The high survival rates for Hodgkin lymphoma are a great success of modern oncology. This success gives us the possibility to see the long-term complications of this treatment that often combines radiotherapy and chemotherapy. Secondary neoplasms are the complications responsible of excess mortality rates in these survivors. Breast cancer is the most common secondary neoplasm. The treatment of Hodgkin lymphoma gives a higher risk of having breast cancer. The aim of our study is to confirm that women with Hodgkin disease have a higher risk of developing breast cancer and to assess the clinical and histological characteristics of breast cancer occurring after Hodgkin's disease.

Study objective: Intra-Operative-RadioTherapy (IORT) with INTRABEAM (Zeiss®) device is a promising method for the treatment of early-stage breast cancers, which allows sparing low risk patients a full course of external radiotherapy with 50 Gy in 25 – 30 fractions. It is however not yet clear whether IORT, providing radiations very close to the chest wall, can produce acute heart damage. In this study, we have investigated, in early-stage breast cancer patients treated with breast conservative surgery (BCT) and IORT, if there is an acute heart damage by assessing Troponine I (TnI) levels before and after the procedure.

Study objective: who should be evaluated initially with 18F-fluorodeoxyglucose (FDG) hybrid positron emission tomography/computed tomography (PET/CT) among breast cancer patients? To provide an answer to this question, herein we aimed to determine the potential diagnostic and therapeutic impact of pre and post-operative FDG PET/CT in patients with breast cancer at high risk of recurrence.

Study objective: The present pilot study was conceived in a multidisciplinary vision with the involvement of radiologists, radiology technicians, clinicians and surgeons. The aim of the present study was to assess the utility of dedicated gamma cameras for guiding surgical treatment in LABC after NAC.

e21127 Background: Circulating tumor cells (CTCs) are an independent prognostic factor in metastatic breast cancer patients. However few data exist on the potential role of CTCs in patients with operable breast cancer. The presence of CTCs in localized breast cancer could predict an increased risk for relapse. We integrated the quantitative data of the CTCs numbers with a new tool for quantifying apoptotic and non apoptotic CTCs. Methods: The presence of CTCs was evaluated by ten milliliters of peripheral blood taken from 10 consecutive breast cancer patients in stage I-IIIA: before surgery, 12 hours after surgery, and before to start any adjuvant treatment (median 30 days after surgery). The automated sample preparation and analysis platform for computing CTCs (CellSearch) was integrated with a monoclonal antibody (M30) targeting a neoepitope disclosed by caspase cleavage at cytokeratin 18 (CK18) in early apoptosis. The CTC M30 negative was classified as non apoptotic. Results: One to two CTCs were found in 2/10 patients immediately before breast surgery; 12 hours after breast surgery one to two CTCs were found in 3/10 patients and 30 days after breast surgery 8/10 patient present one to three CTCs in blood samples. At least one M30 negative CTC (non apoptotic) was found in the two CTCs positive patients before surgery, in 2/3 CTCs positive patients 12 hours after surgery and in 2/8 CTCs positive patients 30 days after surgery. One patient that presented CTCs+ and M30- before surgery was always CTCs positive with at least one M30- CTC in the following two controls. All the patients didn’t present metastatic disease. Conclusions: This preliminary study provides evidence of the presence of CTCs and at least one non apoptotic CTC in operable breast cancer patient before, 12 hours and especially 30 days after surgery. We noted also that not immediately after surgery but 30 days after surgery, a large part of the patients (8/10) were CTCs positive before to start any adjuvant therapy. The study is ongoing.

9114 Background: The aim of this prospective, double-blind study was to evaluate sensitivity, specificity, positive and negative predictive values of VES-13, a 13-item function-based self-report questionnaire, as a rapid tool to uncover vulnerability/frailty compared with full CGA. Methods: All consecutive breast cancer patients aged ≥70 years referred from April 2008 to January 2010 to our medical oncology division underwent both CGA and VES-13. Tests were performed by two different investigator groups, not interchangeable and reciprocally blinded. A final score of 3 or more at the VES-13 was considered as predictive for vulnerability/frailty. At CGA patients were divided into fit, vulnerable and frail (Balducci et al Oncology 2000). Results: 150 patients entered the study, median age 76 years (range 70-94). One hundred twenty-five patients (83.3%) presented with early disease. Ninety-five patients (63.3%) were able to complete VES-13 autonomously, 8 patients (5.3%) required help while in 47 cases (31.4%) the questionnaire was completely administered by a research nurse. With CGA, 84 patients were fit (56.0%), 66 were vulnerable/frail (44%). The median time to perform VES-13 was 4 minutes (range 2-12) compared to 29 minutes (range 11-65) for CGA. Twenty five point nine percent of elderly patients with favourable VES-13 score were vulnerable/frail at full CGA while 34.8% of patients with unfavourable VES-13 were fit, the negative and positive predictive values being 74.1% and 65.2%, respectively. Sensibility and specificity of VES-13 to uncover vulnerability/frailty at full CGA were 68% and 71%, respectively. Conclusions: One third of elderly breast cancer patients had significant troubles in self-compiling the questionnaire. VES-13 significantly reduced the time of geriatric assessment, but sensitivity and specificity were unsatisfactory. Caution should be recommended in using VES-13 as a substitute for full CGA in both everyday practice and clinical trials. No significant financial relationships to disclose.

e11636 Background: Triple negative breast cancer (TNBC) represents around 12–20%. They are high risk in view of poorly differentiated tumor shortened survival, younger age, increased mortality rate in the first 5 years, increased risk of brain metastasis, rapid progression from distant recurrence to death of patients. To provide further insight we have undertaken a comprehensive multi year review of demographics tumor features adjuvant treatment and outcomes in this patients group. Methods: A retrospective analysis of all patients with TNBC treated by adjuvant chemotherapy between January 2000 and June 2008 was done though chart review. Results: Sixty-two patients were seen in our institution. The median age at diagnosis was 57 years (range 27–86 yrs). Forty-three patients underwent conservative breast cancer surgery, mastectomy 19 patients. All patients underwent axillary lymph nodes dissection or sentinel lymph node biopsy. The stage of the disease at diagnosis was: I in 22, IIA in 22, IIB in 8, IIIA in 4, IIIB in 2 and stage 0 in 4 patients. After multidisciplinary evaluation 58 patients received adjuvant treatment with: anthracycline based regimen in 30, anthracycline plus taxane in 4 and 24 patients were treated with Cyclophosphamide, methotrexate and 5-Fluorouracil (CMF) regimen. After median 13 months (4–71), 8 (13.7%) relapses were observed: 6 out 8 were anthracycline based regimen treated. The pattern of disease spread was: local recurrence 5, lymph node 1, liver 2 patients. The median follow-up was 25 months (range 95–1). Conclusions: Treatment options for TNBC are limited because of lack of targeted treatment. Current, old and new drugs alone or in combination (anthracycline, taxanes, platinum salts, bevacizumab, erlotinib, dasatinib, cetuximab) are used in an experimental setting. No significant financial relationships to disclose.

Today breast cancer (BC) patients can expect more prolonged survival than in the past, but obesity at diagnosis and/or weight gain during adjuvant therapies increase the risk of recurrences as well as of weight-related disorders (diabetes, cardiovascular disease…). Therefore lifestyle intervention might offer a valuable approach to positively influence the prognosis of survivors.

606 Background: Neoadjuvant chemotherapy is currently the standard of care for the management of locally advanced breast cancer, as it improves both disease-free and overall survival. Methods: Patients with histologic confirmation of locally advanced breast cancer, age >18 years, left ventricular ejection fraction >50%, good performance status and adequate bone marrow, negative chest and abdominal CT scan, renal and hepatic function were included in the study. Prior systemic therapy and radiotherapy and the presence of metastases were not allowed. The treatment schedule was as follows: GC: 1,250 mg/m2 (day 1); GC 1,000 mg/m2 plus TT 75 mg/m2 plus DX 30 mg/m2 (day 8). Pegfilgrastim was routinely administered as primary prophylaxis against febrile neutropenia. Courses were repeated each 21 days for 4–6 cycles. This study was aimed to assess the activity of GC, DX and TT in locally advanced breast cancer. Results: Fifty patients were enrolled and treated. Median age was 51 years (range: 34–73), 27 (54%) being postmenopausal patients. Infiltrating ductal carcinoma was diagnosed in 84% of cases. Tumor size was as follows: T1 (n=2, 4%), T2 (n= 31, 62%), T3 (n=14, 28%), T4 (n=2, 4%). G3 grading was found in 28% of cases. Median tumor size was 4 cm (range: 2–10). Tumors were ER+, PR+ and c-Erb-B2+ in 34 (68%), 31(62%) and 27 (54%) cases, respectively. Surgery was performed in 47 (94%) patients: 12 (26%) pathologic complete response, 24 (51%) partial response and 9 (19%) stable disease were observed resulting in a pathologic overall response rate of 77%. Logistic regression analysis revealed that larger tumor size, Mib1 higher expression and higher number of cycles were independently associated with better tumor response rates. Conclusions: This combination chemotherapy can yield a high tumor response rate. Correlation analysis suggests that this neoadjuvant regimen might be more effective in patients with larger tumors expressing Mib1, particularly if full treatment can be administered. No significant financial relationships to disclose.

10789 Background: On the basis of general and our own experience neoadjuvant therapy is justified in patients with locally advanced breast cancer to reduce cancer and to perform a conservative surgery. In this study we evaluated the efficacy of G plus D and PLD as first-line therapy in LABC. Methods: To date sixteen consecutive patients with LABC have been enrolled into the study. All patients before neoadjuvant treatment, underwent biopsy for hormonal receptors and c-erb-B2 assessment. Patients received G 1250 mg/m2 on day 1 and G 1000 mg/m2, T 75 mg/m2 and D 25–30 mg/m2 on day 8 (escalation dose was 25 mg/m2 at first cycle, 27.5 mg/m2 at second cycle and 30 mg/m2 at third cycle), every 21 days with G-CSF support on day 3, 10, 12 and 14. Tumor response was evaluated on the basis of surgeon consultation and breast MRI after 4 cycles. If tumor response was higher than 50% patients underwent 2 more cycles; if it was 50% ore less or because of unacceptable toxicity they underwent surgery after 4 cycles. Microscopic assessment of the extent and type of residual tumour was made. Results: 16 patients were enrolled comprehensive of 2 with no symptomatic bone metastases. Median age was 50 years-old, and 100% had a WHO performance status (PS) of 0 and EORTC QoL was submitted. Four patients were submitted to surgery after 4 cycles, one after 5 cycles of CT with 5 pPR more than 50%. Three patients had a pathological complete response, 2 partial response more than 50% and 1 stable disease after 6 cycles. (a total of 70% of pPR, 30% of pRC, 10% of pSD). Five patients are still on treatment. One patient died because of acute respiratory distress syndrome. Major toxicity was mucositis G3–4 in one patient. PPE was G3–4 in 3 patients, one discontinued chemotherapy with PLD and continued with Epirubicin. 2 patients received Epirubicin after the first cycle of PLG because of acute allergic reaction. Conclusions: This regimen of chemotherapy seems feasible and active in LABC. At the interim analysis results it has been noted that the best response to chemotherapy was among patients having worse prognostic factors (histology and staging). No significant financial relationships to disclose.

AIM:To investigate the technical, clinical and pathological findings that can, potentially, affect pre-operative lymphoscintigraphy in visualizing sentinel lymph node (SLN) and intra-operative probe detection of SLN in patients with breast cancer. METHODS:One hundred and forty-two consecutive female patients with, clinically, a solitary, small breast cancer and clinically N0 axilla were enrolled. Preoperative lymphoscintigraphy was performed by a single intradermal injection of 99mTc nacolloidal albumin (Nanocoll) the day before surgery. For radioguided surgery two gamma probes with diameters of 11 mm and 15 mm, and set up with a count rate ranging from 1 to 4 s were used. The following variables were evaluated: patient's age, radiotracer dose, volume of injectate, primary tumour location, primary tumour size, and presence and extension of axillary nodal metastases. RESULTS:Lymphoscintigraphy showed high sensitivity in visualizing the SLN (98% success rate) and it resulted in a rapid technique since SLN was visualized within 30 min from injection in 85.21% of cases for the whole series. The probe detection rate was also very high (97.8% success rate): the mean per cent uptake in the SLN was 0.98. Statistical analysis showed that no parameter was found to have significantly influenced either SLN visualization at lymphoscintigraphy or SLN probe detection at surgery. CONCLUSION:In our experience, lymphoscintigraphy performed by a single intradermal injection of Nanocoll was an effective and rapid technique for visualizing axilla SLNs in breast cancer patients. Moreover, this technique appeared to be independent of any technical, clinical and pathological findings.