ESTRO 36 Abstract Book

S754 ESTRO 36 _______________________________________________________________________________________________

feasible therapeutic option. Adjuvant chemotherapy, in selected patients, can improve survival. EP-1410 Role of PMRT in Elderly Patients with T1-2 and 1 to 3 Positive Nodes Breast Cancer L. Cao 1 , M.Y. Kirova 2 , C. Xu 1 , K.W. Shen 3 , J.Y. Chen 1 1 Ruijin Hospital- Shanghai Jiaotong University School of Medicine, Department of Radiation Oncology, Shanghai, China 2 Institut Curie, Department of Radiation Oncology, Paris, France 3 Ruijin Hospital- Shanghai Jiaotong University School of Medicine, Comprehensive Breast Health Center, Shanghai, China Purpose or Objective Even if evidence of post-mastectomy radiotherapy (PMRT) in patients with T1-2 and 1 to 3 positive nodes breast cancer is increasing, controversies still exist, especially in elderly patients because the risk of treatment-related toxicity. The aim of this study is to evaluate the efficacy and toxicity of PMRT in elderly as well as the place and use of systemic treatment in this population of patients. Material and Methods We retrospectively reviewed records of consecutive patients with T1-2 and 1 to 3 positive nodes treated with mastectomy at our institution between June 2009 and June 2014. Elderly patients were defined as 65 years or above. Patients who had received neoadjuvant treatment were excluded from the analysis. In total, we analyzed 73 patients, of them only 23 received PMRT. Locoregional recurrence (LRR) was defined as any recurrence within the ipsilateral chest wall, ipsilateral axillary, internal mammary, infraclavicular or supraclavicular lymph nodes. All recurrences at other sites were recorded as distant disease recurrence (DDR). Disease-free survival (DFS) was defined as the time from start of PMRT until recurrence of tumor or death from any cause. Overall survival (OS) is defined as the time from start of PMRT until death from any cause. Results The median age was 72 years (range, 65-91 years). There were 10 patients with HER2 positive tumors, of them100% (n=4) received trastuzumab in the PMRT group and 2 of 6 patients in non-PMRT group. All patients with HR positive tumor received endocrine therapy. The patients in the PMRT group were younger (69 years vs. 75 years, P=0.005). Higher number of patients in the PMRT group received adjuvant chemotherapy (82.6 % vs 48 %, P=0.006). At a median follow-up of 48 months (range, 25-85 months), there were 2 LRR diagnosed concurrently with distant metastasis, one in each group respectively. We observed six distant metastases and 5 deaths. In the whole cohort, the 5-year LRR, DDR, DFS and OS were respectively: 3.4%, 13.2%, 84.5% and 92.1%. In the PMRT group, the 5-year LRR, DDR, DFS and OS were 4.5%, 14.1%, 85.9%, and 94.7%, respectively. In the non-PMRT group, the 5-year LRR, DDR, DFS and OS were 2.4%, 12.4%, 84.2% and 92.3%, respectively. In these small single center series, there was no difference in LRR, DDR, DFS and OS between the PMRT and non-PMRT group. There was no significant impact of comorbidity, T-stage, number of positive nodes, HR status, HER2 status and adjuvant chemotherapy on the effect of PMRT. Conclusion The benefit of PMRT might be limited in the unselected elderly patients with T1-2 and 1 to 3 positive nodes. The intensity of anti-cancer treatment including adjuvant chemotherapy and PMRT tends to decrease in patients with increased age at diagnosis. Larger study is needed to identify elderly patients with relative higher risk of LRR and metastasis, as well as the risk of toxicity to better individualize treatment. Clear biomarkers are needed to

decide patients for whom radiotherapy can be avoided.

EP-1411 Chemo-IMRT in elderly head and neck cancer patients I. Ahmed 1 , S. Kotur 1 , D. Sahoo 2 , D. Sougumarane 3 , R. Bhise 4 , K. Vinchurkar 5 , M. Kalloli 5 , A. Sanikoppa 6 1 Kle's belgaum cancer hospital, radiation oncology, Belgaum, India 2 Kle's belgaum cancer hospital, radiaiton oncology, Belgaum, India 3 kle's belgaum cancer hospital, radiation physics, Belgaum, India 4 Kle's belgaum cancer hospital, medical oncology, Belgaum, India 5 Kle's belgaum cancer hospital, surgical oncology, Belgaum, India 6 Kle's belgaum cancer hospital, pathology, belgaum,India Purpose or Objective Elderly patients have been underrepresented in prospective clinical trials that have defined standards of care for head and neck cancer. In the era of improved radiation techniques, improved systemic therapy and better supportive care can claim that chemoradiation does, in fact, improve survival for a large segment of this population and should not be denied for fear of poor tolerance. Material and Methods 21 patients with locally advanced head and neck cancer treated with SIB-IMRT and concurrent weekly cisplatin were prospectively evaluated. After written and informed consent, all patients were immobilised with head and neck thermoplastic mask followed by CT simulation. Critical structures and Planning Target volumes – high risk receiving 70Gy (PTVHR), intermediate risk receiving 63 or 59.4 Gy (PTVIR) and low risk receiving 56 or 54Gy (PTVLR) in 33-35 fractions over 6.5-7 weeks were defined and planned with Eclipse version 11 planning system using 7-9 field arrangements. Concurrent Chemotherapy was administered using weekly cisplatin 40mg/m2 or carboplatin AUC 2 for 6 cycles. All patients were evaluated for treatment compliance and radiation toxicities weekly. Outcomes were analysed in terms of clinical response evaluation using RECIST criteria, acute toxicities according to RTOG-EORTC and overall survival using Kaplan Meir curve. Results Median age of presentation was 69 years (range 65-76) with M: F ratio of 16:5. Primary site of presentation were hypopharynx (10), oropharynx (5) and larynx (6). TNM stage status were T1(2),T2(5), T3(11), T4(3); N1(4), N2(1), N3(1); Stage III(10), IVA(10) and IVB(1). All patients received 70 Gy. Median Overall treatment time was 53 days (range 46-65 days) with treatment interruption of 1- 9 days (median 3 days). All patients received 4-6 cycles of cisplatin/carboplatin (median 6). Acute toxicities are shown in table. Mean weight loss was 8% (range 4- 15%).With a median follow up of 9 months (range 3-15 months), ORR were 71.5% (15 patients) had complete response and 28.5% (6 patients) had partial response. 7 (33%) patients had recurrence with 6 loco regional and 1 distant, out of which 3 expired and 4 are alive with disease. The overall 15 month survival rate is 75.6%. GRADE 1 GRADE 2 GRADE 3 GRADE 4 MUCOSITIS 1(5%) 17(80%) 3(14%) 0 DERMATITIS 17(80%) 3(14%) 1(5%) 0 LARYNGITIS 8(38%) 13(62%) 0 0 ANAEMIA 6(28%) 0 0 0 NEUTROPENIA 4(19%) 0 2(10%) 0 THROMBOCYTOPENIA 1(5%) 1(5%) 0 0