“Ariadne’s thread” is a psycho-educational intervention designed by the Breast Unit and the Clinical Psychology Unit of an Italian Comprehensive Cancer Center and aims to promote empowerment in patients with metastatic breast cancer. It consists of 8 online meetings led by a psycho-oncologist in which informative sessions by patients’ referring physicians alternate with moments of stress management techniques. This study aims to investigate (1) the feasibility of the “Ariadne’s thread” pilot intervention and (2) the satisfaction and perceived benefits of the pilot intervention. We used a mixed method approach in which (1) it was detected: the number of acceptance to the single session of the intervention by both patients and professionals, the number of help requests by patients, and the number of change of date requests by professionals; (2) semi-structured interviews were conducted with the professionals who participated in the intervention; (3) 2 focus groups were conducted with patients, and (4) a questionnaire was submitted to each of them. The intervention is sustainable from the perspective of the organization, professionals, and patients. In particular, the patients declared perceiving benefits in many aspects: improved relationships with doctors, acceptance of their illness, learning of a relaxation technique, possibility to look at the world with trust and hope, etc. The questionnaires show an improvement in empowerment and satisfaction as a result of the intervention. “Ariadne’s thread” is a psycho-educational intervention that effectively addresses the needs of patients with MBC. It can be applied to other contexts (1) if it has been confirmed that similar needs exist or (2) if it can be modified to accommodate other needs.

To report acute toxicities in breast cancer (BC) patients (pts) recruited in a prospective trial and treated with accelerated partial-breast irradiation (APBI) using Volumetric Modulated Arc Therapy (VMAT) delivered with a hypofractionated schedule. From March 2014 to June 2019, pts with early-stage BC (Stage I), who underwent breast conservative surgery (BCS), were recruited in a prospective study started at the National Cancer Institute of Milan. Pts received APBI with a hypofractionated schedule of 30 Gy in five daily fractions. Radiotherapy treatment (RT) was delivered using VMAT. Acute toxicity was assessed according to RTOG/EORTC criteria at the end of RT. Between March 2014 and June 2019, 151 pts were enrolled in this study. 79 Pts had right-side and 72 had left-side breast cancer. Median age was 69 (range 43–92). All pts presented with pathological stage IA BC, molecular classification was Luminal A in 128/151 (85%) and Luminal B in 23/151 (15%) cases. Acute toxicity, assessed at the end of RT, consisted of G1 erythema in 37/151 (24. 5%) pts and skin toxicities higher than G1, did not occur. Fibrosis G1 and G2 were reported in 41/151 (27. 1%) pts and in 2/151 pts (1. 3%), respectively. Edema G1 occurred in 8/151 (5. 3%) pts and asthenia G1 occurred in 1/151 (0. 6%) pts. APBI with VMAT proved to be feasible and can be a valid alternative treatment option after BCS in selected early breast cancer pts according to ASTRO guidelines. A longer follow-up is needed to assess late toxicity.

To assess the impact of age, comorbidities and endocrine therapy (ET) in older breast cancer (BC) patients treated with hypofractionated radiotherapy (Hypo-RT). From June 2009 to December 2017, we enrolled in this study 735 ER-positive BC patients (stage pT1–T2, pNx–1, M0 and age ≥ 65 years) receiving hypo-RT and followed them until September 2019. Baseline comorbidities included in the hypertension-augmented Charlson Comorbidity Index were retrospectively retrieved. Logistic regression model estimated adjusted-odds ratios (ORs) of ET prescription in relation to baseline patient and tumor characteristics. Competing risk analysis estimated 5-year cumulative incidence function (CIF) of ET discontinuation due to side effects (with BC progression or death as competing events), and its effect on locoregional recurrence (LRR) and distant metastasis (DM) (with death as competing event). ET has been prescribed in 89% patients. In multivariable analysis, the odds of ET prescription was significantly reduced in older patients (≥ 80 years, OR 0.08, 95% CI 0.03–0.20) and significantly increased in patients with moderate comorbidity. Patients ≥ 80 years discontinued the prescribed therapy earlier and more frequently than younger (65–69 years) patients (p = 0.060). Five-year CIF of LLR, DM and death from causes other that BC were 1.7%, 2.2% and 7.5%, respectively. Patients who discontinued ET had higher chance of LRR (p = 0.004). ET use did not impact on OS in any of the analyzed groups. In older patients, ET did not show a benefit in terms of overall survival. Further studies focusing on tailored treatment approaches are warranted to offer the best care in terms of adjuvant treatment to these patients.

Background Conflicting evidence challenges clinical decision-making when breast reconstruction is considered in the context of radiotherapy. Current literature was evaluated and key statements on topical issues were generated and discussed by an expert panel at the International Oncoplastic Breast Surgery Meeting in Milan 2017. Methods Studies on radiotherapy and breast reconstruction (1985 to September 2017) were screened using MEDLINE, Embase and CENTRAL. The literature review yielded 30 controversial key questions. A set of key statements was derived and the highest levels of clinical evidence (LoE) for each of these were summarized. Nineteen panellists convened for dedicated discussions at the International Oncoplastic Breast Surgery Meeting to express agreement, disagreement or abstention for the generated key statements. Results The literature review identified 1522 peer-reviewed publications. A list of 22 key statements was produced, with the highest LoE recorded for each statement. These ranged from II to IV, with most statements (11 of 22, 50 per cent) supported by LoE III. There was full consensus for nine (41 per cent) of the 22 key statements, and more than 75 per cent agreement was reached for half (11 of 22). Conclusion Poor evidence exists on which to base patient-informed consent. Low-quality studies are conflicting with wide-ranging treatment options, precluding expert consensus regarding optimal type and timing of breast reconstruction in the context of radiotherapy. There is a need for high-quality evidence from prospective registries and randomized trials in this field.

Purpose or ObjectiveTo analyze the treatment outcomes of ipsilateral cervical lymph node (LN)-positive breast cancer in the absence of other distant metastases, and to compare these outcomes with those of supraclavicular LN (SCL)-positive breast cancer. Material and MethodsSeventy-nine breast cancer patients with involvement of ipsilateral cervical LN above the supraclavicular fossa (cervical LN(+) group) were treated with curative intent from 2000 to 2014 at 7 institutions.Most patients (n=75) received systemic chemotherapy (neoadjuvant and/or adjuvant) and breast surgery followed by locoregional radiotherapy.Outcomes of the cervical LN(+) group were evaluated and compared with those of 183 patients with SCL involvement (SCL(+) group) from the KROG 16-14 study. ResultsMedian follow-up duration was 51.2 months (range, 5.9-138.0).Twenty-two regional failures were found in 15 patients: axillary LN in 8, SCL in 6, internal mammary LN in 3, involved cervical LN in 4, and uninvolved cervical LN in 1.The 5-year overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS) rates were 64.9%, 44.8%, 68.9%, and 55.2%, respectively.Neck dissection failed to improve LRRFS and DFS (p=0.901 and 0.366, respectively).After propensity score matching, survival outcomes of the cervical LN(+) and SCL(+) groups were not statistically different 62.6% vs. 72.2%,p=0.560;DFS, 45.7% vs. 52.2%,p=0.620;LRRFS, 64.7% vs. 78.1%,p=0.110;DMFS, 57.4% vs. 53.2%,p=0.590, respectively). ConclusionBased on comparable clinical outcomes, breast cancer patients with ipsilateral cervical LN metastases without other distant metastases might benefit from aggressive locoregional and systemic treatments as those with N3c disease.

Poster: "ECR 2018 / C-2980 / Random forest analysis to predict disease-free survival using FDG-PET and CT in non-small cell lung cancer" by: "M. Kirienko1, L. Lozza2, N. Gennaro1, A. Rossi1, E. Voulaz1, A. Chiti1, M. Sollini1; 1Milan/IT, 2Bergamo/IT"

ResultsBetween 6/2012 and 11/2015, 48 pts were treated with re-PBI.Median time to recurrence was 137.3 months ( range: 25.6-319 months).Prescription dose was 37.05 Gy in 13 fractions.9 pts were treated with Tomotherapy and 39 pts with VERO.Median age was 60.7 years.The patterns of recurrences were as follows: in 37 cases site of recurrence was the same as the index tumor (true/marginal miss), while in the remaining 17 cases recurrence occurred far from the index quadrant across the breast (elsewhere in breast reappearance).Acute toxicity was moderate: no acute toxicity >G2 was observed at the end of the treatment (erythema G1 in 48% of pts; desquamation G1 in 2% of pts; edema G2 in 8% of pts).Late toxicity according to LENT/SOMA was available for 15/48 patients (Tab.1).All but one had G1-G2 toxicity: one patient experienced G3 retraction.Overall, median follow-up after first relapse was 22.1 months.45 pts are alive without disease while 3 pts showed distant metastasis (DM).Median time to DM event was 12 months and 3/3 have had true/marginal miss local recurrence with high Ki-67. ConclusionSecond conservative surgery combined with additional radiotherapy represents a feasible alternative to mastectomy.None of the patients relapsed locally.Furthermore, good acute toxicity profile and an acceptable early chronic toxicity were observed, although longer follow-up and higher number of pts are needed to confirm these results.

ConclusionDespite adjuvant RNI, patients remain at risk of RNR.RNI fields can be optimized, as in our cohort 34 nodes (39%) were marginal, occurring in areas not adequately covered by the prescribed dose.However, 68% of SCF and 50% of axillary relapses were still 'in-field', suggesting that either our prescribed dose to these areas was not adequate to control disease, or that these patients were at a high risk of systemic relapse.Use of the RTOG atlas did not provide improved coverage.The anatomical data from this cohort will be used to generate an atlas of nodal relapse that can assist in defining optimal radiotherapy volumes for RNI.Whether inclusion of such regions will alter relapse patterns and event rates is unknown.

Purpose: To evaluate toxicity in breast cancer patients treated with anthracycline and taxane based chemotherapy and whole breast hypofractionated radiotherapy, and to identify the risk factors for toxicity.Methods and materials: 537 early breast cancer patients receiving hypofractionated radiotherapy after conservative surgery were enrolled from April 2009 to December 2014, in an Italian cancer institute. The dose was 42.4 Gy in 16 daily fractions, 2.65 Gy per fraction. The boost to the tumor bed was administered only in grade III breast cancer patients and in patients with close or positive margins. Acute and late toxicity were prospectively assessed during and after radiotherapy according to RTOG scale. The impact of patients clinical characteristics, performed treatments and dose inhomogeneities on the occurrence of an higher level of acute skin toxicity and late fibrosis has been evaluated by univariate and multivariate analysis.Results: The mean age was 74 (range 46-91 yrs). 27% of patients received boost. 22% of cases (n = 119) received also chemotherapy. The median follow-up was 32 months.G1 and G2/G3 acute skin toxicity were 61.3% and 20.5% and G1 and G2/G3 late fibrosis 12.6% and 4.3% respectively.Chemotherapy (p = 0.04), diabetes (p = 0.04) and boost administration (p < 0.01) were found to be statistically significant on the occurrence of late fibrosis, but a multivariate analysis did not show any factors connected. The boost administration (p < 0.01), the breast volume (p = 0.05), dose in homogeneities (p < 0.01) and boost volume (p = 0.04) were found to be statistically significant as concerns the occurrence of acute skin reaction at the univariate analysis, but only the boost administration (p = 0.02), at multivariate analysis.Conclusions: The results of our study, according to the large randomized trials, confirmed that hypo fractionated whole breast irradiation is safe, and only the boost administration seems to be an important predictor for toxicity. Chemotherapy does not impact on acute and late skin toxicity. (C) 2016 Elsevier Ltd. All rights reserved.

S647 Dosimetric verification: Delta 4 system has been used for pre-treatment QA. Patient positioning verification: cone beam CT (IGRT) diary. Results:The median age of the patients was: 53 years (32-75).Breast-conserving surgery: 72%; Surgery of the axila was lymphadenectomy in 50% and sentinel node biopsy in 50%.Tumor size (TNM): T1: 50%, T2: 40%, T3: 5%, T4: 5%; positive axillary nodes were found in 50%.Acute skin reactions (RTOG toxicity criteria): G0: 50%, G1: 42,5%, G2: 4,5%, G3: 0%, there was no G4 toxicity.There were no acute adverse cosmetic results (assessed in agreement with the Harvard criteria). Conclusions:The explored hypofractionated radiotherapeutic approach with VMAT and SIB seems to be feasible providing consistent clinical results with excellent short-to-mediumterm toxicity profile.However longer follow-up is required with a major number of patients to asses long-term outcomes.