BALKAN MCO 2011 - E. Vrdoljak - Locoregional therapy in LABC

[object Object],[object Object],[object Object],[object Object]

Justification for the use of postmastectomy radiotherapy (PMRT) for patients with invasive breast cancer ,[object Object],[object Object],EBCTCG. Lancet 2005.

Effects of RT on breast cancer mortality and all cause mortality after breast conserving / mastectomy and axillary clearance EBCTCG. Lancet 2005.

[object Object],[object Object],P ostmastectomy radiotherapy (PMRT) for patients with invasive breast cancer

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Phase III randomized trials

Danish 82b Trial ,[object Object],[object Object],[object Object],[object Object],[object Object]

Results ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],Overgaard et al. NEMJ 1997.

Danish 82c Trial ,[object Object],[object Object],[object Object]

Results ,[object Object],[object Object],[object Object],Overgaard et al. Lancet 1999.

[object Object],[object Object],Overgaard et al. Lancet 1999.

Danish 82b and 82c trials ,[object Object],[object Object],[object Object],[object Object]

Danish 82b and 82c trials ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

PMRT 1-3 L N+ with 8 or more nodes dissected- DBCG 82 b and 82 c trial Overgaard et al. Radioth Oncol 2007. RT No RT p value LRR 4% 27% <0.001 Overall survival 57% 48% 0.03

British Columbia Trial ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

. Pierce L J JCO 2005 . British Columbia Trial - OS

Limitations of Evidence ,[object Object],[object Object],[object Object],[object Object]

Cofactors associated with higher LRR in 1-3 lymph nodes positive and without radiotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object]

Randomized trials comparing systemic therapy with systemic therapy plus PMRT -meta analysis ,[object Object],[object Object],[object Object],[object Object],[object Object]

Summary of ASCO guidelines ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],Patterns of Locoregional Failure in Patients With Operable Breast Cancer Treated by Mastectomy and Adjuvant Chemotherapy With or Without Tamoxifen and Without Radiotherapy: Results From Five National Surgical Adjuvant Breast and Bowel Project Randomized Clinical Trials Taghian A et al. JCO 2004

[object Object],[object Object],Patterns of Locoregional Failure in Patients With Operable Breast Cancer Treated by Mastectomy and Adjuvant Chemotherapy With or Without Tamoxifen and Without Radiotherapy: Results From Five National Surgical Adjuvant Breast and Bowel Project Randomized Clinical Trials Taghian A et al. JCO 2004

Early Breast Cancer Trialists' Collaborative Group (EBCTCG) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival. An overview of the randomised trials Lancet 2005;366:2087-2106

Trials of post-mastectomy RT Effect on LR and breast cancer mortality in N- pts Mastect + AC Mastect + AC Mastect + AC + RT Mastect + AC + RT

Trials of post-mastectomy RT Effect on LR and breast cancer mortality in N+ pts Mastect + AC + RT Mastect + AC Mastect + AC + RT Mastect + AC

Main findings I ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Incidence of 2nd cancers and mortality from causes other than breast cancer

Breast cancer and overall mortality after RM/RT Mastect + AC Mastect + AC + RT Mastect + AC Mastect + AC + RT

Main findings II RT can increase mortality for heart disease and lung cancer and incidence of contr a lateral breast cance r which reduce its net beneficial effect on 15-y breast cancer mortality. Nevertheless, RT produced reductions not only in 15-y breast cancer mortality but also in 15-y overall mortality.

Conclusions ,[object Object],[object Object],[object Object],[object Object]

Radiation t echnique ,[object Object],[object Object],[object Object],[object Object]

Nodal i rradiation ,[object Object],[object Object],[object Object],[object Object]

RT c omplications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Reducing Risk ,[object Object],[object Object]

4D CT: sorting process Full respiratory cycle End-inspiration CT Image Sorting Program End-expiration 4 sec

Opto-electronic system IR flash IR flash Processing unit Motion analyzer Bunker Control room

Breath adapted radiotherapy D eep inspiration breath hold Free breathing Irradiated heart volume 8% Irradiated heart volume 1% AN Pedersen, Copenhagen

BALKAN MCO 2011 - E. Vrdoljak - Locoregional therapy in LABC

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BALKAN MCO 2011 - E. Vrdoljak - Locoregional therapy in LABC