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Radiation Therapy for Inflammatory Breast Cancer

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Part of the 2017 Metastatic Breast Cancer Forum, held by Dana-Farber Cancer Institute.

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Radiation Therapy for Inflammatory Breast Cancer

  1. 1. Radiation Therapy for Inflammatory Breast Cancer Jennifer R. Bellon, M.D. Dana-Farber Cancer Institute / Brigham and Women’s Hospital Harvard Medical School 1st Annual IBC Patient Forum Dana Farber Cancer Institute May 13, 2017
  2. 2. Unique Features of IBC • Predilection for skin involvement, particularly dermal lymphatics • High rate of nodal involvement • Axillary, supraclavicular and internal mammary • These features help define the radiation fields
  3. 3. Tri-modality Therapy • Systemic therapy • Kills cells that may have spread from the breast to other parts of the body • Helps decrease the burden of disease in the breast, and nearby lymph nodes • Surgery • Removes residual gross disease in the breast and axilla • Radiation treats the residual skin/chest wall and nodes that aren’t operated upon
  4. 4. What is the Process of Radiation? CT-Simulation • Standard CT • Lasers to make sure patient is straight • Tiny (freckle-like) tattoos to help with reproducibility
  5. 5. Immobilization
  6. 6. Chest Wall Tangents
  7. 7. Digitally Reconstructed Radiograph Axillary Nodes Heart
  8. 8. Nodal Field
  9. 9. Bolus • Tissue equivalent plastic that ‘fools’ the radiation to deposit its dose at the surface • Commonly used after mastectomy (not typically to the intact breast)
  10. 10. Dynamic Multi-Leaf Collimator
  11. 11. Isodose Curves
  12. 12. Side Effects of Treatment: Short Term • Skin • Redness • Possible peeling/blistering • Chest • Tenderness • Pruritus • Fatigue
  13. 13. Side Effects: Long Term • Cardiac • Long-term coronary artery disease
  14. 14. Heart Movement with Respiration
  15. 15. Chest Monitoring During Radiation
  16. 16. Respiratory Trace During Radiation Time (sec) Chest Excursion Chest Excursion Window dsfjksljfkldsjlkjkjsfdkljfklsd
  17. 17. Side Effects: Long Term • Cardiac • Long-term coronary artery disease • Pulmonary • Pneumonitis • Lymphedema • Impact on Reconstruction
  18. 18. Future Directions • Ongoing studies looking at improving effectiveness of radiation • In large part, this will come from improvements in systemic therapy • Concurrent veliparib (PARP-inhibitor) • Phase I study from U of M • Soon to be launched Phase II randomized trial Radiation with or without veliparib
  19. 19. Conclusions • Radiation, when combined with surgery and systemic therapy is increasingly effective at achieving long-term local control • Efforts are ongoing to ensure maximal safety, with minimal long-term sequelae