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Programma

dinsdag 14 jun

08:00

Welcome

08:50

Opening

Koop Bosscha, oncologisch chirurg, JBZ

Young investigators

Moderator: Jacqueline van Laarhoven

09:00

Prediction of individual risk of developing cancer-related fatigue in breast cancer patients

Lian Beenhakker, PhD student, Universiteit Twente

09:15

Pre-operative partial breast irradiation in low-risk breast cancer patients: a systematic review of literature

Yasmin Civil, Phd student, Amsterdam UMC

09:30

Accuracy of MRI to assess response after neoadjuvant chemotherapy according to molecular breast cancer subtypes; a systematic review and meta-analysis

Liselore Janssen, arts-onderzoeker, UMC Utrecht

09:45

Het effect van intra-operatieve snijvlak beoordeling binnen de borstsparende behandeling van het mammacarcinoom

Sophie Wooldrik, arts-onderzoeker, Franciscus Gasthuis & Vlietland

Session 1: Imaging

Moderator: Maud Bessems

10:00

Towards supplemental MRI screening and nationwide AI after DENSE

Dr. Wouter Veldhuis, radioloog, UMC Utrecht

Bio
Wouter B. Veldhuis (PhD, MD) is an associate professor and radiologist at the University Medical Center Utrecht in the Netherlands. He is the coordinating radiologist of the DENSE trial that has been running on top of the Dutch Breast Cancer Screening Program for the past 10 years. He holds a PhD in Magnetic Resonance Imaging and Spectroscopy Methods, and has authored over 120 publications (bit.ly/PubWV). Before coming to Utrecht he was an Oncologic Imaging Scholar at the Memorial Sloan-Kettering Cancer Centre in New York, funded by the MSKCC and the European Society for Radiology, and a postdoc at the Stanford University Richard M. Lucas MRI Center on a grant from the Dutch Cancer Society (KWF).

In 2015 he received the “Wiarda Award” from the Dutch Society of Radiology for Best Radiology Teacher. In 2021 together with two co-PIs he received the bi-annual FMS Science and Innovation award on behalf of the whole team behind the DENSE trial.

He is the initiator of IMAGR, the vendor neutral AI infrastructure that brings deep-learning algorithms directly into the clinical workflow in the UMC Utrecht, and that has now been licensed to Sectra AB and is being rolled out worldwide. He is the initiator and main software developer of doRadiology.com, an interactive platform for radiology teaching applications, that have been recognized as finalist or winner “Best Radiology Mobile App” by AuntMinnie.com over 10 times in the past years. He furthermore developed myBody-myData.nl, a portal that gives patients direct access to their medical imaging data, and is one of the co-founders of QuantibU, a translational AI startup active in the field of medical imaging.

Samenvatting
U krijgt een overzicht van het pad naar implementatie van aanvullende MRI screening in het bevolkingsonderzoek borstkanker na publicatie van de resultaten van de eerste en tweede ronde van de DENSE trial, alsmede van de kansen die daar liggen voor nation-wide AI en abbreviated MRI protocollen.

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Wouter Veldhuis

10:20

Screening in and after the COVID-pandemic

Prof. dr. Ruud Pijnappel, radioloog, UMC Utrecht & LRCB Utrecht

Bio
Ruud Pijnappel, MD, PhD is professor of Breast Radiology at University Medical Centre Utrecht; Utrecht University, The Netherlands and Chair of the Dutch Expert Center for Screening (LRCB) .

He received his medical training at the University of Amsterdam. His special interest in Breast imaging and intervention was developed during a fellowship at University of Utrecht where he received his PhD in 2002 on the subject ‘The diagnosis of non- palpable breast lesions’.

Since 1996 Prof. Pijnappel main clinical and research interests include breast imaging, screening and intervention. Working with and teaching residents and fellow’s the details of breast cancer screening and assessment in a multidisciplinary setting serves his particular interests. Prof. Pijnappel also serves as a member of the advisory board of Government for the Dutch National Screening Program for Breast Cancer. He is past president of the Dutch College of Breast Imaging (DCBI) and since 2020 Vice President of the EUSOBI.

Summary
The impact of COVID-19 was huge not only as infectious disease but also had its impact on Cancer care. Breast Cancer Screening programs were heavily hampered, and most were forced to stop for a couple of months. The long-term impact of this disturbance on outcome will be highlighted during this session. Not only the screening programs but also the clinical breast care suffered from COVID-19. The impact regarding breast practice will be evaluated in combination with the side effects of vaccination since axillary lymph node enlargement due to vaccination plays an important role in the clinical setting.

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Ruud Pijnappel

10:40

Recent advancements in imaging of the axilla

Dr. Thiemo van Nijnatten, nucleair radioloog i.o. , Maastricht UMC+

Bio
Thiemo van Nijnatten is nucleair radioloog in opleiding in het Maastricht UMC+. Na afronding van zijn proefschrift in 2017, getiteld ‘The enigma of lymph node staging in breast cancer’, is hij gestart met zijn opleiding tot nucleair radioloog in het Maastricht UMC+. Zijn aandachtsgebieden zijn mammaradiologie en nucleaire geneeskunde. Tegelijkertijd heeft hij zijn onderzoek ambities voortgezet als postdoc onderzoeker aan de Universiteit Maastricht. Zijn onderzoek is onder andere gericht op het verbeteren en optimaliseren van (locoregionale) stadiëring en respons evaluatie van neoadjuvante systemische therapie van het mammacarcinoom.

Samenvatting
De laatste jaren hebben er vele ontwikkelingen plaatsgevonden op het gebied van axillaire diagnostiek en behandeling bij het mammacarcinoom, zowel bij patiënten met als zonder lymfekliermetastasen. Beeldvorming speelt hierbij een belangrijke rol. Deze presentatie geeft u een overzicht van recente wetenschappelijke studies op het gebied van axillaire beeldvorming (echografie, MRI, PET/CT en PET/MRI). Tot slot worden axillaire lymfeklierkarakteristieken op beeldvorming bij patiënten met mammacarcinoom versus patiënten na COVID-19 vaccinatie besproken.

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Thiemo van Nijnatten

11:00

Break

Session 2: Topics in radiotherapy

Moderator: Luc Scheijmans

11:30

Repeat lumpectomy and irradiation in locoregional recurrent breast cancer

Dr. Desiree van de Bongard, radiotherapeut-oncoloog, Amsterdam UMC

Bio
Desirée van den Bongard is a radiation oncologist at the Amsterdam UMC. Her main specialization is treatment of breast cancer patients. Her research topics focus on optimization of radiation treatment and decreasing treatment-induced morbidity in breast cancer patients aiming to optimize the quality of life after treatment. These topics are single-dose preoperative partial breast irradiation (instead of standard multiple-sessions of postoperative breast irradiation), MR-guided radiotherapy, and adaptive radiotherapy on CT-linear accelerator in breast cancer patients. Besides clinical care and research, Desirée is chair of the LPRM (Landelijk Platform Radiotherapie Mammacarcinoom), board member of NABON, member of the steering committee of the Dutch guidelines of breast cancer treatment, and faculty member of the ESTRO course Advanced treatment planning.

Summary
Advances in diagnostics and treatment have improved locoregional control and survival of breast cancer patients. The risk of locoregional recurrence in patients treated with breast-conserving surgery and postoperative whole-breast irradiation is approximately 0.5% per year. Despite the low locoregional recurrence risk, the absolute number of breast cancer patients with a locoregional recurrence is increasing due to the enormous growth in the absolute number of long-term breast cancer survivors. Consequently, the absolute number of survivors with late toxicity is increasing, and can result in more survivors with decreased quality of life.

The treatment of local recurrence consists of salvage mastectomy after previous breast-conserving surgery and postoperative whole/partial-breast irradiation according to (inter)national guidelines. The interest in second breast-conserving therapy is rising in order to optimize the quality of life in these patients. Several studies suggest that repeat breast-conserving surgery and post-operative re-irradiation is safe in low-risk patients with a local recurrence. These are patients aged ≥50 years, tumor size ≤2 cm, estrogen-positive and HER2-negative receptors, time interval with primary breast cancer ≥2 years, and tumor negative nodes.

In addition, interest is also rising in preoperative partial breast irradiation showing a promising pathologic complete response up to 42% in low-risk patients with primary breast cancer.  In preoperative partial breast irradiation, a smaller volume of breast is irradiated compared to postoperative partial breast irradiation, resulting in a reduced number of radiotherapy sessions. In the recent future, a feasibility trial will be initiated to study preoperative partial breast irradiation in low-risk patients with a local recurrence.

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Desirée van den Bongard

11:50

Het abscopale effect bij radiotherapie

Dr. Marleen Ansems, tumorimmunoloog, Radboudumc

Bio
In 2011 is Marleen Ansems gepromoveerd op de afdeling Tumorimmunologie van het Radboudumc. Tijdens de 2 daaropvolgende internationale fellowships aan de Washington University School of Medicine, St. Louis, USA (EMBO fellowship) and Yale School of Medicine, New Haven, USA (KWF fellowship) heeft ze verschillende preklinische muismodellen opgezet om onderzoek te doen naar de rol van bepaalde moleculen en cellen in de (micro)omgeving van de tumor. In 2015 keerde zij als VENI-Fellow (NWO) terug naar het Radboudumc en was zij betrokken bij de oprichting van het Radiotherapie & OncoImmunologie laboratorium, bij de afdeling Radiotherapie. De missie van haar onderzoeksgroep is het begrijpen van de moleculaire en cellulaire interacties in een tumor na verschillende soorten radio- en immunotherapiestrategieën. Meer inzicht hierin is nodig om te kunnen voorspellen welk type radio- en immuuntherapie het meest veelbelovend zal zijn voor de patiënt.

Samenvatting (Nederlands)
Hoewel radiotherapie een lokale behandelmodaliteit is, kan deze ook systemische effecten veroorzaken die leiden tot regressie van niet bestraalde laesies.  Dit zogenaamde abscopale effect wordt echter zeer zelden waargenomen in de kliniek. Uitgebreide preklinische studies hebben laten zien dat het immuunsysteem de drijvende kracht is achter dit fenomeen. Ondanks het zeldzame optreden in de dagelijkse praktijk, wordt het abscopale effect met de opkomst van immunotherapie wel steeds vaker waargenomen. Er is dan ook een groeiende consensus dat het combineren van radiotherapie en immunotherapie de mogelijkheid biedt om de abscopale effecten te vergroten. Om dit succesvol te implementeren in de kliniek is er echter meer onderzoek nodig naar de interactie tussen bestraling en het immuunsysteem. Ook zullen nog veel aspecten verder geoptimaliseerd moeten worden, zoals dosis en fractionering, volgorde en timing, en responsevoorspelling van radio- en immunotherapie. In mijn presentatie zal ik de volgende onderwerpen bespreken (i) het veronderstelde mechanisme van het abscopale effect, (ii) waarom dit effect maar zo zelden wordt waargenomen, en (iii) de kansen en uitdagingen van het combineren van radiotherapie en immunotherapie om het abscopale effect te vergroten.

Summary (English)
Radiotherapy, despite being a local therapy, may cause systemic effects leading to regression of non-irradiated metastatic lesions. However, this so-called abscopal effect is rarely observed in the clinic. Extensive preclinical studies have shown that the immune system is the driving force behind this phenomenon. Although an abscopal effect is rarely seen in daily practice, it is increasingly observed with the implementation of immunotherapy in the clinic. Therefore, there is a growing consensus that combining radiotherapy and immunotherapy has the potential to increase the abscopal effects. However, to successfully implement this in the clinic, more research is needed into the interaction between radiation and the immune system. Many aspects will also require further optimization, such as dose and fractionation, scheduling and timing and response prediction of both radio- and immunotherapy. In my presentation I will discuss (i) the presumed mechanism of the abscopal effect, (ii) why this effect is so rarely observed and (iii) the opportunities and challenges of combining radiotherapy and immunotherapy to augment the abscopal effect.

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Marleen Ansems

12:20

Protonentherapie voor borstkanker in Nederland

Prof. dr. Liesbeth Boersma, radiotherapeut-oncoloog, Maastro/ Maastricht UMC+

Bio
Van 1990- 1995 heb ik promotie onderzoek gedaan in het NKI/AVL naar longschade door bestraling. Daarna heb ik daar de opleiding tot radiotherapeut-oncoloog gevolgd tot 2001. Na 2 jaar als staflid in het NKI/AVL gewerkt te hebben besloot ik dat het tijd was voor een nieuwe werk en woon-omgeving. Dat heb ik gevonden in Maastricht. Sinds 2003 werk ik met veel plezier in Maastro, voorheen Radiotherapeutisch Instituut Limburg. Mijn belangrijkste aandachtsgebied is borstkanker. Ik ben daar hoofd van de afdeling geweest van 2015 – 2022, en heb als voorzitter van het Landelijk Platform Protonentherapie de ontwikkeling van landelijke indicatie protocollen protonentherapie gecoördineerd. Sinds begin 2022 leg ik me weer vooral toe op patiëntenzorg en onderzoek op het gebied van borstkanker.

Samenvatting
Liesbeth J. Boersma, Afd. Radiotherapie
 (Maastro), GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht.

Met protonentherapie kunnen de gezonde weefsels meestal beter gespaard worden dan met dede ”gewone” fotonentherapie. Omdat protonentherapie echter 2-3x zo duur is als fotonentherapie, is in Nederland een speciale methode ontwikkeld om patiënten te selecteren voor protonentherapie: de zogenaamde model-based selectie. De rationale achter deze methode is dat protonentherapie kosteneffectief is als je die patiënten selecteert bij wie het dosisverschil ook daadwerkelijk vertaalt naar een klinisch relevante afname in bijwerkingen. Er is consensus binnen de NVRO dat voor (zeer) ernstige (CTCAE graad 4/5) bijwerkingen de afname ≥ 2% moet zijn, voor matig ernstige bijwerkingen (Graad 3) ≥ 5%, en voor mildere bijwerkingen (Graad 2), moet het verschil ≥ 10% zijn om voor protonentherapie in aanmerking te komen. De inschatting van de winst wordt gemaakt op basis van gevalideerde voorspellingsmodellen. Met deze modellen wordt de kans op bijwerkingen berekend aan de hand van de gegeven bestralingsdosis, en eventuele andere klinische factoren, voor zowel het protonen als het fotonen plan van een individuele patiënt. Pas als het verschil in kans op bijwerkingen de drempelwaarde overschrijdt, komt patiënt in aanmerking voor protonentherapie. De voorspellingsmodellen worden vastgelegd in Landelijke Indicatie protocollen protonentherapie (LIPP). Als het LIPP goedgekeurd is door de NVRO, wordt het ingestuurd naar Zorg Instituut Nederland (ZiN). Zodra ZiN het LIPP goedkeurt, is protonentherapie verzekerde zorg voor patiënten die voldoen aan de criteria in het LIPP.

Sinds januari 2019 is het model van Darby et al (2013) opgenomen in het LIPP om de kans op hartschade te voorspellen. In de presentatie zal uitgelegd worden hoe dat praktisch in zijn werk gaat. Sinds februari 2022 zijn ook criteria benoemd in het LIPP op basis waarvan patiënt in aanmerking kan komen voor protonentherapie, ten einde de kans op een stralen-geïnduceerde long of borstkanker te verminderen. In het kort komt het erop neer dat vrouwen in aanmerking komen voor protonentherapie om de kans op borstkanker te verkleinen, indien zij bestraald worden ≤ 40-jarige leeftijd, en als het verschil in gemiddelde contralaterale borstdosis tussen fotonen en protonen ≥ 2 Gy is. Op grond van deze criteria neemt de kans op een contralaterale borstkanker af met ≥ 5%.  Patiënten kunnen in aanmerking komen voor protonentherapie om de kans op longkanker te verkleinen, indien zij bestraald worden op ≤ 50-jarige leeftijd, en roken/≤1 jaar geleden gestopt zijn met roken  of ≥ 20 packyears hebben, en indien het verschil in gemiddelde longdosis tussen fotonen en protonen ≥ 2 Gy is. Op grond van deze criteria neemt de kans op longkanker af met ≥ 2%.

In Nederland is tot nu toe vooral ervaring opgedaan met selectie van patiënten op basis van het verminderde risico op harttoxiciteit. De eerste ervaringen zullen tijdens de presentatie toegelicht worden (Boersma et al, 2022). We zien eigenlijk in de meeste omliggende normale weefsels afname van de bestralingsdosis, met uitzondering van de huid en de oesophagus.  Dat verklaart ook waarom we met name bij de eerste patiënten die met protonentherapie behandeld werden, enige toename van huid toxiciteit en oesophagitis zagen (Verhoeven et al, EBCC 2020). Na aanpassingen van de protonentechniek is deze toxiciteit al verminderd.

Tot slot zal in de presentatie ingegaan worden op de toekomstige plannen m.b.t. analyse van de uitkomsten, ook geplaatst in perspectief van lopende gerandomiseerde trials internationaal.

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Liesbeth Boersma

12:40

Lunch

Session 3: Oncoplastic surgery

Moderators: Linetta Koppert & Emmi Friedeman

14:15

Oncoplastische Chirurgie.. Wat We Nog Niet (precies) Weten

Dr. Mirelle Bröker, chirurg, Franciscus Gasthuis & Vlietland

Bio
Mirelle Bröker, oncologisch chirurg in het Franciscus Gasthuis & Vlietland.

Samenvatting
Meer dan 25 jaar geleden zijn de eerste oncoplastische technieken in de mammachirurgie ontwikkeld. Het bewijs van de voordelen van oncoplastische mammachirurgie is alleen vaak gebaseerd op single-centre observationele studies. Wat weten we nog niet precies weten, zullen we bespreken in deze presentatie met een speciale focus op de kwaliteit van leven van onze patiënten.

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Mirelle Bröker

14:35

Oncoplastic breast reconstructions: an overview

Dr. Marjolein de Kraker, plastisch chirurg, Franciscus Gasthuis & Vlietland

Bio
Ik ben opgeleid tot plastisch chirurg in het Erasmus MC te Rotterdam. Tevens ben ik tijdens mijn opleiding gepromoveerd op the (hypoplastic) thumb: assessment and outcome following reconstruction. Sinds 2016 ben ik als staflid werkzaam in het Erasmus MC en Franciscus Gasthuis. Ik heb me toegelegd op (oncoplastische) mammareconstructies en postbariatrische correcties na massaal gewichtsverlies.

Samenvatting
In de presentatie zal ik een overvieuw geven van de volume displacement technieken en volume replacement technieken die beschikbaar zijn om patiënten met verschillende soorten defecten (toch) mammasparend te kunnen opereren. Daarnaast zal ik voorbeelden van patiënten laten zien voor en na behandeling (en Rtx).

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Marjolein de Kraker

14:55

Radiotherapeutic pitfalls in oncoplastic surgery

Dr. Femke Froklage, radiotherapeut-oncoloog, Erasmus MC/ Franciscus Gasthuis & Vlietland

Bio
Femke Froklage studied Medicine at the Academic Medical Center in Amsterdam. After working as a resident Neurology and Neurosurgery she started as a PhD student at the departments of Neurology and Nucleair Medicine & PET research at the VU Medical Center, Amsterdam & Stichting Epilepsie Instellingen Nederland (SEIN). In 2017 she got her PhD degree. In 2019 she finished her Radiation Oncology internship at the VU Medical Center and started as a Radiation Oncologist at Erasmus MC focusing on breast cancer (including superficial hyperthermia treatment) and on uro-oncology. Now, 2.5 years later, she is supervising three PhD students. Within the breast cancer research her focus is on optimization of (oncoplastic) surgery and radiotherapy techniques to improve cosmetic outcome and quality of life in breast conserving therapy for breast cancer patients and on radiosensitivity.

Summary
The majority of breast cancer patients (> 70%) can be treated with breast conserving therapy consisting of surgical complete removal of the tumor followed by irradiation of the breast. Life expectancy after breast cancer treatment has become significantly longer due to improved multimodality treatment in the past decades. For this reason, long term treatment related side effects affecting quality of life become increasingly important. In oncoplastic reconstructive surgery an oncological resection is combined with plastic reconstructive techniques with the aim to improve cosmetic outcome without compromising oncological safety. Unfortunately, breast fibrosis occurs as a late adverse event in a substantial subset of patients (10-30%) after breast conserving therapy for ductal carcinoma in situ (DCIS) or breast cancer. Fibrosis can be painful and may result in poor cosmetic outcome. Fibrosis as well as poor cosmetic outcome can negatively affect the quality of life. Well-known risk factors for the development of fibrosis are:

  • Patient and tumor related: age, breast volume and tumor size.
  • Surgery related: excision volume and post-operative complications (e.g. seroma and hematoma).
  • Radiotherapy related: boost treatment, boost volume and maximum radiation dose.

In other words, besides patient and tumor related factors, both (oncoplastic) surgery and radiotherapy play a role in the risk of developing fibrosis. A better understanding of the different risk factors contributing to the development of fibrosis, and their interaction, after breast conserving therapy for (pre-invasive) breast cancer is needed.

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Femke Froklage

15:15

Future reconstructive perspectives

Dr. Eveline Corten, plastisch chirurg, Erasmus MC

Bio
Eveline M.L. Corten, M.D., Ph.D., Erasmus MC

Eveline Corten (1979) has been a reconstructive plastic surgeon since 2011 with a profound interest in medical technologies. Her clinical activities focus on oncological reconstructions of the breast, head & neck, and face. In mid-2019, she started her research on Extended Reality (XR). With 3-D technological innovations, she aims to optimize preoperative planning, patient experience, and medical education. She has a network of people with expertise in social sciences, industrial design, and computational imaging.

Summary
Abstract ‘Future reconstructive perspectives’

Technological innovations can offer powerful new tools to improve personalized care for breast cancer patients. Extended Reality (XR) – an umbrella for Augmented Reality (AR) and Virtual Reality (VR)- is an excellent example of such technology. It shows 3D visualizations of virtual objects in an immersive or ‘life-like’ experience. This upcoming technology extends our reality by either blending the ‘virtual’ and ‘real’ worlds or creating an entirely virtual experience. Precisely these features could be a game-changer in future oncological breast surgery.
First, XR could be used to support the breast surgeon and plastic surgeon in oncoplastic surgery during their preoperative assessment of the resection volume in relation to the breast volume. Second, patients could be more prepared for surgery or aided in their decision-making by offering a more life-like experience of the anticipated postoperative result. Third, XR could optimize preoperative planning and intraoperative navigation in lumpectomies and free flap breast reconstructions by visualizing patient-specific radiological images in an immersive environment.
Embracing the possibilities of digital health technologies like XR requires rethinking the conventional research process in healthcare. To successfully develop and implement XR technologies, we should apply a human-centered, holistic design approach within a collaborative network that combines psychosocial, surgical, and industrial design expertise. XR has the potential to cause a transformation in oncological breast surgery if we can provide sustainable XR that is effective, affordable & of value for the patients or healthcare providers.

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Eveline Corten

15:30

Break

Session 4: Neo-adjuvante issues in breast cancer

Moderator: Koop Bosscha

16:00

Descartes: Geen Radiotherapie Na Pathologisch Complete Respons Bij Ct1-2n0 Mammacarcinoom En Borstsparende Chirurgie

Dr. Frederieke van Duijnhoven, chirurg, NKI-AVL

Bio
Frederieke van Duijnhoven is sinds 2013 werkzaam als chirurg-oncoloog in het NKI-AVL, met als specialisatie mamma- en schildklierchirurgie. Haar onderzoek richt zich op de-escalatie van locale behandeling. Zij is co-PI bij de LORD studie (wait-and-see bij low risk DCIS) en kreeg eind 2022 als project leader een KWF-subsidie voor de DESCARTES studie. Sinds 2017 is zij secretaris van de EORTC Breast Cancer Group, en daar betrokken bij onderzoek naar kwaliteit van leven bij borstkankerpatienten. Tevens ondersteunt zij de patiëntenvereniging Phyllodestumoren bij het streven naar een landelijke richtlijn voor deze zeldzame tumoren.

Background
Over 60% of the women diagnosed with breast cancer in the Netherlands receive either adjuvant or neo-adjuvant systemic therapy,. Depending on the intrinsic subtype, 10-75% of patients will attain pathologic complete response (pCR) after neoadjuvant systemic therapy (NST). In patients with pCR, risk of local recurrence (LR) is consistently low across the different subtypes (ref Fraser Symmans, JAMA oncol 2021). The administration of adjuvant radiotherapy after breast conserving surgery (BCS) in these patients reduces LR further [ref], but is not expected to contribute to overall survival (OS) due to the low absolute benefit in local control [ref]. However, radiotherapy may cause added early and late toxicity. The aim of this study is to investigate the hypothesis that omission of radiotherapy after breast conserving surgery (BCS) in patients with a pCR after NST will result in acceptable low LR rates and good quality of life without compromising cancer worry levels.

Methods
The DESCARTES study is a national, multicenter, single arm prospective cohort study. Radiotherapy will be omitted in cT1-2N0 patients, regardless of hormone receptor and HER2- status who achieve a pCR of the breast and lymph nodes after NST followed by BCS plus sentinel node procedure. A pCR is defined as ypT0N0 (i.e. absence of invasive carcinoma and in-situ carcinoma in the breast). Primary endpoint is the 5-year LR rate, which is expected to be 4% and deemed acceptable if less than 6%. In total, 595 patients are needed to achieve a power of 80% (one-side alpha of 0.05) to assess non-inferiority of the primary endpoint after a median follow-up period of 5 years.

Secondary outcomes are quality of life, measured using EORTC-QLQ-C30, EORTC-QLQ-BR23 and Cancer Worry Scale questionnaires at baseline and at one and four years after surgery, and disease specific and overall survival. Projected accrual period is five years.

Discussion
This study bridges the knowledge gap regarding LR rates when radiotherapy is omitted in cT1-2N0 patients achieving pCR  treated with BCS after NST. If the results are positive, radiotherapy may be safely omitted in selected breast cancer patients with a favourable clinical tumour staging  and pCR after NST.

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Frederieke van Duijnhoven

16:15

How complete is radiologic complete response after NAC?

Claudette Loo, radioloog, NKI-AVL

Bio
Claudette Loo is a dedicated experienced breast radiologist. In 2002 she started a fellowship oncology at the radiology department at the Netherlands Cancer Institute – Antoni van Leeuwenhoek (AVL) in Amsterdam. During the fellowship she focused on the diagnostic imaging of breast cancer, with a special interest in breast MRI. She became a dedicated breast radiologist and settled in the radiology staff and diagnostic research group. She is a deputy trainer of the oncology internship AVL for residents of the AMC and responsible of the breast radiology fellowship at the AVL. Since 2011 she is working for the Dutch national breast cancer screening program as a screening radiologist and coordinating the radiology group ‘Noord-Holland Noord’. Her primary research topic is on breast MRI, which has resulted in her thesis titled: DCE MRI for monitoring response to neoadjuvant chemotherapy in breast cancer.

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Claudette Loo

16:25

Surgical management of the breast and axilla

Dr. Andrea Barrio, surgeon, Breast Service, MSKC, New York

Bio
Andrea V. Barrio, MD, FACS
Associate Attending
Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center

Andrea V. Barrio, MD, FACS is an Associate Attending with the Breast Service, Department of Surgery at Memorial Sloan Kettering Cancer Center, and an Associate Professor of Surgery at Weill Cornell Medical College. Dr. Barrio received her BS degree from the University of California, Los Angeles and her MD from the University of California, Los Angeles School of Medicine, where she was elected to the membership of the Alpha Omega Alpha Honor Medical Society. She completed her surgical residency at New York Presbyterian Hospital, Weill Cornell Medical Center, followed by one year of breast surgical oncology fellowship training at Memorial Sloan Kettering Cancer Center.

Dr. Barrio’s clinical practice is focused on the surgical treatment of breast disease, particularly breast cancer. Her research interests include the management of the axilla in patients receiving neoadjuvant chemotherapy, and the study of lymphedema in early-stage breast cancer patients. Dr. Barrio is currently the principal investigator of two investigator-initiated, grant-funded prospective studies: a lymphedema study evaluating incidence, risk factors, and quality of life in breast cancer patients treated with axillary lymph node dissection, and a single-arm prospective study evaluating the technical feasibility and false-negative rate of sentinel lymph node biopsy after neoadjuvant chemotherapy in patients presenting with locally advanced breast cancer.

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Andrea Barrio

16:45

When still radiotherapy?

Dr. Astrid Scholten, radiotherapeut-oncoloog, NKI-AVL

Bio
Astrid Scholten is radiotherapeut-oncoloog, werkzaam in het Antoni van Leeuwenhoek (AVL) in Amsterdam. Zij rondde haar opleiding in het LUMC in 2006 af, en bleef daar tot 2013 als radiotherapeut-oncoloog werken, waarna zij de overstap maakte naar het AVL. Haar aandachtsgebieden zijn het mammacarcinoom en sarcomen. Na haar promotie in 2005, richt haar onderzoek zich vooral op de-escalatie studies bij borstkanker.

Samenvatting
De afgelopen jaren is er veel veranderd in het radiotherapeutisch beleid bij vrouwen met borstkanker. Bestralingsseries zijn vaak korter geworden, doelvolumina kleiner en bestraling wordt steeds vaker achterwege gelaten. Doordat steeds meer patiënten hun systeemtherapie neo-adjuvant krijgen, kunnen we het effect van de systeemtherapie ook meewegen in onze beslissing t.a.v. radiotherapie. Voor welke patiënten is radiotherapie nog aangewezen? En zal dat ook zo blijven?

103-Scholten-Astrid

Astrid Scholten

17:10

Drinks

19:00

Dinner and fire place lecture by Andries Tunru

https://www.andriestunru.nl

woensdag 15 jun

08:00

Welcome

Session 1: Endocrine therapy and beyond

Moderator Maud Bessems

09:10

Extending or intensifying endocrine therapy

Prof. dr. Vivianne Tjan-Heijnen, medisch oncoloog, Maastricht UMC+

Bio
Prof dr. Vivianne Tjan-Heijnen (1964) is medical oncologist. She chairs the department of Medical Oncology (> Sept 2006) and chairs the breast team of Maastricht University Medical Centre. She was initiator and first director of the Comprehensive Cancer Network South-East Netherlands (OncoZON), involving in total 11 institutes (2010-2015). She is the past president of the National Breast Cancer Organization of the Netherlands (NABON; 2008-2012) and initiated the NABON-Breast Cancer Audit, yearly assessing quality of breast cancer care in Dutch hospitals. She was chair of the  Dutch Committee-BOM (assessing cost-effective use of new oncological drugs; 2008-2013). She was member of the Supervisory Board of the Dutch Comprehensive Cancer Centre (CCC) South Netherlands (RvT IKZ, 2012–2013) and of CCC Netherlands (RvT IKNL, 2014-2015). She was a member of one of KWF committees (2018-2022). Her main field of interest is breast cancer. Her research focuses on quality of care in daily practice and cost-effective implementation of new treatments. She initiated several Dutch breast cancer studies (Two-to-Six, INTENS, DATA, MIRROR, SONABRE) and is involved in many international studies. She (co-)authored 275 peer-reviewed full papers and is/was supervisor of 50 PhD students.

Summary
Improving outcome of HR+ breast cancer during previous decades is the result of improving every step within the treatment chain of early HR+/HER2- breast cancer. In my lecture, I will focus on the role of extending endocrine treatment (aromatase inhibitors) after the first 5 years and the results of CDK4/6 inhibitor treatment as seen in the global MonarchE trial.

Breast cancer mortality has stepwise reduced by the introduction of 5 years of tamoxifen and the switch strategy (tamoxifen – aromatase inhibitor) in postmenopausal women. Nevertheless, the risk of breast cancer recurrence is still very high for women with early breast cancer who have unfavourable tumour characteristics.

In order to improve outcome, many studies have been done using extended endocrine treatment, more specifically extended aromatase inhibitor treatment. We studied this in the national DATA trial. The Oxford Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) has collected all individual patient data on relevant trials and are able to detect small, but yet clinically relevant differences that might lead to guideline changes. During the lecture I will give a summary of the results on extended aromatase inhibitor treatment and some considerations hereon.

Next, I will discuss the MonarchE trial. In this trial patients with high-risk early breast cancer were assigned to two years abemaciclib treatment (a CDK4/6 inhibitor) or to the control arm. All patients were free to undergo (neo)adjuvant chemotherapy and were recommended to use endocrine treatment according to guidelines. EMA has recently approved the use of abemaciclib in patients with high-risk early breast cancer, but it is not yet available in the Netherlands. I will present the latest updated results of MonarchE and will place these next to the results of extended aromatase inhibitor treatment.

119-Tjan-Heijnen-Vivianne

Vivianne Tjan-Heijnen

09:30

Early discontinuation of endocrine therapy & breast cancer recurrence

Prof. dr. Deirdre Cronin Fenton, Associate Professor, Aarhus University Hospital

Bio
Deirdre Cronin Fenton holds a Ph.D. in Molecular Biology and Cancer Research from Dublin City University, Ireland and performed a Post-doctoral Fellowship in Cancer Epidemiology at the U.S. National Cancer Institute and National Cancer Registry, Ireland. Currently she is an Associate Professor at the Department of Clinical Epidemiology, Aarhus University where she leads the Breast Cancer Research Group. Her research interests are in cancer epidemiology, specifically cancer risk and prognosis, and how molecular and genetic markers can be combined with population-based research to further understand the risk, prognosis, and aftermath of cancer. Her recent contributions include developing biobanks coupled to registry data to elucidate predictive and prognostic cancer biomarkers, uncovering the incidence of complications after cancer-directed treatment and the impact of prescription drugs on cancer risk and prognosis, and developing and validating algorithms to identify the long-term risk of cancer recurrence, and prognosis after cancer recurrence.

Summary – Talk 1
Endocrine therapy is a cornerstone of the treatment of estrogen receptor positive (ER+) breast tumors. Premenopausal women with ER+ breast tumors are recommended to receive at least 5 years and up to 10 years of tamoxifen therapy. Tamoxifen therapy is associated with substantial survival benefit, but is associated with adverse side effects, which may lead to treatment discontinuation. Early discontinuation of tamoxifen therapy has been associated with increased risk of breast cancer recurrence. This talk outlines research performed using the “Predictors of Breast Cancer Recurrence” (ProBeCaRe) cohort—a cohort of premenopausal women diagnosed with early stage (non-distant metastatic) breast cancer. I will present our findings on the association of early discontinuation of endocrine therapy with the risk of breast cancer recurrence.

118-Deirdre-Cronin-Fenton _credit Simon Byrial Fischel

Deirdre Cronin Fenton - photo credit Simon Byrial Fischel

09:55

New options in adjuvant endocrine therapy in breast cancer

Prof. Giuseppe Curigliano, medical oncologist, European Institute of Oncology, Milano, Italy

10:20

Break

Session 2 : Breast cancer in young women

Moderator: Vivianne Tjan

11:00

Young women with breast cancer: epidemiology and socioeconomic status

Marissa van Maaren, klinisch epidemioloog, IKNL, Utrecht

Bio
Marissa van Maaren is klinisch epidemioloog bij het Integraal Kankercentrum Nederland (IKNL) en onderzoeker en docent onderzoeksmethodologie aan de Universiteit Twente. Ze behaalde haar PhD in 2018 bij de Universiteit Twente, waarbij ze promoveerde op het onderwerp: ‘Local management of early breast cancer and clinical risk prediction of survival’.

In haar huidige onderzoek focust zij voornamelijk op de predictie van langetermijneffecten (m.n. recidieven) na verschillende behandelingen bij borstkanker. Verder is ze betrokken bij meerdere onderzoeken op het gebied van variatie in behandeling en follow-up. Op dit moment is ze druk bezig met het verzamelen van alle pathologisch bevestigde recidieven in de Nederlandse Kankerregistratie.

Marissa is bestuurslid van de Vereniging voor Epidemiologie, waar zij focust op de meer geavanceerde epidemiologische methoden: hoe zorgen we ervoor dat zowel epidemiologen binnen en buiten de academie bekend zijn met de nieuwste ontwikkelingen en hoe kunnen bestaande kennis het beste verspreiden. Verder coördineert ze de externe toetsingsprocedure van NKR gegevensaanvragen op het gebied van borstkanker in de NABON-BOOG wetenschappelijke toetsingscommissie.

Samenvatting
Borstkanker bij jonge vrouwen presenteert zich vaak in een agressievere vorm dan bij oudere vrouwen. Omdat de prognose in deze groep anders is, is het belangrijk om deze groep apart te analyseren. Op het moment is er veel aandacht voor verschillen in overleving tussen sociaaleconomische klassen. Uit onderzoek blijkt dat deze verschillen het grootst zijn in de groep jonge vrouwen, maar onduidelijk is hoe recidiefpatronen verschillen in deze groep. In deze presentatie worden de resultaten van een onderzoek naar de relatie tussen sociaaleconomische status, recidiefpatronen en relatieve overleving in jonge vrouwen (<40 jaar) gepresenteerd.

107-van_Maaren-Marissa

Marissa van Maaren

11:20

Guidelines/kwaliteit van leven

Dr. Linetta Koppert, oncologisch chirurg, Erasmus MC

11:55

Adjuvant treatment in HR+ breast cancer

Dr. Judith Kroep, medisch oncoloog, LUMC Leiden

Bio
Judith Kroep, MD, PhD, associate professor LUMC

Judith Kroep, MD, PhD, associate professor, is a Medical Oncologist at the LUMC Leiden. She is specialized in the treatment of breast and gynecological cancers and translational research in this field. She is chair of the neoadjuvant group of the BOOG.

Summary
Breast cancer (BC) in young women is relatively rare. About 15% of patients with BC are diagnosed during their reproductive years. Breast cancer in young women requires special attention due to its specific morphologic and prognostic characteristics and unique aspects, including genetic testing, fertility preservation and pregnancy wish during adjuvant endocrine therapy. Age has been shown to be an independently prognostic for survival in HR +/HER2- BC. Although the basics of chemotherapy and endocrine therapy are the same for patients of all ages, younger women have some special considerations. Moreover, the DIRECT-2 trial on fasting mimicking Diet program to ImpRovE ChemoTherapy in HR+, HER2- breast cancer will be discussed.

109-Judith-Kroep

12:15

Lunch

Asperges and strawberries

Session 3: DCIS, breast cancer and recurrence

Moderator: Koop Bosscha

13:30

Late breast cancer recurrence: risk and prognosis

Prof. dr. Deirdre Cronin Fenton, Associate Professor, Aarhus University Hospital

Bio
Deirdre Cronin Fenton holds a Ph.D. in Molecular Biology and Cancer Research from Dublin City University, Ireland and performed a Post-doctoral Fellowship in Cancer Epidemiology at the U.S. National Cancer Institute and National Cancer Registry, Ireland. Currently she is an Associate Professor at the Department of Clinical Epidemiology, Aarhus University where she leads the Breast Cancer Research Group. Her research interests are in cancer epidemiology, specifically cancer risk and prognosis, and how molecular and genetic markers can be combined with population-based research to further understand the risk, prognosis, and aftermath of cancer. Her recent contributions include developing biobanks coupled to registry data to elucidate predictive and prognostic cancer biomarkers, uncovering the incidence of complications after cancer-directed treatment and the impact of prescription drugs on cancer risk and prognosis, and developing and validating algorithms to identify the long-term risk of cancer recurrence, and prognosis after cancer recurrence.

Summary – Talk 2
Close to 75% of women with breast cancer survive at least 10 years after primary diagnosis. This high survival calls for better understanding of the risk and clinical course of “late” breast cancer recurrence—i.e., local or metastatic recurrence of breast cancer that occurs >=10 years after primary diagnosis. In this talk, I present research involving the development of an algorithm to ascertain late breast cancer recurrence from Danish population-based and medical registries. I will give an overview of our findings on the epidemiology of late breast cancer recurrence, focused on the risk and prognosis of late breast cancer recurrence.

118-Deirdre-Cronin-Fenton _credit Simon Byrial Fischel

Deirdre Cronin Fenton - photo credit Simon Byrial Fischel

13:50

Surgical issues

Dr. Andrea Barrio, surgeon, Breast Service, MSKC, New York

Bio
Andrea V. Barrio, MD, FACS
Associate Attending
Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center

Andrea V. Barrio, MD, FACS is an Associate Attending with the Breast Service, Department of Surgery at Memorial Sloan Kettering Cancer Center, and an Associate Professor of Surgery at Weill Cornell Medical College. Dr. Barrio received her BS degree from the University of California, Los Angeles and her MD from the University of California, Los Angeles School of Medicine, where she was elected to the membership of the Alpha Omega Alpha Honor Medical Society. She completed her surgical residency at New York Presbyterian Hospital, Weill Cornell Medical Center, followed by one year of breast surgical oncology fellowship training at Memorial Sloan Kettering Cancer Center.

Dr. Barrio’s clinical practice is focused on the surgical treatment of breast disease, particularly breast cancer. Her research interests include the management of the axilla in patients receiving neoadjuvant chemotherapy, and the study of lymphedema in early-stage breast cancer patients. Dr. Barrio is currently the principal investigator of two investigator-initiated, grant-funded prospective studies: a lymphedema study evaluating incidence, risk factors, and quality of life in breast cancer patients treated with axillary lymph node dissection, and a single-arm prospective study evaluating the technical feasibility and false-negative rate of sentinel lymph node biopsy after neoadjuvant chemotherapy in patients presenting with locally advanced breast cancer.

104-Barrio-Andrea

Andrea Barrio

14:10

Radiotherapy for DCIS, to do or not to do?

Marcel Stam, radiotherapeut, Radiotherapiegroep Arnhem/Ede

Bio
Bekijk zijn LinkedIn pagina: https://www.linkedin.com/in/marcel-stam-96b77033/?locale=nl_NL

Samenvatting
In deze presentatie zal een kort overzicht van de beschikbare literatuur evidence en rationale voor postoperatieve radiotherapie van DCIS gegeven worden. Vervolgens worden de belangrijkste ontwikkelingen, van de afgelopen 15 jaar, binnen de radiotherapie, in het kader van de mammasparende therapie, toegelicht. Daarbij wordt ook de toenemende overbehandeling van het DCIS besproken met een overzicht van verschillende lokaal recidief voorspellende nomogrammen/testen. Als laatste wordt nog kort de BRASA keuzehulp gepresenteerd.

106-Stam-Marcel

Marcel Stam

14:40

Break

Session 4: Topics in oncology

Moderator: Marianne Melsen

15:10

Antibody drug conjugates

Prof. Giuseppe Curigliano, medical oncologist, European Institute of Oncology, Milano, Italy

15:30

Latest developments on immune checkpoint inhibor for BC

Marleen Kok, medisch oncoloog, NKI-AVL

15:50

European guidelines in advanced disease

Allessandra Gennari, medical oncologist, University hospital, Novara, Italy

16:15

Farewell drinks