![Page 1: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/1.jpg)
Recent advances and current status of radiotherapy for breast
cancer
Dr Gerry Hanna
Clinical Senior Lecturer in Radiation Oncology Centre for Cancer Research and Cell Biology
Queens University Belfast
@gerryhanna E: [email protected]
![Page 2: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/2.jpg)
Overview • Defining the target volume
• Surgical Clips • ESTRO consensus
• Fractionation • Breast Boost • IMRT • Partial Breast Irradiation • Cardiac Sparing • Internal Mammary Chain Irradiation • Safe Omission of Radiotherapy
![Page 3: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/3.jpg)
Titanium Clips
![Page 4: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/4.jpg)
Titanium Clips – Level III
![Page 5: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/5.jpg)
Titanium Clips
Introduced in UK via IMPORT Low Study
![Page 6: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/6.jpg)
![Page 7: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/7.jpg)
Delineating breast CTV: ESTRO Guidelines 1.1
Offersen BV, et al. Radiotherapy and Oncology 2016;118:205–208.
![Page 8: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/8.jpg)
SCF Borders ESTRO guidelines 1.1
Offersen BV, et al. Radiotherapy and Oncology 2016;118:205–208.
![Page 9: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/9.jpg)
ESTRO Guidelines 1.1
Offersen BV, et al. Radiotherapy and Oncology 2016;118:205–208.
![Page 10: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/10.jpg)
ESTRO Guidelines 1.1
Offersen BV, et al. Radiotherapy and Oncology 2016;118:205–208.
![Page 11: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/11.jpg)
Hypofractionation
![Page 12: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/12.jpg)
Dose and Fractionation
• START Trials • START A - 50 Gy/25F/5 weeks vs 39Gy/13F/5 weeks
vs 41.6Gy/13F/5 weeks • START B - 50 Gy/25F/5 weeks vs 40Gy/15F/3 weeks • No difference in OS or LRR or cosmesis • Canadian Trial • 1234 pts 42.5/16F/22 days vs 50/25F/35days • No diff in DFS/OS
![Page 13: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/13.jpg)
START Trial Design and Endpoints
![Page 14: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/14.jpg)
Trial B: Local Tumour Relapse
![Page 15: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/15.jpg)
Fast Study
The Fast Trialists Group. Radiother Oncol 2011;100:93–100
![Page 16: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/16.jpg)
FAST Forward Trial (N=4000)
N TD (Gy) # (Gy) T (wk) Control 15 40.0 2.67 3 Test 1 5 27.0 5.4 1 Test 2 5 26.0 5.2 1
![Page 17: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/17.jpg)
![Page 18: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/18.jpg)
TROG DCIS – BIG 3-07
• Patients with completely excised non-low risk DCIS and BCS, n=1600
![Page 19: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/19.jpg)
UK Consensus Statement on Hypofractionation
STATEMENT: •There is no indication to use more than 15 fractions for the breast, chest wall or nodal areas
![Page 20: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/20.jpg)
UK Consensus Statement on Hypofractionation
STATEMENT: •There is no indication to use more than 15 fractions for the breast, chest wall or nodal areas
• 40 Gy in 15 fractions over 3 weeks (Breast, CW, Nodal)
• 13.35 Gy in fractions over 1 week (boost)
![Page 21: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/21.jpg)
Breast Boost
![Page 22: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/22.jpg)
Bartelink H, et al. Lancet Oncol 2015;16:47-56.
![Page 23: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/23.jpg)
Breast RT Boost
UK Consensus statements • A tumour bed boost should be considered for women less
than 50 years old. • For those over 50 years old with higher risk pathological
features (especially Grade 3 and/or extensive intraductal component [EIC]), consider the benefit of boost in context of both local recurrence and normal tissue toxicity risks.
• Tumour bed clips should be considered the standard of care to improve planning (and delivery) of the boost.
• Photon boost using intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) is recommended, including simultaneous integrated photon boost (SIB).
• Electron and mini-tangents are acceptable alternatives when IMRT boost is not clinically appropriate.
![Page 24: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/24.jpg)
Breast RT Boost
UK Consensus statements • A tumour bed boost should be considered for women less
than 50 years old. • For those over 50 years old with higher risk pathological
features (especially Grade 3 and/or extensive intraductal component [EIC]), consider the benefit of boost in context of both local recurrence and normal tissue toxicity risks.
• Tumour bed clips should be considered the standard of care to improve planning (and delivery) of the boost.
• Photon boost using intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) is recommended, including simultaneous integrated photon boost (SIB).
• Electron and mini-tangents are acceptable alternatives when IMRT boost is not clinically appropriate.
• Breast boost standard in < 50 yr olds and those with high risk features
![Page 25: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/25.jpg)
IMPORT High
![Page 26: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/26.jpg)
Breast IMRT
![Page 27: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/27.jpg)
Breast IMRT
![Page 28: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/28.jpg)
2D Versus 3D Forward Planned IMRT
2D Plan 3D IMRT Plan
Donovan et al. Radiother Oncol 2007;82:254-264
• Randomised trial -demonstrated clinical benefit of using 3D forward planned IMRT
![Page 29: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/29.jpg)
![Page 30: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/30.jpg)
• Simple Forward Planned IMRT is now standard of care in breast RT
![Page 31: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/31.jpg)
Partial Breast RT
![Page 32: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/32.jpg)
Types of Partial Breast Irradiation
• EBRT • Photons
• 3D Conformal • IMRT
• Electrons
• Mammosite • Interstitial Brachytherapy • Intra-operative
![Page 33: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/33.jpg)
Partial Breast Irradiation
Suggested benefit of partial breast irradiation is comparable tumour control, yet reduced acute and late toxicity with subsequent improvement in cosmesis
![Page 34: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/34.jpg)
Partial Breast RT
Marta GN, et al. Radiotherapy and Oncology 2015;114:42–49.
![Page 35: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/35.jpg)
Partial Breast RT
Marta GN, et al. Radiotherapy and Oncology 2015;114:42–49.
• Partial Breast Still Remains Experimental
![Page 36: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/36.jpg)
? IORT
Study Sample
size IORT
technique IORT dose
EBRT Whole breast dose
Median follow-
up (Years)
IBTR for IORT
Group (%)
IBTR for EBRT
Group (%)
IBTR Hazard ratio in
favour of IORT
Eliot [14] 1305 Intra-
operative Electrons
21 Gy
50 Gy / 25 Fx, whole breast, followed by 10
Gy / 5 Fx tumour bed
boost
5.8 4.4 0.4 9·3 (95% CI 3·3–26·3).
TARGIT-A [42] 3451 Intrabeam 20 Gy
40–56 Gy with or without a boost of 10–
16 Gy
2.4 3.3 1.3 Not reported
Hanna GG and Kirby AM. Br J Radiol. 2015;88(1049):20140686.
![Page 37: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/37.jpg)
? IORT
Study Sample
size IORT
technique IORT dose
EBRT Whole breast dose
Median follow-
up (Years)
IBTR for IORT
Group (%)
IBTR for EBRT
Group (%)
IBTR Hazard ratio in
favour of IORT
Eliot [14] 1305 Intra-
operative Electrons
21 Gy
50 Gy / 25 Fx, whole breast, followed by 10
Gy / 5 Fx tumour bed
boost
5.8 4.4 0.4 9·3 (95% CI 3·3–26·3).
TARGIT-A [42] 3451 Intrabeam 20 Gy
40–56 Gy with or without a boost of 10–
16 Gy
2.4 3.3 1.3 Not reported
Hanna GG and Kirby AM. Br J Radiol. 2015;88(1049):20140686.
![Page 38: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/38.jpg)
Cardiac Irradiation and DIBH
![Page 39: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/39.jpg)
RT induced heart disease
Cuzick J, et al. J Clin Oncol 1994;12:447-453.
![Page 40: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/40.jpg)
Radiation induced heart disease Radiation-induced heart disease manifest as three distinct diseases:
1. Radiation-induced pericarditis may occur if a large proportion of the heart (>30%) receives a dose of ≥50Gy. The mean latency is approximately 1 year.
2. Radiation-induced myocardial damage may be diagnosed at lower mean doses to the heart. The mean latency is > 5 years.
3. The risk of radiation-induced cardiovascular disease begins to increase 10 years after irradiation and is progressive with time.
A significant increase of risk of cardiovascular disease has been observed after mean heart doses lower than 10% of the generally accepted tolerance dose to the heart of 40-50 Gy.
![Page 41: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/41.jpg)
Left anterior descending coronary artery
Right coronary artery
Circumflex coronary artery
Modern Left breast irradiation
Gy 40 20 4 2
*Taylor et al, Int J Radiat Oncol Biol Phys 2009; 73(4):1061-1068
![Page 42: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/42.jpg)
Is a RT dose response present?
Darby SC, et al. N Engl J Med. 2013 Mar 14;368(11):987-98.
![Page 43: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/43.jpg)
Methods of reducing cardiac dose
• Change wedge angle • MLC cardiac shielding • Use direct electrons (post-mastectomy only) • Prone planning • IORT / Brachytherapy • DIBH • Protons
![Page 44: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/44.jpg)
MLC Cardiac Shielding
Bartlett FR, et al. Clin Oncol 2013;25:690-696.
![Page 45: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/45.jpg)
Prone Breast Planning
Kirby AM, et al. Radiotherapy and Oncology 96 (2010) 178–184
![Page 46: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/46.jpg)
Prone versus DIBH
Bartlett FR, et al. Radiother Oncol 2015;114:66–72.
![Page 47: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/47.jpg)
Prone versus DIBH
Bartlett FR, et al. Radiother Oncol 2015;114:66–72.
![Page 48: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/48.jpg)
DIBH visual display system
![Page 49: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/49.jpg)
Deep inspiration breath hold
Moran JM, et al. IJROBP 2009;75:294–301.
![Page 50: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/50.jpg)
IMC / Nodal Irradiation
![Page 51: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/51.jpg)
EOSTC IM-MS Study
![Page 52: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/52.jpg)
![Page 53: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/53.jpg)
After adjustment for stratification factors p=0.04
![Page 54: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/54.jpg)
Canadian MA-20 Study
![Page 55: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/55.jpg)
![Page 56: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/56.jpg)
Locoregional RT fields in MA-20 test arm
![Page 57: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/57.jpg)
MA-20 Results
Whelan TJ, et al. N Engl J Med 2015;373:307-16.
![Page 58: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/58.jpg)
Nodal Irradiation
• Appears to improve both local control • Additional toxicity is limited • Uncertainty regarding late cardiac effects
• Possible Criteria for IMC RT
• N2-3 disease • Medial central tumours with N1 and other adverse
features • ??? T3NO with adverse features
![Page 59: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/59.jpg)
Safe omission of radiotherapy
![Page 60: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/60.jpg)
![Page 61: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/61.jpg)
PRIME II: 5 Year LRR
Kunkler I, et al. Lancet Oncol 2015;16(3):266-273.
![Page 62: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/62.jpg)
CI: Charlotte Coles
![Page 63: Recent advances and current status of radiotherapy for ......Recent advances and current status of radiotherapy for breast cancer Dr Gerry Hanna . Clinical Senior Lecturer in Radiation](https://reader035.vdocument.in/reader035/viewer/2022063020/5fe223e23775b90b6c76babb/html5/thumbnails/63.jpg)
Breast RT – Current Status Summary
Tumour bed clips are essential for
accurate breast RT
Hypofractionation is now standard of
care for breast RT
IMRT reduces inhomogeneity and
reduces toxicity
APBI and IORT remain experimental
techniques DIBH permits cardiac
sparing
IMC / Nodal RT should be
considered in node positive patients