Search

s / The Breast 23 (2014) S1eS6 S2 A CARDIAC SPARING TECHNIQUE FOR BREAST CANCER RADIATION TREATMENT Christopher Kelly, Kirsten Stuart, Tim Wang, Drew Latty, Verity Ahern. Crown Princess Mary Cancer Centre (CPMCC), and Breast Cancer Institute NSW, Westmead Hospital, Australia Background: Historically left-sided breast cancer radiation treatment has been associatedwith an excess risk of cardiac deaths1, and every additional 1Gy mean cardiac dose results in a relative increase in cardiac events of 7.4%2. Methods: A deep inspiratory breath hold (DIBH) techniquewas introduced as a method of reducing the volume of heart in breast / chest wall tangential radiation treatment at CPMCC in 2010, one of the few centres using this technique in Australia. This study evaluates the impact of DIBH on cardiac radiation dose. Results: A total of 51 patients underwent an attempt at radiation treatment simulation by DIBH as well as the conventional ‘free breathing’ (FB) approach between December 2010 and April 2013. Thirty eight patients proceeded to treatment delivery by DIBH. Thirteen patients did not undergo treatment by DIBH, either because DIBH did not reduce the cardiac dose (6 patients) or because they were not able to follow instructions for DIBH (7 patients). For the 38 patients who underwent DIBH, the simulated size of the heart measured as a volume varied between FB and DIBH by 72% 115%. The mean irradiated heart dose calculated by simulation was 6.2Gy by the DIBH technique and higher by the FB technique for all 38 patients .It was a mean of 7.0Gy for the 13 patients treated by FB .Six of 38 patients underwent fluoroscopic imaging of one radiation field during treatment on at least two occasions. For the six patients as a group, the heart moved between 1 and 6mm during the fluoroscopic imaging. Conclusions: DIBH is a suitable technique to reduce the cardiac volume irradiated for some patients with left sided breast cancer. We are now exploring the best method of measuring cardiac position during treatment, and how we can help more women cope with this procedure. References [1] Darby SC, McGale P, Taylor CW et al. Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: Prospective study of about 300,000 women in US SEER cancer registries, Lancet Oncol 2005;6:557-565. [2] Feng M, Moran JM, Koelling T et al. Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer. Int J Radiat Oncol Biol Phys 2011;79:10-18. INTRA-OPERATIVE ULTRASOUND REFINES BREAST CONSERVING SURGERY FOR PALPABLE BREAST CANCERS G.A. Regalo, C.J. O'Neill, C. Douglas, D.A. Clark. The Breast & Endocrine Centre, Gateshead, New South Wales, Australia Background and purpose: Excision of a breast cancer with a tumour-free margin is the principle aim of breast-conserving surgery. Tumourinvolved margins of up to 41% are reported with palpation-guided excision. Satisfactory cosmetic outcome is an important secondary aim, with poor cosmesis associated with excision volumes greater than 85cm3. Intra-operative ultrasound (US) has the potential to reduce positive margin rates and tissue volume for palpable breast cancers. The purpose of this study is to report outcomes of a five-year experience in the use of this technique. Methods: A retrospective review was conducted of 176 consecutive patients with a palpable breast cancer, undergoing breast-conserving surgery between 2008-2012. All patients underwent intra-operative US localisation followed by specimen US. Sonography was performed by a breast surgeon or breast sonographer. Specimen volumes were calculated and compared to an optimum specimen volume. Results: Thirty-eight (22%) patients had involved margins on final pathology, with 15 (9%) showing invasive carcinoma, and 23 (13%) having DCIS. The rate of tumour-involved margins was higher for lobular carcinoma (29%) than invasive ductal carcinoma (6%). Of those with positive margins, 93% underwent re-excision, with 40% having residual cancer at resection. Specimen interrogation resulted in 25 patients having additional tissue excised. Two had cancer, and four DCIS, in the marginal tissue. The median value for specimen volume was 60cm3, with 23% of patients having excision volumes greater than 85cm3. Conclusions: Use of intra-operative US localisation coupled with specimen interrogation demonstrated a low rate of positive margins. For the majority of patients, specimen volumes remain lower than those associated with cosmetic dissatisfaction. Intra-operative ultrasound is a useful adjunct to breast conserving surgery. RISK FACTORS ASSOCIATED WITH MORTALITY FROM BREAST CANCER IN WAIKATO, NZ e A CASE CONTROL STUDY S.A. Seneviratne, I.D. Campbell, N. Scott, R. Lawrenson, M. Elwood. Waikato Clinical School, University of Auckland, New Zealand Background: New Zealand (NZ) has the seventh highest age standardized breast cancer mortality in theworld1. Maori women fare evenworsewith a 60% higher mortality rate compared to NZ European women2. We performed a case control study to identify key characteristics associated with death from breast cancer in Waikato, NZ. Methods: Women diagnosed with breast cancer during 2002-2010 were identified from theWaikato Breast Cancer Register and NZ Cancer Registry. Cases e All women who died of breast cancer during 2002-2012 with a diagnosis during 2002-2010. Controls e Age (±1 year) and year of diagnosis, matched controls (up to three controls per each case) that were alive on the date of death of the case to which they were being matched Results: 258 women who died of breast cancer and 652 matched controls were identified. Proportion of Maori women among cases was higher compared to controls (17.4% vs. 13.3%). Compared to controls (59.2%) a higher proportion of cases (84.5%) were diagnosed symptomatically. 61% of cases had advanced cancers (stage III and IV) compared to only 14.2% for controls. 50.7% cases were grade-3 cancers compared to 17.5% controls. Significantly higher (p (27.3% vs. 9.6%) and HER-2 positive compared to controls (30.1% vs. 14.8%). Among cases, compared to NZ Europeans, Maori women had advanced staged (p more HER-2 positive (p tumour stage, grade and ER/PR status as tumour factors significantly associated with mortality from breast cancer among Waikato women. Conclusions: Advanced stage, higher grade, ER/PR negativity and HER-2 positivity were found to be significantly associated with mortality from breast cancer. Higher proportion of advanced staged, ER/PR negative and HER-2 positive cancers are likely contributors to mortality inequity seen among Maori women. References [1] Ferlay J, Shin H, Bray F, Forman D, Mathers C, Parkin D. GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide IARC Cancer Base 2010. Lyon, France: International Agency for Research on Cancer; 2010. [2] Cancer: New Registrations and Deaths 2009. New Zealand Health In- formation Service, Ministry of Health, Wellington; 2012. DEVELOPMENT OF A REALISTIC MODEL FOR TEACHING BREAST EXAMINATION D. Veitch., M. Bochner . 1 Faculty of Industrial Design, Delft University of Technology (TU Delft), The Netherlands; Breast Endocrine and Surgical Oncology Unit, Royal Adelaide Hospital, Adelaide, S.A., Australia Background and purpose: Breast cancer mortality can be significantly reduced by early detection, however many medical students and doctors report that they feel they could improve their skills in clinical breast ex- amination (CBE). There are more medical students and fewer opportu- nities for them to practice on patients. Realistic simulationmodels can help address this need. Training programs including silicone breast simulators can improve the rate of detection of lumps in patients. (Saslow CA Cancer 2004) Despite this, medical students and trainees typically have low per- formance scores for breast examination. This indicates that current simulation models are not sufficient to provide the training required for