter in patients with mammography findings (25 months, 16–34) than in patients with palpable findings (38 months, 16–51) or ultrasound lesions (69 months, 14–83). This difference is probably due to the fact that post lumpectomy with IORT mammography calcifications represent fat necrosis and appear earlier while ultrasound and palpatory findings represent fibrotic changes which appear later. Conclusion: Single high dose irradiation dose administered to the breast tissue is causing unusual clinical and imaging findings. These findings, which represent benign lesions in 68% of patients, lead to increased need for invasive diagnostic procedures like breast core biopsy. Disclosure of Interest: No significant relationships. P295 Comparison of complication, cosmetic outcome with or without irradiation after breast reconstruction J. Ishiguro1 *, M. Sawaki1 , M. Hattori1 , N. Kondou1 , A. Yoshimura1 , H. Kotani1 , Y. Adachi1 , T. Hisada1 , S. Okumura2 , H. Iwata1 . 1 Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan, 2 Department of Plastic and Reconstructive Surgery, Aichi Cancer Center, Nagoya, Japan Goals: To study complications of irradiation following immediate breast reconstruction using autologous tissue in patients compared with those having no irradiation, and to find predictive factors for complications. Irradiation for chest wall is recommended to improve the outcome in high-risk cases with mastectomy by guidelines of all over the world. However, the safety of irradiation after reconstruction with autologous tissue is still unclear. Methods: 125 patients who received mastectomy for primary breast cancer and breast reconstruction using autologous tissue with or without radiation therapy between January of 2011 and September of 2014 were included in the study. 106 patients were evaluated, excluding 3 patients with prereconstruction irradiation for metachronous breast cancer, and 16 patients without data of cosmetic outcome. We compared the irradiated group (RT) to the non-irradiated group (OP) after breast reconstruction for cosmetic