C. De Luca Cardillo

Respiratory Function Tests after Mantle Irradiation in Patients with Hodgkin's Disease

Pulmonary function tests were performed in 43 patients with Hodgkins disease before mantle irradiation and at 3, 6, 9, 12 and 15 or more months thereafter. Treatment was given with a telecobalt unit to a total dose of 36 to 42 Gy, the higher dose being reserved for cases with considerable mediastinal involvement. The functional parameters explored included static and dynamic lung volumes, gas exchanges, ventilatory efficiency, and airway resistance. Measured parameters were expressed as a percentage of the pre-treatment value (PTV) in the individual patient. In the whole group, only small variations in the functional indices were observed at 3 to 6 months after mantle irradiation. In patients with normal PTVs a greater variation in static and dynamic volumes was observed at 3 to 6 months after mantle irradiation, with complete recovery thereafter. The gas exchange parameters also showed a similar variation at 3 to 6 months but no recovery was demonstrated in the subsequent examinations. No changes in ventilatory efficiency and airway resistance were observed. In patients with abnormal PTVs, usually presenting large mediastinal adenopathy, all parameters improved after mantle irradiation, and the favourable effect of tumour regression was probably more important than the radiation damage on the pulmonary parenchyma.

Pegylated Liposomal Doxorubicin (Caelyx®) and Oral Vinorelbine in First-Line Metastatic Breast Cancer Patients Previously Treated with Anthracyclines

Abstract Doxorubicin is highly effective and widely used in breast cancer; however, its use is limited by cardiotoxicity related to its cumulative dose. In previous studies, pegylated liposomal doxorubicin (PLD) has shown an acceptable toxicity profile with minimal cardiotoxicity. Between June 2006 and October 2009, 27 metastatic breast cancer patients were treated with first-line PLD and vinorelbine at the University of Florence, Radiotherapy Unit. PLD (30 mg/m2) was administered on day 1, and oral vinorelbine (60 mg/m2) was administered on days 1 and 8 of a 4-week cycle. All patients were previously treated with anthracycline-based adjuvant chemotherapy. Median age was 52 years (range 38–69) and median time to metastasis was 78.5 months. There were no treatment interruptions or discontinuation for cardiac toxicity and no treatment-related deaths. Grade 3 hematological toxicity was observed in 18.6% of patients, and 3.7% had grade 3 non-hematological adverse events. With a median follow-up of 13.2 months (range 3–33), median response duration was 6.1 months, and median PFS was 5.3 months. The overall clinical benefit rate was 55.5%. Our experience adds to evidence supporting the activity and cardiac safety of PLD and vinorelbine in metastatic breast cancer patients previously treated with anthracycline-based adjuvant chemotherapy.

Oral Ibandronate in Metastatic Bone Breast Cancer: The Florence University Experience and a Review of the Literature

Abstract Ibandronate is an amino-bisphosphonate approved in metastatic breast cancer to reduce skeletal complications and to alleviate bone pain. We report our experience about the safety of oral ibandronate and review the literature. We treated 44 patients and administered 524 cycles of oral ibandronate (a single cycle was defined as a 50 mg capsule once daily for 28 days) with a median of 12 cycles (range 6-24). At a median follow-up of 18.5 months (range 6-28) the mean pain score decreased from 1.59 (SD±0.97) at baseline to 0.41 (SD±0.72) after 48 weeks of treatment. The mean analgesic score was 1.89 (SD±1.37) at baseline and 1.46 (SD±1.62) after 48 weeks of treatment. Ibandronate was generally well-tolerated; we had no Grade 3-4 adverse events. No patients had deterioration of renal function. No patients developed bisphosphonate-associated osteonecrosis of the jaw. Our experience confirmed that ibandronate may be a useful and safe co-analgesic to conventional treatments for bone pain in selected metastatic breast cancer patients.

Use of Doxorubicin Plus Cyclophosphamide Followed by Docetaxel as Adjuvant Chemotherapy for Breast Cancer

Abstract We evaluated the feasibility and incidence of hematological toxicity in a series of 39 breast cancer patients treated at our institute with doxorubicin plus cyclophos-phamide (AC) followed by docetaxel, using prophylactic G-CSF (Pegfilgrastim). We prescribed G-CSF as secondary prophylaxis during the AC regimen and as primary prophylaxis during treatment with docetaxel. for the AC treatment, we recorded 6 cases of grade III (15.3%) and one case of grade IV (2.5%) neutropenia; we found one case of Grade IV anemia. for the docetaxel regimen, we registered one case of Grade IV (2.5%) neutropenia and three cases of Grade III leukopoenia without neutropenia. No patients experienced cardiac symptoms or baseline LVEF rate decrease. All patients concluded the programmed chemotherapy. Our experience shows the safety of docetaxel in combination with anthracyclines and the efficacy of prophylaxis with G-CSF in breast cancer adjuvant chemotherapy.

Adjuvant Trastuzumab in Breast Cancer: Experience from the University of Florence

Abstract The objective of this study was to evaluate the efficacy and tolerability profile of sequential trastuzumab in the adjuvant treatment of non-metastatic breast cancer. We analyzed 94 patients with non-metastatic breast cancer who under went postoperative treatment between November2003 and December 2008 at the University of florence. All patients received one year of sequential trastuzumab after adjuvant chemotherapy. Cardiac monitoring in our study consisted of assessment of left ventricular ejection fraction (LVEF) by echocardiography at baseline, after the completion of chemotherapy, then every 3 months during trastuzumab treatment and every 6 months thereafter. 91.6% of patients were alive without evidence of distant or local relapse, while 8.4% developed disease recurrence. The cumulative incidence of cardiotoxicity was 14.5%. In our experience trastuzumab given postoperatively with adjuvant chemotherapy was well tolerated and produced optimal clinical results in terms of disease-free survival.

Doxorubicin and Cyclophosphamide versus Cyclophosphamide, Methotrexate, and 5-Fluorouracil as Adjuvant Chemotherapy in Breast Cancer

Abstract This study evaluated whether doxorubicin and cyclophosphamide are superior to cyclophosphamide, methotrexate and 5-fluorouracil as adjuvant chemotherapy in breast cancer patients. Between July 1976 and December 2004, 1045 breast cancer patients received adjuvant chemotherapy at the Radiotherapy Unit of the University of florence. 927 were administered i.v. CMF (cyclophosphamide 600 mg/m2, methotrexate 40mg/m2 and 5-fluorouracil 600 mg/m2 on days 1 and 8, repeated every 28 days for a total of six cycles) and 118 i.v. DC (doxorubicin 60 mg/m2and cyclophosphamide 600 mg/m2 on day 1 repeated every 21 days for a total of four cycles). All patients under-went adjuvant radiotherapy as well. The survival analysis, stratified according to treatment, did not show any significant difference in metastasis occurrence between the two groups (log rank test p=0.42). According to multivariate analysis four parameter semerged as independent prognostic factors for distant metastases in patients treated with the CMF regimen: pT (p=0.0005), number of positive axillary lymph nodes(p=<0.0001), tamoxifen use (p=0.0109) and local relapses (p=<0.0001). Only number of positive axillary lymph nodes and local relapses were significant predictors of metastases occurrence according to multivariate analysis in the DC group, 17 and p=0.028, respectively. No significant difference between the two regimens was ob-served with regards to number of involved nodes. DC and CMF produced similar out-come in breast cancer patients.

EP-1156: Radiotherapy for ductal carcinoma in situ: patterns of recurrence and risk factors stratification

withdrawn EP-1158 Should breathing adapted radiation therapy also be applied for right-sided breast irradiation? M. Essers Dr. Bernard Verbeeten Instituut, Department of Medical Physics, Tilburg, The Netherlands , P.M. Poortmans, K. Verschueren, S. Hol, D.C. Cobben Radboud University Medical Centre, Radiation Oncology, Nijmegen, The Netherlands Dr. Bernard Verbeeten Instituut, Radiation Oncology, Tilburg, The Netherlands Purpose or Objective: Voluntary moderate deep inspiration breath-hold (vmDIBH) is widely used for patients with left sided breast cancer. The purpose of this study was to investigate the utility of vmDIBH in local and locoregional radiation therapy (RT) for patients with right-sided breast cancer. Material and Methods: For fourteen patients with right-sided breast cancer, forward IMRT plans were calculated on freebreathing (FB) and vmDIBH CT-scans, for localas well as locoregional breast treatment, with and without internal mammary lymph nodes (IMN). We compared dose volume parameters to estimate the reduction in the risk of radiation pneumonitis, the influence on pulmonary lung function tests and the risk of secondary lung cancer with the use of vmDIBH. Results: For local breast treatment, no relevant reduction in mean lung dose (MLD) was found. For locoregional breast treatment without IMN, the average MLD reduced from 6.5 to 5.4 Gy (p<0.005) for the total lung and from 11.2 to 9.7 Gy (p<0.005) for the ipsilateral lung. For locoregional breast treatment with IMN, the average MLD reduced from 10.8 to 9.1 Gy (p<0.005) for the total lung and from 18.7 to 16.2 Gy (p<0.005) for the ipsilateral lung. We also found a reduction in mean heart dose between 0.6 and 2.6 Gy in four patients; with a mean of 0.4 Gy for all 14 patients together (p=0.07). We estimate that 1 out of 100 patients will not develop radiation pneumonitis when breath-hold is applied during locoregional right-sided breast cancer treatment. For eversmoking women, the risk of secondary lung cancer might also be reduced by vmDIBH. Conclusion: Breathing adapted radiation therapy in patients with left-sided breast cancer is becoming widely introduced. As a result of the slight reduction in lung dose found for

PO-0695: Lobectomy vs Stereotactic Ablative Radiotherapy in NSCLC:a multicentric series in four centers

S325 ________________________________________________________________________________ Patients were treated consecutively in the University Hospitals of Leuven between 2005 and 2014 and their data were retrospectively retrieved. PORT MPM patients were treated with RT doses up to 64 Gy in 2-Gy fractions. PORT NSCLC were treated with RT doses up to 60 Gy in 2-Gy fractions. Non-surgical patients were treated with RT doses up to 66 Gy in 2.75 Gy sequentially with chemotherapy or up to 70 Gy in 2 Gy fractions concurrently with chemotherapy. Dyspnea scores (CTCAE 4.03) before and after RT were retrieved and delta dyspnea was calculated as the difference between the dyspnea after RT (worse at any time point) and before RT. For every patient, 2 CT scans were retrieved: 1) CT0: a free breathing planning CT scan; 2) CT3M: deep inspiration breath-hold diagnostic follow up CT scan 3-6 months after the end of RT. CT0 and CT3M were non-rigidly co-registered in MIM. Differences in Hounsfield Unit (delta HU=HU3M-HU0) were represented as the slope of the dosedependent delta HU between 0 and 20 Gy (expressed in delta HU/Gy). Primary endpoint was delta dyspnea >= 2. Univariate and multivariate logistic regression analysis were performed in order to identify significant predictors of delta dyspnea >= 2. A p-value of < 0.05 was considered statistically significant.