Tumor Bed Boost

Question 1

EORTC 22881

Tumor characteristics?

Answer 1

Stage I-II
T 1-2
N 0-1 (90% cN0, 78% pN0)
M 0

Question 2

EORTC 22881

Exclusion criteria?

Answer 2

Age > 70
Pure carcinoma in situ
Multiple tumor foci in more than 1 quadrant
hx of malignant disease
ECOG > 2
Residual microcalcifications
Gross residual disease after lumpectomy

Question 3

EORTC 22881

Randomization arms?

Answer 3

-ve margins
Boost (16 Gy + 1.5 cm margin)
No Boost

Question 4

EORTC 22881

RT dose?

Answer 4

50 Gy in 25 fx

Question 5

EORTC 22881

LR Results?

Answer 5

LR @ 5 yrs
Boost: 4%
No Boost: 7%

LR @ 10 yrs
Boost: 6%
No Boost: 10%

Question 6

EORTC 22881

Did boost reduce salvage mastectomy rates?

Answer 6

Reduced salvage mastectomy rates by 41%

Question 7

EORTC 22881

DFS and OS results?

Answer 7

No difference b/w arms

Question 8

EORTC 22881

What treatment did the pt’s receive before trial?

Answer 8

Lumpectomy
Systemic Therapy if SLN+ (pre-menopausal tamoxifen, post-menopausal chemotherapy)
RT w/i 9 weeks of surgery

Question 9

EORTC 22881

Boost RT dose?

Answer 9

16 Gy w/ electrons or tangential fields

Iridium-192 at dose rate 0.5 Gy per hr

Question 10

EORTC 22881

Pt characteristics?

Answer 10

Median Age 55
cN0 90%
pN0 78%

Question 11

EORTC 22881

of pts?

Answer 11

~5500

Question 12

EORTC 22881

Median FU?

Answer 12

10.8 yrs

Question 13

Lyon Trial

of pts?

Answer 13

1024

Question 14

Lyon Trial

Purpose

Answer 14

Define the role of 10 Gy boost to the primary tumor in prevention of ipsilateral tumor recurrence

Question 15

Lyon Trial

Pt characteristics for inclusion?

Answer 15

Age < 70
T < 3 cm
-margins (absence on ink)
no distant mets
no hx of other cancer (except basal cell skin cancer ir cervical carcinoma IS)

Question 16

Lyon Trial

Tumor characteristics?

Answer 16

T1 vs T2

N0 vs N1-2

Question 17

Lyon Trial

What were the tx?

Answer 17

Surgery (tumorectomy or quadrantectomy with gross surgical margin > 1 cm

Chemotherapy if +LNs: FU, doxorubicin, cyclophosphamide for 3 wks before and 3 wks after surgery

Hormonal therapy w/ tamoxifen for 5 yrs

RT to 50Gy in 2.5Gy fxs (tx 4 days/wk)
Boost to 10Gy in 4 fx’s (tx 4 days/wk)

Question 18

Lyon Trial

Primary End Point

Answer 18

Time to local recurrence

Question 19

Lyon Trial

Secondary End Point

Answer 19

OS
DFS
Local, regional, or metastatic relapse

Question 20

Lyon Trial

LR Results?

Answer 20

LR @ 5 yrs. Sig
Boost 3.6%
Control 4.5%

DFS @ 5 yrs. NS
Boost 86%
Control 82.2

OS @ 5 yrs. NS
Boost 92.9%
Control 90.4%