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- 2. Breast Cancer • Most common cancer in women • Ductal carcinoma most common • Treatment options: – Surgery + radiation – Surgery + radiation + chemo – Surgery alone (mastectomy)
- 3. Breast anatomy • Superior border- 2nd costal cartilage • Inferior border- 6th costal cartilage • Medial border- Sternal edge • Lateral border- anterior axillary line
- 5. Routes of Spread • Lymph nodes: – Axillary – Internal Mammary – Transpectoral • Lung, Bone, Brain, Liver
- 6. Immobilization and Positioning • First concern is the movement of the arm • Custom molds • Wingboards • Breast board • Headrest • Knee wedge
- 7. Simulation set-up • Disrobe from waist up • Lie supine, straighten patient • 3pt set-up • Both arms or ipsilateral arm only raised into position • Head straight or turned to contralateral side • Wires and BBs
- 8. Treatment techniques • Tangentials • Tangentials + Sclav • Tangentials + Sclav + PAB • Tangentials + Sclav + PAB + Internal Mammary • FinF • IGRT
- 10. Whole Breast IGRT 4860cGy @ 180cGy/fx
- 11. Breast Boost 1620cGy @ 180cGy/fx
- 12. Tangential Breast 4860cGy @ 180cGy/fx followed by a boost
- 15. Doses • Tangents: 4680cGy-5040cGy • Boost: to 6000cGy • Sclav: 4680cGy • PAB: whatever dose brings midline dose to 4680cGy
- 16. Hodgkins • Very radiosensitive • Bi-modal age range 15-24 yrs & 50+ • Cervical or supraclavicular 75% • Mediastinal 60% • Fever, night sweats, weight loss
- 17. Treatment • Surgery to diagnose and stage • Radiation alone • Chemo alone • Radiation and Chemo
- 18. Immobilization and Positioning • Patient supine • No headrest, chin extended • Arms above head or akimbo • Custom molds • Site specific custom blocks
- 19. Treatment techniques • AP:PA mantle • AP:PA inverted Y
- 21. Lung Cancer • Leading cause of cancer death in males and females • Chemo, surgery and radiation • Routes of spread – Cervical L.N – Liver, brain, bones
- 22. Lung Anatomy • Rt. Lung- 3 Lobes • Lt. Lung- 2 Lobes • Carina @ T5
- 23. Immobilization and Positioning • Supine • Headrest • Wingboard • Arms above head holding poles • Be aware of respiratory problems
- 24. Simulation • 3 pt set-up • Contrast? • Gating • Breath hold technique
- 25. Treatment techniques • AP:PA • Off cord obliques • IGRT
- 26. Doses • SCLC 4500cGy-5400cGy • NSCLC 6000cGy-7500cGy
- 27. IGRT Rt. Upper Lobe 4500cGy @ 180 cGy/fx. Concurrent chemo
- 30. IGRT Rt. Lung with Nodes 4500cGy @ 180cGy/fx with concurrent chemo