IMG_5397.jpeg

# Seminar Gynäkologie ## 15 Seminar: Radiation Therapy for Breast Cancer **Importance** * Almost all women with breast cancer receive radiation. * Primary adjuvant radiation after breast-conserving surgery (BCS) significantly improves local control and survival. * Positive effect for all subgroup...

# Seminar Gynäkologie ## 15 Seminar: Radiation Therapy for Breast Cancer **Importance** * Almost all women with breast cancer receive radiation. * Primary adjuvant radiation after breast-conserving surgery (BCS) significantly improves local control and survival. * Positive effect for all subgroups, including older patients. * Standard: 5 fractions/week for 10 minutes, about 5 weeks. * Boosting: Increasing the local dose in the old tumor bed leads to a reduced risk of recurrence. * Post-mastectomy: * Positive effect for all subgroups, including older patients. * Not always, only in (T3-) TF tumors or nodal involvement. * Radiation of lymphatic drainage pathways. * Axillary before sentinel lymph nodes supraclavicular, retrosternal (internal mammary artery). * Goal: reducing axillary lymph node recurrences and distant metastases, thus improving overall survival. * Distinguishing between axillary and other radiation. * NB: no longer radical lymph node dissection (NE: lymph edema); in case of permanent LN, radiation. **Dosage and Technique** * Efficiency in reducing the risk to other body organs and thus the risk of side effects has increased. * 3D-radiation therapy tangential * Intensity-modulated * Free breathing vs. DIBH = Deep Inspiration Breath Hold (safeguarding the heart and lungs). * Dosage: approx. 50 Gy (25 x 2 Gy). **Post-BET (breast surgery enhancement therapy)** * Without LAW (unknown): * Standard: conventional, 5 fractions per week for 5 weeks. * Alternate hypo-fractionated radiation for 3 weeks. **Post-Breast Cancer Surgery Enhancement Therapy + LAW** * Standard: conventional, 5 fractions/week for 5 weeks. * Alternative: hypo-fractionated radiation for 3 weeks. * Temporal Coordination: * Always adjuvant, never neoadjuvant. * 4-8 weeks post chemotherapy + surgery, or 2-4 weeks post surgery + chemotherapy (distance to surgery is important). * If hormone therapy: also adjuvant first, e.g., parallel to radiation (and beyond). **Radiation Field Size** * Almost always the whole breast. * Sometimes only partial irradiation, e.g., in the case of re-irradiation after recurrence (Gy accumulation) or in young women with a desire for children or in older patients with a low risk profile. **Side effects** * Overall, these are relatively mild. * General: * Fatigue * Nausea/Vomiting * Specific: * Skin reactions: Late fibrosis and telangiectasia * Secondary malignancies (0.5%; higher risk for smokers with bronchial cancer) * Heart (primarily left-sided and during breast irradiation): Fibrosis. * Lungs: Late effects: Fibrosis. * Angina Pectoris, heart rhythm disturbances. * Pneumonitis (less than 1%) - dyspnea, cough; treatment: cortisol