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Vakalis breast radiotherapy

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Vakalis breast radiotherapy

  1. 1. FUZZ-IEEE 2009 Ακτινοθεραπευτής Ογκολόγος Euromedica – Αθήναιον Α Ιατρικό Κέντρο Αθηνών Βακάλης Ξενοφών
  2. 2. FUZZ-IEEE 2009
  3. 3. FUZZ-IEEE 2009
  4. 4. Breast Cancer Nomogram: Ductal Carcinoma In Situ (DCIS) Recurrence
  5. 5. Breast Cancer Nomogram: Ductal Carcinoma In Situ (DCIS) Recurrence
  6. 6. OncoTypeDX for 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
  7. 7. clinical stage I, IIA, or a subset of stage IIB disease (T2N1)
  8. 8. (EBCTCG, Lancet 366:17,2005)
  9. 9. FUZZ-IEEE 2009
  10. 10. FUZZ-IEEE 2009 Nodal Radiotherapy
  11. 11. www.wondershare.com
  12. 12. www.wondershare.com
  13. 13. www.wondershare.com
  14. 14. www.wondershare.com
  15. 15. www.wondershare.com
  16. 16. www.wondershare.com
  17. 17. www.wondershare.com MA-20
  18. 18. www.wondershare.com
  19. 19. SLND Negative SLN No 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
  20. 20. www.wondershare.com
  21. 21. www.wondershare.com
  22. 22. • 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
  23. 23. www.wondershare.com
  24. 24. 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
  25. 25. AMAROS MA20 N+ MA20 High risk N0
  26. 26. FUZZ-IEEE 2009
  27. 27. Limit LRR 15% for RT
  28. 28. G.M. Freedman ASTRO Spring Refresher Course 2013
  29. 29. G.M. Freedman ASTRO Spring Refresher Course 2013
  30. 30. FUZZ-IEEE 2009 Tumor Bed Boost
  31. 31. www.wondershare.com Stage I-II
  32. 32. www.wondershare.com
  33. 33. www.wondershare.com No difference in overall survival, breast cancer mortality, or disease-free survival at 10 years
  34. 34. Bartelink H, et al., J Clin Oncol 2007 Jones, H. A. et al. J Clin Oncol 2009
  35. 35. www.wondershare.com
  36. 36. • 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
  37. 37. www.wondershare.com NCIC CTG MA.33
  38. 38. www.wondershare.com
  39. 39. FUZZ-IEEE 2009
  40. 40. www.wondershare.com lack of prospective data
  41. 41. www.wondershare.com
  42. 42. www.wondershare.com
  43. 43. FUZZ-IEEE 2009
  44. 44. www.wondershare.com
  45. 45. FUZZ-IEEE 2009
  46. 46. www.wondershare.com
  47. 47. www.wondershare.com
  48. 48. www.wondershare.com
  49. 49. FUZZ-IEEE 2009
  50. 50. www.wondershare.com
  51. 51. www.wondershare.com
  52. 52. www.wondershare.com
  53. 53. www.wondershare.com
  54. 54. www.wondershare.com
  55. 55. www.wondershare.com NCCN-No
  56. 56. www.wondershare.com
  57. 57. www.wondershare.com
  58. 58. A lot of subgroups No RT of breast in DCIS No RT of breast in early stage of invasive ca No boost Hypofractionated RT of whole breast Accelerated Partial RT
  59. 59. THANKS FOR YOUR ATTENTION!

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