Whole Breast Irradiation: Class vs. Hypofractionation

Size: px
Start display at page:

Download "Whole Breast Irradiation: Class vs. Hypofractionation"

Transcription

1 Whole Breast Irradiation: Class vs. Hypofractionation Kyung Hwan Shin, MD, PhD. Dept. of Radiation Oncology, Seoul National University Hospital GBCC

2 Treatment Trends of Early Breast Cancer Less surgery lumpectomy vs mastectomy sentinel LNB vs axillary dissection Less radiation partial breast irradiation vs whole breast irradiation omitting RT (old age) hypofractionation Less chemotherapy determining who doesn t benefit from chemo by molecular subtypes or alternative molecular profiling schema (Oncotype-DX, Mammaprint, PAM50, etc)

3 Whole breast radiotherapy 50 Gy / 25 fx (± boost) - the most world wide frequent schedule - has been considered as standard fractionation

4 Prospective randomized trials comparing Lumpectomy Alone vs. with WBRT Trial N F/U (yr) op Breast recurrence (%) BCS BCS + RT % reduction Sweden Q Milan III Q NSABP-B L Ontario L Scottish L England 399 >5 L Finland L NSABP-B L * 83 * Patients received tamoxifen

5 EBCTCG, Meta-analysis EBCTCG Lancet 378: , 2014

6 Post-operative Breast Irradiation Daily fractional dose (Gy) RT Volume Total RT duration Conventional whole breast Gy Whole breast 6-7 weeks Accelerated whole breast (AWBI) (Hypofractionated) Gy Whole breast 3-4 weeks Accelerated partial breast (APBI) 3.8 bid-6 Gy qd Partial breast 1 week

7 Adjuvant radiation therapy options after breast conserving surgery

8 Post-operative Breast Irradiation Daily fractional dose (Gy) RT Volume Total RT duration Conventional whole breast Gy Whole breast 6-7 weeks Accelerated whole breast (AWBI) (Hypofractionated) Gy Whole breast 3-4 weeks Accelerated partial breast (APBI) 3.8 bid-6 qd Gy Partial breast 1 week

9 Hypofractionated RT 1) Shorter total treatment time 2) More convenient for patient ( time and money ) 3) Less resource intensive At least treatment outcome, normal tissue effect and cometic outcome should be non-inferior to standard fractionation.

10 RCT s: Treatment Scheme Fisher et al. J Clin Oncol 2014;32:

11 Equivalent local control to standard fractionation Total dose(gy) / fractionation Daily dose /total weeks 5yr local recurrence (%) 10yr local recurrence (%) RMH/GOC 50/25 39/ /13 2Gy/5wks 3Gy/5wks 3.3Gy/5wks START A 50/25 39/ /13 2Gy/5wks 3Gy/5wks 3.2Gy/5wks START B 50/25 40/15 2Gy/5wks 2.67Gy/3wks Canadian 50/ /16 2Gy/5wks 2.66Gy/3.5wks

12 Cumulative risk of LR Overall Survival Whelan TJ, NEJM 362:513-20, 2010

13 Canadian Trial: Late Toxicity Whelan et al. N Engl J Med 2010;362:

14 Canadian Trial: Cosmesis Whelan et al. N Engl J Med 2010;362:

15 Cumulative risk of LRR Disease Free Survival Haviland JS, Lancet Oncol 14: , 2013

16 Late normal tissue effect and cosmetic factors START A START B 40Gy/15fx seems gentler than 50Gy/25fx. Haviland JS, Lancet Oncol 14: , 2013

17 Late adverse effects of START-A, B START-A (%) START-B (%) 50Gy 41.6Gy 39Gy Total 50Gy 40Gy Total Symptomatic rib fracture Symptomatic lung fibrosis Ischemic heart disease (left sided) Haviland JS, Lancet Oncol 14: , 2013

18 Meta-analysis a) LR (p = 0.74) b) LRR (p = 0.32) c) Cancer-related mortality (p = 0.97) BCRT 162: , 2017

19 a) Risk of acute toxicity (p = ) b) Cosmesis (p=0.55) BCRT 162: , 2017

20 Linear-Quadratic (LQ) model for radiotherapy S=e - D- D2

21 Survival / ratio linear ( ) and the quadratic ( ) component of cell killing are equal. D= D 2 D D 2 Dose / ratio: shape of cell survival curve, BED (biological effective dose)

22 Therapeutic ratio of tumor and normal tissue 2 Gy 4 Gy Daily dose Tumor SF Normal tissue SF Therapeutic ratio 2Gy More kill Less damage better 4Gy Less kill More damage poorer

23 α/β ratio of Breast α/β ratio, Gy Conventional Tumor Normal tissue effect 10 3 In vitro human breast ca. cell lines 4 *Locoregional tumor control Change in photographic breast appearance *Bentzen SM. Lancet Oncol 9:331-41, 2008

24 α/β ratio of breast cancer (from 4 key randomized trials) Outcome RMH/GOC RMH/GOC + START A (5yr) START A (10yr F/U) RMH/GOC + START A (10yr) Local Recurrence Breast appearance (Any change) Breast Induration Telangiectasia cf. (α/β ratio 10 for other tumor tissues) Kim et al. ROJ 2016

25 Breast cancer 2 Gy 3 Gy α/β ratio of breast cancer: 4.6 Gy breast normal tissue: 3.4 Gy Breast cancer is as sensitive to fraction size as the dose-limiting normal tissues.

26 Actually, EQD2 of AWBI was less than conventional regimen Benjamin D Smith, ASTRO 2017

27 All three regimens on flat part of dose-response curve for local control Either extra 5 Gy is not needed, or shorter treatment course compensated for less dose due to less repopulation 40 Gy/15 fx confers lower normal tissue dose leading to less late toxicity Benjamin D Smith, ASTRO 2017

28 Kim KS, Shin KH et al, Radiat Oncol J 34:81-87, 2016

29 Issues to be solved Regional nodal irradiation Tumor bed boost Heart DCIS Biologic subtype Tumor grade

30 Regional nodal irradiation and boost RMH/GOC START A START B Canadian No. of pts Age <50 yrs 30.3% 23% 21% 25% Stage T1-3N0-1 T1-3N0-1 T1-3N0-1 T1-2N0 pn0 40% 69% 74% 100% HG III - 28% 23% 19% BCS 100% 85% 92% 100% CTx 13.9% 35% 22% 11% RNI 21% 14% 7% 0% Boost 75% 61% 39% 0% Boost dose 14 Gy/7fx 10 Gy/5fx 10 Gy/5fx - Holloway CL. The breast 19:163-7, 2010

31 Arm and Shoulder effects in START Trials - Regional Nodal Irradiation Haviland et al. Radiother Oncol 2018;126:

32 PMRT Phase II Trial Khan et al. J Clin Oncol 2018;126:

33 Heart Major coronary events increased linearly with mean heart dose Darby SC. NEJM 368(11): , 2013

34 Heart Hypofractionated adjuvant RT did not significantly increase the risk of cardiac mortality. Marhin W. IJROBP 69:483-9, 2007

35 DCIS, retrospective data. Conventional 50Gy/25fx (n=104) AWBI 42.4Gy/16fx or 40Gy/16fx+12.5Gy boost (n=162) Williamson D. Radiot Oncol 95: , 2010

36 Loco-regional relapse free survival after BCS Basal HER2 Breast cancer is known to have heterogeneous subtypes Different α/β ratio (cell survival curve) between subtypes? Voduc, JCO 28:1684, 2010

37 Molecular subtype Canadian trial Bane AL, Ann Oncol, 25: 993,2014

38 Tumor grade Whelan TJ, NEJM 362:513, 2010 Central Path Review (N=989 of 1234 enrolled patients) Bane AL, Ann Oncol, 25: 993,2014

39 START Trials: Subgroup Analysis Haviland et al. Lancet Oncol 2013;14:

40 Korean Data

41

42 JY Kim, KH Shin. IJROBP 87: , 2013

43

44 Comparison with other studies This study START A START B Canadian Patient, n Stage T1-2 N0-1 T1-3aN0-1 T1-3aN0-1 T1-2 N0 Median F/U 4.9 years 5.1 years 6 years 12 years Dose schedule 39 Gy / 13 F + 9 Gy / 3F (Boost) A : 39 Gy / 13F B : 41.6 Gy / 13F C : 50 Gy / 25F A : 40 Gy / 15 F B : 50 Gy / 25F A : 42.5 Gy / 16 F B : 50 Gy / 25F Boost RT 100% 61% 43% 0% Results 5-year LRR - 1.4% 5-year LRR - 39 Gy : 5.2% Gy : 3.5% - 50 Gy : 3.6% 5-year LRR - 40 Gy : 2.2% - 50 Gy : 3.3% 10-year LRR Gy : 6.2% - 50 Gy : 6.7%

45 This study This study

46 Cosmesis RMH/GOC START A START B Canadian Total dose(gy) / fractionation 50/25 39/ /13 50/25 39/ /13 50/25 40/15 50/ /16 Excellent/Good Cosmesis or no change (%) (5 year) This study 39/13+boost 9/ (3 year)

47 Skin toxicity Total dose(gy) / fractionation Moderate /Marked Induration (%) 5 yr 10 yr Skin toxicity (%) 5 yr 10 yr RMH/GOC 50/25 39/ / START A 50/25 39/ / (HR) START B 50/25 40/ (HR) Canadian 50/ / This study 39/13+boost 9/3 2.7 (3yr) Grade 1 (3yr) Hyperpigmentation 1.8 breast pain 7.1 induration 2.7

48 Retrospective Data in Korea pt1-2n0-1 breast-conserving surgery hypofractionated RT: 39 Gy/13fx National Cancer Center conventional RT: 50.4 Gy/28fx Seoul National University Hospital 379 patients in each group Lee et al. Medicine(Baltimore) 2016;95:e3320.

49 Lee et al. Medicine(Baltimore) 2016;95:e3320.

50 BCS+RT, pt1-2n0-1m0 AWBI (39Gy+ boost, NCC) n=330 CWBI (50.4Gy+boost, SNUH) n=330 S-W Lee, KH Shin. Oncotarget 7: , 2016

51 Hazard ratios for IBTR

52 Skin toxicities

53 ASTRO Guideline [2011] 50 yrs or older at diagnosis pt1-2n0 breast-conserving surgery w/o systemic chemotherapy acceptable dose heterogeneity 50 Gy/25 fx in 5 wks 42.5 Gy/16 fx in 3 wks Smith et al. Int J Radiat Oncol Biol Phys 2011;81:59-68.

54 According to Period Medicare + Medicaid data: 65 yr & BCS + WBRT Gillespie et al. Int J Radiat Oncol Biol Phys 2016;96:

55 According to Chemotherapy NCDB data: 50 yr & pt1-2n0 & WBRT alone Diwanji et al. Breast Cancer Res Treat 2017;165:

56 ASTRO Guideline [2018] Original WBI guideline was published in In June 2015, the Guidelines Subcommittee formed a work group to evaluated the guideline for updating. The proposal to develop a new guideline was approved by the ASTRO Board of Directors in October Not yet published

57 Nov. 2016

58 There is no indication to use more than 15 fractions for the breast, chest wall or nodal areas. Strong support (70-90% support) DCIS, regional nodal irradiation : favor hypofx Nov. 2016

59

60 Looking to the future, why consider conventionally fractionated breast radiotherapy at all? At present, there are more limited data available on tumor control and toxic effects outcomes with hypofractionated irradiation for patients with ductal carcinoma in situ and for patients receiving regional nodal irradiation. Nonetheless, the mounting evidence supporting hypofractionation can no longer be ignored. With comparable tumor control, lower costs, and reduced morbidity, hypofractionation should be strongly considered for the majority of patients with earlystage disease. JAMA Oncol J 1: , 2017

61 Patterns of Care Survey in Korea Shared decision (N=11) No (N=41) Yes (N=23) Physician s choice (N=12) Unpublished data

62 Patient preference Hoopes DJ et al. 1,807 patients respond 10% 62% 28% IJROBP 82: , 2011

63 RCT s: Treatment Scheme Fisher et al. J Clin Oncol 2014;32:

64 SNUH AWBI: Scheme Conventional RT 60.4 Gy / daily dose 1.8Gy / 33 fractions /6.6 weeks Whole breast (28 fx) week Tumor bed boost (5 fx) Hypofractionated RT 50.1 Gy / daily dose 2.7 Gy / 19 fractions / 3.8 weeks Whole breast (15 fx) week Tumor bed boost (4 fx)

65 Thank you

How can we Personalize RT as part of Breast-Conserving Therapy?

How can we Personalize RT as part of Breast-Conserving Therapy? How can we Personalize RT as part of Breast-Conserving Therapy? Jay R. Harris Dana-Farber Cancer Institute (DFCI) Brigham and Women s Hospital (BWH) Harvard Medical School Disclosures I have no COI disclosures

More information

Radiation and DCIS. The 16 th Annual Conference on A Multidisciplinary Approach to Comprehensive Breast Care and Imaging

Radiation and DCIS. The 16 th Annual Conference on A Multidisciplinary Approach to Comprehensive Breast Care and Imaging Radiation and DCIS The 16 th Annual Conference on A Multidisciplinary Approach to Comprehensive Breast Care and Imaging Einsley-Marie Janowski, MD, PhD Assistant Professor Department of Radiation Oncology

More information

Post-Lumpectomy Radiation Techniques and Toxicities

Post-Lumpectomy Radiation Techniques and Toxicities Post-Lumpectomy Radiation Techniques and Toxicities Laura Willson, MD Abbott Northwestern Hospital Dept. of Radiation Oncology February 2, 2019 Learning Objectives How radiation therapy works Standard

More information

PMRT for N1 breast cancer :CONS. Won Park, M.D., Ph.D Department of Radiation Oncology Samsung Medical Center

PMRT for N1 breast cancer :CONS. Won Park, M.D., Ph.D Department of Radiation Oncology Samsung Medical Center PMRT for N1 breast cancer :CONS Won Park, M.D., Ph.D Department of Radiation Oncology Samsung Medical Center DBCG 82 b & c Overgaard et al Radiot Oncol 2007 1152 pln(+), 8 or more nodes removed Systemic

More information

Hypofractionated Radiotherapy for breast cancer: Updated evidence

Hypofractionated Radiotherapy for breast cancer: Updated evidence 2 rd Bangladesh Breast Cancer Conference, Dhaka, December 2017 Hypofractionated Radiotherapy for breast cancer: Updated evidence Tabassum Wadasadawala Associate Professor of Radiation Oncology Tata Memorial

More information

Hypofractionated RT in Cervix Cancer. Anuja Jhingran, MD

Hypofractionated RT in Cervix Cancer. Anuja Jhingran, MD Hypofractionated RT in Cervix Cancer Anuja Jhingran, MD Hypofractionated RT in Cervix Cancer: Clinicaltrials.gov 919 cervix trials 134 hypofractionated RT trials Prostate, breast, NSCLC, GBM 0 cervix trials

More information

03/14/2019. Postmastectomy radiotherapy; the meta-analyses, and the paradigm change to altered fractionation Mark Trombetta M.D.

03/14/2019. Postmastectomy radiotherapy; the meta-analyses, and the paradigm change to altered fractionation Mark Trombetta M.D. radiotherapy; the meta-analyses, and the paradigm change to altered fractionation Mark Trombetta M.D. Division of Radiation Oncology Allegheny Health Network Cancer Institute Professor of Radiation Oncology

More information

San Antonio Breast Cancer Symposium 2010 Highlights Radiotherapy

San Antonio Breast Cancer Symposium 2010 Highlights Radiotherapy San Antonio Breast Cancer Symposium 2010 Highlights Radiotherapy Kathleen C. Horst, M.D. Assistant Professor Department of Radiation Oncology Stanford University The Optimal SEquencing of Adjuvant Chemotherapy

More information

Radiation Therapy for the Oncologist in Breast Cancer

Radiation Therapy for the Oncologist in Breast Cancer REVIEW ARTICLE Chonnam National University Medical School Sung-Ja Ahn, M.D. Adjuvant Tamoxifen with or without in Patients 70 Years of Age with Stage I ER-Positive Breast Cancer: Efficacy Outcomes (10

More information

Principles of breast radiation therapy

Principles of breast radiation therapy ANZ 1601/BIG 16-02 EXPERT ESMO Preceptorship Program 2017 Principles of breast radiation therapy Boon H Chua Professor Director of Cancer and Haematology Services UNSW Sydney and Prince of Wales Hospital

More information

BREAST CONSERVATION TREATMENT IN EARLY STAGE DISEASE AND DCIS LAWRENCE J. SOLIN, MD, FACR, FASTRO

BREAST CONSERVATION TREATMENT IN EARLY STAGE DISEASE AND DCIS LAWRENCE J. SOLIN, MD, FACR, FASTRO BREAST CONSERVATION TREATMENT IN EARLY STAGE DISEASE AND DCIS LAWRENCE J. SOLIN, MD, FACR, FASTRO Chairman Department of Radiation Oncology Albert Einstein Healthcare Network Philadelphia, PA Professor

More information

Radiotherapy Management of Breast Cancer Treated with Neoadjuvant Chemotherapy. Julia White MD Professor, Radiation Oncology

Radiotherapy Management of Breast Cancer Treated with Neoadjuvant Chemotherapy. Julia White MD Professor, Radiation Oncology Radiotherapy Management of Breast Cancer Treated with Neoadjuvant Chemotherapy Julia White MD Professor, Radiation Oncology Agenda Efficacy of radiotherapy in the management of breast cancer in the Adjuvant

More information

Radiation Treatment for Breast. Cancer. Melissa James Radiation Oncologist August 2015

Radiation Treatment for Breast. Cancer. Melissa James Radiation Oncologist August 2015 Radiation Treatment for Breast Cancer Melissa James Radiation Oncologist August 2015 OUTLINE External Beam Radiation treatment. (What is Radiation, doctor?) Role of radiation. (Why am I getting radiation,

More information

Breast cancer: Clinical evidence. of new treatments. Aero academy Conference Innovation and Safety. Patients Come First

Breast cancer: Clinical evidence. of new treatments. Aero academy Conference Innovation and Safety. Patients Come First Breast cancer: Clinical evidence of new treatments Aero academy Conference Innovation and Safety Patients Come First January 26 & 27, 2018 Lisbon, Portugal Disclosure & Disclaimer An honorarium is provided

More information

State of the Art in 2000 State of the Art today Gazing forward

State of the Art in 2000 State of the Art today Gazing forward 2010 Buschke Lecture: The Relationship between Local Recurrence and Survival in Breast Cancer Jay R. Harris Dana-Farber Cancer Institute (DFCI) Brigham and Women s Hospital (BWH) Harvard Medical School

More information

ACCELERATED BREAST IRRADIATION EVOLVING PARADIGM FOR TREATMENT OF EARLY STAGE BREAST CANCER

ACCELERATED BREAST IRRADIATION EVOLVING PARADIGM FOR TREATMENT OF EARLY STAGE BREAST CANCER ACCELERATED BREAST IRRADIATION EVOLVING PARADIGM FOR TREATMENT OF EARLY STAGE BREAST CANCER KHANH NGUYEN, MD, MA DEPARTMENT OF RADIATION ONCOLOGY BAYHEALTH CANCER CENTER BREAST CANCER STATISTICS Most common

More information

BREAST CONSERVATION TREATMENT IN EARLY STAGE DISEASE AND DCIS LAWRENCE J. SOLIN, MD, FACR, FASTRO

BREAST CONSERVATION TREATMENT IN EARLY STAGE DISEASE AND DCIS LAWRENCE J. SOLIN, MD, FACR, FASTRO BREAST CONSERVATION TREATMENT IN EARLY STAGE DISEASE AND DCIS LAWRENCE J. SOLIN, MD, FACR, FASTRO Chairman Department of Radiation Oncology Albert Einstein Medical Center Philadelphia, PA Professor (Adjunct)

More information

Intraoperative. Radiotherapy

Intraoperative. Radiotherapy Intraoperative Radiotherapy ROBERTO ORECCHIA UNIVERSITY of MILAN & EUROPEAN INSTITUTE of ONCOLOGY & CNAO FOUNDATION Breast Cancer Brescia, 30th September 2011 IORT, very selective technique to intensify

More information

Bruno CUTULI Policlinico Courlancy REIMS. WORKSHOP SULL IRRADIAZIONE MAMMARIA IPOFRAZIONATA Il carcinoma duttale in situ

Bruno CUTULI Policlinico Courlancy REIMS. WORKSHOP SULL IRRADIAZIONE MAMMARIA IPOFRAZIONATA Il carcinoma duttale in situ Bruno CUTULI Policlinico Courlancy REIMS WORKSHOP SULL IRRADIAZIONE MAMMARIA IPOFRAZIONATA Il carcinoma duttale in situ XXI CONGRESSO AIRO GENOVA 22.11.2011 INTRODUCTION Due to wide diffusion of mammography,

More information

Post-Mastectomy RT after Neoadjuvant Chemotherapy (NAC)

Post-Mastectomy RT after Neoadjuvant Chemotherapy (NAC) Post-Mastectomy RT after Neoadjuvant Chemotherapy (NAC) Jay R. Harris, M.D. Dana-Farber Cancer Institute Brigham and Women s Hospital Harvard Medical School Conclusions When considering PMRT, use both

More information

Implications of ACOSOG Z11 for Clinical Practice: Surgical Perspective

Implications of ACOSOG Z11 for Clinical Practice: Surgical Perspective :$;7)#*8'-87*4BCD'E7)F'31$4.$&'G$H'E7)F&'GE'>??ID >?,"'@4,$)4*,#74*8'!74/)$++'74',"$'A.,.)$'7%'()$*+,'!*42$)!7)74*67&'!3 6 August 2011 Implications of ACOSOG Z11 for Clinical

More information

Why Do Axillary Dissection? Nodal Treatment and Survival NSABP B04. Revisiting Axillary Dissection for SN Positive Patients

Why Do Axillary Dissection? Nodal Treatment and Survival NSABP B04. Revisiting Axillary Dissection for SN Positive Patients Memorial Sloan-Kettering Cancer Center 1275 York Avenue, New York, NY 10065 10th International Congress on the Future of Breast Cancer Coronado, CA Why Do Axillary Dissection? 6 August 2011 Implications

More information

IORT What We ve Learned So Far

IORT What We ve Learned So Far IORT What We ve Learned So Far The 16 th Annual Conference on A Multidisciplinary Approach to Comprehensive Breast Care and Imaging Einsley-Marie Janowski, MD, PhD Assistant Professor Department of Radiation

More information

Implications of ACOSOG Z11 for Clinical Practice: Surgical Perspective

Implications of ACOSOG Z11 for Clinical Practice: Surgical Perspective Memorial Sloan-Kettering Cancer Center 1275 York Avenue, New York, NY 10065 10th International Congress on the Future of Breast Cancer Coronado, CA 6 August 2011 Implications of ACOSOG Z11 for Clinical

More information

Consensus Guideline on Accelerated Partial Breast Irradiation

Consensus Guideline on Accelerated Partial Breast Irradiation Consensus Guideline on Accelerated Partial Breast Irradiation Purpose: To outline the use of accelerated partial breast irradiation (APBI) for the treatment of breast cancer. Associated ASBS Guidelines

More information

Breast cancer. (early and advanced) Radiotherapy

Breast cancer. (early and advanced) Radiotherapy Breast cancer (early and advanced) Radiotherapy Need for RT. ESTRO-HERO estimation Tumor site RT courses 2012 Increase in number 2025 Increase in rate (%) Breast 396,891 40,524 10.2 Lung 315,197 56,558

More information

Breast Cancer Radiotherapy: Clinical challenges in 2011 from a European Perspective. Dr DA WHEATLEY CONSULTANT ONCOLOGIST ROYAL CORNWALL HOSPITAL

Breast Cancer Radiotherapy: Clinical challenges in 2011 from a European Perspective. Dr DA WHEATLEY CONSULTANT ONCOLOGIST ROYAL CORNWALL HOSPITAL Breast Cancer Radiotherapy: Clinical challenges in 2011 from a European Perspective Dr DA WHEATLEY CONSULTANT ONCOLOGIST ROYAL CORNWALL HOSPITAL Radiotherapy in Early Breast Cancer Why do we do it? Who

More information

Case Conference: Post-Mastectomy Radiotherapy

Case Conference: Post-Mastectomy Radiotherapy Case Conference: Post-Mastectomy Radiotherapy Outline - Case Intro Guidelines Studies - Case Conclusion Summary Outline Case Intro to PMRT Guidelines Studies Case conclusion Summary Outline - Case Intro

More information

Recent Updates in Surgical Management of Breast Cancer Asian Patient's Perspective

Recent Updates in Surgical Management of Breast Cancer Asian Patient's Perspective Recent Updates in Surgical Management of Breast Cancer Asian Patient's Perspective Tokyo-West Tokushukai Hospital Department of Breast Oncology Tokyo-West Tokushukai Hospital, Tokyo, Japan Kaz Sato, MD,

More information

Acute and late adverse effects of breast cancer radiation: Two hypo-fractionation protocols

Acute and late adverse effects of breast cancer radiation: Two hypo-fractionation protocols ORIGINAL ARTICLES Acute and late adverse effects of breast cancer radiation: Two hypo-fractionation protocols Mohamed Abdelhamed Aboziada 1, Samir Shehata 2 1 Department of Radiation Oncology, South Egypt

More information

Hypofractionated radiotherapy for breast cancer: too fast or too much?

Hypofractionated radiotherapy for breast cancer: too fast or too much? Editorial Hypofractionated radiotherapy for breast cancer: too fast or too much? Vassilis E. Kouloulias 1, Anna G. Zygogianni 2 1 2nd Department of Radiology, Radiotherapy unit, Attikon University Hospital,

More information

2017 Topics. Biology of Breast Cancer. Omission of RT in older women with low-risk features

2017 Topics. Biology of Breast Cancer. Omission of RT in older women with low-risk features 2017 Topics Biology of Breast Cancer Early-stage HER2+ breast cancer-can we avoid RT? Prediction tools for locoregional recurrence Omission of RT in older women with low-risk features Local-Regional Recurrence

More information

Current Status of Accelerated Partial Breast Irradiation. Julia White MD Professor, Radiation Oncology

Current Status of Accelerated Partial Breast Irradiation. Julia White MD Professor, Radiation Oncology Current Status of Accelerated Partial Breast Irradiation Julia White MD Professor, Radiation Oncology I have no disclosures relative to the presented material Agenda ABPI Timeline APBI by Method Clinical

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Breast Brachytherapy for Accelerated Partial Breast Radiotherapy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: breast_brachytherapy_for_accelerated_partial_breast_radiotherapy

More information

Early Stage Breast Cancer

Early Stage Breast Cancer Local-Regional Management of Early Stage Breast Cancer Meena S. Moran, MD Associate Professor, Yale University School of Medicine Disclosure I have no conflicts of interest to disclose. Learning Objectives

More information

Neoadjuvant Treatment of. of Radiotherapy

Neoadjuvant Treatment of. of Radiotherapy Neoadjuvant Treatment of Breast Cancer: Role of Radiotherapy Neoadjuvant Chemotherapy Many new questions for radiation oncology? lack of path stage to guide indications should treatment response affect

More information

Evaluating the Z011 study and how local-regional therapy for early breast cancer may change

Evaluating the Z011 study and how local-regional therapy for early breast cancer may change Evaluating the Z011 study and how local-regional therapy for early breast cancer may change Karen Hoffman, M.D., M.H.Sc., M.P.H. Dept of Radiation Oncology The University of Texas MD Anderson Cancer Center

More information

RADIOTHERAPY IN BREAST CANCER :

RADIOTHERAPY IN BREAST CANCER : RADIOTHERAPY IN BREAST CANCER : PAST, PRESENT, FUTURE Dr Jyotirup Goswami Consultant Radiation Oncologist Narayana Cancer Institute Narayana Superspecialty Hospital Breast cancer is the classic paradigm

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Accelerated Breast Irradiation and Brachytherapy Boost Page 1 of 23 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Accelerated Breast Irradiation and Brachytherapy

More information

Partial Breast Irradiation for Breast Conserving Therapy

Partial Breast Irradiation for Breast Conserving Therapy To Radiate or Not? Is APBI the Right Compromise Solution? Partial Breast Irradiation for Breast Conserving Therapy Julia White MD Professor, Radiation Oncology Agenda Role of radiotherapy in breast conservation

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Accelerated Breast Irradiation and Brachytherapy Boost Page 1 of 27 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Accelerated Breast Irradiation and Brachytherapy

More information

SSO-ASTRO Consensus Guidance Margins for Breast-Conserving Surgery with Whole Breast Irradiation in Stage I and II Invasive Breast Cancer

SSO-ASTRO Consensus Guidance Margins for Breast-Conserving Surgery with Whole Breast Irradiation in Stage I and II Invasive Breast Cancer SSO-ASTRO Consensus Guidance Margins for Breast-Conserving Surgery with Whole Breast Irradiation in Stage I and II Invasive Breast Cancer Dr. Yvonne Tsang St. Paul s Hospital Introductions Breast-conserving

More information

Disclosure. Objectives 03/19/2019. Current Issues in Management of DCIS Radiation Oncology Considerations

Disclosure. Objectives 03/19/2019. Current Issues in Management of DCIS Radiation Oncology Considerations Current Issues in Management of DCIS Radiation Oncology Considerations Fariba Asrari, M.D. Director. Johns Hopkins Breast Center at Green Spring Station Department of Radiation Oncology & Molecular Sciences

More information

By Rufus Mark, MD, Gail Lebovic, MD, Valerie Gorman, MD, Oscar Calvo, PhD. TABLE 1 EARLY STAGE BREAST CANCER RANDOMIZED TRIALS M vs.

By Rufus Mark, MD, Gail Lebovic, MD, Valerie Gorman, MD, Oscar Calvo, PhD. TABLE 1 EARLY STAGE BREAST CANCER RANDOMIZED TRIALS M vs. EVOLUTION OF BREAST CONSERVATION RADIATION TREATMENT TECHNIQUES IN BREAST CANCER : FROM 6 WEEKS TO 3 WEEKS TO 1 WEEK TO 1 DAY AND FROM WHOLE BREAST TO PARTIAL BREAST By Rufus Mark, MD, Gail Lebovic, MD,

More information

First results from the clinically controlled randomized DBCG PBI trial

First results from the clinically controlled randomized DBCG PBI trial First results from the clinically controlled randomized DBCG PBI trial BV Offersen 1, MS Thomsen 1, HM Nielsen 1, EH Jacobsen 2, M Berg 2, MH Nielsen 3, E Lorenzen 3, L Stenbygaard 4, I Jensen 4, AN Petersen

More information

Breast Conservation Therapy

Breast Conservation Therapy May 18, 2018 Breast Conservation Therapy One Treatment No Longer Fits All Presenter: Paul B. Fowler, MD Radiation Oncology, MGSH/MUMH 1 Objectives: 1. Define stages of breast cancer that are candidates

More information

Objectives Intraoperative Radiation Therapy for Early Stage Breast Cancer

Objectives Intraoperative Radiation Therapy for Early Stage Breast Cancer Objectives Intraoperative Radiation Therapy for Early Stage Breast Cancer Cristina Lopez-Peñalver, MD, FACS October 11, 2014 Disclosures I have no relevant commercial relationships to disclose. Discuss

More information

Slide 1. Slide 2. Slide 3 History of Nurse Navigator

Slide 1. Slide 2. Slide 3 History of Nurse Navigator Slide 1 The Nurse Navigators role in Early Stage Breast Cancer, and Development of Tailored Treatment Plan Laura Ochoa, RN, ANP-BC, Ph.D. Slide 2 Barnes Jewish Hospital at Washington University Slide 3

More information

ASTRO Refresher Course 2016 Breast Cancer

ASTRO Refresher Course 2016 Breast Cancer ASTRO Refresher Course 2016 Breast Cancer Jennifer R. Bellon, M.D. Dana-Farber Cancer Institute Associate Professor of Radiation Oncology Harvard Medical School I have no relevant conflicts of interest

More information

Evolution of Regional Nodal Management of Breast Cancer

Evolution of Regional Nodal Management of Breast Cancer Evolution of Regional Nodal Management of Breast Cancer Bruce G. Haffty, MD Director (Interim) Rutgers Cancer Institute of New Jersey Professor and Chair Department of Radiation Oncology Rutgers, The State

More information

Loco-Regional Management After Neoadjuvant Chemotherapy

Loco-Regional Management After Neoadjuvant Chemotherapy 1 Loco-Regional Management After Neoadjuvant Chemotherapy Terry Mamounas, M.D., M.P.H., F.A.C.S. Medical Director, Comprehensive Breast Program UF Health Cancer Center at Orlando Health Professor of Surgery,

More information

Protocol of Radiotherapy for Breast Cancer

Protocol of Radiotherapy for Breast Cancer 107 年 12 月修訂 Protocol of Radiotherapy for Breast Cancer Indication of radiotherapy Indications for Post-Mastectomy Radiotherapy (1) Axillary lymph node 4 positive (2) Axillary lymph node 1-3 positive:

More information

What are Adequate Margins of Resection for Breast-Conserving Therapy?

What are Adequate Margins of Resection for Breast-Conserving Therapy? What are Adequate Margins of Resection for Breast-Conserving Therapy? Jay R. Harris Dana-Farber Cancer Institute (DFCI) Brigham and Women s Hospital (BWH) Harvard Medical School What are Adequate Margins

More information

Genomic Profiling of Tumors and Loco-Regional Recurrence

Genomic Profiling of Tumors and Loco-Regional Recurrence 1 Genomic Profiling of Tumors and Loco-Regional Recurrence Terry Mamounas, M.D., M.P.H., F.A.C.S. Medical Director, Comprehensive Breast Program UF Health Cancer Center at Orlando Health Professor of Surgery,

More information

Advances in Breast Cancer

Advances in Breast Cancer Advances in Breast Cancer Developed in collaboration Learning Objectives Upon completion, participants should be able to: Apply genomic medicine to treatment decisions for patients with HR+/HER2- early

More information

Recent Update in Surgery for the Management of Breast Cancer

Recent Update in Surgery for the Management of Breast Cancer Recent Update in Surgery for the Management of Breast Cancer Wonshik Han, MD, PhD Professor, Department of Surgery, Seoul National University College of Medicine Chief of Breast Care Center, Seoul National

More information

Results of the ACOSOG Z0011 Trial

Results of the ACOSOG Z0011 Trial DCIS and Early Breast Cancer Symposium JUNE 15-17 2012 CAPPADOCIA Results of the ACOSOG Z0011 Trial Kelly K. Hunt, M.D. Professor of Surgery Axillary Node Dissection Staging, Regional control, Survival

More information

Ca in situ e ormonoterapia. Discussant : LORENZA MARINO

Ca in situ e ormonoterapia. Discussant : LORENZA MARINO Ca in situ e ormonoterapia Discussant : LORENZA MARINO Ca in situ e ormonoterapia Quali fattori di rischio? Radioterapia? Ormonoterapia? BCS Recurrence rates (FUP 13-20y) Cuzick, Lancet Oncol.2011; 12(1):

More information

Loco-Regional Management After Neoadjuvant Chemotherapy

Loco-Regional Management After Neoadjuvant Chemotherapy 1 Loco-Regional Management After Neoadjuvant Chemotherapy Terry Mamounas, M.D., M.P.H., F.A.C.S. Medical Director, Comprehensive Breast Program UF Health Cancer Center at Orlando Health Professor of Surgery,

More information

Anthony E. Dragun, M.D. Associate Professor Vice Chair and Residency Program Director U of L SOM, Dept. of Radiation Oncology

Anthony E. Dragun, M.D. Associate Professor Vice Chair and Residency Program Director U of L SOM, Dept. of Radiation Oncology Anthony E. Dragun, M.D. Associate Professor Vice Chair and Residency Program Director U of L SOM, Dept. of Radiation Oncology KCR 29 th Annual Advanced Cancer Registrars Workshop 10 September 2015 1. What

More information

POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY

POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY - Original Issue Date (Created): November 22, 2011 Most Recent Review Date (Revised): May 20, 2014 Effective Date: October 1, 2014 POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS

More information

Breast Cancer Earlier Disease. Stefan Aebi Luzerner Kantonsspital

Breast Cancer Earlier Disease. Stefan Aebi Luzerner Kantonsspital Breast Cancer Earlier Disease Stefan Aebi Luzerner Kantonsspital stefan.aebi@onkologie.ch Switzerland Breast Cancer Earlier Disease Diagnosis and Prognosis Local Therapy Surgery Radiation therapy Adjuvant

More information

New Technologies in Radiation Oncology. Catherine Park, MD, MPH Advocate Good Shepherd Hospital

New Technologies in Radiation Oncology. Catherine Park, MD, MPH Advocate Good Shepherd Hospital New Technologies in Radiation Oncology Catherine Park, MD, MPH Advocate Good Shepherd Hospital Breast Radiation Early Stage Breast Cancer Whole Breast Radiation Delivered to the whole breast Boost to the

More information

Recent Advances in Breast Radiotherapy

Recent Advances in Breast Radiotherapy Recent Advances in Breast Radiotherapy Dr Anna Kirby Consultant Clinical Oncologist 2 The Royal Marsden Overview: Key innovations 1. 2D to 3D planning 2. Hypofractionation 3. Intensity modulated radiotherapy

More information

Adjuvant Radiotherapy

Adjuvant Radiotherapy Diagnosis and Treatment of Patients with Primary and Metastatic Breast Cancer Adjuvant Radiotherapy Adjuvant Radiotherapy (RT) Versions 2002 2012: Souchon / Blohmer / Friedrichs / Göhring / / Janni / Möbus

More information

Is Complete Axillary Dissection Needed Following Mastectomy and Sentinel Node Biopsy for N1 disease?

Is Complete Axillary Dissection Needed Following Mastectomy and Sentinel Node Biopsy for N1 disease? Is Complete Axillary Dissection Needed Following Mastectomy and Sentinel Node Biopsy for N1 disease? Mylin A. Torres, MD Director, Glenn Family Breast Center Louis and Rand Glenn Family Chair in Breast

More information

Debate Axillary dissection - con. Prof. Dr. Rodica Anghel Institute of Oncology Bucharest

Debate Axillary dissection - con. Prof. Dr. Rodica Anghel Institute of Oncology Bucharest Debate Axillary dissection - con Prof. Dr. Rodica Anghel Institute of Oncology Bucharest Summer School of Oncology, third edition Updated Oncology 2015: State of the Art News & Challenging Topics Bucharest,

More information

Radiotherapy Implications of ACOSOG Z-11 for Clinical Practice. Julia White, MD Professor of Radiation Oncology Medical College of Wisconsin

Radiotherapy Implications of ACOSOG Z-11 for Clinical Practice. Julia White, MD Professor of Radiation Oncology Medical College of Wisconsin 1 Radiotherapy Implications of ACOSOG Z-11 for Clinical Practice Julia White, MD Professor of Radiation Oncology Medical College of Wisconsin Disclosures: none Agenda 1. ACOSOG Z-11: Another perspective

More information

University of Groningen. Local treatment in young breast cancer patients Joppe, Enje Jacoba

University of Groningen. Local treatment in young breast cancer patients Joppe, Enje Jacoba University of Groningen Local treatment in young breast cancer patients Joppe, Enje Jacoba IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from

More information

Indications for Post- Mastectomy Radiotherapy and Considerations in Treatment Planning

Indications for Post- Mastectomy Radiotherapy and Considerations in Treatment Planning Indications for Post- Mastectomy Radiotherapy and Considerations in Treatment Planning Lori J. Pierce M.D., FASTRO Professor of Radiation Oncology University of Michigan Comprehensive Cancer Center Post-Mastectomy

More information

Accelerated Partial Breast Irradiation

Accelerated Partial Breast Irradiation Accelerated Partial Breast Irradiation OSCO/OU Stephenson Cancer Center Saturday, March 5, 2016 Robert Kuske, MD, FAACE Founder, Medical Director Arizona Breast Cancer Specialists Scottsdale, Arizona 1

More information

Radiotherapy and Oncology

Radiotherapy and Oncology Radiotherapy and Oncology 106 (2013) 15 20 Contents lists available at SciVerse ScienceDirect Radiotherapy and Oncology journal homepage: www.thegreenjournal.com Review Accelerated fractionation with a

More information

M D..,., M. M P.. P H., H, F. F A.. A C..S..

M D..,., M. M P.. P H., H, F. F A.. A C..S.. Implications of NSABP B-32 and Loco-Regional Therapy Considerations After Neoadjuvant Chemotherapy Terry Mamounas, M.D., M.P.H, F.A.C.S. Professor of Surgery Northeastern Ohio Medical University Medical

More information

Multidisciplinary management of breast cancer

Multidisciplinary management of breast cancer Multidisciplinary management of breast cancer C. Polgár 1,2 1 National Institute of Oncology 2 Semmelweis University Department of Oncology Incidence of breast cancer in Hungary 2014 Female population

More information

Breast Cancer: Management of the Axilla in Greg McKinnon MD FRCSC SON Vancouver Oct 2016

Breast Cancer: Management of the Axilla in Greg McKinnon MD FRCSC SON Vancouver Oct 2016 Breast Cancer: Management of the Axilla in 2016 Greg McKinnon MD FRCSC SON Vancouver Oct 2016 No Disclosures Principle #1 There is no point talking about surgical therapy in isolation. From a patient

More information

Clinical Case Conference Melanoma

Clinical Case Conference Melanoma Clinical Case Conference Melanoma Epidemiology ~60,000 cases and 8,000 deaths per year in US Caucasian:African American = 10:1 15% arise from existing nevi 91% are cutaneous 15% are LN+ at presentation

More information

Clinical outcomes of patients treated with accelerated partial breast irradiation with high-dose rate brachytherapy: Scripps Clinic experience

Clinical outcomes of patients treated with accelerated partial breast irradiation with high-dose rate brachytherapy: Scripps Clinic experience Original Article Clinical outcomes of patients treated with accelerated partial breast irradiation with high-dose rate brachytherapy: Scripps Clinic experience Rachel Murray 1, Fantine Giap 2, Ray Lin

More information

Clinicopathological Factors Affecting Distant Metastasis Following Loco-Regional Recurrence of breast cancer. Cheol Min Kang 2018/04/05

Clinicopathological Factors Affecting Distant Metastasis Following Loco-Regional Recurrence of breast cancer. Cheol Min Kang 2018/04/05 Abstract No.: ABS-0075 Clinicopathological Factors Affecting Distant Metastasis Following Loco-Regional Recurrence of breast cancer 2018/04/05 Cheol Min Kang Department of surgery, University of Ulsan

More information

RESEARCH ARTICLE. Abstract. Introduction

RESEARCH ARTICLE. Abstract. Introduction DOI:10.22034/APJCP.2016.17.11.4819 RESEARCH ARTICLE Comparison of Conventional and Hypofractionated Radiotherapy in Breast Cancer Patients in Terms of 5-Year Survival, Locoregional Recurrence, Late Skin

More information

Speaker s Bureau. Travel expenses. Advisory Boards. Stock. Genentech Invuity Medtronic Pacira. Faxitron. Dune TransMed7 Genomic Health.

Speaker s Bureau. Travel expenses. Advisory Boards. Stock. Genentech Invuity Medtronic Pacira. Faxitron. Dune TransMed7 Genomic Health. Management of DCIS Shawna C. Willey, MD, FACS Professor of Surgery, Georgetown University Director, Medstar Regional Breast Health Program Chief, Department of Surgery Medstar Georgetown University Hospital

More information

Accelerated Radiation Treatment for Early Stage Breast Cancer. update and perspective

Accelerated Radiation Treatment for Early Stage Breast Cancer. update and perspective Accelerated Radiation Treatment for Early Stage Breast Cancer update and perspective School of Breast Oncology Atlanta, 11/2012 Douglas W. Arthur, M.D. Professor Traditional Whole Breast Irradiation WBI

More information

What is an Adequate Lumpectomy Margin in 2018?

What is an Adequate Lumpectomy Margin in 2018? What is an Adequate Lumpectomy Margin in 2018? Stuart J. Schnitt, M.D. Brigham and Women s Hospital, Dana-Farber Cancer Institute, and Harvard Medical School Boston, MA None Disclosures Topics Current

More information

Clinical Trials of Proton Therapy for Breast Cancer. Andrew L. Chang, MD 張維安 Study Chair

Clinical Trials of Proton Therapy for Breast Cancer. Andrew L. Chang, MD 張維安 Study Chair Clinical Trials of Proton Therapy for Breast Cancer Andrew L. Chang, MD 張維安 Study Chair AndrewLChangMD@gmail.com Disclosure Proton Center Development Corporation Scripps San Diego Proton Therapy Center

More information

Trends in the Use of Implantable Accelerated Partial Breast Irradiation Therapy for Early Stage Breast Cancer in the United States

Trends in the Use of Implantable Accelerated Partial Breast Irradiation Therapy for Early Stage Breast Cancer in the United States Trends in the Use of Implantable Accelerated Partial Breast Irradiation Therapy for Early Stage Breast Cancer in the United States A THESIS SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL OF THE UNIVERSITY

More information

Hypofractionation and positioning in breast cancer radiation. John Hardie, M.D., Ph.D. November 2016

Hypofractionation and positioning in breast cancer radiation. John Hardie, M.D., Ph.D. November 2016 Hypofractionation and positioning in breast cancer radiation John Hardie, M.D., Ph.D. November 2016 At McFarland/MGMC we treat early stage breast cancer with 42.4 Gy in 16 fractions, in the prone position.

More information

Long-Term Results of Hypofractionated Radiation Therapy for Breast Cancer

Long-Term Results of Hypofractionated Radiation Therapy for Breast Cancer The new england journal of medicine original article Long-Term Results of Radiation Therapy for Breast Cancer Timothy J. Whelan, B.M., B.Ch., Jean-Philippe Pignol, M.D., Mark N. Levine, M.D., Jim A. Julian,

More information

Hypo- versus normofractionated radiation therapy of early breast cancer in the randomized DBCG HYPO trial

Hypo- versus normofractionated radiation therapy of early breast cancer in the randomized DBCG HYPO trial Hypo- versus normofractionated radiation therapy of early breast cancer in the randomized DBCG HYPO trial BV Offersen 1, HM Nielsen 1, EH Jacobsen 2, MH Nielsen 3, M Krause 4, L Stenbygaard 5, I Mjaaland

More information

Adjuvant Radiotherapy for completely resected NSCLC

Adjuvant Radiotherapy for completely resected NSCLC Adjuvant Radiotherapy for completely resected NSCLC ESMO Preceptorship on lung Cancer Manchester February 2017 Cécile Le Péchoux Radiation Oncology Department IOT Institut d Oncologie Thoracique Local

More information

38 years old, premenopausal, had L+snbx. Pathology: IDC Gr.II T-1.9cm N+2/4sn ER+100%st, PR+60%st, Her2-neg, KI %

38 years old, premenopausal, had L+snbx. Pathology: IDC Gr.II T-1.9cm N+2/4sn ER+100%st, PR+60%st, Her2-neg, KI % 38 years old, premenopausal, had L+snbx Pathology: IDC Gr.II T-1.9cm N+2/4sn ER+100%st, PR+60%st, Her2-neg, KI67 5-10% Question: What will you do now? 1. Give adjuvant chemotherapy 2. Send for Oncotype

More information

The Evolution of SBRT and Hypofractionation in Thoracic Radiation Oncology

The Evolution of SBRT and Hypofractionation in Thoracic Radiation Oncology The Evolution of SBRT and Hypofractionation in Thoracic Radiation Oncology (specifically, lung cancer) 2/10/18 Jeffrey Kittel, MD Radiation Oncology, Aurora St. Luke s Medical Center Outline The history

More information

Minesh Mehta, Northwestern University. Chicago, IL

Minesh Mehta, Northwestern University. Chicago, IL * Minesh Mehta, Northwestern University Chicago, IL Consultant: Adnexus, Bayer, Merck, Tomotherapy Stock Options: Colby, Pharmacyclics, Procertus, Stemina, Tomotherapy Board of Directors: Pharmacyclics

More information

Emerging Approaches for (Neo)Adjuvant Therapy for ER+ Breast Cancer

Emerging Approaches for (Neo)Adjuvant Therapy for ER+ Breast Cancer Emerging Approaches for (Neo)Adjuvant Therapy for E+ Breast Cancer Cynthia X. Ma, M.D., Ph.D. Associate Professor of Medicine Washington University in St. Louis Outline Current status of adjuvant endocrine

More information

Partial Breast Irradiation using adaptive MRgRT

Partial Breast Irradiation using adaptive MRgRT Partial Breast Irradiation using adaptive MRgRT Shyama Tetar, radiation-oncologist VUmc Amsterdam 15-12-2017 5 th Vumc SBRT symposium 2017 Current practice Breast conserving treatment (BCT) Breast conserving

More information

Optimal Management of Isolated HER2+ve Brain Metastases

Optimal Management of Isolated HER2+ve Brain Metastases Optimal Management of Isolated HER2+ve Brain Metastases Eliot Sims November 2013 Background Her2+ve patients 15% of all breast cancer Even with adjuvant trastuzumab 10-15% relapse Trastuzumab does not

More information

Hypofractionated Radiotherapy as Adjuvant Treatment in Early Breast Cancer. A Review and Meta-Analysis of Randomized Controlled Trials

Hypofractionated Radiotherapy as Adjuvant Treatment in Early Breast Cancer. A Review and Meta-Analysis of Randomized Controlled Trials Review Article Breast Care 2015;10:240 245 DOI: 10.1159/000439007 Published online: August 19, 2015 Hypofractionated Radiotherapy as Adjuvant Treatment in Early Breast Cancer. A Review and Meta-Analysis

More information

Accelerated Radiation Treatment for Early Stage Breast Cancer. update and perspective

Accelerated Radiation Treatment for Early Stage Breast Cancer. update and perspective Accelerated Radiation Treatment for Early Stage Breast Cancer update and perspective School of Breast Oncology Atlanta, 11/2013 Douglas W. Arthur, M.D. Professor Traditional Whole Breast Irradiation WBI

More information

The Challenge of Individualizing Loco-Regional Treatments for Patients with Localized Breast Cancer

The Challenge of Individualizing Loco-Regional Treatments for Patients with Localized Breast Cancer The Challenge of Individualizing Loco-Regional Treatments for Patients with Localized Breast Cancer Le défi des traitements locorégionaux individualisés pour les patientes présentant un cancer du sein

More information

Invasive Breast Cancer

Invasive Breast Cancer Invasive Breast Cancer Eileen Rakovitch MD MSc FRCPC Sunnybrook Health Sciences Centre Medical Director, Louise Temerty Breast Cancer Centre LC Campbell Chair in Breast Cancer Research Associate Professor,

More information

The Role of a Boost Radiation Dose in Patients with Negative Re-Excision Findings

The Role of a Boost Radiation Dose in Patients with Negative Re-Excision Findings 24 The Open Breast Cancer Journal, 2011, 3, 24-28 Open Access The Role of a Boost Radiation Dose in with Negative Re-Excision Melanie C. Smitt and Kathleen C. Horst * Department of Radiation Oncology,

More information

The Management of Breast Cancer 2015 ASTRO Spring Refresher

The Management of Breast Cancer 2015 ASTRO Spring Refresher The Management of Breast Cancer 2015 ASTRO Spring Refresher Gary M. Freedman, M.D. Associate Professor Disclosure I have no conflicts of interest to disclose. 2 Learning Objectives Apply knowledge of randomized

More information