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Intensity Modulated Radiation Therapy (IMRT) for Breast Cancer

Intensity Modulated Radiation Therapy (IMRT) for Breast Cancer. Vincent Remouchamps Service de Radiothérapie Clinique et Maternité Ste Elisabeth Namur www.cmsenamur.be. Belgian Breast Meeting 2008 October 3-4, Brussels. Intensity Modulated Radiation Therapy(IMRT) for Breast Cancer.

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Intensity Modulated Radiation Therapy (IMRT) for Breast Cancer

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  1. Intensity Modulated Radiation Therapy (IMRT) for Breast Cancer Vincent Remouchamps Service de Radiothérapie Clinique et Maternité Ste Elisabeth Namur www.cmsenamur.be Belgian Breast Meeting 2008 October 3-4, Brussels

  2. Intensity Modulated Radiation Therapy(IMRT) for Breast Cancer • Clinical problem: skin toxicity • Technical solutions: IMRT and 3D optimization • Clinical outcome from 2 Randomized Trials • Ontario (Donovan et al. Radioth. Oncol. 2007 Mar;82(3):254-64) • Royal Marsden (Pignol et al. JCO 2008; 26(13):2085-92) • Combination with breath hold (for heart protection) • Combination with complex radiation fields (nodal) • Conclusions

  3. Acute Skin Side Effects Desquamation, Oedema Sagital isodoses view Kestin et al, IJROBP 2000 Standard Wedges 115% 110% 105% 100% 95% 90% Hot spots

  4. 3D Optimisation

  5. Sagital isodoses view Standard Filters Optimized 3D / IMRT 115% 110% 105% 100% 95% 90%

  6. Electronic compensators • Breast IMRT • Follow the shape of the breast

  7. Donovan et al Radiother. Oncol.2007 Mar;82(3):254-64240 patients, randomized

  8. Donovan et al: Any palpable induration:

  9. Pignol et al, J Clin Oncol. 2008 May 1;26(13):2085-92358 patients, Randomized

  10. Radiotherapy after breast-conserving surgery, generally with axillary clearance (BCSRT) in all women (7311 women, 17% with node +disease) META-ANALYSE: EBCTCG Lancet 2005; 366: 2087-2106

  11. Effect of radiotherapy on non-breast cancer mortality (29 623 women) • Why non-breast cancer surmortality? • Main reasons: • Heart toxicity and lung cancer • Cohort studies: • Mostly left-sided radiation META-ANALYSE: EBCTCG Lancet 2005; 366: 2087-2106

  12. To Protect the Heart: Heart Deep Inspiration Breath Hold Free Breathing

  13. Nodal extension Anatomy of the lymphatic routes of the breast. In: Del Regato JA, Spjut HJ: Ackerman and del Regato’s Cancer: Diagnosis, Treatment, and Prognosis, ed. 6 St. Louis, CV Mosby, 1985

  14. Conclusions: Breast « IMRT » • improve the radiation dose homogeneity • is feasable • reduces acute and chronic toxicities (level 1) • can be combined with advanced techniques • breath hold for heart protection • perfect junctioning

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