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Radiation-induced Organizing Pneumonia after Breast-conserving Therapy: Is Corticosteroid Necessary?
I. J. Radiation Oncology d Biology d Physics
S232
2040
Volume 81, Number 2, Supplement, 2011
Radiation-induced Organizing Pneumonia after Breast-conserving Therapy: Is Corticosteroid Necessary?
K. Otani, Y. Kawaguchi, K. Nishiyama, O. Suzuki, S. Nakamura, H. Inaji Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan Purpose/Objective(s): Radiation-induced organizing pneumonia (RIOP), also called as radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome is rarely observed after radiation therapy for breast cancer as lung injury outside tangential fields. Corticosteroids are the mainstay for RIOP, which responds well. However, corticosteroid therapy requires reconsideration because of frequent exacerbation. Materials/Methods: From January 1997 to December 2009, 2120 patients underwent breast-conserving therapy at our institute. They received tangential radiotherapy of 50 Gy with/without electron beam boost of 13.2Gy to the residual breast. The subjects of the present study were 22 patients (1.1%) that encountered RIOP during the follow-up time. All of the subjects met the following criteria: (1) occurrence within 12 months after tangential radiation therapy to the residual breast (2) lung infiltration outside the irradiated volume, and (3) no evidence of other specific causes. Whereas we defined recurrence of RIOP as a new shadow after confirming complete disappearance or only fibrotic scars of the previous shadows, a new shadow before remission was defined as migration. Results: Eighteen patients had symptoms such as a dry cough and/or a fever. The other 4 were found by chest X-ray. The median interval between radiation and onset of RIOP was 3.3 months (range: 1.1-6.8). Five patients received corticosteroid therapy at their first diagnosis. Four of these 5 patients relapsed (recurrence rate: 80%). The median administration time of corticosteroids in these 5 patients was 13.6 months (1.1-145). Seventeen patients received non-steroidal medication which included NSAIDs, antibiotics, and antitussives at their first diagnosis, and 2 of the 17 relapsed (recurrence rate: 12%). One of these 2 patients started corticosteroid for recurrence. The median overall treatment time of 16 patients treated without steroids patients and 5 with steroids were 3.4 and 14.2 months, respectively. None of the subjects resulted in respiratory failure or death. Conclusions: In this study, those who received non-steroidal treatment were less likely to relapse and took shorter overall treatment time. Non-steroidal treatment could be a favorable treatment for RIOP. Recurrence of RIOP by corticosteroid administration
Recurrence(+) Recurrence(-) Total
Steroid(+)
Steroid(-)
Total
4 1 5
2 15 17
6 16 22
Author Disclosure: K. Otani: None. Y. Kawaguchi: None. K. Nishiyama: None. O. Suzuki: None. S. Nakamura: None. H. Inaji: None.
2041
Factors Influencing Local Control after Re-irradiation of Breast Cancer Recurrences
A. Mueller1, F. Eckert1, V. Heinrich1, M. Bamberg1, S. Brucker2, T. Hehr3 1 3
Department of Radiooncology, Tuebingen 72076, Germany, 2Department of Gynecology, Tuebingen 72076, Germany, Department of Radiooncology, Marienhospital Stuttgart, Germany
Purpose/Objective(s): Repeat radiation is a rarely performed treatment strategy and remains a therapeutic challenge. We investigated tumor- and treatment-related factors and their impact on local control after a second curative radiotherapy for recurrent breast cancer. Materials/Methods: Forty-two patients were treated from 1993 to 2003 with resection and postoperative re-irradiation (n = 30) or definitive re-irradiation (n = 12) for recurrent breast cancer. Concurrent hyperthermia was performed in 29 patients. The median age was 57 years. The median pre-radiation exposure was 54Gy. Re-irradiation was conventionally fractionated to a median total dose of 60Gy. Sub-analyses on local control were performed for initial tumor parameters [nodal stage, estrogen receptor status, time to first recurrence (2 years), number of recurrences until re-irradiation (one vs. more than one)] and treatment related factors (surgery of recurrence, margin status, concurrent hyperthermia, lymph node irradiation, sequential chemotherapy and antihormonal therapy). Results: After a median follow-up of 41 months (range 3-92 months), 48 months for survivors, the estimated 5-year local control rate reached 62%. Local failures occurred in 10 patients (Resection margin R0: 3/14, R1: 3/16; R2/irresectable: 4/12). Endocrine therapy increased local control (93 vs. 31%, p = 0.01). Local control decreased significantly from 91% to 31% (p = 0.02) if at least two recurrences were experienced until the start of re-irradiation. Time of less than two years to first recurrence (\2 years vs. .2years: 16 vs. 68%, p = 0.14) did not significantly lower local control. However, long-term local control at last follow-up was improved to 70 percent (n = 35/42) due to curative resection of recurrences after re-irradiation in three patients. A performed subanalysis of concurrent hyperthermia for R1-resected patients revealed a statistically not significant prolonged local control (86 vs. 50%, p = 0.19; with one salvage treatment after re-irradiation 93 vs. 50%, p = 0.05). All other investigated factors did not significantly affect local control. Conclusions: Local control of re-irradiated breast cancer recurrences was improved by endocrine therapy and by early re-treatment i.e. at first recurrence. Due to overlapping parameters concurrent hyperthermia did only show insignificant improvement of local control. Author Disclosure: A. Mueller: None. F. Eckert: None. V. Heinrich: None. M. Bamberg: None. S. Brucker: None. T. Hehr: None.
S232
2040
Volume 81, Number 2, Supplement, 2011
Radiation-induced Organizing Pneumonia after Breast-conserving Therapy: Is Corticosteroid Necessary?
K. Otani, Y. Kawaguchi, K. Nishiyama, O. Suzuki, S. Nakamura, H. Inaji Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan Purpose/Objective(s): Radiation-induced organizing pneumonia (RIOP), also called as radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome is rarely observed after radiation therapy for breast cancer as lung injury outside tangential fields. Corticosteroids are the mainstay for RIOP, which responds well. However, corticosteroid therapy requires reconsideration because of frequent exacerbation. Materials/Methods: From January 1997 to December 2009, 2120 patients underwent breast-conserving therapy at our institute. They received tangential radiotherapy of 50 Gy with/without electron beam boost of 13.2Gy to the residual breast. The subjects of the present study were 22 patients (1.1%) that encountered RIOP during the follow-up time. All of the subjects met the following criteria: (1) occurrence within 12 months after tangential radiation therapy to the residual breast (2) lung infiltration outside the irradiated volume, and (3) no evidence of other specific causes. Whereas we defined recurrence of RIOP as a new shadow after confirming complete disappearance or only fibrotic scars of the previous shadows, a new shadow before remission was defined as migration. Results: Eighteen patients had symptoms such as a dry cough and/or a fever. The other 4 were found by chest X-ray. The median interval between radiation and onset of RIOP was 3.3 months (range: 1.1-6.8). Five patients received corticosteroid therapy at their first diagnosis. Four of these 5 patients relapsed (recurrence rate: 80%). The median administration time of corticosteroids in these 5 patients was 13.6 months (1.1-145). Seventeen patients received non-steroidal medication which included NSAIDs, antibiotics, and antitussives at their first diagnosis, and 2 of the 17 relapsed (recurrence rate: 12%). One of these 2 patients started corticosteroid for recurrence. The median overall treatment time of 16 patients treated without steroids patients and 5 with steroids were 3.4 and 14.2 months, respectively. None of the subjects resulted in respiratory failure or death. Conclusions: In this study, those who received non-steroidal treatment were less likely to relapse and took shorter overall treatment time. Non-steroidal treatment could be a favorable treatment for RIOP. Recurrence of RIOP by corticosteroid administration
Recurrence(+) Recurrence(-) Total
Steroid(+)
Steroid(-)
Total
4 1 5
2 15 17
6 16 22
Author Disclosure: K. Otani: None. Y. Kawaguchi: None. K. Nishiyama: None. O. Suzuki: None. S. Nakamura: None. H. Inaji: None.
2041
Factors Influencing Local Control after Re-irradiation of Breast Cancer Recurrences
A. Mueller1, F. Eckert1, V. Heinrich1, M. Bamberg1, S. Brucker2, T. Hehr3 1 3
Department of Radiooncology, Tuebingen 72076, Germany, 2Department of Gynecology, Tuebingen 72076, Germany, Department of Radiooncology, Marienhospital Stuttgart, Germany
Purpose/Objective(s): Repeat radiation is a rarely performed treatment strategy and remains a therapeutic challenge. We investigated tumor- and treatment-related factors and their impact on local control after a second curative radiotherapy for recurrent breast cancer. Materials/Methods: Forty-two patients were treated from 1993 to 2003 with resection and postoperative re-irradiation (n = 30) or definitive re-irradiation (n = 12) for recurrent breast cancer. Concurrent hyperthermia was performed in 29 patients. The median age was 57 years. The median pre-radiation exposure was 54Gy. Re-irradiation was conventionally fractionated to a median total dose of 60Gy. Sub-analyses on local control were performed for initial tumor parameters [nodal stage, estrogen receptor status, time to first recurrence (2 years), number of recurrences until re-irradiation (one vs. more than one)] and treatment related factors (surgery of recurrence, margin status, concurrent hyperthermia, lymph node irradiation, sequential chemotherapy and antihormonal therapy). Results: After a median follow-up of 41 months (range 3-92 months), 48 months for survivors, the estimated 5-year local control rate reached 62%. Local failures occurred in 10 patients (Resection margin R0: 3/14, R1: 3/16; R2/irresectable: 4/12). Endocrine therapy increased local control (93 vs. 31%, p = 0.01). Local control decreased significantly from 91% to 31% (p = 0.02) if at least two recurrences were experienced until the start of re-irradiation. Time of less than two years to first recurrence (\2 years vs. .2years: 16 vs. 68%, p = 0.14) did not significantly lower local control. However, long-term local control at last follow-up was improved to 70 percent (n = 35/42) due to curative resection of recurrences after re-irradiation in three patients. A performed subanalysis of concurrent hyperthermia for R1-resected patients revealed a statistically not significant prolonged local control (86 vs. 50%, p = 0.19; with one salvage treatment after re-irradiation 93 vs. 50%, p = 0.05). All other investigated factors did not significantly affect local control. Conclusions: Local control of re-irradiated breast cancer recurrences was improved by endocrine therapy and by early re-treatment i.e. at first recurrence. Due to overlapping parameters concurrent hyperthermia did only show insignificant improvement of local control. Author Disclosure: A. Mueller: None. F. Eckert: None. V. Heinrich: None. M. Bamberg: None. S. Brucker: None. T. Hehr: None.