ESTRO 37 Abstract book

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ESTRO 37

trials. Cardiac toxicity particularly from irradiation of the left sided internal mammary nodes remains a concern and the follow up of more recent trials is too probably not long enough to define this. The greater use of more effective systemic therapies, the greater prevalence of lower risk disease at presentation and improved surgical treatment mean a much improved prognosis and a lower ‘event’ rate for patients presenting today compared to those presenting within the recruitment periods for the available randomised trials. In particular patients with node negative or minimally node positive disease have a generally good prognosis and thus have less to gain from regional irradiation. A comprehensive and inclusive individual patient meta- analysis is ongoing within EBCTCG and this will better define patient and disease characteristics that allow an informed targeting of regional/IMC irradiation. The use of this treatment in patients with generally good prognosis early breast cancer including those with minimally node positive disease may not be justifiable at the present time. Risk stratification strategies need to be developed that take account of these concerns and uncertainties and allow the selection of higher risk patients most appropriately defined by nodal disease burden. SP-0019 Brother and sister: guidelines for bringing breast reconstruction and radiation therapy together. O. Kaidar-Person 1 1 Rambam Health Care Campus - Faculty of Medicine, Oncology Institute, Haifa, Israel Abstract text The use of breast reconstruction is increasing, with new surgical techniques for reconstruction aiming to improve cosmesis are constantly introduced (different location of prosthesis, use of prosthesis and flap, lipofilling, etc ). The indications for post-mastectomy radiation therapy increased over the last years. However, little is known about the oncological outcomes of these techniques and how they affect or affected by radiation therapy. Therefore, all disciplines involved in the treatment of the patient need to understand the challenges: respecting patient’s wishes without compromising oncological outcomes. The aim of this talk is to provide some guidelines to for post-mastectomy radiation therapy in the setting of breast reconstruction to optimize treatment. SP-0020 Organ preservation in bladder cancer – an evidence-based alternative to radical surgery N. James 1 1 University of Birmingham, Institute of Cancer and Genomic Sciences, Birmingham, United Kingdom Abstract text Surgical removal of the bladder is considered by some as the ‘gold standard’ in many countries with series citing very high success rates. However, when data from registry series are examined, the 5 year survival from both surgical and radiotherapy series is similar at around 45-50% 1,2 , suggesting single centre series are driven by case selection. Evidence for this is the age distribution in the widely cited paper by Stein et al from University of Southern California – median age in this large series was 66 years 3 with a similar median in the two largest neoadjuvant chemotherapy trials 4,5 , whereas 55% of UK cases are aged over 75 years at diagnosis (CRUK Cancerstats) This lack of data supporting a survival Symposium: Current issues in the treatment of muscle- invasive bladder cancer

advantage for surgery does not stop its proponents presenting it as the gold standard 3,7 . It is, however, more likely that survival in bladder cancer is driven by the presence or absence of distant spread at the time of local therapy and will not be affected by the means adopted for local control. Furthermore, all patients undergoing surgery will need reconstructive bladder surgery. Thus there are many patients for whom radical surgery is simply not suitable and hence bladder-preserving techniques are appropriate. Despite this, use of radiotherapy varies enormously worldwide with possibly a majority receiving radiotherapy in the UK 2 , around 25% in Scandinavia 8 but only around 10% in the USA 9 . Radiotherapy alone suffers from a relatively high rate of incomplete response or local recurrence (up to 50% or more). The addition of synchronous chemotherapy with 5 fluouro-uracil and mitomycin C (5FU/MMC) reduces the invasive recurrence rate by 45% with improved bladder cancer specific survival. Furthermore long-term quality of life was excellent, with no penalty from adding 5FU/MMC to standard dose radiotherapy 6 . Similar results were seen in the BCON trial using carbogen/nicotinamide as hypoxic cell sensitizers 10 and in a non-randomised trial using gemcitabine 11 . The more complicated North American “trimodality therapy” schedules show similar outcomes 12 . Radiotherapy should thus always be given, wherever possible, with a simultaneous radio-sensitiser, the most robust data with UK fractionation being with 5FU/MMC or the BCON schedule. 1. Hayter CR, Paszat LF, Groome PA, et al: The management and outcome of bladder carcinoma in Ontario, 1982-1994. Cancer 89:142-51, 2000 2. Munro NP, Sundaram SK, Weston PM, et al: A 10-year retrospective review of a nonrandomized cohort of 458 patients undergoing radical radiotherapy or cystectomy in Yorkshire, UK. International journal of radiation oncology, biology, physics 77:119-24, 2010 3. Stein JP, Lieskovsky G, Cote R, et al: Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. Journal of Clinical Oncology 19:666-675, 2001 4. Grossman HB, Natale RB, Tangen CM, et al: Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer.[see comment][erratum appears in N Engl J Med. 2003 Nov 6;349(19):1880]. New England Journal of Medicine 349:859-866, 2003 5. Griffiths G, Hall R, Sylvester R, et al: International phase III trial assessing neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle- invasive bladder cancer: long-term results of the BA06 30894 trial. J Clin Oncol 29:2171-7, 2011 6. James ND, Hussain SA, Hall E, et al: Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. The New England journal of medicine 366:1477- 88, 2012 7. Zehnder P, Studer UE, Skinner EC, et al: Unaltered oncological outcomes of radical cystectomy with extended lymphadenectomy over three decades. BJU Int 112:E51-8, 2013 8. Jahnson S, Damm O, Hellsten S, et al: A population- based study of patterns of care for muscle-invasive bladder cancer in Sweden. Scand J Urol Nephrol 43:271- 6, 2009 9. Konety BR, Joslyn SA: Factors influencing aggressive therapy for bladder cancer: an analysis of data from the SEER program. J Urol 170:1765-71, 2003 10. Hoskin P, Rojas A, Bentzen S, et al: Radiotherapy With Concurrent Carbogen and Nicotinamide in Bladder Carcinoma. J Clin Onc 28:4912-4918, 2010 11. Choudhury A, Swindell R, Logue JP, et al: Phase II study of conformal hypofractionated radiotherapy with concurrent gemcitabine in muscle-invasive bladder cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 29:733-8,