Proceedings of the 42nd Annual ASTRO Meeting 293

were no severe toxicities, recurrences or deaths. One patient was taken off study due to a low cardiac ejection fraction preventing her from receiving ADR. Cosmesis impressions were excellent for 27% , good for 45% fair for 18% and poor for 9%.

Conclusion: Results of this pilot study suggest that this AHFRT schedule for BCT patients is well tolerated. By shortening the overall treatment time, such a schedule may improve accessibility of BCT for patients for whom the duration of conventional RT is prohibitive. This shortened schedule may also be easier to integrate with chemotherapy. Additional follow-up of these patients will be necessary to determine the long-term morbidity and cosmesis of this treatment schedule. and further study in a larger group of patiens will be required to confirm its efficacy in terms of local control.

2057 L ong 4 erm results of neoadjuvant radiation therapy for breast cancer

E. Calitchi.’ Y. M. Kirova.’ Y. Otmezguine,’ F. Feuilhade,’ Y. Piedbois,’ G. Revelon.’ J. P. Le Bourgeois

‘Deprrr-tnwnt of Rtrdiothernpy, Henri Mondor University Hmpitol, Assi.smnce Puhlique - Hfipitmn dr Puris, Crrtril. Frcmw, ‘A. E.R.O., Albert Chrnevier Hospital, Assistnnce Publique Hi,pitmr de Ptrr-is. Cretei/. FIYIIKY~. ‘Deportnwnt of

Rtrdiology, Henri Mmdor University Hospitcrl, Assi.stmce Publique Hfipitcua de Pnri.r. Cwtril. Fnrwr

Purpose: To determine the long-term outcome and the possible role of neoadjuvant radiation therapy for breast cancers unsuitable for primary conservative surgery.

Materials and Methods: From 1977 to 1992, 75 unifocal non-inflammatory and non-meta\tatic breast cancer5 unsuitable for primary tumorectomy (T2 and T3) have been treated in the Department of Radiotherapy of Henri Mondor University Hospital, CrCteil, France. All of these patients underwent initial external beam radiotherapy (4.5 Gy/25 fr./Swks). followed by secondary limited surgery.

Results: The population of 74 patients, aged from 32 to 82 years (median 56 years), presenting 49 (65%) T2 tumors and 26 (35%) T3 tumors, have been studied. There were 66 infiltrating ductal carcinomas (Y well differentiated. 31 moderately differentiated, 14 poorly differentiated. and I2 unknown histologic grade specification): 4 lobular carcinomas and 5 mucinou\ carcinomas. There were 56 NO patients. I8 Nl, and 1 N2 patient. Forty-eight (647~) patients were menopaused. All of the patients underwent primary external beam radiation therapy. Seventy two patients (96%) underwent secondary tumorectomy and 3 patients (4%;)-reduction mammaplasty. The secondary tumorectomy was followed by a postoperative boost of 20 Gy (range 15-25 Gy), delivered with LDR brachytherapy. The follow-up time varied from 7 to 22 years. There were X recurrences (1 I c/o), treated by mastectomy in 7 cases and by tumorectomy in one case. There were 5 patients who developed a controlateral cancer. Twenty five patients showed secondary dissemination. Fifty patients (67%) are still alive and free of disease. Fourty one patients (56%) are breast conserved and free of disease. There were 37 patients (55.2%) presenting excellent or good cosmetic results. 26 (38.8%) with satisfactory results, and 4 (6%) patients with poor cosmetic result. Compared to primary tumorectomy, no particular complications were observed. There were two cases (2.7%) of fibrosis and two cases (2.7%) of lymphoedema. No late complications such a treatment induced malignancy was observed.

Conclusions: Our long-term results of neoadjuvant radiation therapy for breast cancer show that conservative management is possible for larger tumors. Preoperative radiotherapy enables the use of conservative surgery in large T2 and T3 tumors with excellent overall survival, disease-free survival. and metastases-free survival.

2058 The impact of young age on outcome after breast-conserving surgery (BCS) and radiation therapy (RT) for Carcinoma-in situ of the breast (DCIS)

C. C. Park,’ A. Recht.‘.’ R. Gelman,‘,J S. .I. Schnitt,’ J. Connolly.’ B. Silver,’ J. R. Harri\‘,’

‘Joint Crrttrr ,for Radicltion Therapy, Boston, MA, ‘Beth Isrrrrl Deaconess Medim/ Currtrr.. Boston, MA ‘Brightrrrr md Wonrcw ‘.\ Hospital. Boston, MA, iDma-Farber Ctrncrr Institute, Bmtm. MA

Background: The combination of BCS and RT is a widely accepted treatment option for DCIS. However, the precise rate of ipailateral local recurrences (LR) and contralateral breast cancers (CBC) after BCS and RT as well as risk factors for \uch failures are not clearly established.

Purpose: To assess the effectiveness of BCS and RT and to identify factors associated with recurrence.

Methods: Between 1968-1994, 175 patients were treated at the Joint Center for Radiation Therapy for AJCC Tis carcinoma in situ of the breast (DCIS). The study population comprised I37 patients who received BCS and RT and who had a minimum potential follow-up of 5 years. The median dose to the primary tumor bed was 60 Gy (range.46-7 I). No patient received tamoxifen. Outcomes were scored according to sites of first failure as 1) LR, when tumor appeared in the ip?ilateral breast with or without other simultaneous sites:2) CBC, when tumor appeared in the contralateral breaat:or 3) alive with no evidence of disease (NED). Characteristics analyzed for the probability of any breast failure were: age, family history. menopausal status. parity, age at first pregnancy, palpable lesion, use of re-excision, final margin status (per report). radiation fraction size. total radiation dose. total tissue volume excised (TTV), and time interval from surgery to radiation. Margin status was scored a\ positive, close, negative or unknown. Fisher’s exact test was performed for variables containing all events in one subgroup. A logistic regression analysis was then performed on the 66 patients <SO years of age.

Results: At S years, 130 (95%) patients were alive without evidence of disease. and there were no distant failures or deaths. There were 6 (4%) breast failures which included 4 (3%) LR’s and 2 (1%) CBC’s. One patient died of lung cancer after 5 years. Time to failure ranged from 16-57 months. Up to 5 years, all breast failures occurred among patients age < SO. (p = 0.05 I). 86%(95/I I I) of patients with known margin status had negative margins and there was no significant association between 1,R and margin status. In the logistic regression model among patients < 50 years of age, no factors were signilicantly associated with LR. In patients < 50 years of age, the LR rate was 11% (3/26) among patients with TTV 560 cc, and similarly, the LR rate was II% (l/9) among patients with TTV~60cc.