Transcript חידושים בטיפול קרינתי לשד: קרינה חלקית ו

‫חידושים בטיפול קרינתי לשד‪:‬‬
‫קרינה מקוצרת‬
‫דיאנה מצייבסקי‪,‬‬
‫מחלקה אונקולוגית‪ ,‬מכון‬
‫קרינה‬
‫‪24.04.13‬‬
External beam radiotherapy
Whole Breast
Radiotherapy
(WBRT)
Standard tangential field
Simulation
Radiotherapy For Breast Cancer
Increases Heart Disease Risk
N Engl J Med 2013; 368:1055-1056March 14, 2013
FATIGUE
RADIATION DERMATITIS
RADIATION DERMATITIS
Changes in breast appearance
Rib fractures
LYMPHEDEMA
Conventional Whole breast
Radiotherapy plan
Boost
25 fractions
8 fractions
2Gy per
fraction
FASTER, FASTER!
The UK standardisation of Breast
Radiotherapy (START)Trial A and B of Radiotherapy
hypofracyionation for treatment
of early breast cancer:
a randomized trial
Hypofractionation


«START»
25 х 2 Gy = 15 х 2,67 Gy
START
Randomization
50 Gy-
40 Gy-
in 25 fractions
in 15 fraction
1105
1110
Hypofractionated
Radiation Therapy for Breast
Cancer
RANDOMIZATION
50 Gy in 25
fractions
612
42,5 Gy in 16
fractions
622
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
What still is questionable?


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
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 ?
Reasonable approach
(supported by ASTRO/ESTRO)



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
Women >50y
Tumor < 5 cm
Node negative
Without prior chemo?
Boost?
Partial Breast Irradiation
Rationale for Partial Breast
Irradiation
 ~ 80% of local
recurrences after
conservative surgery
+ WBRT occur in
tumor bed region

“Elsewhere”
recurrences in
breast rare after CS
+/- WBRT
Partial Breast Radiotherapy
Mammosite
Interstitial Breast Brachytherapy
5 days-2 daily fractions
Intra-operative radiotherapy
External Beam Partial Breast
Irradiation
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
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
Partial Breast Irradiation:
Not Yet the Standard-ofCare