Breast Cancer Webinar


Published on

Published in: Health & Medicine
1 Like
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Breast Cancer Webinar

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