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Breast Cancer Webinar
 

Breast Cancer Webinar

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    Breast Cancer Webinar Breast Cancer Webinar Presentation Transcript

    • Early Breast Cancer:The role of Radiation Therapy
      Rationale
      How it’s Done
      What to Expect
      James T. Richardson, M.D.
      Radiation Oncologist
    • Objectives
      Magnitude and epidemiology of breast cancer including risk factors
      Role of radiotherapy in the context of Breast conservation for early breast cancer
      Ways of delivering radiotherapy to the breast
      Results and side effects
      Questions
    • Breast Cancer
      Most common cancer of American women
      Second most common cause of cancer death
      More than 200,000 diagnosed yearly
      Risk factors
      Female (only 1% of cases are in men)
      Older age
      Length of estrogen exposure
      Family history/Genetic risk
      Diet? Alcohol
      Pre-invasive changes DCIS & LCIS (marker  risk)
    • Early Stage Breast Cancer
      Noninvasive cancer---DCIS, LCIS
      Insitu = “in place”
      Invasive cancers up to 5 cm (2”) in size
      Infiltrating ductal cancer
      Infiltrating lobular cancer
      With or without involved lymph nodes---not adherent to one another or to surrounding tissues
    • Symptoms
      None at all---change in mammogram
      Lump or thickening
      Change in size, shape or consistency of breast
      Nipple discharge or tenderness
    • Mammogram
    • Local treatmentEarly Stage Cancer
      Mastectomy
      No lymph nodes involved— local treatment complete
      Lumpectomy “breast conservation”
      Local radiation to whole breast with or without addition of radiation to draining lymph nodes
    • Why give radiation?
      To decrease local recurrence risk
      Non-invasive cancer DCIS “pre-cancer”
      32%16% (NSABP B-17, 12 year) 818pts
      26%  15% (EORTC, 10 year) > 1000 pts
      Invasive cancer “breast cancer”
      39.2%14.3% (20 year data)
      Same local control as mastectomy
      Same overall survival as mastectomy
    • Breast Cancer“Local Control”
    • Whole Breast Radiotherapy
    • Early Breast Cancer Local Treatment
      Surgery
      Mastectomy
      Lumpectomy “breast conservation”
      Requires radiation to remainder of breast +/- nodes
      Contraindications to breast conservation
      Diffuse cancer
      Incomplete removal of cancer Re-excision?
      Prior radiation
      Pregnancy
      Connective tissue disorders
    • Post-lumpectomy Radiation
      Whole breast radiation
      Standard of care
      5 – 6 ½ weeks radiation M-F
      Accelerated whole breast radiation
      Larger daily doses per daily treatment
      Complete treatment in three to four weeks
      Equivalent local tumor control
      Well tolerated with similar side effects
    • Accelerated Partial breast radiation
      Limited radiation fields to tumor bed and margin
      Large doses twice daily. Complete in 1 week!
      Promising results for appropriate candidates
      Tumor found on mammogram
      Small tumors excised with negative margins
      0-3 lymph nodes involved
      Surgical bed < 30% breast volume
      Not too close to skin surface
      Very low local recurrence rates: 0-4%
    • Partial breast radiation types
      Brachytherapy
      Needle implant
      Mammosite®
      Conformal external beam radiation
      3-D treatment planning
      Multiple external beams converge on tumor bed with margin
    • Catheter Interstitial Brachytherapy
    • Mammosite® Balloon Brachytherapy
    • Partial Breast3-D external beam
    • Breast ConservationLumpectomy and Radiation
      Benefits
      • Improved sense of well being
      • Less disfiguring/morbid
      • Improved quality of life
      Results
      • Equivalent tumor control to mastectomy
      • Equivalent survival to mastectomy
      • Absolutely EQUIVALENT treatment to mastectomy
      `
    • Side Effects
      Radiation is focal therapy
      Fatigue?
      Skin reaction, usually mild “skin sparing”
      Redness, tanning
      Fibrosis, soft tissue thickening
      Lymphedema
      Rib fracture < 5% long term
      Coronary artery disease
      Pneumonitis
    • Conclusions
      Breast conservation is mainstay and preferred treatment for most women
      Breast conservation offers equivalent local tumor control and survival to mastectomy
      Partial breast accelerated treatment appears promising and exacts less time commitment but further study is needed
      Radiation therapy is well tolerated and results in good to excellent cosmesis