PO104 THE SURGICAL MANAGEMENT OF LUNG NODULES IN BREAST CANCER PATIENTS

Abstracts / The Breast 24 S3 (2015) S21–S75

Background: Bone metastasis is a frequent complication of cancer. It occurs in up to 70% of patients with advanced breast cancer. Breast cancer has the tendency to relapse in the bones, and 56% of autopsy cases reveal the occurrence of bone metastasis. The most frequent sites of bone metastasis are the thoracic and lumbosacral spine. The present analysis aims to bring forth an unusual site of bony recurrence in treated patients of LABC (locally advanced carcinoma breast) and the effect of palliative RT in these inoperable patients. Material and Methods: 9 patients with sternum as site of metastasis were detected during follow up of 10 months of post treated LABC cases .All, except one, patient were on hormonal therapy at the time of detection and had earlier undergone MRM, RT and chemotherapy (CAF × 6 cyc). 6/9 patients were postmenopausal and 3/9 patients were premenopausal. 6 patients had ER+,PR+ as receptor status, 2 patients ER+,PR-ve and 1 patient ER-ve, PR-ve. Out of 6 receptor positive (ER+,PR+ve) 4 patients were receiving tab. Letrozole while 2 were on tab. tamoxifen. 2 patients with ER+,PR- were on tab. tamoxifen. Metastasis in these patients was confirmed with bone scan (increased tracer uptake) and FNAC from the sternal site (metastastic adenocarcinoma consistent with breast primary), rest workup was negative for metastasis elsewhere. All patients presented with swelling and pain at sternal site and were found to be inoperable hence were given palliative RT (20Gy/5#) and inj. zolidronic acid. Results: 2/9 had significant pain reduction, 6 had partial response to pain while 1 patient had minimal response to pain as assessed by VAS scale. Conclusion: Pain at sternal metastasis to a certain extent can be taken care of with the palliative radiation therapy and/or zolidronic chemotherapy but the exact etiopathogenesis, prevention protocols and definitive modality of treatment in inoperable cases of sternal metastasis still needs to be explored and discussed.

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administered following the European Standard Operative Procedures of Electrochemotherapy. Tumor response was clinically assessed adapting the Response Evaluation Criteria in Solid Tumors (RECIST) and toxicity was evaluated according to CTAE 4.0. Cox regression analysis was used to identify predictive factors. Results: Tumor response was evaluable in 113 patients for a total of 214 tumors (median 1/patient, range 1−3). The overall response rate after two months was 90.2%, while the complete response (CR) rate was 58.4%. In multivariate analysis, small tumor size (P<0.001), absence of visceral metastases (P=0.001), estrogen receptor (ER) positivity (p=0.016), and low Ki-67 index (P=0.024) were significantly associated with CR. In the first 48 hours, 10.4% of patients reported severe skin pain. Dermatological toxicity included G3 skin ulceration (8.0%) and G2 skin hyperpigmentation (8.8%). One-year local progression-free survival was 86.2% (95% CI 79.3-93.8) and 96.4% (95% CI 91.6−100) in the subgroup of complete responders. Conclusions: In this study, small tumor size, absence of visceral metastases, ER-positivity, and low Ki-67 index were predictors of CR after ECT. Patients who achieved CR experienced durable local control. ECT represents a valuable skin-directed therapy for selected patients with BC.

PO104 THE SURGICAL MANAGEMENT OF LUNG NODULES IN BREAST CANCER PATIENTS Kazuo Matsuura1, Midori Noma1, Ryosuke Arata1, Keiso Matsubara1, Satoshi Sueoka1, Masateru Yamamoto1, Ryuta Ide1, Toshiyuki Itamoto1, Takayuki Kadoya2, Morihito Okada2, Koji Arihiro2 1 Hiroshima Prefectural Hospital, Breast Surgery, Hiroshima, Japan; 2 Hiroshima University Hospital, Breast Surgery, Hiroshima, Japan

Clinical Issues: Surgical Oncology BP103 ELECTROCHEMOTHERAPY IN THE TREATMENT OF CUTANEOUS METASTASES FROM BREAST CANCER: A MULTICENTER COHORT ANALYSIS Roberto Agresti8, Carlo Cabula11, Luca Campana14, Gretha Grilz2, Riccardo Bussone2, Sara Galuppo14, Sara Valpione14, Leonardo De Meo4, Antonio Bonadies12, Pietro Curatolo10, Michelino De Laurentiis13, Maria Renne3, Tommaso Fabrizio6, Nicola Solari5, Michele Guida7, Antonio Santoriello1, Massimiliano D’Aiuto9 1 “Federico II” University, Department of Medicine and Surgery, Napoli, Italy; 2A.O.U. Città della Salute e della Scienza, Breast Surgery Unit, Torino, Italy; 3Fondazione T. Campanella, Oncologic Surgery, Catanzaro, Italy; 4Humanitas-Centro Catanese di Oncologia, Oncologic Surgery, Catania, Italy; 5IRCCS San Martino-IST, Surgical Unit 1, Genova, Italy; 6 IRCCS, Referral Cancer Center of Basilicata, Plastic Surgery Unit, Rionero in Vulture, Italy; 7Istituto dei Tumori, Medical Oncology Unit, Bari, Italy; 8 Istituto Nazionale dei Tumori, Breast Surgery Unit, Milano, Italy; 9Istituto Nazionale Tumori “Pascale”, Breast Surgery Unit, Napoli, Italy; 10La Sapienza University, Dermatology and Plastic Surgery Department, Roma, Italy; 11Ospedale Oncologico A. Businco, Oncologic Surgery, Cagliari, Italy; 12 San Gallicano Dermatologic Institute, Plastic Surgery Unit, Roma, Italy; 13 Seconda Università di Napoli, Medical Oncology, Napoli, Italy; 14Veneto Institute of Oncology IOV-IRCCS, Oncologic Surgery, Padova, Italy Background: The management of breast cancer (BC) skin metastases represents a therapeutic challenge. Electrochemotherapy (ECT) combines the administration of bleomycin (BLM), a poorly permeant cytotoxic agent, with temporary permeabilization induced by locallyadministered electric pulses. Preliminary experience with ECT in BC patients is encouraging. Patients and Methods: 125 patients with BC and skin metastases, who underwent ECT at 13 Italian centers between 2010 and 2013, were enrolled in a multicenter retrospective cohort study. The treatment was

Background: A biopsy of lung nodules in patients, who had received previous surgery for breast cancer, can be performed with three aims: to confirm that the lesion is lung metastasis, to confirm the diagnosis of other diseases including primary lung cancer, and to reassess the biological features of recurrent tumors. Discordance in estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status between primary breast cancer and metastatic lesions has been reported. The aim of this study was to evaluate the role of lung biopsy in the diagnosis and to reassess the changes in tumor phenotype of lung metastases. Methods: A total of 53 consecutive patients who underwent surgery in 45 or lung biopsy in 8 for lung nodules at two institutions between 1997 and 2014 after curative operation for breast cancer were retrospectively reviewed. Results: The pathologic diagnoses of lung nodules were lung metastases of breast cancer in 25 patients, primary lung tumor in 21 (adenocarcinoma in 17; large cell carcinoma in 2; small cell carcinoma and carcinoid tumor in 1 each), and other diagnoses in 7 (Inflammation in 4; organizing pneumonia in 2 and hamartoma in 1). Median follow up duration were 117.9 months in metastatic breast cancer patients and 93.2 months in other histology patients (p=0.103). The average diseasefree interval from the treatment for primary breast cancer were 66.3 months in metastatic breast cancer patients and 52.7 months in other histology patients (p=0.325). The 3-year survival rate after the lung biopsy were 84.2% in metastatic breast cancer patients and 91.7% in other histology patients (p=0.436). Of all cases, 30 patients (57%) had a single lung nodule. The 3-year survival rate after the lung biopsy was significantly longer in patients with single nodule (100%), including primary lung cancer patients, than in patients with multiple nodules (71.9%) (p=0.00341). Of 25 cases of metastatic breast cancer, 17 patients maintained the same tumor phenotype, whereas discordance of ER, PR, HER2, and Ki67 expression was observed between primary sites and metastatic sites in 6 (24%), respectively ER gain, 2; PR gain, 1; Ki67 gain, 1 and HER2 loss, 2. Especially, 3 cases of ER, PR gain could receive endocrine therapy instead of chemotherapy. Conclusion: As lung nodules that appear in breast cancer patients are not always lung metastases, the pathologic diagnosis should be confirmed,

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Abstracts / The Breast 24 S3 (2015) S21–S75

and surgery is an option for the pathologic confirmation. Furthermore, discordance in tumor phenotype from primary breast cancer to matched lung metastasis occurred in 24% of cases. It is necessary for clinicians to check biomarker profile in recurrent breast cancer patients as it may assist a shift in the treatment plan.

PO106 N2 LYMPH NODES POST-PRIMARY CHEMOTHERAPY MAY PREDICT RECURRENCE IN LOCALLY ADVANCED BREAST CANCER Carol Ann Benn1,3, P. Mapunda3,2, S. Rayne1,3 Helen Joseph Breast Care Clinic, Johannesburg, South Africa; 2University of Edinburgh, Edinburgh Surgical Sciences Qualification, Edinburgh, United Kingdom; 3University of the Witwatersrand, Faculty of Health Sciences, Department of Surgery, Johannesburg, South Africa

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PO105 SUCCESS AND FAILURE OF PRIMARY MEDICAL, NON-OPERATIVE MANAGEMENT IN PATIENTS WHO PRESENT WITH STAGE IV BREAST CANCER Uwe Güth2,5, Dorothy Huang5, Andreas Schötzau3, Seraina Schmid4,1 Breast Center St. Gallen, Spital Grabs, Grabs, Switzerland; 2Cantonal Hospital Winterthur, Breast Center “Senosuisse“, Winterthur, Switzerland; 3 Eudox, Institute for Biomathematics, Basel, Switzerland; 4Spital Grabs, Gynecology & Obstetrics, Grabs, Switzerland; 5University Hospital Basel, Gynecology & Obstetrics, Basel, Switzerland

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Introduction: There is a long-standing controversy as to whether there is benefit to resecting the primary tumor in patients who present with stage IV breast cancer (BC). Many retrospective studies have demonstrated significant survival advantage in patients who underwent surgery; on the other hand, two prospective randomized trials failed to confirm these results. However, survival is only one component in a non-operative approach. If patients and physicians agree on nonoperative treatment as initial management, this decision is made on the assumption that the patient’s life expectancy is limited and that long-term control of locoregional disease can be achieved with systemic therapy only. Thus, success of a non-operative management might also be reached independent of survival time when one major aim of this approach is reached: the avoidance of clinically relevant locoregional progression during the further disease course. We evaluate the rates of and predictive factors for success and failure of this particular therapy approach. Methods: Forty-four patients with stage IV BC, diagnosed between 1990 and 2009 at the University Women’s Hospital Basel, Switzerland, who were initially treated only systemically and in whom local control while avoiding surgery was the intended long-term therapy goal were analyzed. Failure of therapy was defined when a) secondary surgery had to be performed due to locoregional progression; or b) in case of no surgery, severe locoregional clinical signs/symptoms were observed during the further course of the disease. The study cohort had a median age of 67.5 years at diagnosis. The median MDS survival was 24.5 months. Results: Most patients responded positively after starting medical treatment (n=34, 77.3%). In six patients (13.6%), secondary surgery had to be performed. In the cases where no surgery was performed (n=38), 14 women (36.8%) suffered from severe locoregional symptoms in the further disease course. In total, our defined therapy goal of nonoperative but systemic therapy as first-line management was not met in 20 patients (45.5%). Overall survival time (p=771), hormone receptor status (p=1.00) and the number of metastatic sites (p=1.00) had no impact on therapy success. Older patients and those with larger tumors had a trend toward failure of therapy (both p=0.076); non-inflammatory skin involvement was significantly associated with failure of therapy (p=0.035). Discussion: Non-operative treatment may be offered to BC patients with primary metastatic disease. The patients must be informed that, with regard to survival, the impact of this approach is still unclear; but nevertheless, is not successful in more than 40% of the cases with regard to local control.

Background: Locally advanced breast cancer at initial presentation is a common entity in South Africa. Historically almost all patients with big T4 breast cancers were categorized as inoperable. Advances in oncology therapies and in reconstructive techniques have enabled us to downstage these tumours and render them operable. Timing and benefit of surgery on durable local control should be better defined particularly in relation to factors which may predict early recurrence. This study looked retrospectively at the relationship between clinical factors, neo-adjuvant treatment response and early local or systemic recurrence. Through this we hope to better select the patients who will benefit from comprehensive local excision and the timing of surgery in relation to oncology treatment. Methods: This was a retrospective records review over a three-year period of patients diagnosed with T4 breast cancer at the Helen Joseph Breast Care Clinic based in a government hospital in Johannesburg, South Africa. All patients diagnosed histologically with an invasive breast cancer of any subtype presenting with the clinical stage T4NxMx were included (nodal status and metastases are not in the recruitment criteria). Medical records were reviewed for demographics, clinical and radiological characteristics, and histology. Response to treatment outcome was also documented. Results: Of the 87 patients who were included with a T4 (NxMx) diagnosis, 65 were black (74.7%), 13 were white (14.9%), 6 Indian (6.9%) and 3 coloured (3.4%). Median age at presentation was 62 years (range: 31-103 years). 11 patients had loco-regional recurrences. They all received primary chemotherapy and were deemed clinically resectable. 9 out of the 11 were alive 18 months post surgery. Chemotherapy protocols involved either 6AC, or AC T. 10/11 of the patients who reoccurred had N2 lymph nodes on final histology. The histology of the recurrences were majority luminal B 8/11. Conclusion: Timing of surgery in T4 LABC patients may be better predicted by a focused nodal ultrasound prior to decision to operate or continue chemotherapy in clinical responders. These patients benefit from surgery but a significant rate of recurrence (one quarter in this study) should be expected. Nodal disease burden may be an accurate indicator of recurrence in this group.

PO107 SURGICAL RESECTION OF THE PRIMARY TUMOR IS ASSOCIATED WITH INCREASED LONG-TERM SURVIVAL IN PATIENTS WITH STAGE IV BREAST CANCER Anna Sukhotko, A. D. Zikiryahodjaev, L.V. Bolotina, A.A. Volchenko Moscow P.A. Gerzen’s Cancer Research Institute – The National Medical Research Radiologic Center of the Ministry of Health of the Russian Federation, Department of Oncology and Reconstructive-plastic Surgery of the Breast and Skin, Moscow, Russian Federation Purpose: To evaluate the expediency and timeliness of performance of surgical treatment as a component of multi-therapy treatment of patients with stage IV breast cancers. Materials and Methods: This investigation comparatively analyzed the results of complex treatment with or without surgery in patients with metastatic breast cancer. We analyzed retrospectively treatment experience of 196 patients with generalized breast cancer in the department of oncology and breast reconstructive surgery of P.A. Herzen Moscow Cancer Research Institute from 2000 to 2012. Average age was (58±1.1) years. Invasive ductual carcinoma was verified in 128