Post-mastectomy radiotherapy. Sabine Balmer Majno Radiation Oncology Geneva University Hospital. SRO Tutorial 20/09/2006. Post-mastectomy radiotherapy (PMRT). RT as post-operative «adjuvant» to total mastectomy (usually with axillary surgery)
Sabine Balmer Majno
Geneva University Hospital
SRO Tutorial 20/09/2006
Set-up of the patient on the breast board
SINMED BV Posiboard-2
The Posiboard-2 breast board is a
complete solution for the positioning of
breast patients. It is made of a low
density foam core covered with an ultra
thin layer of carbon fiber. This allows
the beam to transfer the Posiboard-2 from
any angle with minimal attenuation. For
arm positioning, several comfortable and
adjustable supports are available. To
prevent the patient from sliding down, an
adjustable bottom stop is integrated. The
Posiboard-2 is compact , lightweight and
can be positioned on any couch top with
the aid of specifically designed couch top
fixation pieces. For additional support, a
breast mask can be mounted using a quick
release system. When the Posiboard-2 is
not in use, it is hung on the wall with the
supplied wall mount plate.
Red crosses (initial position for the scan) are drawn on the skin to check the position of the patient before marking the isocenters of the different fields.
130 kV - 200 mA
Index 4 - Thickness 4
Transfer of the data set to ACQSIM.
Outline of the superior border slice of the breast = inferior border
of the SC field. Determining the isocenter for the SC field. SSD= 100 cm.
Rotation of the gantry to avoid the spinal cord.
A modification of the isocenter is possible.
shifts if necessary
Coordinates of the isocenter - Add shifts if necessary.
Determination of the central slice for the tangential beams.
Drawing the box
Automatic set-up of the isocenter.
Displacement of isocenter, if needed.
Virtual simulation software.
Randomised trials of the local management of early breast cancer by various types of surgery and/or radiotherapy
Meta-analyses: 42,000 women in 79 trials from the year 2000 EBCTCG meeting
Richard Peto, Sarah Darby & Paul McGale,
on behalf of the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG)
Meta-analysis putting together the results from all (old or new) trials of radiotherapy
Shows that breast cancer mortality can be affected by better local disease control
Isolated local recurrence
Absolute difference in risk of isolated local recurrence: 20%, mostly within the first 5 years.
15-year breast cancer mortality in the trials of any type of radiotherapy (RT) versus no RT(total: 24,000 women randomised in 46 trials)
Breast cancer mortality
Absolute difference in risk of death from breast cancer: 4%, mostly after the first 5 years.
Little difference in breast cancer mortality during the first 5 years.
EBCTCG local treatment comparisons(NB Absolute 5-year gain in local recurrence risk depends on treatment comparison and on nodal status, N- or N+)
: 24 meta-analyses