BACKGROUND: This study sought to determine if treatment time impacts pelvic failure (PF), distant failure (DF), or disease-specific mortality (DSM) in patients undergoing concurrent chemoradiotherapy (CCRT). METHODS: A retrospective review was performed of 113 consecutive eligible patients with stage IB2 to IIIB cervical cancer. All patients received whole-pelvis radiation with concurrent chemotherapy and consolidative intracavitary brachytherapy (BT) to the cervix, followed by an external beam parametrial boost when appropriate. The effect of treatment time on PF, DF, and DSM was examined with univariate and multivariate analyses. Characteristics of patients with and without treatment prolongation were compared to explore reasons for treatment prolongation. RESULTS: The median time to completion of BT was 60 days, and the median time to complete all RT was 68 days. The 3-year cumulative incidence of PF, DF, and DSM were 18%, 23%, and 26%, respectively. On multivariate analysis, time to completion of BT >56 days was associated with increased PF (hazard ratio, 3.8; 95% confidence interval, 1.2-16; P ¼ .02). The 3-year PF for >56 days versus 56 days was 26% versus 9% (P ¼ .04). Treatment time was not associated with DF or DSM. Treatment prolongation was found to be associated with delay in starting BT and higher incidence of acute grade 3/4 toxicities. CONCLUSIONS: In the setting of CCRT, treatment time >56 days is detrimental to pelvic control but is not associated with an increase in DF or DSM. To maximize pelvic control, we recommend completing BT in 8 weeks or less. Cancer 2013;119:325-31. V C 2012 American Cancer Society.KEYWORDS: cervical cancer, treatment time, radiation timing, prognostic factor, concurrent chemoradiation. INTRODUCTIONHistorically, locally advanced cervical carcinomas were treated with radical radiation therapy (RT) alone using a combination of external beam RT to the whole pelvis and a brachytherapy (BT) boost to the cervix. In 1999, the treatment paradigm shifted to concurrent chemoradiotherapy (CCRT) after the publication of 5 randomized trials that demonstrated a survival advantage with the addition of cisplatin-based chemotherapy to RT in the adjuvant and definitive setting.1-5 A number of patient and tumor characteristics have been found to be prognostic in the setting of RT alone or CCRT. For patients treated with RT alone, the detrimental effect of RT prolongation is well established. Total RT time beyond 7 to 9 weeks results in increased pelvic failures (PFs), decreased cause-specific survival, and decreased overall survival (OS).

Breast MRI detects mammographically occult cancer in half of women with axillary metastases, regardless of breast density. MRI is a powerful tool for stage II and stage IV patients with occult primary breast cancer.

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Among obese and large-breasted women, there was no increase in acute skin toxicity with the use of HypoRT. HypoRT should be considered in obese and large-breasted women when advanced planning techniques are used.

e11512 Background: There is increasing evidence that prolonged disease control is possible in patients with a limited number of metastatic sites compared to those with more diffuse disease, especially when aggressive local therapy (surgery and/or stereotactic radiation) is administered. The objective of this study is to describe the frequency of oligometastatic breast cancer in patients who develop distant disease and to characterize their disease course. Methods: A retrospective review was performed of a tri-institutional database of Stage I-III breast cancer patients treated from 1978 to 2005. Patients were categorized as "oligometastatic" (OM) if ≤ 5 sites of disease were identified at time of first failure or “polymetastatic” (PM) if failure occurred at > 5 sites. Patients were followed for ≥ 3 y after first metastasis, until death, or until development of > 5 sites of metastatic disease. T and N stage, hormone receptor status, presenting symptoms of metastasis, number and site of metastases, actuarial overall survival (OS), and overall survival after first failure (OSAF) were examined. Kaplan-Meier, chi-square, and log-rank tests were used for statistical analysis. Results: Of 2,249 patients reviewed, 114 (5.1%) failed at distant sites and met inclusion criteria. The OM phenotype was observed in 21.9% (25/114). Of patients presenting with symptoms of metastasis, 18.3% were OM, whereas patients with metastases identified incidentally or by screening were OM in 42.1% of cases (p = 0.02). Median OSAF was significantly longer in OM patients (44.7 mos) than PM patients (18.1 mos) with 5 y OS of 48.5% and 10.7% respectively (p < 0.001). Outcome of OM patients compared favorably to that of patients with bone-only metastases in whom the median OSAF was 25 mos and 5 y OS was 12.5%. Baseline features of OM and PM patients did not differ according to initial tumor size (p = 0.94), nodal stage (p = 0.5), or ER+ (p = 0.28). Conclusions: A significant proportion of early stage breast cancer patients with distant failure will have OM disease, and this subset is expected to have prolonged overall survival. The relatively favorable prognosis of patients with OM disease warrants consideration of aggressive local therapy and may have implications in the design of future clinical trials.