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Title:

Radiation Therapy for Breast Cancer

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Breast conserving therapy consisting of lumpectomy and RT. Mastectomy /- reconstruction ... Clinical Trials Comparing Lumpectomy with and without RT ... – PowerPoint PPT presentation

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Title: Radiation Therapy for Breast Cancer


1
Radiation Therapy for Breast Cancer
  • Ping Zhou, MD, PhD
  • Nashua Regional Cancer Center
  • Radiation Oncology Associates PA
  • October 2009

2
Major Options for Local Treatment
  • Breast conserving therapy consisting of
    lumpectomy and RT
  • Mastectomy /- reconstruction
  • Based on long term results of randomized clinical
    trials, these two approaches have been
    established as equivalent for survival

3
Is radiation always necessary after lumpectomy?
4
Clinical Trials Comparing Lumpectomy with and
without RT
  • 5 randomized trials for invasive breast cancer
    all show a large reduction (70) in local
    recurrence with RT.
  • The overall local recurrence risk is 26
    without RT, vs 7 with RT.
  • This results in 17 reduction in cancer
    mortality.

5
Is RT always necessary in pts gt70 yrs ?
  • Recurrence risk is lower in older patients with
    ER cancer, compared to younger patients.
  • Tamoxifen alone without RT may be a reasonable
    option in woman with serious co-morbid illnesses.
  • However, its less applicable in healthy older
    patients with anticipated long life expectancy.

6
Side effects
  • Acute side effects
  • Sun burn reaction in the treated breast
  • Mild fatigue
  • Potential long term side effects
  • Majority of patients have little or no long term
    problems
  • Uncommon shrinkage of the breast
  • Rare rib fracture, lung scarring, heart damage
    when left breast treated, radiation related
    cancer
  • Sophisticated modern radiation planning has
    resulted in less short term and long term
    complications

7
Radiation Program
  • Typically 6 weeks of daily radiation, Monday to
    Friday, 15 minutes each day
  • First 4.5 wks treating the entire breast /-
    nodes
  • Last 1.5 wks boosting the surgical bed where the
    recurrence risk is the highest
  • Selective pts may be candidates for shorter
    course ( 4 wks)

8
Simulation
  • Patient placed in the treatment position
  • CT images acquired
  • Tattoos and measurements taken

9
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10
Treatment Planning
  • CT images are transferred to 3D radiation
    treatment planning workstations.
  • Radiation oncologist identifies treatment targets
    and critical structures, and prescribes the
    treatment volume and dosage.
  • Medical physicist develops the plan and
    calculates the dose.
  • Tangential breast fields to encompass the breast
    with only a small margin of the lung included.
    Heart is usually excluded from the RT field.

11
New Technology Forward Planning IMRT
  • A new form of 3D conformal RT
  • Modifying the intensity of each radiation beam to
    generate optimal dose distribution
  • Less short term and long term side effects
  • Nashua Regional Cancer Center is among the first
    in NH in incorporating this new technology in
    routine breast radiation

12
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13
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14
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15
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16
Accelerated Partial Breast Irradiation, such as
Mammosite
  • Radiation to the tumor bed only
  • Larger dose/day and shorten treatment to 1 week
  • Potentially minimizing irradiation of critical
    organs
  • Convenience

17
However,
  • Relatively short track record
  • Long term safety and efficacy requires further
    evaluation
  • Await results from ongoing phase III study
    comparing whole breast RT vs. partial breast RT

18
American Society of Radiation Oncology Consensus
Guideline for Using PBI Outside of Clinical
Trial
  • Conservative patient selection criteria
  • T lt2cm, negative nodes, invasive ductal
    histology, unicentric tumor, Age gt60, ER ,
    margin gt 2mm, no lymphovascular invasion
  • Informed consent
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