Kaouthar Khanfir

Clinical review – Breast adenoid cystic carcinoma

OBJECTIVES To review the published literature on the diagnosis and management of adenoid cystic carcinoma (ACC) of the breast. MATERIALS AND METHODS Papers were identified by searching PubMed using the terms « adenoid cystic carcinoma » and « breast ». Additional papers were identified by reviewing references of relevant articles. RESULTS ACC of the breast is a rare tumour comprising less than 0.1% of breast malignancies. Its cellular origin in the breast remains unclear. The histological characteristics of ACC in the breast are similar to those of ACC of the salivary glands. However the prognosis of ACC of the breast is better than that of other localizations with prolonged survival. Breast-conserving treatment including postoperative radiotherapy seems to be equivalent to mastectomy alone with respect to survival. The value of adjuvant systemic therapies is not established. Late relapses can occur, so long-term follow-up is mandatory for these patients. CONCLUSIONS ACC of the breast has a favourable prognosis. An accurate diagnosis and appropriate treatment are therefore important.

Management of Adenoid Cystic Carcinoma of the Breast: A Rare Cancer Network Study

BACKGROUND Mammary adenoid cystic carcinoma (ACC) is a rare breast cancer. The aim of this retrospective study was to assess prognostic factors and patterns of failure, as well as the role of radiation therapy (RT), in ACC. METHODS Between January 1980 and December 2007, 61 women with breast ACC were treated at participating centers of the Rare Cancer Network. Surgery consisted of lumpectomy in 41 patients and mastectomy in 20 patients. There were 51(84%) stage pN0 and 10 stage cN0 (16%) patients. Postoperative RT was administered to 40 patients (35 after lumpectomy, 5 after mastectomy). RESULTS With a median follow-up of 79 months (range, 6-285), 5-year overall and disease-free survival rates were 94% (95% confidence interval [CI], 88%-100%) and 82% (95% CI, 71%-93%), respectively. The 5-year locoregional control (LRC) rate was 95% (95% CI, 89%-100%). Axillary lymph node dissection or sentinel node biopsy was performed in 84% of cases. All patients had stage pN0 disease. In univariate analysis, survival was not influenced by the type of surgery or the use of postoperative RT. The 5-year LRC rate was 100% in the mastectomy group versus 93% (95% CI, 83%-100%) in the breast-conserving surgery group, respectively (p = 0.16). For the breast-conserving surgery group, the use of RT significantly correlated with LRC (p = 0.03); the 5-year LRC rates were 95% (95% CI, 86%-100%) for the RT group versus 83% (95% CI, 54%-100%) for the group receiving no RT. No local failures occurred in patients with positive margins, all of whom received postoperative RT. CONCLUSION Breast-conserving surgery is the treatment of choice for patients with ACC breast cancer. Axillary lymph node dissection or sentinel node biopsy might not be recommended. Postoperative RT should be proposed in the case of breast-conserving surgery.

Stereotactic body radiation therapy in stage I inoperable lung cancer: from palliative to curative options.

Surgery has historically been the standard of care for operable stage I non-small cell lung cancer (NSCLC). However, nearly one-quarter of patients with stage I NSCLC will not undergo surgery because of medical comorbidity or other factors. Stereotactic ablative radiotherapy (SABR) is the new standard of care for these patients. SABR offers high local tumour control rates rivalling the historical results of surgery and is generally well tolerated by patients with both peripheral and centrally located tumours. This article reviews the history of SABR for stage I NSCLC, summarises the currently available data on efficacy and toxicity, and describes some of the currently controversial aspects of this treatment.

Locoregional Control and Toxicity in Head and Neck Carcinoma Patients following Helical Tomotherapy-Delivered Intensity-Modulated Radiation Therapy Compared with 3D-CRT Data

Objectives: To assess the feasibility and efficacy of intensity-modulated radiation implemented with helical tomotherapy image-guided with daily megavoltage computed tomography for head and neck cancer. Methods: Between May 2010 and May 2013, 72 patients were treated with curative intent. The median age was 64 years, with 57% undergoing definitive and 43% postoperative radiotherapy. Primary tumour sites were oral cavity (21%), oropharynx (26%), hypopharynx (20%), larynx (22%), and others (11%). Staging included 4% stage I, 15% II, 26% III, 48% IVa, and 7% IVb. Radiotherapy was combined with chemotherapy in 64%. Primary endpoint was locoregional control, and secondary endpoints survival and toxicity. Results: Median follow-up was 20 months, with 11 locoregional recurrences. Three-year disease-free survival was 58% and overall survival 57%. In the multivariate analysis, age under 64 years, no extracapsular extension, postoperative radiotherapy, induction chemotherapy, and non-oral cavity tumour were significant favourable prognostic factors for disease-free-survival. The overall incidence of acute grade ≥3 toxicities were mucositis 32%, pain 11%, xerostomia 7%, dysphagia 53%, radiodermatitis 44%, and osteonecrosis 1%. Late grade ≥3 toxicities were fibrosis 6%, dysphagia 21%, fistula 1%, and skin necrosis 1%. Conclusions: Intensity-modulated radiation with helical tomotherapy achieved respectable locoregional control and overall survival, with acceptable toxicity, in head and neck cancer patients.

Sequential or concomitant chemotherapy in limited stage small-cell lung cancer

PURPOSE Chemotherapy (CT) combined with radiation therapy (RT) is the standard treatment for limited disease small-cell lung cancer (LDSCLC). Many questions including RT dose, fractionation, and sequence of RT/CT administration remain controversial. In this paper, we retrospectively assessed the outcome of patients with LDSCLC treated with radiation of at least 50 Gy. METHODS AND MATERIALS From December 1997 to January 2006, 69 consecutive patients with LDSCLC were treated at our institutions. Treatment consisted of at least 4 cycles of CT, and 3D conformal thoracic RT. The median age was 61 years (range, 37-78 years). Sequential or concomitant CT/RT was given in 47 (68%) and 22 (32%) of the patients, respectively. The median RT dose was 60 Gy. Prophylactic cranial irradiation (PCI) was administered in 47 (68%) patients. RESULTS With a median follow-up of 36 months (range, 6-107), 16 patients were alive without disease. The median overall survival time was 24 months, with a 3-year survival rate of 29%. The 3-year disease-free survival (DFS) and loco-regional control (LRC) rates were 23% and 60%, respectively. A better DFS was significantly associated with performance status (PS) 0 (p = 0.004), complete response to treatment (p = 0.03), and PCI group (p = 0.03). A trend towards improved overall survival (OS) was observed for patients who underwent PCI (p = 0.07). Patients treated with sequential CT/RT had a better outcome than those treated with concomitant treatment (3-year DFS rate 27% vs. 13%; p = 0.04). However, PCI was delivered more frequently for the sequential group. No significant dose-response relationship was found in terms of LRC. The multivariate analysis showed that complete response to treatment was the only significant factor for OS. CONCLUSION Complete response to treatment was the most important factor for OS. A better DFS was significantly associated with the PCI group. We did not find a significant difference in outcome between patients receiving doses of 60 Gy or more and patients receiving 60 Gy or less.

P1-208: Sequential or concomitant chemo- and 3D conformal radiotherapy in limited stage small cell lung cancer

Sequential or concomitant chemoand 3D conformal radiotherapy in limited stage small cell lung cancer Ozsahin, Mahmut1 Elhfid, Mohamed1 Khanfir, Kaouthar2 Matzinger, Oscar1 Stupp, Roger1 Do, Huu-Phuoc1 Bieri, Sabine3 Mirimanoff, Rene O.1 Zouhair, Abderrahim1 1 University Medical Center, University of Lausanne, Lausanne, Switzerland 2 Sion Regional Hospital, Lausanne, Switzerland 3 Sion Regional Hospital, Sion, Switzerland Background: Chemotherapy (CT) combined to radiation therapy (RT) is the standard treatment in limited disease small cell lung cancer (LDSCLC). Many questions including RT dose, volume, and RT/CT sequence of administration remain controversial. We assess the outcome of patients with LDSCLC. Methods: From September 1998 to 2006, 69 patients with LDSCLC were treated at our institutions. Treatment consisted of CT and 3D conformal thoracic irradiation in all patients. Median age was 61 years (range: 37-78). Sequential or concomitant CT/RT was given in 47 (68%) and 22 (32%) of the patients, respectively. Chemotherapy consisted of either cisplatin and etoposide (PE) in 74% of the patients, or ifosfamid, cisplatin and etoposide (ICE) in 26%. Clinical target volume (CTV) included gross tumor volume and enlarged/involved lymph nodes. In 23% of the patients, positron emission tomography was used in the CTV delineation. The median RT dose was 60 Gy. Prophylactic cranial irradiation was given in 47 (68%) patients in complete remission. Results: All patients have completed full treatment. With a median follow-up of 36 months (range: 6-107), 16 patients are alive without disease. Median overall survival time was 24 months, with survival rates of 29% at 3 years. The 3-year disease-free survival (DFS) and locoregional control rates were 23% and 60%, respectively. No significant dose-response relationship was found in terms of locoregional control or survival. However, patients treated with full-dose sequential CT/RT had better outcome than those treated with concomitant treatment (3-year DFS: 27% vs. 13%; p = 0.04; Fig.1). ICE chemotherapy resulted with better outcome (3-year overall survival: 41% vs. 25%; p = 0.04; Fig.2). No major (CTV v3.0 grade 3 or 4) treatment-related morbidity was observed. Conclusions: Sequential administration of ICE chemotherapy followed by 60-Gy 3D conformal RT seems to be better than concomitant PE chemotherapy and RT. P1-209 SCLC: Combined Modality Therapy Posters, Mon, Sept 3