Catherine Philippson

Special focus on cardiac toxicity of different sequences of adjuvant doxorubicin/docetaxel/CMF regimens combined with radiotherapy in breast cancer patients

BACKGROUND AND PURPOSE Cardiac toxicity associated with anthracyclines and taxanes and/or radiotherapy (RT) can be life-threatening and can adversely affect quality of life. The aim was to evaluate treatment-related cardiac toxicity in breast cancer patients treated with doxorubicin/docetaxel/CMF sequential or combined regimens and RT. METHODS AND MATERIALS From 1996 to 1998, 64 patients with stages II-III breast cancer were included in a pilot study that investigated the efficacy/feasibility of sequential and combined doxorubicin/docetaxel/CMF regimens. No patients had any cardiovascular history or ECG abnormalities. The same RT technique was performed in all patients. LVEF measurements were obtained at baseline, during, at the end of chemotherapy, at the end of radiotherapy and subsequently during the follow-up. A cardiac event was defined as a myocardial infraction or clinical evidence of congestive heart failure. RESULTS Median age was 48 years (range 29-65 years). The median follow-up was 6 years. Significant drop in the post-treatment LVEF occurred in 21 patients (median decrease of 10%). Notwithstanding, all patients have preserved normal cardiac function and regained their initial LVEF value during follow-up. No cardiac events were reported. CONCLUSION Sequential and combined doxorubicin/docetaxel/CMF regimens plus conventional RT in selected non high-risk cardiac patients are relatively safe without cardiac toxicity at mid-term follow-up.

Early Invasive Cancer and Partial Intraoperative Electron Radiation Therapy of the Breast: Experience of the Jules Bordet Institute

Objectives. The aim of this prospective phase II study is to evaluate the treatment of early-stage breast cancer (T1 N0) with intraoperative electron radiation therapy (IOERT) in terms of local control, early complications, and cosmesis. Patients and Methods. From February 2010 to February 2012, 200 patients underwent partial IOERT of the breast. Inclusion criteria were unifocal invasive ductal carcinoma, age ≥40 years, histological tumour size ≤20 mm, and no lymph node involvement. A 21 Gy dose was prescribed over the 90% isodose line in the tumour bed. Median follow-up is 23.3 months (7–37). Results. Acute toxicity was not frequent (Grade 1: 4.5%, Grade 2: 1%). The cosmetic result was considered to be very good or good in 92.5%. One ipsi lateral out-quadrant recurrence at 18 months was observed. The crude and actuarial local recurrence rates after median follow-up were 0.5% and 0.9%, respectively. Conclusion. The preoperative diagnostic work-up must be comprehensive and the selection process must be rigorous for this therapeutic approach reserved for small ductal unifocal cancers. After a 23.3-month median follow-up time, the clinical results of IOERT for selected patients are encouraging for the locoregional recurrence and the toxicity rates. The satisfaction of our patients in terms of quality of life was extremely high.

OC-0567: In vivo dosimetry in Intra-Operative Partial Breast Irradiations

Purpose/Objective: To implement a time effective solution to enable radiotherapy centres across the UK to remotely access and register a database of CT/CBCT images. The purpose was to facilitate the IGRT training and assessment of RTTs throughout the UK in order to provide QA for those clinical trials requiring IGRT. Materials and Methods: The process was initially implemented for the HYpofractionated Bladder Radiotherapy with or without Image guided aDaptive planning (HYBRID) Trial (CRUK/12/055), requiring CBCT analysis for plan of the day selection. The anonymised treatment datasets from 5 patients, each containing 6 CT/CBCT images registered to the acquisition position, were imported into two vendor systems. Three patient cases (18 CBCT images) and the consensus plan of the day selection, consistent with the HYBRID Trial RT guidelines, were provided for training. 2 patient cases (12 CBCT images) were provided for assessment. Detailed instructions and support were provided for participating centres in remotely accessing their vendor appropriate database. Individual centres were asked to complete an internet survey to obtain feedback on the process regarding image quality, usability, and general experience. Results: Remote training has been accessed by 10 Radiotherapy centres across the UK recruiting patients into the HYBRID Trial. One centre completed the training as a group, while others accessed individually. The assessment required individuals to perform a bladder registration of CT and CBCT, and select the correct treatment plan from a library of 3 plans. This has been completed by 67 Individuals. 54 individuals successfully completed the assessment cases with a pass mark of 83% (10/12 cases) or above on a first attempt; the remaining 13 achieved the pass mark on a second attempt following verbal feedback on the QA process. A pre-requisite of the adaptive trial was that centres had previous experience in CBCT soft tissue analysis for bladder cancer. The majority of centres (70%) reported individuals taking less than 1 hour to complete the training cases and 86% of the respondents reported that the image quality across the systems was sufficient for them to effectively carry out the assessment. All centres responded that the training and assessment cases provided were sufficient to familiarise them with the trial protocol, and that the training and assessment had prepared them for plan selection within the trial. Conclusions: It is feasible and practical to use remote systems to train and assess IGRT competency for multi-centre clinical trials. This solution will be extended to UK clinical trials involving IGRT for other anatomical sites.