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Vakalis breast radiotherapy
 

Vakalis breast radiotherapy

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    Vakalis breast radiotherapy Vakalis breast radiotherapy Presentation Transcript

    • 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 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
    • 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
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    • www.wondershare.com MA-20
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    • 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
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    • • 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
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    • 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
    • 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
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    • 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
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    • • 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
    • www.wondershare.com NCIC CTG MA.33
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    • FUZZ-IEEE 2009
    • www.wondershare.com lack of prospective data
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    • FUZZ-IEEE 2009
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    • FUZZ-IEEE 2009
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    • FUZZ-IEEE 2009
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    • 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
    • THANKS FOR YOUR ATTENTION!