Session Item

May 24
08:00 - 18:00
Mining the radiotherapy dose: exploring dose-response patterns in radiation therapy (no online session)
Choice of workshop
Preoperative radiation therapy in breast cancer: preliminary results from ROCK trial (NCT03520894)
Vanessa Di Cataldo, Italy


Preoperative radiation therapy in breast cancer: preliminary results from ROCK trial (NCT03520894)

Vanessa Di Cataldo1, Giulio Francolini2, Luca Visani1, Carlotta Becherini2, Erika Scoccimarro3, Laura Masi1, Raffaela Doro1, Giulia Salvatore4, Simonetta Bianchi5, Vania Vezzosi6, Elisa Lemmi6, Jacopo Nori7, Luis Sanchez8, Lorenzo Orzalesi8, Marco Bernini8, Mauro Loi2, Isacco Desideri4, Monica Mangoni4, Icro Meattini4, Lorenzo Livi4

1IFCA, Cyberknife, Florence, Italy; 2Azienda Ospedaliero-Universitaria Careggi, Radiation Oncology Unit, Oncology Department, Florence, Italy; 3University of Florence, Department of Experimental and Clinical Biomedical Sciences Mario Serio, Florence, Italy; 4University of Florence, Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Florence, Italy; 5 Azienda Ospedaliero-Universitaria Careggi, Division of Pathological Anatomy, Florence, Italy; 6Azienda Ospedaliero-Universitaria Careggi, Division of Pathological Anatomy, Florence, Italy; 7Azienda Ospedaliero-Universitaria Careggi, Diagnostic Senology Unit, Florence, Italy; 8Azienda Ospedaliero-Universitaria Careggi, Breast Surgery Unit, Florence, Italy

Show Affiliations
Purpose or Objective

Preoperative radiation therapy in early breast cancer (BC) may have potential advantage if compared with standard breast conserving surgery (BCS) followed by postoperative radiation. Our institution is currently conducting an exploratory study enrolling early BC patients undergoing preoperative robotic stereotactic radiosurgery (prRS) (NCT03520894-ROCK trial).

Material and Methods

Womens age 50 or older, with histologically proven invasive BC, positive hormonal receptors, HER-2 negative, without lymphovascular invasion, and tumour size up to 25 mm, negative clinical nodal status, eligible for BCS were enrolled. Fiducial markers were introducted in peri/intralesional position (3-5 markers) one week before planning CT. Magnetic resonance imaging (MRI) was used in conjunction with standard computed tomography (CT)-based planning to identify contrast enhancing tumor. Patients received 21 Gy in single fraction prRS followed by definitive surgery two weeks later. Objects of this preliminary analysis were incidence of acute skin toxicity after treatment according to EORTC/RTOG scale and efficacy.


Of 49 patients screened on mammography findings, 18 were elegible for histology. Of those, 7 were excluded at the time of MRI due to multifocal disease and 12 patients were succesfully treated. All required dosimetric parameters were met in all patients, as were normal tissue constraints. The median follow-up was 18 months (range 6-29.8). All treated patients underwent to BCS within 14 day from prRS without any delay or complication. No patients showed erythema or pain at the time of BCS and no wound dehiscence was observed. No patients experienced acute skin toxicity of grade 2 or higher, only 1 patients had a grade 1 erythema at the 1 month postoperative visit.  According to Chevallier’s classification 1 patient had a pathological complete response (pCR).


Preliminary results from ROCK trials showed that prRS in BC is a feasible technique of implementing single dose preoperative radiation therapy. PrRS is well tolerated with a tolerable safety profile and a promising rate of response.  This new approach in breast cancer management is currently based on limited data but should be further investigated to corroborate these findings. Considering drop out rate if compared to overall cohort of screened patients, selection criteria and multidisciplinary collaboration represent a critical issue in this scenario.