ESTRO 36 Abstract Book

S624 ESTRO 36 _______________________________________________________________________________________________

Purpose or Objective To investigate if a relationship exists between the dose volume parameters leading to moderate oesophagitis in early breast cancer patients receiving radiotherapy to both the breast and supraclavicular nodes (SCF). Oesophagitis has been widely reported in treatment sites such as lung and head and neck, however there is limited data for breast cancer patients. Material and Methods Seventy-seven breast cancer patients receiving radiotherapy to their breast and SCF were recruited for the study. Patients were prescribed 50Gy to the breast or chest wall and SCF +/- a simultaneous integrated boost to the tumour bed of 57Gy. Analysis of the dose volume histogram (DVH) data of the irradiated volume of the oesophagus was performed. Patients were graded twice weekly with a modified RTOG oesophagitis scale to determine the onset, duration and severity of reported oesophagitis. Patients who experienced a grade 1B or worse by the end of their treatment were followed up twice weekly until the symptoms of oesophagitis had resolved. Results From the 77 patients analysed, 2 patients had no reaction, 22 patients reached a grade 1A reaction, 30 patients reached grade 1B, 16 patients reached grade 2A and 7 patients reached grade 2B. The onset of each grade reached throughout the treatment showed those who reached a maximum grade of 1B, did so at an average of 13 fractions. Patients that reached a maximum grade of 2A, reached grade 1B at 10 fractions and 2A at 18 fractions. Patients that reached a maximum grade of 2B reached the 1B grade at just 8.3 fractions, the 2A at 14 fractions and the 2B at 21.7 fractions suggesting the faster the onset, the worse the outcome for the patient. The average mean dose to the oesophagus for patients that had a maximum grade of 0-1A was 31.95Gy, 1B was 32.46Gy, 2A was 34.22Gy and 2B was 34.64Gy. The average maximum doses recorded for 0-1A was 49.86Gy, 1B 50.44Gy, 2A 50.36Gy and 2B 51.26Gy; maximum doses did not seem to have an impact on the incidence of oesophagitis, however the mean dose showed a steady increase from grade 0-1A up to 2B. Also recorded was the mean dose delivered at each grade, based on when the patient reported the changes.

mean oesophageal dose to 32Gy could decrease the severity of oesophagitis in these patients. EP-1148 Distress and self-awareness of disease severity in early breast cancer: two Institutions comparison I. Meattini 1 , T. Zagar 2 , G. Francolini 1 , A. Deal 2 , G. Carta 1 , J. Camporeale 2 , L. Terzo 2 , L. Livi 1 , O. Kaidar-Person 2 1 Azienda Ospedaliero Universitaria Careggi - University of Florence, Radiation Oncology Unit - Oncology Department, Florence, Italy 2 University of North Carolina, Department of Radiation Oncology, Chapel Hill, USA Purpose or Objective Coping with cancer, even in the curative setting, may lead to emotional and psychological distress. However, resilience is dependent on many factors including social support and ethnic/cultural coping strategies. The aim of this multicenter retrospective study is to evaluate the distress among curative breast cancer (BC) patients in two different continents: USA and Europe. Material and Methods We collected data from medical records of early BC patients treated with curative intent at the Florence University Hospital (FUH; Italy) and at the University of North Carolina (UNC; USA) seen between November 2014 and December 2015. Data included demographics, stage, BC subtype, treatment received, referral to supportive services (SP), and use of mood/anxiety lytic and sleep medications (meds). Patients with inoperable or metastatic disease, known psychiatric disorder, or recurrent/synchronous cancer were excluded from this study. The use of SP and meds were compared between the two cohorts using Wilcoxon, Fisher´s exact, and Jonckheere–Terpstra tests. Adjusted relative risks (RR) were estimated using Poisson regression. Results In patients treated at FUH (n=110), rate of SP referral and use of meds was not significantly influenced by adjuvant or primary systemic therapy (PST), type of surgery (mastectomy versus conservative surgery), regional nodal irradiation (RNI) or use of boost, T or N stage. Patients treated at UNC (n=121) who received mastectomy had higher rates of SP vs BCT (62% vs 35%)p=0.02). The use of meds was significantly higher in patients who received adjuvant chemotherapy and RNI. Both SP referral and use of meds were significantly associated with increasing T stage (p=0.03 and p=0.003, respectively) and N stage (p=0.03 and p=0.0004, respectively). Younger UNC patients (age <60 years) had a significantly higher rate of meds use (55% vs 33%, p=0.02). UNC patients had a significantly higher rate of SP referral (41% vs 29%, p=0.003), meds (44% vs 18%, p<0.0001), PST (p=0.03), mastectomy (p=0.002), RNI (<0.0001), and tumor bed boost administration (p=0.03) compared to FUH. After adjusting for age, subtype, T stage, surgery, and PST: UNC patients remained significantly more likely to refer to SP (RR=1.7) and to receive meds (RR=2.4).

Figure 1 Difference in the average mean dose between grades 1 and 2 The graph (Figure 1) shows between grades 1A-1B there is almost a plateau and similarly between grade 2A-2B, however there is a sharp increase between grade 1B-2A, suggesting a potential limiting mean dose of 32Gy. Conclusion Moderate oesophagitis is prevalent in breast cancer patients receiving radiotherapy to the SCF. Limiting the