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Vakalis breast radiotherapy
- 1. FUZZ-IEEE 2009 Ακτινοθεραπευτής Ογκολόγος Euromedica – Αθήναιον Α Ιατρικό Κέντρο Αθηνών Βακάλης Ξενοφών
- 10. Breast Cancer Nomogram: Ductal Carcinoma In Situ (DCIS) Recurrence
- 11. Breast Cancer Nomogram: Ductal Carcinoma In Situ (DCIS) Recurrence
- 13. 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
- 16. clinical stage I, IIA, or a subset of stage IIB disease (T2N1)
- 21. FUZZ-IEEE 2009
- 41. 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
- 44. • 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
- 46. 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
- 48. FUZZ-IEEE 2009
- 50. Limit LRR 15% for RT
- 52. G.M. Freedman ASTRO Spring Refresher Course 2013
- 55. G.M. Freedman ASTRO Spring Refresher Course 2013
- 56. FUZZ-IEEE 2009 Tumor Bed Boost
- 59. www.wondershare.com No difference in overall survival, breast cancer mortality, or disease-free survival at 10 years
- 60. Bartelink H, et al., J Clin Oncol 2007 Jones, H. A. et al. J Clin Oncol 2009
- 62. • 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
- 65. FUZZ-IEEE 2009
- 69. FUZZ-IEEE 2009
- 71. FUZZ-IEEE 2009
- 75. FUZZ-IEEE 2009
- 85. 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
- 86. THANKS FOR YOUR ATTENTION!