Intraoperatory radiotherapy (IORT) during breast cancer surgery: Acute cardiac safety tested by troponin

S S15 Study objective: Intra-Operative-RadioTherapy (IORT) with INTRABEAM (Zeiss ) device is a promising method for the treatment of earlystage breast cancers, which allows sparing low risk patients a full course of external radiotherapy with 50 Gy in 25 e 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 earlystage 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. Material and methods: All the patients who receive IORT for breast cancer in our Institute have signed the consent to enter the TARGIT-A trial. We enrolled 42 patients treated with IORT: 21 with left breast cancer and 21 with right breast cancer. We measured TnI levels immediately before surgery and IORT, and 6 hours after the end of the procedure. For the patients with left breast cancer, a little tungsten sheet was placed under the major pectoralis muscle, on the chest projection of the X-ray source, in order to protect the heart. Main results: IORT was delivered to all 42 patients, according to the guidelines of the TARGIT-A protocol. None of the patients showed altered serum levels of TnI before surgery and IORT; no increase in TnI serum levels was reported 6 hours after the surgical and radiological treatment. TnI before and after treatment were similar, being lower the normal value (<0.017 ng/mL). No difference was noticed between right-sided and leftsided breast cancer treated with BCT and IORT. Conclusion: TnI levels do not increase in patients treated with IORT for early-stage breast cancer thus suggesting that the procedure does not cause any acute heart damage. More studies are needed to evaluate if it is safe to avoid a tungsten sheet under the major pectoralis muscle in case of left breast cancer, and to evaluate the role of other molecules, as BNP, as markers of potential acute heart damage induced by IORT. http://dx.doi.org/10.1016/j.ejso.2014.10.040 Feasibility, efficacy and safety of stent insertion for the palliation of malignant strictures in the cervical segment of the esophagus and the hypopharynx A. Antonello*, S. Realdon, C. Castoro, M. Cagol, F. Giacomini, G. Battaglia 1 Istituto Oncologico Veneto I.R.C.S.S., Padova, Italy * Corresponding author: Alessandro Antonello, Istituto Oncologico Veneto I.R.C.S.S., Padova, Italy. E-mail address: alessandro.antonello@gmail.com (A. Antonello) Study objective: 50% of esophageal cancers are inoperable at the time of the diagnosis, and around 15% involve cervical esophagus. Due to their contiguity there is often an involvement of the hypopharynx as well. Endoscopic treatment of these areas is considered to be limited due to technical challenges, low patient tolerance and high complication rates. We reviewed our experience on stent insertion in cervical esophagus and hypopharynx to evaluate its efficacy and safety. Material and methods: We retrospectively reviewed data on 69 consecutive patients treated for a malignant stricture involving cervical esophagus. Dysphagia before and after the procedure was evaluated with the Mellow-Pinkas scale, and a reduction of the score to 0/1 was regarded as an excellent palliation. The main outcome parameters were the differences of dysphagia scores one month after the procedure and throughout the follow up and the rate of complications. The influence of patientor procedure-related factors was evaluated as well. Main results: 21 patients (30.43%) patients had a hypopharyngeal involvement by the stricture. Stent insertion was achieved in 100% patients. 4 weeks from the procedure dysphagia improved from a median of 3 to 0 (p < 0.001), and an excellent palliation was achieved in 76.81% patients. The 30-day mortality rate was 14.50% (0% procedure related). An excellent palliation throughout the follow-up was achieved in 72.88% of the surviving patients. Complications occurred in 31.88% patients, of these major complications (perforation [5], tracheal compression [1], hemorrhage [2]) occurred in 11.59% and minor (stent migration [13], pain [8], cancer ingrowth [4], food impaction [1]) in 23.19%. The procedure-related mortality rate was 2.3%. Stent migration (OR 5.18, 95% CI 1.04e25.77, P 1⁄4 0.04) and to a lesser extent pain (OR 8.00; 95% CI 0.94-e67.96; P 1⁄4 0.06) were associated with radiotherapy before treatment. Dilation before stent insertion was associated with a less efficient dysphagia palliation (OR 0.18, 95% CI 0.05e0.60, P 1⁄4 0.008). Conclusion: Stent insertion is a safe and effective palliative treatment for cervical esophageal strictures, even if there is an involvement of the hypopharynx. Radiotherapy before positioning of the prosthesis is associated with a higher risk of stent migration and pain. Dilation before stent insertion should be avoided. http://dx.doi.org/10.1016/j.ejso.2014.10.041 Risk of early and late relapse in stage I breast cancer: A retrospective study on 621 cases L. Capuano*, L. De Franco, D. Marrelli, A. Neri, F. Ferrara, G. Di Mare, C. Voglino, M. Scheiterle, F. Roviello Dipartimento di scienze mediche, Chirurgiche e neuroscienze Policlinico Santa Maria alle Scotte Universita di Siena, Italy * Corresponding author: Lucia Capuano, Siena, Italy. Study objective: Breast cancer prognosis has significantly improved in recent years, but a significant proportion of patients relapse, with some relapses occurring late in the follow-up. Recently attention is focused on the primary prognostic role of the biological subtypes of breast cancers as categorized by genomic analysis. Our study focused on the correlations between traditional prognostic factors and time of relapse in Stage I breast cancer patients. Material and methods: We performed this retrospective study on 621 pT1 node negative breast cancer patients operated on at our institution. Surgical treatment included a radical mastectomy in 193 patients and a quadrantectomy in 428 patients. Follow-up data were collected directly from our outpatient clinic records. An adjuvant medical treatment was administered in 397 cases. In order to analyse the prognostic factors related to different time to relapse (TTR) in the population at risk during the different periods of follow-up, patients were divided in three groups, as early relapse (within 60 months-EaR), late relapse (after 60 months-LaR) and no relapse (NoR). Main results: Median follow-up was 88 months. During the follow-up, 98 relapses were recorded with a median TTR of 40 months and an actuarial DFS of 87.4% at 5 years and of 79.8% at 10 years. Actuarial OS for the whole study group was 95.5% at 5 years and of 89.6% at 10 years, with 45 patients dying of disease. According to different TTR, patients were divided in a group of EaR consisting of 70 patients, a group of LaR including 28 patients and a group of 523 patients free of disease (NoR). At univariate analysis, age less than 40 years old, premenopausal status, presence of LVI, absence of estrogen receptors (ER) and high values ofMib1 were significantly related to EaR. The same analysis showed that presence of LVI, absence of ER and tumor multiplicity significantly related to LaR. At multivariate analysis, only age less than 40 years old, presence of LVI and absence of ER resulted independent prognostic factors for EaR, while presence of LVI and high values of Mib-1 were independent factors for LaR. Conclusion: Our study showed that biological factors such as ER expression and proliferative activity are independent prognostic indicators but their role is different according to TTR. LVI is a major prognostic factor either in EaR and LaR. http://dx.doi.org/10.1016/j.ejso.2014.10.042