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Radiotherapy  in Carcinoma of the Breast Patrick S Swift, MD Director, Radiation Oncology Alta Bates Comprehensive Cancer Center Berkeley, CA
Breast Conserving Therapy  BCT ,[object Object],[object Object],[object Object],[object Object]
Distant Failure 34% 32% 6 859 1983-89 Denmark 82TM 30% 34% 10 903 1980-86 EORTC 10801 39% 34% 20 279 1979-89 US NCI 40% 33% 20 1406 1976-84 NSABP06 54% 51% 20 701 1973-80 Milan I 23% 24% 22 yrs 179 1972-79 WHO BCT Mast. Time pt. # Trial
Overall Survival 67% 67% 6 859 1983-89 Denmark 82TM 82% 79% 10 903 1980-86 EORTC 10801 65% 66% 20 279 1979-89 US NCI 53% 58% 20 1406 1976-84 NSABP06 46% 47% 20 701 1973-80 Milan I 42% 41% 22 yrs 179 1972-79 WHO BCT Mast. Time pt. # Trial
Absolute Contraindications to BCT ,[object Object],[object Object],[object Object],[object Object],[object Object]
Relative Contraindications to BCT ,[object Object],[object Object],[object Object]
NOT contraindications to BCT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Positive Margins after Lumpectomy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Extensive Intraductal Component  (EIC) ,[object Object],[object Object],[object Object]
Treatment by Stage
DCIS Ductal Carcinoma in Situ ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
NSABP-17 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
EORTC 10853 ,[object Object],[object Object],[object Object],[object Object],[object Object]
UKCCCR DCIS Working Group ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Radiation Technique DCIS ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Van Nuys Prognostic Index  Scores of 3-4 - 98% local control without RT Scores of 5-7 - 32% failed without RT, 16% with RT Scores of 8-9 - 100% failure without RT, 60% with RT
Radiation Technique T1-2 N0 ,[object Object],[object Object],[object Object],[object Object],[object Object]
ASTRO 2008 Plenary 42.5 Gy in 16 fractions v. 50 Gy in 25 fractions
ASTRO 2008 Plenary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
If getting chemotherapy… ,[object Object],[object Object],[object Object],[object Object]
Surgery alone without RT? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Surgery alone without RT? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Radiation Technique T3-4  (after neoadjuvant chemo) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Nodal Irradiation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Full SCLV Field
IM Nodal Radiation Technique
 
Post-mastectomy RT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Post-MRM RT Trials (all with chemo and modern RT) 36% 35% No RT 45% 8% RT 1375 Danish 82c 46% 33% No RT 54% 13% RT 318 Vancouver 45% 32% No RT 54% 9% RT 1708 Danish 82b Overall Survival Local failure
RT Complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Reducing Risk ,[object Object],[object Object],[object Object]
 
 
 
 
Partial Breast Irradiation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Radiotherapy In Carcinoma Of The Breast

  • 1. Radiotherapy in Carcinoma of the Breast Patrick S Swift, MD Director, Radiation Oncology Alta Bates Comprehensive Cancer Center Berkeley, CA
  • 2.
  • 3. Distant Failure 34% 32% 6 859 1983-89 Denmark 82TM 30% 34% 10 903 1980-86 EORTC 10801 39% 34% 20 279 1979-89 US NCI 40% 33% 20 1406 1976-84 NSABP06 54% 51% 20 701 1973-80 Milan I 23% 24% 22 yrs 179 1972-79 WHO BCT Mast. Time pt. # Trial
  • 4. Overall Survival 67% 67% 6 859 1983-89 Denmark 82TM 82% 79% 10 903 1980-86 EORTC 10801 65% 66% 20 279 1979-89 US NCI 53% 58% 20 1406 1976-84 NSABP06 46% 47% 20 701 1973-80 Milan I 42% 41% 22 yrs 179 1972-79 WHO BCT Mast. Time pt. # Trial
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  • 18. Van Nuys Prognostic Index Scores of 3-4 - 98% local control without RT Scores of 5-7 - 32% failed without RT, 16% with RT Scores of 8-9 - 100% failure without RT, 60% with RT
  • 19.
  • 20. ASTRO 2008 Plenary 42.5 Gy in 16 fractions v. 50 Gy in 25 fractions
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  • 29. IM Nodal Radiation Technique
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  • 32. Post-MRM RT Trials (all with chemo and modern RT) 36% 35% No RT 45% 8% RT 1375 Danish 82c 46% 33% No RT 54% 13% RT 318 Vancouver 45% 32% No RT 54% 9% RT 1708 Danish 82b Overall Survival Local failure
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