חידושים בטיפול קרינתי לשד: קרינה מקוצרת - PowerPoint PPT Presentation

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חידושים בטיפול קרינתי לשד: קרינה מקוצרת

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  1. חידושים בטיפול קרינתי לשד: קרינה מקוצרת דיאנה מצייבסקי, מחלקה אונקולוגית, מכון קרינה 24.04.13

  2. Whole Breast Radiotherapy (WBRT) External beam radiotherapy

  3. Standard tangential field

  4. Simulation

  5. Radiotherapy For Breast Cancer Increases Heart Disease Risk N Engl J Med 2013; 368:1055-1056March 14, 2013

  6. FATIGUE

  7. RADIATION DERMATITIS

  8. RADIATION DERMATITIS

  9. Changes in breast appearance

  10. Rib fractures

  11. LYMPHEDEMA

  12. Conventional Whole breast Radiotherapy plan Boost 2Gy per fraction 25 fractions 8 fractions

  13. FASTER, FASTER!

  14. The UK standardisation of Breast Radiotherapy (START)-Trial A and B of Radiotherapy hypofracyionation for treatment of early breast cancer: a randomized trial

  15. Hypofractionation • «START» • 25 х 2 Gy = 15 х 2,67 Gy

  16. START Randomization 50 Gy- in 25 fractions 40 Gy- in 15 fraction 1105 1110

  17. HypofractionatedRadiation Therapy for Breast Cancer RANDOMIZATION 50 Gy in 25 fractions 42,5 Gy in 16 fractions 612 622

  18. Shorter fractionation schedules: ■No difference in local recurrence ■No difference in overall survival ■A significant decrease in acute radiation toxicity ■No difference in late skin toxicity, ischemic heart disease, or rib fractures ■No difference in breast appearance

  19. What still is questionable? The effect not clear in large breasts The safety of shorter course in combination with chemotherapy or monoclonal antibodies (Herceptin, Pertuzumab)? The “boost” issue What about treatment for regional lymph nodes ?

  20. Reasonable approach (supported by ASTRO/ESTRO) Women >50y Tumor < 5 cm Node negative Without prior chemo? Boost?

  21. Partial Breast Irradiation

  22. ~ 80% of local recurrences after conservative surgery + WBRT occur in tumor bed region “Elsewhere” recurrences in breast rare after CS +/- WBRT Rationale for Partial Breast Irradiation

  23. Partial Breast Radiotherapy Mammosite Interstitial Breast Brachytherapy 5 days-2 daily fractions

  24. Intra-operative radiotherapy

  25. External Beam Partial Breast Irradiation

  26. PBI: Where are we? • While several preliminary studies have had excellent 5-yr results, they contain only small numbers of highly-selected pts • NSABP B-39/RTOG : 10 yrs for data to mature

  27. Consensus Statements on PBI: American Society of Breast Surgeons and American Brachytherapy Society. PBI “off protocol” should be limited to pts: age > 50 IDC histology or DCIS Tumor < 2 cm (including DCIS) Margin > 2 mm Lymph node - negative

  28. Partial Breast Irradiation: Not Yet the Standard-of-Care