HSC 340
11-18-2010
Breast Cancer
Hodgkin's
Lung Cancer
Breast Cancer
• Most common cancer in women
• Ductal carcinoma most common
• Treatment options:
– Surgery + radiation
– Su...
Breast anatomy
• Superior border- 2nd
costal cartilage
• Inferior border- 6th
costal cartilage
• Medial border- Sternal ed...
Routes of Spread
• Lymph nodes:
– Axillary
– Internal Mammary
– Transpectoral
• Lung, Bone, Brain, Liver
Immobilization and Positioning
• First concern is the movement of the arm
• Custom molds
• Wingboards
• Breast board
• Hea...
Simulation set-up
• Disrobe from waist up
• Lie supine, straighten patient
• 3pt set-up
• Both arms or ipsilateral arm onl...
Treatment techniques
• Tangentials
• Tangentials + Sclav
• Tangentials + Sclav + PAB
• Tangentials + Sclav + PAB + Interna...
Whole Breast IGRT 4860cGy @ 180cGy/fx
Breast Boost 1620cGy @ 180cGy/fx
Tangential Breast 4860cGy @ 180cGy/fx
followed by a boost
Sclav:
5040cGy
PAB: 720cGy
Tangents:
6120cGy
Doses
• Tangents: 4680cGy-5040cGy
• Boost: to 6000cGy
• Sclav: 4680cGy
• PAB: whatever dose brings midline dose to
4680cGy
Hodgkins
• Very radiosensitive
• Bi-modal age range 15-24 yrs & 50+
• Cervical or supraclavicular 75%
• Mediastinal 60%
• ...
Treatment
• Surgery to diagnose and stage
• Radiation alone
• Chemo alone
• Radiation and Chemo
Immobilization and Positioning
• Patient supine
• No headrest, chin extended
• Arms above head or akimbo
• Custom molds
• ...
Treatment techniques
• AP:PA mantle
• AP:PA inverted Y
Dose
• 3600cGy-4400cGy
Lung Cancer
• Leading cause of cancer death in males and
females
• Chemo, surgery and radiation
• Routes of spread
– Cervi...
Lung Anatomy
• Rt. Lung- 3
Lobes
• Lt. Lung- 2
Lobes
• Carina @ T5
Immobilization and Positioning
• Supine
• Headrest
• Wingboard
• Arms above head holding poles
• Be aware of respiratory p...
Simulation
• 3 pt set-up
• Contrast?
• Gating
• Breath hold technique
Treatment techniques
• AP:PA
• Off cord obliques
• IGRT
Doses
• SCLC 4500cGy-5400cGy
• NSCLC 6000cGy-7500cGy
IGRT Rt. Upper Lobe 4500cGy @ 180 cGy/fx.
Concurrent chemo
IGRT Rt. Lung with Nodes 4500cGy @ 180cGy/fx with
concurrent chemo
Hsc 340 11 18
Hsc 340 11 18
Hsc 340 11 18
Hsc 340 11 18
Hsc 340 11 18
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Hsc 340 11 18

  1. 1. HSC 340 11-18-2010 Breast Cancer Hodgkin's Lung Cancer
  2. 2. Breast Cancer • Most common cancer in women • Ductal carcinoma most common • Treatment options: – Surgery + radiation – Surgery + radiation + chemo – Surgery alone (mastectomy)
  3. 3. Breast anatomy • Superior border- 2nd costal cartilage • Inferior border- 6th costal cartilage • Medial border- Sternal edge • Lateral border- anterior axillary line
  4. 4. Routes of Spread • Lymph nodes: – Axillary – Internal Mammary – Transpectoral • Lung, Bone, Brain, Liver
  5. 5. Immobilization and Positioning • First concern is the movement of the arm • Custom molds • Wingboards • Breast board • Headrest • Knee wedge
  6. 6. Simulation set-up • Disrobe from waist up • Lie supine, straighten patient • 3pt set-up • Both arms or ipsilateral arm only raised into position • Head straight or turned to contralateral side • Wires and BBs
  7. 7. Treatment techniques • Tangentials • Tangentials + Sclav • Tangentials + Sclav + PAB • Tangentials + Sclav + PAB + Internal Mammary • FinF • IGRT
  8. 8. Whole Breast IGRT 4860cGy @ 180cGy/fx
  9. 9. Breast Boost 1620cGy @ 180cGy/fx
  10. 10. Tangential Breast 4860cGy @ 180cGy/fx followed by a boost
  11. 11. Sclav: 5040cGy PAB: 720cGy Tangents: 6120cGy
  12. 12. Doses • Tangents: 4680cGy-5040cGy • Boost: to 6000cGy • Sclav: 4680cGy • PAB: whatever dose brings midline dose to 4680cGy
  13. 13. Hodgkins • Very radiosensitive • Bi-modal age range 15-24 yrs & 50+ • Cervical or supraclavicular 75% • Mediastinal 60% • Fever, night sweats, weight loss
  14. 14. Treatment • Surgery to diagnose and stage • Radiation alone • Chemo alone • Radiation and Chemo
  15. 15. Immobilization and Positioning • Patient supine • No headrest, chin extended • Arms above head or akimbo • Custom molds • Site specific custom blocks
  16. 16. Treatment techniques • AP:PA mantle • AP:PA inverted Y
  17. 17. Dose • 3600cGy-4400cGy
  18. 18. Lung Cancer • Leading cause of cancer death in males and females • Chemo, surgery and radiation • Routes of spread – Cervical L.N – Liver, brain, bones
  19. 19. Lung Anatomy • Rt. Lung- 3 Lobes • Lt. Lung- 2 Lobes • Carina @ T5
  20. 20. Immobilization and Positioning • Supine • Headrest • Wingboard • Arms above head holding poles • Be aware of respiratory problems
  21. 21. Simulation • 3 pt set-up • Contrast? • Gating • Breath hold technique
  22. 22. Treatment techniques • AP:PA • Off cord obliques • IGRT
  23. 23. Doses • SCLC 4500cGy-5400cGy • NSCLC 6000cGy-7500cGy
  24. 24. IGRT Rt. Upper Lobe 4500cGy @ 180 cGy/fx. Concurrent chemo
  25. 25. IGRT Rt. Lung with Nodes 4500cGy @ 180cGy/fx with concurrent chemo

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