Radiation Therapy for the Oncologist in Breast Cancer

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Chester Logan
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years) Tam. + RT Tam. Alone (n=317) (n=319) p lpsilateral Breast Tumor Recurrence 6 ( 2%) 27 ( 9%).

1 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 years) Tam. + RT Tam. Alone (n=317) (n=319) p lpsilateral Breast Tumor Recurrence 6 ( 2%) 27 ( 9%).0001 Ultimate Mastectomy 4 ( 2%) 10 ( 4%).1779 Second Primary Cancer 36 (12%) 33 ( 9%).7268 Distant Metastasis 21 ( 5%) 16 ( 5%).461 Death 157 (33%) 166 (33%).8045 Breast cancer 12 ( 3%) 8 ( 2%)

2 Summary of Immunohistochemical Criteria for Defining Breast Cancer Intrinsic Subtypes. Criteria and Subtype ER PR HER2 CK5/6 EGFR Ki-67 Criteria for positive result >1% of >1% of HercepTest* 3 +or 2+ and Any cytoplasmic or Any cytoplasmic or 14% of tumor nuclei tumor nuclei FISH amplificationratio> 2.0 Membranous staining Membranous staining tumor nuclei Subtype Luminal A Either ER or PR positive Negative Any Any Negative Luminal B Either ER or PR positive Negative Any Any Positive Luminal-HER2 Either ER or PR positive Positive Any Any Any HER2 enriched Negative Negative Positive Any Any Any Basal-like Negative Negative Negative CK5/6 or EGFR positive Any TNP-nonbasal Negative Negative Negative Negative Negative Any 24 Sung-Ja Ahn

3 Korean Journal of Clinical Oncology Summer 2011;Vol.7,NO.1: Results of Randomized trial (OCOG) evaluating hypofractionation for WBI Conventional Hypofractionation RT Schedule 50 Gy/25fx 42.5 Gy/16fx No. of patients Local recurrence, 5y (%) Local recurrence, 10y (%) Survival, 5y (%) Survival, 10y (%) Toxicity, G2-3, 5y (%) Skin Subcutaneous Adverse cosmetics (%) 5yr yr Patient selection criteria for Partial Breast Irradiation American Brachytherapy Society American Society of Breast Surgeon Age Pathology Invasive ductal ca IDC or DCIS Size (cm) 3 2 margin Nodal status Negative: no tumor involving inked margin Negative including sentinel LN evaluation Negative: at least 2mm in all directions Negative including sentine l LN evaluation REFERENCES 1. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomized trials. Early Breast Cancer Trialists Collaborative Group (EBCTCG). Lancet 366: , Meeting highlights. The annual meeting of the American Society of Clinical Oncology. Clinical Breast cancer , Paik S, et al. A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. New Eng J Med 351: , Mamounas EP, et al. Association between the 21-gene recurrence score assay and risk of locoregional recurrence in node-negative, estrogen receptor-positive breast cancer: results from NSABP B-14 and NSABP B-20. J of Clin Oncol 28(10): , Overgaard M, et al. Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes, as 25

4 recommended in international consensus reports? A subgroup analysis of the DBCG 82 b & c randomized trials. Radiother & Oncol 82: , Goulart J, et al. Outcomes of node-negative breast cancer 5 centimeters and larger treated with and without postmastectomy radiotherapy. Int J Radiat Oncol Biol Phys, in press Taghian AG, et al. Low locoregional recurrence rate among node-negative breast cancer patients with tumors 5cm or larger treated by mastectomy, with or without adjuvant systemic therapy and without radiotherapy: results from five National Surgical Adjuvant Breast and Bowel Project Randomized Clinical trials. J of Clin Oncol 24(24): , Pinnaro P, et al. Long-term results of a randomized trial on the sequencing of radiotherapy and chemotherapy in breast cancer. Am J of Clin Oncol, in press, Buchholz TA et al. Statement of the science concerning locoregional treatments after preoperative chemotherapy for breast cancer: a National Cancer Institute Conference. J of Clin Oncol 26(5): , Whelan TJ, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 362(6):513-20, Sher DJ, et al. Partial-breast irradiation versus whole-breast irradiation for early-stage breast cancer: a cost-effectiveness analysis. Int I Radiat Oncol Biol Phys 74(2): , Pignol J, Olivotto I, Rakovitch E, et al. A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J of Clin Oncol 26(13): , Sung-Ja Ahn

5 Korean Journal of Clinical Oncology Summer 2011;Vol.7,NO.1: Department of Radiation Oncology, Chonnam National University Medical School Sung-Ja Ahn, M.D. Purpose : About 20% of colorectal cancer patients were diagnosed with stage IV at the initial presentation, and less than 30% of those could be treated curatively via surgical resection. In this study, we investigated the prognostic factors for unresectable stage IV colorectal cancer and evaluated the benefit of surgical treatment. Method : Retrospective analysis of 125 patients diagnosed with stage IV colorectal cancer in Korea Uinversity Guro Hospital from 2003 to 2006 was performed for patient and tumor characteristics, metastatic status, treatment modality, and the survival outcome. Result : Ninety patients were included in analysis for complete follow up data. Median survival was 11.1 month and estimated 5 year survival rate was 8.1%. Resection of primary lesion was performed in 15.5%, and resection of primary lesion combined with incomplete resection of metastatic lesion was performed in 8.9%. In multivariate analysis, peritoneal metastasis, curative resection of primary lesion with metastatic lesion and the resection of primary lesion combined with the incomplete metastectomy was an independent poor prognostic factor (p<0.05). Conclusion : Surgical treatment for incurable colorectal cancer could be beneficial in selected condition, and further prospective studies are required for evaluating surgical role in the multidisciplinary approach of incurable colorectal cancer. 27

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