- Email: [email protected]
The Effect of Postmastectomy Radiation on Survival in Young Women with Node-negative Breast Cancer Who Have High Grade, Hormone Receptor-negative, Large Primary Tumors
Proceedings of the 51st Annual ASTRO Meeting revealed invasive ductal carcinoma (IDC) in 28.6%, DCIS in 28.6%, and both IDC and DCIS in 42.8%. The median age of patients with secondary lesions detected by MRI was 57 years (range 45-83 years). The proportion of patients with false-positive MRI findings was 8.2% (C.I. 4.1-12.4%), and the positive predictive value of MRI was 56.3% (C.I. 39.1-73.4%). MRI was the only modality to identify the primary tumor in 3.8% of patients. Conclusions: In women who are considered candidates for PBI based on mammogram, ultrasound, and initial pathology, MRI identified additional disease in 7.6% of patients rendering them ineligible for PBI. MRI should be increasingly considered in the staging of potential PBI candidates. Prospective study is needed to further define the true utility of MRI in this setting. Author Disclosure: P.L. Dorn, None; H. Al-Hallaq, None; A. Chaudhary, None; G. Vlacich, None; S. Chmura, None.
2014
The Effect of Postmastectomy Radiation on Survival in Young Women with Node-negative Breast Cancer Who Have High Grade, Hormone Receptor-negative, Large Primary Tumors
M. M. Crowley1, K. Huber2, L. Price3, D. Wazer2,4 1 3
Tufts University School of Medicine, Boston, MA, 2Tufts Medical Center, Department of Radiation Oncology, Boston, MA, Tufts Medical Center, Department of Statistics, Boston, MA, 4Rhode Island Hospital, Providence, RI
Purpose/Objective(s): The role of adjuvant radiation in women with lymph node-negative breast cancer who have had mastectomy remains controversial. Recently, two Surveillance, Epidemiology, and End Results (SEER) database analyses failed to find a solitary risk factor that identifies a subset of T3N0 patients who gain a survival benefit from postmastectomy radiotherapy (PMRT). These studies found that estrogen receptor-negative disease and high-grade tumors were associated with increased mortality, although individually these factors did not identify a subset benefiting from PMRT. We hypothesize that patients with multiple high risk characteristics may benefit from PMRT. In this analysis, we examined whether younger women (age \ 50 years) with large primary tumors that are both hormone receptor-negative and high-grade would demonstrate a survival benefit from PMRT despite having lymph node-negative disease. Materials/Methods: The SEER database was searched for women age 20-49 diagnosed from 1990-2005 with N0, M0, invasive breast cancer and treated with mastectomy. Multivariate proportional hazards analysis assessed the association between PMRT and survival in high risk (tumor size .5.0cm, grade III-IV, and estrogen receptor (ER) or progesterone receptor (PR) negative), intermediate risk (having one or two of the high risk characteristics), and low risk (size #5cm, grade I-II, and ER and PR positive) groups. Results: A total of 12,104 patients were identified, of which 301 (2.5%) were high risk, 7,220 (59.6%) were intermediate risk, and 4,583 (37.9%) were low risk. Receipt of PMRT was 49.2%, 11.4%, and 7.5% in the risk groups, respectively. In the high risk group, PMRT was associated with significantly improved cause specific survival (CSS) (hazard ratio [HR]=0.439; 95% confidence interval [CI]=0.223-0.865; p = 0.017) and overall survival (OS) (HR=0.527; CI=0.283-0.981; p = 0.043). PMRT was associated with worse CSS and OS in the intermediate and low risk groups (intermediate risk CSS: HR=1.526; CI=1.215-1.916; p \0.001; intermediate risk OS: HR=1.511; CI=1.225-1.862; p \0.001; low risk CSS: HR=2.023; CI=1.220-3.354; p = 0.006; low risk OS: HR=1.601; CI=1.023-2.507; p = 0.04). Conclusions: Young patients with large primary tumors who have hormone receptor-negative and high grade breast cancer may be an additional uncommon subset of lymph-node negative patients who derive a survival benefit from PMRT. The decrease in CSS and OS with PMRT in the low and intermediate risk groups suggests that the choice to give PMRT was associated with risk factors for death from breast cancer that are not reported in the SEER database (such as lymphovascular invasion, close or involved margin status, and use of systemic therapy). Author Disclosure: M.M. Crowley, None; K. Huber, None; L. Price, None; D. Wazer, None.
2015
Toxicity of Concurrent Capecitabine and External Beam Irradiation in the Adjuvant Treatment of High Risk Breast Cancer: A Phase II Trial
P. M. DeRose, T. Boike, J. H. Heinzerling, R. Abdulrahman, A. Spangler, H. Choy, D. Tripathy, D. Garwood University of Texas Southwestern Medical Center, Dallas, TX Purpose/Objective(s): Capecitabine is an oral 5-FU pro-drug that is preferentially converted to the active form 5-FU within tumor tissue. Pharmacodynamically, capecitabine behaves similarly to and may offer many of the same benefits of continuous 5-FU infusion with the convenience of oral delivery. In various malignancies, combination therapy with chemotherapy and radiation therapy has proved more efficacious than either modality alone. If radiation therapy and concurrent capecitabine can more effectively eliminate local microscopic residual disease, this will result in improved local control and may potentially increase overall survival. This phase II study was performed to ascertain the safety and feasibility of capecitabine concurrent with radiation therapy in high risk breast cancer. Materials/Methods: Eligible pts who had previously undergone surgery and chemotherapy for high risk breast cancer, were enrolled. 825 mg/m2 of capecitabine was administered once daily on the days of radiation therapy. The primary endpoint of this study is toxicity which was scored using CTCAE v3.0 up to a follow up of 12 months. Clinically significant toxicities (CSTs) are defined as skin toxicity of grade 3 or greater, hematological toxicity of grade 3 or greater, other toxicity felt to be related to capecitabine of grade 2 or greater. CSTs led to dose modifications and were the basis of study stopping rules with the exception of grade 3 skin toxicity due to its common occurrence during radiation therapy. Feasibility was described as the percent of pts completing the course of capecitabine and the percent of pts completing radiation therapy to a dose of at least 5040 cGy. Cosmesis was rated by the physician and patient separately. Results: 33 pts were enrolled in the study. The mean age was 52 (range 34-69). Mean follow up was 8 months (range 1-12). Grade 3 or greater toxicity was observed in 7 pts. Treatment related toxicities included 3 pts with grade 3 radiation dermatitis, 1 patient with grade 4 diarrhea due to capecitabine, and 1 patient with grade 5 cardiac arrest possibly related to capecitabine. Other grade 3 or greater toxicities were not treatment related. Patients completed radiation therapy at a rate 97% and capecitabine therapy at a rate 76%. Mean cosmesis scores at baseline were ‘‘good’’ as per physician assessment and ‘‘good’’ as per patient assessment. This remained stable at 6 month follow up for both physician and patient assessment.
S187
2014
The Effect of Postmastectomy Radiation on Survival in Young Women with Node-negative Breast Cancer Who Have High Grade, Hormone Receptor-negative, Large Primary Tumors
M. M. Crowley1, K. Huber2, L. Price3, D. Wazer2,4 1 3
Tufts University School of Medicine, Boston, MA, 2Tufts Medical Center, Department of Radiation Oncology, Boston, MA, Tufts Medical Center, Department of Statistics, Boston, MA, 4Rhode Island Hospital, Providence, RI
Purpose/Objective(s): The role of adjuvant radiation in women with lymph node-negative breast cancer who have had mastectomy remains controversial. Recently, two Surveillance, Epidemiology, and End Results (SEER) database analyses failed to find a solitary risk factor that identifies a subset of T3N0 patients who gain a survival benefit from postmastectomy radiotherapy (PMRT). These studies found that estrogen receptor-negative disease and high-grade tumors were associated with increased mortality, although individually these factors did not identify a subset benefiting from PMRT. We hypothesize that patients with multiple high risk characteristics may benefit from PMRT. In this analysis, we examined whether younger women (age \ 50 years) with large primary tumors that are both hormone receptor-negative and high-grade would demonstrate a survival benefit from PMRT despite having lymph node-negative disease. Materials/Methods: The SEER database was searched for women age 20-49 diagnosed from 1990-2005 with N0, M0, invasive breast cancer and treated with mastectomy. Multivariate proportional hazards analysis assessed the association between PMRT and survival in high risk (tumor size .5.0cm, grade III-IV, and estrogen receptor (ER) or progesterone receptor (PR) negative), intermediate risk (having one or two of the high risk characteristics), and low risk (size #5cm, grade I-II, and ER and PR positive) groups. Results: A total of 12,104 patients were identified, of which 301 (2.5%) were high risk, 7,220 (59.6%) were intermediate risk, and 4,583 (37.9%) were low risk. Receipt of PMRT was 49.2%, 11.4%, and 7.5% in the risk groups, respectively. In the high risk group, PMRT was associated with significantly improved cause specific survival (CSS) (hazard ratio [HR]=0.439; 95% confidence interval [CI]=0.223-0.865; p = 0.017) and overall survival (OS) (HR=0.527; CI=0.283-0.981; p = 0.043). PMRT was associated with worse CSS and OS in the intermediate and low risk groups (intermediate risk CSS: HR=1.526; CI=1.215-1.916; p \0.001; intermediate risk OS: HR=1.511; CI=1.225-1.862; p \0.001; low risk CSS: HR=2.023; CI=1.220-3.354; p = 0.006; low risk OS: HR=1.601; CI=1.023-2.507; p = 0.04). Conclusions: Young patients with large primary tumors who have hormone receptor-negative and high grade breast cancer may be an additional uncommon subset of lymph-node negative patients who derive a survival benefit from PMRT. The decrease in CSS and OS with PMRT in the low and intermediate risk groups suggests that the choice to give PMRT was associated with risk factors for death from breast cancer that are not reported in the SEER database (such as lymphovascular invasion, close or involved margin status, and use of systemic therapy). Author Disclosure: M.M. Crowley, None; K. Huber, None; L. Price, None; D. Wazer, None.
2015
Toxicity of Concurrent Capecitabine and External Beam Irradiation in the Adjuvant Treatment of High Risk Breast Cancer: A Phase II Trial
P. M. DeRose, T. Boike, J. H. Heinzerling, R. Abdulrahman, A. Spangler, H. Choy, D. Tripathy, D. Garwood University of Texas Southwestern Medical Center, Dallas, TX Purpose/Objective(s): Capecitabine is an oral 5-FU pro-drug that is preferentially converted to the active form 5-FU within tumor tissue. Pharmacodynamically, capecitabine behaves similarly to and may offer many of the same benefits of continuous 5-FU infusion with the convenience of oral delivery. In various malignancies, combination therapy with chemotherapy and radiation therapy has proved more efficacious than either modality alone. If radiation therapy and concurrent capecitabine can more effectively eliminate local microscopic residual disease, this will result in improved local control and may potentially increase overall survival. This phase II study was performed to ascertain the safety and feasibility of capecitabine concurrent with radiation therapy in high risk breast cancer. Materials/Methods: Eligible pts who had previously undergone surgery and chemotherapy for high risk breast cancer, were enrolled. 825 mg/m2 of capecitabine was administered once daily on the days of radiation therapy. The primary endpoint of this study is toxicity which was scored using CTCAE v3.0 up to a follow up of 12 months. Clinically significant toxicities (CSTs) are defined as skin toxicity of grade 3 or greater, hematological toxicity of grade 3 or greater, other toxicity felt to be related to capecitabine of grade 2 or greater. CSTs led to dose modifications and were the basis of study stopping rules with the exception of grade 3 skin toxicity due to its common occurrence during radiation therapy. Feasibility was described as the percent of pts completing the course of capecitabine and the percent of pts completing radiation therapy to a dose of at least 5040 cGy. Cosmesis was rated by the physician and patient separately. Results: 33 pts were enrolled in the study. The mean age was 52 (range 34-69). Mean follow up was 8 months (range 1-12). Grade 3 or greater toxicity was observed in 7 pts. Treatment related toxicities included 3 pts with grade 3 radiation dermatitis, 1 patient with grade 4 diarrhea due to capecitabine, and 1 patient with grade 5 cardiac arrest possibly related to capecitabine. Other grade 3 or greater toxicities were not treatment related. Patients completed radiation therapy at a rate 97% and capecitabine therapy at a rate 76%. Mean cosmesis scores at baseline were ‘‘good’’ as per physician assessment and ‘‘good’’ as per patient assessment. This remained stable at 6 month follow up for both physician and patient assessment.
S187