vakalis breast radiotherapy
TRANSCRIPT
FUZZ-IEEE 2009
Ακτινοθεραπεία Ca μαστού ενδείξεις ανά στάδιο
ειδικές ομάδες ασθενών
Ακτινοθεραπευτής Ογκολόγος Euromedica – Αθήναιον Α Ιατρικό Κέντρο Αθηνών
Βακάλης Ξενοφών
Breast cancer
Breast cancer
FUZZ-IEEE 2009
Radiotherapy in DCISDuctal Carcinoma In-Situ
Radiotherapy in DCIS
Radiotherapy in DCIS
FUZZ-IEEE 2009
Radiotherapy in DCISDuctal Carcinoma In-Situ
Radiotherapy in DCIS
Radiotherapy in DCIS
Breast Cancer Nomogram: Ductal Carcinoma In Situ (DCIS) Recurrence
Breast Cancer Nomogram: Ductal Carcinoma In Situ (DCIS) Recurrence
Radiotherapy in DCIS
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
Radiotherapy in DCIS
Radiotherapy in early stage invasive BC
clinical stage I, IIA, or a subset of stage IIB disease (T2N1)
Radiotherapy in early stage invasive BC
Radiotherapy in early stage invasive BC
Radiotherapy in early stage invasive BC
EBCTCG Meta-analysis of BCS +/- RT
(EBCTCG, Lancet 366:17,2005)
FUZZ-IEEE 2009
Radiotherapy in early stage invasive breast cancer
Radiotherapy in early stage invasive BC
Radiotherapy in early stage invasive BC
Radiotherapy in early stage invasive BC
Radiotherapy in early stage invasive BC
Radiotherapy in early stage invasive BC
Radiotherapy in early stage invasive BC
Radiotherapy in early stage invasive BC
Radiotherapy in early stage invasive BC
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
Nodal Radiotherapy (IMN)
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Nodal Radiotherapy (IMN)
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
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
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
Nodal Radiotherapy
AMAROS
MA20N+
MA20High risk
N0
FUZZ-IEEE 2009
Post-Mastectomy Radiotherapy
Post-Mastectomy Radiotherapy
Limit LRR 15% for RT
Post-Mastectomy Radiotherapy
Post-Mastectomy RadiotherapyIndications for PMRT
G.M. Freedman ASTRO Spring Refresher Course 2013
Post-Mastectomy Radiotherapy
Post-Mastectomy Radiotherapy
Post-Mastectomy RadiotherapyIndications for PMRT
G.M. Freedman ASTRO Spring Refresher Course 2013
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
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
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
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
FUZZ-IEEE 2009
Radiotherapy after Neoadjuvant Chemotherapy
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Radiotherapy after Neoadjuvant Chemotherapy
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
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
Radiotherapy in invasive BC
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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