EP-1163: Selection of patients with left breast cancer for Deep-Inspiration Breath-Hold Radiotherapy Technique

B. Czeremszynska, S. Drozda, M. Górzyński, L. Kępka
2016 Radiotherapy and Oncology  
ESTRO 35 2016 S555 ________________________________________________________________________________ guidelines, and TG-101. Cosmesis was assessed using the Harvard Breast Cosmesis Scale. Results: Twenty patients were treated successfully. At a median follow-up of 18 months (1-78), all patients remain locally controlled (100%) and no significant adverse events have occurred. All patients continue to experience goodexcellent cosmetic outcomes. At least 3 fiducials were tracked in 85% of cases.
more » ... in 85% of cases. Fiducial tracking was not successful in one patient. The mean number of beams delivered was 145 . The mean treated PTV30Gy was 74 cm3 (15-142 cm3) with a mean prescription isodose line of 82% (75-86%). 99% of the PTV30Gy received the prescription dose (95-100%) with a mean maximum dose of 36 Gy (34.5-40Gy). The mean ipsilateral breast V30Gy and V15Gy were 12% (3-26%) and 30% respectively (8-58%) sparing significant amounts of normal breast tissue. Patient tolerance was excellent and acute toxicity was rarely observed. 2 patients experienced grade 1 localized dermatitis at the initial 4 week follow-up visit. Conclusions: CyberKnife stereotactic accelerated partial breast irradiation is a suitable radiotherapy technique for the delivery of partial breast irradiation. The CK platform produces highly conformal treatments with excellent normal tissue sparing and offers improvements over existing PBI techniques. Our experience indicates that CK-SAPBI delivered in five fractions is well tolerated with excellent short term local control and breast cosmesis. Longer follow-up is needed for assessment of late toxicity and oncologic outcomes. Purpose or Objective: The voluntary deep-inspiration breath-hold radiotherapy technique (DIBHRT) in the treatment of left breast cancer has the ability to reduce doses to heart left anterior descending coronary artery (LAD) and lung. Before introduction of DIBHRT into routine clinical practice, we conducted a prospective study to assess the extent of dosimetric benefit of this technique in order to select a group of patients for whom this technique should be routinely applied Material and Methods: Thirty one consecutive patients qualified for whole breast irradiation (WBI) with tangential fields following breast conserving surgery for left-sided early breast cancer were included. All patients underwent breathhold training, free-breathing (FB) and DIBH planning-CT. Separate radiotherapy treatment plans for WBI in total dose of 39.9Gy in 15 fraction were prepared based on both planning-CT. Doses like mean heart, heart V20Gy, maximum LAD, left lung V20Gy were calculated for each plan and the difference of respective values (delta) for FB and DIBH were calculated. If relative improvement of at least 20%for any evaluated dosimetric parameter were found for DIBH plan without significant worsening of other measures, this plan was selected for treatment. Daily tree-dimensional surface imaging (VisionRT) and weekly electronic portal imaging were performed. The data distribution were assessed using chi² test, correlations were analyzed using the Pearson test. Furthermore, receiver operating characteristic (ROC) analysis was performed. Results: In 30 of 31 patents a reduction at least 20% in one or more evaluated parameters (i.e.mean heart, heart V20Gy, maximum LAD and left lung V20Gy in 29, 29, 26, and 7 patents respectively)was achieved. The relative worsening of left lung V20Gy was found for in 10 and cases and of maximum LAD in 2 cases. Eventually 25 patients were qualified to DIBHRT. Mean delta(Gy) were:mean heart 1.51 (range:0.06-6.45),heart V20Gy:3.0 (range:0.0-6.59),maximum LAD:18.5(range:-3.29-36.68), left lung V20Gy:1.7(range:-2.71-8.7). Correlations between delta values of mean heart, maximum LAD, heart V20Gy with length of cardiac contact distance (CCD) (p< 0.05, AUC>0,6) and maximum LAD, heart V20Gy with Body Mass Index (BMI)(p<0.05;AUC>0.6) were found. ROC analysis showed that a 2.5 cm of CCD is a threshold for reduction at least 20% in one or more parameters. For BMI no specific threshold for predefined improvement of any dosimetric parameter was identified, which means that despite correlation of dosimetric cardiac benefit with higher BMI, some patients with low BMI may also have cardiac doses reduced with DIBHRT. Conclusion: In our center we have prospectively confirmed an ability of DIBHRT for heart and LAD but not for lungsparing. We are going to use this technique routinely for leftsided breast cancer patients with CCD above 2.5 cm EP-1164 Outcomes of postmastectomy radiotherapy in patients with 1 to 3 positive nodes in single institute Purpose or Objective: Post-mastectomy radiation therapy (PMRT) is standard care for breast cancer patients with high risk for locoregional recurrence after mastectomy. The indication for PMRT in patients with 1 to 3 positive nodes has been in discussion. We reported that patients concomitantly with 1 to 3 positive nodes and extensive lymphatic invasion, who had not been treated with PMRT from 1990 to 2000, had 13.1% (12/92) of locoregional recurrence rate. Since then we have performed PMRT for patients with 1 to 3 positive nodes and extensive lymphatic invasion. To investigate the effectiveness of PMRT for patients with 1 to 3 positive nodes and extensive lymphatic invasion. Material and Methods: Between 2005 and 2013, 639 patients were treated with PMRT and 277 patients of those have not been without neoadjuvant chemotherapy until the lymph node dissection. Among these patients, 81 were diagnosed with 1 to 3 positive nodes pathologically, 65 were with 1 to 3 positive nodes and extensive lymphatic invasion. The 3-D conformal RT, using the partial wide tangent technique to the chest wall, internal mammary lymph nodes and supraclavicular nodes, was applied for all patients, delivering 50 Gy in 25 fractionation over 5 weeks. In the patients with positive surgical margin, 10 Gy of electron boost to the tumor bed was added. We retrospectively reviewed and compared locoregional recurrence rates of 65 patients with 1 to 3 positive nodes and extensive lymphatic invasion treated with PMRT and that of 92 patients without PMRT. Results: Baseline patient characteristics; the median age of these patients was 47 years old (range; 34-76). Survivals; the median duration of overall survival was 114 months (30 to 121 months), the five-year survival rate is 97%, and the median progression-free survival time after PMRT was 93 months (7.0 to 110 months). Of the 65 patients in the current analysis, 58 patients (89%) were alive and free of cancer. Initial failure patterns; the locoregional recurrence was observed in 3 patients (4.6%), classifying into 1 chest wall, 1 regional lymph node, and 1 both. All patients with locoregional recurrence were developed the distant metastases then after. As toxicity; radiation induced pneumonitis graded 1 was observed in 9 patients, nor been graded 2 or more observed. Acute radiation induced dermatitis was observed almost all patients at least grade 1, grade3 was observed in 9 patients. One patient denied continuing PMRT at dose of 46Gy, 7 months later her chest wall recurrence was observed.
doi:10.1016/s0167-8140(16)32413-6 fatcat:3zwjcrna3fgyti5xvfzc4zsqh4