1. ISIORT Europe IOERT to the tumor bed, followed by whole breast irradiation: Update of the Pooled Analysis on the BIO-Boost Sedlmayer F, Fastner G, Merz F, Reitsamer R, Menzel C Salzburg / A Ciabattoni A, Petrucci A Rom SGF Neri / I Hagen E Klagenfurt / A Willich N, Schuck A, Brinkmann M Münster / D Orecchia R Mailand /I Valentini V Rom UC Gemelli/I

2. BIO-Boost: Linac-based IORT with Electrons 9-10 Gy IORT Boost + 50 Gy Whole-Breast

3. ISIORT Europe Breast Intraoperative Boost (BIO- Boost) : Pooled Analysis* 10/98 – 12/05: 1200 treatments Salzburg 870 SFN/Rom 142 Klagenfurt 74 Mailand 65 Münster 38 UC Gemelli/Rom 11 *4/07

4. Patients ISIORT BIO-Boost Pooled Analysis „ Best Selection“: T1-2 N0 G1-2, >50a: 331 Patients (30%) N-positive and/or G3 and/or T3 and/or Age<45a. 716 Pat. (60%) Age: 57,3 a (22,5 – 89,9) 62 29 21 n.st. 3 Gx 9 Nx 7 T3 284 G3 7 N3 295 T2 538 G2 32 N2 695 T1 143 G1 343 N1 5 T0 611 N0 8 Dcis Grading N T

9. In-Breast Recurrences

10. In-Breast Recurrences

11. In-Breast Recurrences

12. In-Breast Recurrences

13. In-Breast Recurrences

15. Disease Free Survival (7a): N0: 93,2 % N1: 82,9 % N2: 69,1% T1 : 91,7 % T2 : 85 %

16. Follow-up 2/08: Disease Specific Survival (7a) 7 a: 94,8% (all)

17. Follow-up 4/07: Overall Survival (7a) 5 a: 95,6% 7 a: 91,5% (all)

18. Boost-RT for everybody ?

19. Effect of age and radiation dose on local control after breast conserving treatment: EORTC trial 22881-10882 Antonini N, …. Bartelink H Radiotherapy and Oncology 82 (2007) 265–271 Boost (16 Gy) versus No-Boost following WBRT with 50 Gy n = 5.318 Pat. Re-Analysis at 77,5 Mo med FU: Boost-advantage for all age groups

20. Spline Kurve for age and risk for developement of a local recurrence LN-Transformation function in terms of Hazard Risk ratios (5-a-steps) 1. Age-independent boost effect : halfened LR-Rates 2. Reduced absolute LR-Risk with growing age 3. Highest absolute gain at ages < 45 a

21. IOERT with 10 Gy has an iso-effect of at least 17 Gy in standard fractionation IOERT vs. postop. Boost Int J Cancer 2006 In-Breast Tumor Recurrence after 5 a: 4,3 vs. 0 % P < 0,01

23. Bio-Boost Milano/ELIOT Veronesi, Orecchia et al Ann Surg 2005

27. PATTERN OF LOCAL RECURRENCE AFTER CONSERVATIVE SURGERY AND WHOLE-BREAST IRRADIATION True local recurrence rates: 2%, 5%, and 7% (5–9%) at 5, 10, and 15 years, In-Breast-Recurrences „elsewhere“ : rare at 5 (1%) and 10 (2%) years, but increased to 6 (3–9%) at 15 years (same rates!) Different times to recurrence : Freedman et al, IJROBP 2005 1190 pts. IBTR „elsewhere“ is counterbalanced by HT, but: without WBRT ???