ณ อาคารเฉลิมพระบารมี 50 ปี ซ.

ศูนย์วิจยั กรุงเทพ
วันที่ 12-14 กรกฎาคม 2553

รศ.นพ. ประเสริฐ เลิศสงวนสินชัย

 Role / indications of radiation in
Breast Cancer

 Radiation Technique

 Result of Radiation Therapy

 Optimising locoregional control
and eradicating occult blood borne
micrometastasis are important
treatment objectives
Multidisciplinary management
 Surgery

 Radiation

 Systemic treatment (chemotherapy,

hormone)
 Targeted therapy
1. Postmastectomy Radiotherapy
(PMRT)
2. Breast Conserving Therapy (BCT)
2.1 Invasive breast cancer (INV)
2.2 Ductal Carcinoma in Situ (DCIS)
3. Locally Advanced Breast Cancer
4. Palliative Radiation Therapy
5. Locoregional Recurrence Breast
Cancer
 Bleeding
 Ulceration

 Pain

 Arm edema

 Brachial plexus paralysis

Fowble et al. J Clin Onco 6: 1107-1117, 1988

07-09-2007
 Stage LR recurrence (%) at 5 Y
T1T2N0 5-10%
N0 3-10%
N1-3 10-20%
N4 20-40%
T3 30-50%
Number of node % locoregional
involved recurrence at 10 y
0 <15%
1-3  25%
4-9  35%
10  55%
Acta Oncologica 2000; 39: 295-305
Results :- 55% disease recurrence
5 years 10years
Isolated LRF 10.1% 13%
LRF + DF 6.3% 8%
DF alone 24.5% 34%
10 years follow up LRF  DF
Node 1-3 12.9%
Node 4 28.7%
ECOG JCO Vol 17; 1999: 1689-1700
Number axillary node 10 year
involved Isolated LRR (%) Total LRR
0 4% 7%
1-3 10% 14%
4-9 21% 25%
 10 22% 33%
JCO Vol. 18; 2000: 2817-2827
 Modified radical mastectomy was the
primary treatment for breast cancer

Last 30 years (since 1980) a breast conserving

surgery with radiation is an acceptance for
treatment
Studies LRF (%) Survival (%) Follow up
(months)
CBS CBS+RT CBS CBS+RT

Milan 19 2 85 87 48
NSABP 35 10 58 63 150
Swedish 18 2 90 91 64
Ontario 29 7 85 87 66
Scotland 24.5 5.8 78 80 68
Studies LRF (%) Survival (%) Follow up
BCT MRM BCT MRM (Years)

Milan 7 4 65 65 18
NSABP 10 8 63 59 12
EORTC 13 9 54 61 8
DBCG 5 6 79 82 6
IGR 9 14 73 65 15
NCI 16 6 77 75 10
DCIS
 Conventional RT (2D)

 3-D Conformal RT (3D-CRT)

 Intensity Modulated RT (IMRT)

LINAC
 2D RT

Tangential fields, directed at chest wall

 2D RT

Supraclavicular
Area
2D 3D
CHEST WALL (3DCRT)
RECURRENCE CA BREAST (IMRT)
 Due to questioning to the efficacy of
whole breast radiation in selected
patients

 Selected patients:- T1N0M0

- negative margin
- age > 45 years
PBI – LINAC
MAMMO SITE
Aims of Treatment
 Palliation
 Treatment decision for
Advance Breast Cancer

1. Improve symptom(s) control

2. Improve QOL
3. Improve long term / prolong survival
4. Delay progression of disease
07-09-2007 10-05-2008

11-06-2009 22-03-2010
 Reduce locoregional recurrence

 Could Radiotherapy improve overall

survival ?

 Cosmesis of the treatment

 The overview of eight unconfounded
randomized trials of radiotherapy initiated
before 1975 (total 7,941 women)

Surgery alone VS Surgery + Radiation

None of the patients received chemotherapy

Surgery = radical mastectomy or simple
mastectomy

J. Cuzick JCO 12: 447-453,1994

 The overall mortality rate was similar in the first 10 years
A divergence in favor of patients not given radiotherapy is apparent
after approximately 15 years in the radical mastectomy trials
For the simple mastectomy trials, the overall survival curves remain
similar after 10 years

JCO 12 : 447-453,1994
 Effects of radiotherapy for early breast
cancer on local recurrence and 15-year survival
Lancet 2005; 366: 2089-2106

Meta-analysis of randomized trials that began

by 1995
78 randomized trial, 42,000 women comparison
of radiotherapy VS no radiotherapy
 25,000 women (both node-negative and node-

positive) postmastectomy, axillary clearance

NO RT vs RT

5-Y LRR 26% 7%

15-Y breast cancer 49.5% 44.6% (reduction 5%)

mortality (p<0.00001)
 8500 women with mastectomy (with axillary
clearance, and node positive disease)

NO RT vs RT

5-Y LRR 23% 6%

15-Y breast cancer 60% 54.7% (reduction

mortality 5.4%)

15-y overall mortality reduction 4.4% p=0.0009

 7300 women with breast conserving surgery (BCS)
(most had axillary clearance and node-negative disease)

NO RT vs RT

5-Y LRR 26% 7% (reduction

19%)
15-Y breast cancer 35.9% 30.5% (reduction
mortality 5.4%)

15-y overall mortality reduction 5.3% p=0.005

 Among women received systemic therapy and
radiotherapy
NO RT RT
5 y local recurrence 28% 8%
15 year breast cancer 55.1% 49.1%
mortality
Absolute reduction 5.9% p<0.00001

Better local treatment adds to the effect of systemic

therapy on local recurrence and on breast cancer
mortality
 Locoregional control

 Survival benefit

 Cosmesis / Complication
THANK YOU FOR YOUR
ATTENTION