1. Post-mastectomy radiotherapy Sabine Balmer Majno Radiation Oncology Geneva University Hospital SRO Tutorial 20/09/2006

4. Set-up of the patient on the breast board

5. Breast board 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. SINMED BV Posiboard-2

6. Patient with radio-opaque markers on the skin 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.

7. CT Parameters Pilot scan 130 kV - 200 mA Pitch 2.00 Index 4 - Thickness 4

8. Transfer of the data set to ACQSIM.

9. 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.

10. Rotation of the gantry to avoid the spinal cord. A modification of the isocenter is possible. Add shifts if necessary ESTRO MARCONI ESTRO MARCONI

11. Coordinates of the isocenter - Add shifts if necessary .

12. Determination of the central slice for the tangential beams. Drawing the box

13. Automatic set-up of the isocenter.

14. Displacement of isocenter, if needed.

15. Virtual simulation software.

30. 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)

31. EBCTCG 2000: trials of local therapy 42,000 9,000 9,000 24,000 Women 21,000 79 TOTAL 5000 17 More surgery v RT + less surgery 4000 16 More surgery v less surgery 12,000 46 Radiotherapy (RT) versus no RT Deaths Trials Available for the EBCTCG year 2000 meta-analyses Treatment comparison

33. Isolated local recurrence in the trials of any type of radiotherapy (RT) versus no RT Isolated local recurrence Absolute difference in risk of isolated local recurrence: 20%, mostly within the first 5 years.

34. Breast cancer mortality 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) 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.

36. : 24 meta-analyses

39. Danish DBCG Trials 82b & 82c (Hojris et al , Lancet 1999) N=3,083, MFU 122 mo

43. Sites of LRF after mastectomy (Recht et al, 1999)

47. Supraclavicular recurrence

54. LRF after modified radical mastectomy and optimal systemic therapy (Recht et al, 1999)