• Lorenzo Livi, Icro Meattini, Davide Franceschini, Calogero Saieva, Fiammetta Meacci, Livia Marrazzo, Elena Gerlain, Isacco Desideri, Vieri Scotti, Jacopo Nori, Luis Jose Sanchez, Lorenzo Orzalesi, Pierluigi Bonomo, Daniela Greto, Simonetta Bianchi, and Giampaolo Biti.
• Radiotherapy Unit, University of Florence, Italy.
• Radiother Oncol. 2013 Aug 1; 108 (2): 273-8.

PurposeTo investigate the outcome of invasive early breast cancer patients that underwent breast-conserving surgery and adjuvant radiotherapy (RT), treated with a prospective margin-directed institutional policy for RT boost dose, based on final margins status (FMS).Methods And MaterialsA total of 2093 patients were treated between 2000 and 2008. 10 Gy boost was prescribed in case of FMS>5mm; 16 Gy boost with FMS between 2 and 5mm; 20 Gy boost in case of FMS<2mm or positive.ResultsAfter a median follow up of 5.2 years, we recorded 41 local relapse (LR, 2%). Concerning LR free survival, age at diagnosis, nuclear grade, hormonal status, T-stage, adjuvant hormonal therapy and adjuvant chemotherapy emerged as significant parameters (p-values from log rank test <0.05). FMS, that directed the RT boost dose, did not have significant impact on LRFS (p=0.46). LR rates were 2.3% for FMS<2mm, 2.6% for 2-5mm FMS and 1.8% for FMS>5mm. At multivariate analysis, higher nuclear grade (p=0.045), triple negative subtype (p=0.036) and higher T-stage (p=0.02) resulted as the independent predictors of LR occurrence.ConclusionsOur experience showed that a margin-directed policy of RT boost dose-escalation seems to reduce the negative impact of FMS on LR, but it is not able to overcome the unfavorable effect of higher nuclear grade, higher T stage and triple negative subtype.Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

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