FUZZ-IEEE 2009
Ακτινοθεραπευτής Ογκολόγος
Euromedica – Αθήναιον Α
Ιατρικό Κέντρο Αθηνών
Βακάλης Ξενοφών
FUZZ-IEEE 2009
FUZZ-IEEE 2009
Breast Cancer Nomogram:
Ductal Carcinoma In Situ (DCIS) Recurrence
Breast Cancer Nomogram:
Ductal Carcinoma In Situ (DCIS) Recurrence
OncoTypeDX
for Estimating Recurrence Risk After Lumpectomy with No Radiation
Score Any Recurrence Invasive Recurrence
Low ...
clinical stage I, IIA, or a subset of stage IIB disease (T2N1)
(EBCTCG, Lancet 366:17,2005)
FUZZ-IEEE 2009
FUZZ-IEEE 2009
Nodal Radiotherapy
www.wondershare.com
www.wondershare.com
www.wondershare.com
www.wondershare.com
www.wondershare.com
www.wondershare.com
www.wondershare.com
MA-20
www.wondershare.com
SLND
Negative SLN
No additional axillary
treatment necessary
•Milan trial, SLN = ALND
•NSABP B-32, SLN = ALND
Positive SLN...
www.wondershare.com
www.wondershare.com
• High tangent fields includes
most of area at risk
• Superior border: Just below
humeral head
• Posterior border: 2 cm
wi...
www.wondershare.com
Standard ALND Radiotherapy P-value
5-year Axillary Recurrence rate 0.54% (4/744) 1.03% (7/681)
5-year Overall Survival Rat...
AMAROS
MA20
N+
MA20
High risk
N0
FUZZ-IEEE 2009
Limit LRR 15% for RT
G.M. Freedman ASTRO Spring Refresher Course 2013
G.M. Freedman ASTRO Spring Refresher Course 2013
FUZZ-IEEE 2009
Tumor Bed Boost
www.wondershare.com
Stage I-II
www.wondershare.com
www.wondershare.com
No difference in overall survival, breast cancer mortality, or disease-free survival at 10 years
Bartelink H, et al., J Clin Oncol 2007
Jones, H. A. et al. J Clin Oncol 2009
www.wondershare.com
• 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 t...
www.wondershare.com
NCIC CTG MA.33
www.wondershare.com
FUZZ-IEEE 2009
www.wondershare.com
lack of prospective data
www.wondershare.com
www.wondershare.com
FUZZ-IEEE 2009
www.wondershare.com
FUZZ-IEEE 2009
www.wondershare.com
www.wondershare.com
www.wondershare.com
FUZZ-IEEE 2009
www.wondershare.com
www.wondershare.com
www.wondershare.com
www.wondershare.com
www.wondershare.com
www.wondershare.com
NCCN-No
www.wondershare.com
www.wondershare.com
A lot of subgroups
No RT of breast in DCIS
No RT of breast in early stage of invasive ca
No boost
Hypofractionated RT ...
THANKS FOR YOUR ATTENTION!
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
Vakalis breast radiotherapy
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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