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

2. 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 Mar;82(3):254-64)
Royal Marsden (Pignol et al. JCO 2008; 26(13): )
Combination with breath hold (for heart protection)
Combination with complex radiation fields (nodal)
Conclusions

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

4. 3D Optimisation

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

6. Electronic compensators
Breast IMRT
Follow the shape of the breast

7. Donovan et al Radiother. Oncol
Donovan et al Radiother. Oncol Mar;82(3): patients, randomized

8. Donovan et al: Any palpable induration:

9. Pignol et al, J Clin Oncol
Pignol et al, J Clin Oncol May 1;26(13): patients, Randomized

10. 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:

11. 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:

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

14. 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

15. 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