ESTRO 38 Abstract book

S700 ESTRO 38

assessment. With regard to postoperative appearance, early cosmetic results are not impaired EP-1276 A Comparison of Breast Cosmetic Evaluation Methods in Hypofractionated Whole Breast Irradiation M. Nozaki 1 , Y. Kagami 2 , M. Takahashi 3 , R. Machida 4 , T. Shibata 5 , Y. Ito 2 , Y. Nishimura 6 , Y. Kawaguchi 7 , Y. Saito 8 , Y. Nagata 9 , Y. Matsumoto 10 , T. Akimoto 11 , M. Hoiraoka 12 1 Dokkyo Medical University Saitama Medical Center, Radiology, Koshigaya, Japan ; 2 Showa University School of Medicine, Department of Radiation Oncology, Shinagawa, Japan ; 3 Kiryu Kosei General Hospital, Department of Radiology, Kiryu, Japan ; 4 National Cancer Center Hospital, Japan Clinical Oncology Group Data Center, Chuo, Japan ; 5 National Cancer Center Hospital, Japan Clinical Oncology Group Data Center, Chuo, Japan ; 6 Kindai University Faculty of Medicine, Department of Radiation Oncology, Osaka-sayama, Japan ; 7 International Cancer Institute, Department of Radiation Oncology, Osaka, Japan ; 8 Saitama Cancer Center, Division of Radiation Oncology, Kitaadachi, Japan ; 9 Hiroshima University Graduate School of Biomedical and Health Sciences, Department of Radiation Oncology, Hiroshima, Japan ; 10 Niigata Cancer Center Hospital, Department of Radiation Oncology, Niigata, Japan ; 11 National Cancer Center Hospital East, Division of Radiation Oncology and Particle Therapy, Kashiwa, Japan ; 12 Kyoto University Graduate School of Medicine, Department of Radiation Oncology and Image- applied Therapy, Kyoto, Japan Purpose or Objective A favorable cosmetic outcome has been defined as an important endpoint in breast-conserving therapy. Various evaluation methods have been studied, but the optimal evaluation method has yet to be identified. The present ancillary analysis of JCOG0906 focused on comparing three methods for evaluating breast cosmetic outcomes after hypofractionated whole breast irradiation (HF-WBI). Material and Methods Between February 2010 and August 2012, 312 Japanese women were registered in a Japanese HF-WBI trial, JCOG0906 (UMIN000003200), and 306 received HF-WBI. Of them, 292 were evaluated for breast cosmetic outcomes before and three years after HF-WBI using three evaluation methods: an institutional evaluation (IE), a panel evaluation (PE), and a computer-program evaluation (CE), on a scale of 4-points (excellent/good/fair/poor). IEs were performed using a check sheet by individual institutional radiation oncologists who directly saw each patient and took a frontal-breast photograph with all personal information masked. PEs and CEs were performed using the 584 photographs of the 292 patients. PEs were assessed by consent of two experts twice, with a three- year interval between the first and second PEs. CE was performed using BCCT. core software individually by two radiation oncologists (A and B). The intra-observer variability of PE, the inter-observer variability of CE, and the degree of agreement between IE and PE or CE were calculated using the kappa ( k ) and weighted kappa ( wk ) statistics. The degree of agreement was considered to be poor for kappa values < 0.21, fair for 0.21-0.40, moderate for 0.41-0.60, substantial for 0.61-0.80, and excellent for 0.81-1.00. Results The agreement between the first and second PEs using 292 photographs before HF-WBI was moderate ( k =0.5974, wk =0.6405), and that using 292 photographs three years after HF-WBI was similar ( k =0.5303, wk =0.6032). The agreement between A and B on CE using photographs before HF-WBI was substantial ( k =0.7210, wk =0.7569), and that using photographs after HF-WBI was similar ( k =0.7174, wk =0.7656). The agreement between IE and the second PE using photographs before HF-WBI was fair ( k =0.3002, wk =0.3865), and that using photographs after

We describe here one of the largest published series of NBP patients. Diagnosis is often difficult and delayed but necessary, to possibly treat them: chemotherapy in irradiated R 2 patients; usual RT in never irradiated R 0 patients. Salvage plexus RT in R 1 patients was possible. RT was better performed by Vmat technique helping dose/volume homogeneity and sustainable efficiency. Best volume and dose (50Gy) have to be defined for these hyperalgesic and paretic patients. EP-1275 Hypofractionated whole breast irradiation and IOERT in breast cancer: Toxicity and cosmetic outcome G. Fastner 1 , R. Reitsamer 2 , K. Peter 1 , Z. Ingrid 1 , C. Fussl 1 , F. Zehentmayr 1 , B. Grambozov 1 , W. Hitzl 3 , D. Murawa 4 , A. Karzcewska 5 , P. Milecki 5 , B. Urbański 5 , E. Hager 6 , J. Reiland 7 , A. Ciabattoni 8 , C. Matuschek 9 , W. Budach 9 , R. Brimmer 10 , C. Schumacher 11 , A. Ricke 11 , U. Ricardi 12 , V. Fusco 13 , F. Sedlmayer 1 1 Paracelsus Medical University- University Hospital Salzburg- Landeskrankenhaus, Radiotherapy and Radio- Onocology, Salzburg, Austria ; 2 Paracelsus Medical University- University Hospital Salzburg- Landeskrankenhaus, Gynecology, Salzburg, Austria ; 3 Paracelsus Medical University, Research Office – Biostatistics, Salzburg, Austria ; 4 Wielkopolska Cancer Centre, Oncological Surgery Clinic, Poznań, Poland ; 5 Wielkopolska Cancer Centre, Oncological Radiotherapy Clinic, Poznań, Poland ; 6 Landeskrankenhaus Klagenfurt, Radiotherapy/Radiooncology, Klagenfurt, Austria ; 7 Avera Regional Medical Center, Institut Breast Surgery, Sioux Falls, USA ; 8 San Filippo Neri Hospital, Radiotherapy, Rome, Italy ; 9 Heinrich Heine University, Medical Faculty- Dep. of Radiation Oncology, Düsseldorf, Germany ; 10 St.Lukes Hospital, General Surgery, Cedar Rapids, USA ; 11 St.-Elisabeth Hospital, Breast center/Dep. of Senology, Cologne-Hohenlind, Germany ; 12 University of Turin, Oncology- Radiation Oncology, Turin, Italy ; 13 IRCCS CROB Reference Cancer Center Basilicata, Radiation Oncology, Rionero in Vulture, Italy Purpose or Objective To prospectively assess the role of an intraoperative electron tumorbed-boost (IOERT) in combination with hypofractionated whole breast irradiation (HF-WBI) after breast conserving surgery (BCS) in terms of in breast recurrence (IBR), treatment tolerance and cosmetic outcome. Material and Methods Patient recruitment within the study protocol (NCT01343459) started in 2011. Treatment consisted of BCS, IOERT of 11.1 Gy and HF-WBI up to total dosages of 40.5 Gy in 15 fractions. Acute toxicity, late reactions and cosmesis were evaluated by CTC-scoring (Vers. 2), LENT- SOMA criteria and by a 5-point-Scoring System (van Limbergen et al), respectively. 5-year IBR will be analyzed in 3 different age groups (35–40y, 41-50y, >50y) and tested against predefined benchmarks by the sequential probability ratio test (SPRT). Results Of 627 eligible patients 583 were evaluated. For acute effects CTC-score 0-1 was observed in 91-92% at the end of HF-WBI and 4 weeks later. Late toxicity Grading 0-1 (mean values) by LENT-SOMA criterions occurred in 92.7% (89.6-97.3) at 4/5 months up to 96.5% (91-100) at 6 years after HF-WBI. Baseline cosmesis was first assessed after wound healing prior to HF-WBI. Of 583 patients cosmesis was scored as satisfactory (excellent/good) in 84% by subjective (patient) and in 67% by objective (doctor) assessment with no impairment thereafter. After a median follow-up of 45 months (range 0 – 74), no in-breast recurrence was noted. Conclusion Acute and late treatment tolerance of a combined IOERT/HF-WBI regimen is excellent in mid-term