83 Background: To determine clinical outcomes for patients treated with accelerated partial breast irradiation (APBI) based on breast cancer subtype. Methods: We evaluated 516 consecutive patients who received APBI with a minimum follow-up of 6 months. Methods of APBI delivery included interstitial brachytherapy (n=221), balloon-based brachytherapy (n=201), and 3D-CRT (n=106). Women were assigned a breast cancer subtype (BCST) based on results of testing for estrogen (ER), progesterone (PR), and human epidermal growth factor (HER2/neu) receptors. Those without test results for all three receptors were excluded. 278 patients were eligible and submitted for analysis. Receptor subtypes were approximated as follows: ER+, PR+/–, and HER-2 negative [luminal A (LA), 164 pts.]; ER+, PR+/–, and HER-2 positive [luminal B (LB), 81 pts.]; ER/PR–, HER-2+ [HER-2 (H2), 5 pts.], and ER/PR/HER-2 negative [basal (B), 28 pts.]. An analysis was then performed to estimate IBTR, RNF, DM, DFS, CSS, and OS. Results: Mean age was 66 years, median follow-up was 4.9 yrs. Basal and H2 subtype patients had higher histologic grades (Gr. 3 = 75% vs. 10% LA/LB, p<0.001), larger tumors (13.0mm vs. 10.7mm LA/LB, p=0.05), and were more likely to receive chemotherapy (68% vs. 15% LA/LB, p<0.001). Basal subtype patients were also more likely to be African American (18% vs. 4% LA/LB, p=0.002). Margin and nodal status were similar between all BCSTs. At five years, IBTR rates were 2.9%, 3.2%, 0%, and 4.8% for LA, LB, H2, and B subtypes, respectively (p=0.75). The IBTR within the B subtype group was due to a single elsewhere failure, the rate of which was not statistically different than that for the LA subtype (2.9%, p=0.30). DM was only seen in LA (2.5%) and LB (1.4%) (p=0.87). Disease-free survival (95-100%), CSS (97%-100%), and OS (80-100%) (Table) were also not statistically different (p=0.98, 0.85, 0.24, respectively) between BCST categories. Conclusions: Five-year local control rates after treatment with APBI are excellent for luminal, HER2, and triple-negative phenotypes of early-stage breast cancer. Further study of BCST is important and may be useful when counseling patients on adjuvant treatment options following breast-conserving surgery.

Purpose/Objective(s)Revised guidelines for the estrogen receptor (ER) status of breast cancer now classify a tumor as ER negative only if nuclear staining is <1% while a new category of ER weak positive has been introduced by some institutions for staining between 1-9%. Mixed data has been published between the relationship of estrogen receptor (ER) status and ipsilateral breast tumor recurrence (IBTR) in women undergoing accelerated partial breast irradiation (APBI). We present our five-year outcomes for ER negative patients stratified by degree of estrogen receptor expression (ERE).Materials/MethodsA total of 346 patients treated with APBI had results for degree of ERE. ER status was assessed based on the amount of positive staining of the tumor cells' nuclear membranes for the ER receptor by immunohistochemistry and stratified into three groups: ER True Negative (ERTN: <1%), ER Weak Positive (ERWP: 1-9%), and ER Positive (ERP: ≥10%). Patient demographics and tumor characteristics were evaluated by ER grouping. Outcomes analyzed include ipsilateral breast tumor recurrence (IBTR), regional recurrence (RR), distant metastases (DM), disease-free survival (DFS), cause-specific survival (CSS), and overall survival (OS).ResultsMedian age was 63 years (range: 41-93 years) while median tumor size was 11.2 mm (range: 1.0-35.0mm). Median follow-up for all patients was 5.7 years (range: 0.2-18.0 yrs). Statistically significant differences existed for tumors with low ER expression including a propensity to be higher grade (Grade 3: 77% vs. 67% vs. 11%, p < 0.001) and treated with chemotherapy (35% vs. 43% vs. 14%, p < 0.001; ERTN, ERWP, and ERP, respectively). ER weak positive tumors were more likely to be treated with endocrine therapy (32% vs. 15%) vs. ER true negative tumors (p < 0.001) but less likely than true ER positive tumors to receive anti-ER therapy (32% vs. 66%, p < 0.001). Clinical outcomes are presented in the Table by degree of ER expression. No differences in IBTR, DFS, CSS, or OS were noted with a significant difference in RR noted (0% vs. 3.6% vs. 0%, p = 0.008) and a trend for increased distant metastases (5.9% vs. 11.1% vs. 2.6%, p = 0.06) for tumors with lower degrees of ER expression.ConclusionsPoster Viewing Abstract 2059; TableFive-year actuarial outcomes by degree of estrogen receptor expressionERTN (ERE <1%) (n = 26)ERWP (ERE: 1-9%) (n = 30)ERP (ERE: ≥ 10) (n = 290)p valueIBTR4.2%5.6%2.4%0.65RR0%3.6%0%0.008DM5.9%11.1%1.8%0.06DFS89.8%88.9%95.8%0.48CSS93.3%92.2%99.1%0.16OS93.2%85.6%92.9%0.33 Open table in a new tab Purpose/Objective(s)Revised guidelines for the estrogen receptor (ER) status of breast cancer now classify a tumor as ER negative only if nuclear staining is <1% while a new category of ER weak positive has been introduced by some institutions for staining between 1-9%. Mixed data has been published between the relationship of estrogen receptor (ER) status and ipsilateral breast tumor recurrence (IBTR) in women undergoing accelerated partial breast irradiation (APBI). We present our five-year outcomes for ER negative patients stratified by degree of estrogen receptor expression (ERE). Revised guidelines for the estrogen receptor (ER) status of breast cancer now classify a tumor as ER negative only if nuclear staining is <1% while a new category of ER weak positive has been introduced by some institutions for staining between 1-9%. Mixed data has been published between the relationship of estrogen receptor (ER) status and ipsilateral breast tumor recurrence (IBTR) in women undergoing accelerated partial breast irradiation (APBI). We present our five-year outcomes for ER negative patients stratified by degree of estrogen receptor expression (ERE). Materials/MethodsA total of 346 patients treated with APBI had results for degree of ERE. ER status was assessed based on the amount of positive staining of the tumor cells' nuclear membranes for the ER receptor by immunohistochemistry and stratified into three groups: ER True Negative (ERTN: <1%), ER Weak Positive (ERWP: 1-9%), and ER Positive (ERP: ≥10%). Patient demographics and tumor characteristics were evaluated by ER grouping. Outcomes analyzed include ipsilateral breast tumor recurrence (IBTR), regional recurrence (RR), distant metastases (DM), disease-free survival (DFS), cause-specific survival (CSS), and overall survival (OS). A total of 346 patients treated with APBI had results for degree of ERE. ER status was assessed based on the amount of positive staining of the tumor cells' nuclear membranes for the ER receptor by immunohistochemistry and stratified into three groups: ER True Negative (ERTN: <1%), ER Weak Positive (ERWP: 1-9%), and ER Positive (ERP: ≥10%). Patient demographics and tumor characteristics were evaluated by ER grouping. Outcomes analyzed include ipsilateral breast tumor recurrence (IBTR), regional recurrence (RR), distant metastases (DM), disease-free survival (DFS), cause-specific survival (CSS), and overall survival (OS). ResultsMedian age was 63 years (range: 41-93 years) while median tumor size was 11.2 mm (range: 1.0-35.0mm). Median follow-up for all patients was 5.7 years (range: 0.2-18.0 yrs). Statistically significant differences existed for tumors with low ER expression including a propensity to be higher grade (Grade 3: 77% vs. 67% vs. 11%, p < 0.001) and treated with chemotherapy (35% vs. 43% vs. 14%, p < 0.001; ERTN, ERWP, and ERP, respectively). ER weak positive tumors were more likely to be treated with endocrine therapy (32% vs. 15%) vs. ER true negative tumors (p < 0.001) but less likely than true ER positive tumors to receive anti-ER therapy (32% vs. 66%, p < 0.001). Clinical outcomes are presented in the Table by degree of ER expression. No differences in IBTR, DFS, CSS, or OS were noted with a significant difference in RR noted (0% vs. 3.6% vs. 0%, p = 0.008) and a trend for increased distant metastases (5.9% vs. 11.1% vs. 2.6%, p = 0.06) for tumors with lower degrees of ER expression. Median age was 63 years (range: 41-93 years) while median tumor size was 11.2 mm (range: 1.0-35.0mm). Median follow-up for all patients was 5.7 years (range: 0.2-18.0 yrs). Statistically significant differences existed for tumors with low ER expression including a propensity to be higher grade (Grade 3: 77% vs. 67% vs. 11%, p < 0.001) and treated with chemotherapy (35% vs. 43% vs. 14%, p < 0.001; ERTN, ERWP, and ERP, respectively). ER weak positive tumors were more likely to be treated with endocrine therapy (32% vs. 15%) vs. ER true negative tumors (p < 0.001) but less likely than true ER positive tumors to receive anti-ER therapy (32% vs. 66%, p < 0.001). Clinical outcomes are presented in the Table by degree of ER expression. No differences in IBTR, DFS, CSS, or OS were noted with a significant difference in RR noted (0% vs. 3.6% vs. 0%, p = 0.008) and a trend for increased distant metastases (5.9% vs. 11.1% vs. 2.6%, p = 0.06) for tumors with lower degrees of ER expression. ConclusionsPoster Viewing Abstract 2059; TableFive-year actuarial outcomes by degree of estrogen receptor expressionERTN (ERE <1%) (n = 26)ERWP (ERE: 1-9%) (n = 30)ERP (ERE: ≥ 10) (n = 290)p valueIBTR4.2%5.6%2.4%0.65RR0%3.6%0%0.008DM5.9%11.1%1.8%0.06DFS89.8%88.9%95.8%0.48CSS93.3%92.2%99.1%0.16OS93.2%85.6%92.9%0.33 Open table in a new tab

146 Background: Current guidelines for APBI stratify appropriateness of treatment outside of a clinical trial. Limited data are available, however, regarding the impact of the number of risk factors (RFs) per patient on clinical outcomes. Methods: 692 patients were treated with APBI at a single institution between 10/1992 and 10/2011. Patients were stratified by the ASTRO guidelines as suitable, cautionary, and unsuitable. Outcomes including ipsilateral/contralateral breast tumor recurrence (IBTR/CBTR), regional recurrence (RR), distant metastases (DM), disease-free survival (DFS), cause specific survival (CSS), and overall survival (OS) were evaluated by risk group and number of RFs. Results: Median follow-up was 5.2 years (range: 0-18.3).Distribution within CP risk-groups was suitable: 240, cautionary: 343, and unsuitable: 109 patients. Increased IBTR (2.0% v. 0.6%, p=0.03), DM (6.5% v. 1.5%, p=0.02), and decreased DFS (92% v. 98%, p=0.01) were noted for patients with 2+ cautionary RFs (n=115) vs. 1 RF (n=228). Those with 2+ unsuitable RFs had higher RR (7.7% v. 1.7%, p=0.05). Pooled analysis revealed increased IBTR/RR for patients with 3+ combined cautionary/unsuitable RFs vs. 2 or fewer combined RFs (Table). Univariate analysis showed increased DM with increasing tumor size/T-stage (p<0.01), ER negativity (p=0.04), LVSI (p=0.01), + LN (p<0.01), and increasing number of RFs (p<0.01). No single RF was associated with an increased risk of local recurrence on UVA. Conclusions: Three or more cautionary or unsuitable APBI RFs is associated with higher local, regional, and distant recurrence. Patients with fewer than 3 total RFs have a 98% locoregional control at 5 years and likely remain good candidates for APBI. Future attempts to risk stratify patients may need to account for the number of RF present in order to appropriately classify patients. [Table: see text]

Purpose: Triple negative receptor status (TNRS) of patients undergoing breast-conserving therapy treated with whole-breast irradiation has been associated with increased distant metastasis and decreased disease-free and overall survival. This paper reports the outcomes of TNRS patients treated with accelerated partial breast irradiation (APBI).Methods and Materials: We studied 455 patients who received APBI at our institution, using interstitial, intracavitary, and three-dimensional conformal radiation therapy. TNRS was assigned if a patient tested negative for all three (ER [estrogen receptor], PR [progesterone receptor], and HER2/neu) receptors. Of 202 patients with all receptor results available, 20 patients were designated TNRS, and 182 patients had at least one receptor positive (RP). We analyzed ipsilateral breast tumor recurrence (IBTR), regional nodal failure (RNF), distant metastasis (DM), and overall survival (OS).Results: Mean follow-up was 4.1 years for the TNRS group and 5.1 years for the RP cohort (p = 0.11). TNRS patients had a higher histologic grade (59% TNRS vs. 13% RP; p < 0.001). Mean tumor size, stage N1 disease, and margin status were similar. Based on a 5-year actuarial analysis, the TNRS cohort experienced no IBTR, RNF, or DM, with an OS of 100% versus rates of 1.4% IBTR, 1.5% RNF, and 2.8% DM in the RP cohort (p > 0.52). OS for the RP cohort was 93% at 5 years (p > 0.28).Conclusions: In our patient population, TNRS conferred a clinical outcome similar to that of patients with RP disease treated with APBI. Further investigation with larger patient populations and longer follow-up periods is warranted to confirm that APBI is a safe and effective treatment for patients with localized TNRS breast cancer. (c) 2011 Elsevier Inc.

To determine effects of baseline fitness (FIT) and Body Mass Index (BMI) on fatigue reports (FTG) and physical activity measured in steps per day (SPD) during radiation for breast cancer. Following institutional review board approvals, 51 women (55.3 ± 9.9 yrs) with breast cancer signed informed consent and completed the study. The subject sample size was chosen to reflect moderate effect size for adequate statistical power in this pilot study. A prospective, quasi-experimental repeated measures design was used to measure steps per day (SPD) using the Sense Wear © Body Monitoring System, and FTG using the Brief Fatigue Inventory (BFI). BMI, the measurement of body fat, was calculated utilizing the baseline height and weight. The BFI was completed weekly and SPD were measured during the first, fourth, and sixth weeks of radiation. FIT was determined using five SPD categories described by Tudor-Locke; sedentary, low active, somewhat active, active and high active. Significant differences in FTG and subsequent SPD were assessed using a two-way analysis of variance with between subject factors of FIT and BMI each with treatment week. Where indicated, Tukey's Honestly Significant Difference was used post-hoc analysis with p ≤ 0.05 (one-tailed). FIT levels determined by baseline SPD classified 13 subjects sedentary, 16 low-active, 9 somewhat-active, 11 active, and 2 high-active; two high-active subjects' data were combined with active group data to enable analysis. Overall FTG increased by 19.4%; however, changes were not significant (F = .325, df = 2, p = 0.723). Significant differences were found in FTG between FIT (F = 3.16, df = 3, p = 0.027) and between BMI categories (F = 2.98; df = 3; p = 0.034) with higher FIT and lower BMI reporting less FTG. Overall SPD declined 7.3%; however, changes were non-significant (F = .615, df = 2, p = .271). Significant differences in SPD were found between FIT (F = 53.74, df = 3, p<.001) and between BMI categories (F = 4.27; df = 3; p = .006) with higher FIT and lower BMI being more physically active. Study results support the impact of baseline fitness and BMI on fatigue and physical activity levels during radiation for breast cancer. These findings provide further support for the importance of remaining physically fit and maintaining a normal weight to decrease fatigue levels experienced during radiation treatment for breast cancer.

BACKGROUND:Data on patients who received breast-conserving therapy (BCT) for early stage breast cancer were examined to detect differences in disease presentation, management techniques, long-term treatment outcomes, and toxicities based on race. METHODS:Six hundred ninety-nine women with breast cancer (39 African-American [AA] women and 660 Caucasian [C] women) who received BCT were analyzed on race, clinical and pathologic characteristics at presentation, management techniques, treatment-related toxicities, recurrence, and survival. The median follow-up was 12.2 years. RESULTS:At diagnosis, AA women were younger (aged<50 years, 49% vs 29%; P=.002), had larger tumors (mean, 17.0 mm vs 13.9 mm; P=.032), had more estrogen receptor-negative tumors (56% vs 18%; P<.001), and higher nuclear grade tumors (grade 3, 52% vs 29%; P=.006). Compared with C women, AA women more frequently received adjuvant chemotherapy (59% vs 19%; P<.001) and lymph node irradiation (26% vs 13%; P=.033). No other significant treatment differences were observed. After treatment, AA women experienced more breast pain (P=.001), more arm edema (P=.046), and less excellent cosmetic results (P=.008), but there were no statistically significant differences in local recurrence (P=.232), distant metastasis (P=.263), overall survival (P=.131), or cause-specific survival (P=.092) based on race. CONCLUSIONS:The current results suggested that AA women present with larger and more aggressive breast tumors and, as a result, more frequently received adjuvant chemotherapy and lymph node irradiation. Small differences in treatment-related toxicities and cosmesis were observed, but no differences in efficacy were identified.