Intensity Modulated Radiation Therapy (IMRT) for Breast Cancer

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Intensity Modulated Radiation Therapy (IMRT) for Breast Cancer Vincent Remouchamps Service de Radiothérapie Clinique et Maternité Ste Elisabeth Namur www.cmsenamur.be Belgian Breast Meeting 2008 October 3-4, Brussels

Intensity Modulated Radiation Therapy(IMRT) for Breast Cancer Clinical problem: skin toxicity Technical solutions: IMRT and 3D optimization Clinical outcome from 2 Randomized Trials Ontario (Donovan et al. Radioth. Oncol. 2007 Mar;82(3):254-64) Royal Marsden (Pignol et al. JCO 2008; 26(13):2085-92) Combination with breath hold (for heart protection) Combination with complex radiation fields (nodal) Conclusions

Sagital isodoses view Kestin et al, IJROBP 2000 Standard Wedges Desquamation, Oedema Acute Skin Side Effects 115% 110% 105% 100% 95% 90% Hot spots

3D Optimisation

Sagital isodoses view Standard Filters Optimized 3D / IMRT 115% 110% 105% 100% 95% 90%

Electronic compensators Breast IMRT Follow the shape of the breast

Donovan et al Radiother. Oncol Donovan et al Radiother. Oncol. 2007 Mar;82(3):254-64 240 patients, randomized

Donovan et al: Any palpable induration:

Pignol et al, J Clin Oncol Pignol et al, J Clin Oncol. 2008 May 1;26(13):2085-92 358 patients, Randomized

Radiotherapy after breast-conserving surgery, generally with axillary clearance (BCSRT) in all women (7311 women, 17% with node +disease) META-ANALYSE: EBCTCG Lancet 2005; 366: 2087-2106

Effect of radiotherapy on non-breast cancer mortality (29 623 women) Why non-breast cancer surmortality? Main reasons: Heart toxicity and lung cancer Cohort studies: Mostly left-sided radiation META-ANALYSE: EBCTCG Lancet 2005; 366: 2087-2106

To Protect the Heart: Heart Deep Inspiration Breath Hold Free Breathing

Nodal extension Anatomy of the lymphatic routes of the breast. In: Del Regato JA, Spjut HJ: Ackerman and del Regato’s Cancer: Diagnosis, Treatment, and Prognosis, ed. 6 St. Louis, CV Mosby, 1985

Conclusions: Breast « IMRT » improve the radiation dose homogeneity is feasable reduces acute and chronic toxicities (level 1) can be combined with advanced techniques breath hold for heart protection perfect junctioning