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Transcript of Vakalis breast radiotherapy
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FUZZ-IEEE 2009
Ακτινοθεραπεία Ca μαστού ενδείξεις ανά στάδιο
ειδικές ομάδες ασθενών
Ακτινοθεραπευτής Ογκολόγος Euromedica – Αθήναιον Α Ιατρικό Κέντρο Αθηνών
Βακάλης Ξενοφών
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Breast cancer
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Breast cancer
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FUZZ-IEEE 2009
Radiotherapy in DCISDuctal Carcinoma In-Situ
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Radiotherapy in DCIS
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Radiotherapy in DCIS
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FUZZ-IEEE 2009
Radiotherapy in DCISDuctal Carcinoma In-Situ
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Radiotherapy in DCIS
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Radiotherapy in DCIS
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Breast Cancer Nomogram: Ductal Carcinoma In Situ (DCIS) Recurrence
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Breast Cancer Nomogram: Ductal Carcinoma In Situ (DCIS) Recurrence
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Radiotherapy in DCIS
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OncoTypeDXfor Estimating Recurrence Risk After Lumpectomy with No Radiation
Score Any Recurrence Invasive Recurrence
Low Risk 12% 5%
Intermediate Risk 25% 9%
High Risk 27% 19%
E5194 study
http://www.genomichealth.com/en-US/OncotypeDX.aspx further validation of these results is required
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Radiotherapy in DCIS
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Radiotherapy in early stage invasive BC
clinical stage I, IIA, or a subset of stage IIB disease (T2N1)
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Radiotherapy in early stage invasive BC
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Radiotherapy in early stage invasive BC
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Radiotherapy in early stage invasive BC
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EBCTCG Meta-analysis of BCS +/- RT
(EBCTCG, Lancet 366:17,2005)
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FUZZ-IEEE 2009
Radiotherapy in early stage invasive breast cancer
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Radiotherapy in early stage invasive BC
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Radiotherapy in early stage invasive BC
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Radiotherapy in early stage invasive BC
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Radiotherapy in early stage invasive BC
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Radiotherapy in early stage invasive BC
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Radiotherapy in early stage invasive BC
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Radiotherapy in early stage invasive BC
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Radiotherapy in early stage invasive BC
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FUZZ-IEEE 2009
Nodal Radiotherapy
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Nodal Radiotherapy
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Nodal Radiotherapy
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Nodal Radiotherapy
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Nodal Radiotherapy
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Nodal Radiotherapy
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Nodal Radiotherapy
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Nodal Radiotherapy (IMN)
MA-20
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Nodal Radiotherapy (IMN)
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Nodal Radiotherapy (IMN)
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How to Manage Axilla in cN0 after SLNDSLND
Negative SLNNo additional axillary treatment necessary•Milan trial, SLN = ALND•NSABP B-32, SLN = ALND
Positive SLN•Full node dissection•No Axillary treatment
• ACOSOG Z0011 •IBCSG 23-01 •AMAROS
How to Manage Axilla after SLND
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How to Manage Axilla after SLND
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How to Manage Axilla after SLND
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High Tangents Cover Most ofLevel I/II Axilla
• High tangent fields includes most of area at risk
• Superior border: Just below humeral head
• Posterior border: 2 cm within the lung includes:– over 95% of SLN– over 80% of level I and II axilla
Schlembach, Int J Rad Oncol Biol Phys, 2001
How to Manage Axilla after SLND
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How to Manage Axilla after SLND
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AMAROS
Standard ALND Radiotherapy P-value
5-year Axillary Recurrence rate 0.54% (4/744) 1.03% (7/681)
5-year Overall Survival Rate 93.3 92.5 0.338
5-year Disease-free Survival Rate 86.9 82.7 0.179
ASCO 2013
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Nodal Radiotherapy
AMAROS
MA20N+
MA20High risk
N0
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FUZZ-IEEE 2009
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Post-Mastectomy Radiotherapy
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Post-Mastectomy Radiotherapy
Limit LRR 15% for RT
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Post-Mastectomy Radiotherapy
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Post-Mastectomy RadiotherapyIndications for PMRT
G.M. Freedman ASTRO Spring Refresher Course 2013
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Post-Mastectomy Radiotherapy
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Post-Mastectomy Radiotherapy
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Post-Mastectomy RadiotherapyIndications for PMRT
G.M. Freedman ASTRO Spring Refresher Course 2013
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FUZZ-IEEE 2009
Tumor Bed Boost
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Tumor Bed BoostStage I-II
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Tumor Bed Boost
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Tumor Bed Boost
No difference in overall survival, breast cancer mortality, or disease-free survival at 10 years
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Effects of Boost on 10-Year LRby Age & Grade
Bartelink H, et al., J Clin Oncol 2007Jones, H. A. et al. J Clin Oncol 2009
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Tumor Bed Boost
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NCCN Guidelines Version 3.2013
• The breast should receive a dose of 45-50 Gy in 1.8 – 2 Gy per fraction, 42.5 Gy at 2.66 Gy per fraction.
• A boost to the tumor bed is recommended for patients in higher risk for local failure:– Age < 50– Positive lymph nodes– LVI– Close margins
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Tumor Bed Boost (DCIS)
NCIC CTG MA.33
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Tumor Bed Boost
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FUZZ-IEEE 2009
Radiotherapy after Neoadjuvant Chemotherapy
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Radiotherapy after Neoadjuvant Chemotherapy
lack of prospective data
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Radiotherapy after Neoadjuvant Chemotherapy
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Radiotherapy after Neoadjuvant Chemotherapy
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FUZZ-IEEE 2009
Radiotherapy after Neoadjuvant Chemotherapy
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Radiotherapy after Neoadjuvant Chemotherapy
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FUZZ-IEEE 2009
Radiotherapy after Neoadjuvant Chemotherapy
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Radiotherapy after Neoadjuvant Chemotherapy
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Radiotherapy after Neoadjuvant Chemotherapy
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Radiotherapy after Neoadjuvant Chemotherapy
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FUZZ-IEEE 2009
Whole Breast Hypofractionation
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Whole Breast Hypofractionation
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Whole Breast Hypofractionation
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Whole Breast Hypofractionation
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Whole Breast Hypofractionation
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Whole Breast Hypofractionation
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Whole Breast Hypofractionation
NCCN-No
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ACCELERATED PARTIAL BREAST IRRADIATION
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ACCELERATED PARTIAL BREAST IRRADIATION
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Radiotherapy in invasive BC
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Individualized Radiotherapy in BC
A lot of subgroups
No RT of breast in DCISNo RT of breast in early stage of invasive caNo boostHypofractionated RT of whole breastAccelerated Partial RT
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THANKS FOR YOUR ATTENTION!