Breast

Question 1

What are the RToptions for post-lumpectomy patients?

Answer 1

1. whole breast RT

2. partial breast

Question 2

What are the whole breast RT options?

Answer 2

1. standard fractionation 50Gy in 25# with boost of 16Gy in 8#
2. hypofractionation (42.5Gy in 16#)

Question 3

What are the RT options for partial breast patients?

Answer 3

1. external beam 1 week

2. brachy –> interstitial or intracavitary

Question 4

Why are patients treated prone/ problems with supine treatment for larger women?

Answer 4

• large separation, requiring the use of 10MV beams that resulted in skin sparing
• numerous tissue folds causing severe skin reactions
• large tangential cuts that resulted in increased lung doses and for left sided tangential fields increased dose to the heart

Question 5

What are indications for prone?

Answer 5

• patients who breast, when lying supine, relaxes lateral-posteriorly causing an excessive amount of underlying lung to be included in the treatment volume
• when chest well coverage is not essential
• to reduce dose to the heart for left sided tangential fields
• for patients capable of lying prone in the treatment position for periods up to 30 minutes

Question 6

What are some set-up considerations for prone?

Answer 6

• patient’s torso is rotated into the treatment window for more lateral beam direction and to allow maximum amount of breast to extend into the treatment window without touching the couch top
• this may be limited by the amount of rotation that the patient can comfortably maintain
• minimise stomach folds by pulling by pulling abdomen inferioly
• the patient is straightened using the longitudinal laser inf of mid thorax

Question 7

What are some planning considerations for prone?

Answer 7

• important to note that in the prone position it is not necessary to oppose the tangents
• angles dependent on patient contour
• the anterior oblique field can be angled to avoid coming through the breast board

Question 8

What are the considerations for prone patients requiring electron boosts?

Answer 8

• patient will need to be treated supine for boost which requires separate CT scan
• breast may be required to be taped to reduce folds
• cannot create a composite plan (overlap of plans to see overall dose)

Question 9

When are photon boosts used?

Answer 9

• due to the size of the breasts it is sometimes difficult to achieve the boost PTV coverage with an electron field
• possible to use photon boosts in the prone position

Question 10

What are the consideration when the head is turned for supraclavicular fossa?

Answer 10

• moving the head brings the SC closer

- decreases neck folds and thus skin reactions

Question 11

What are the side effects of RT?

Answer 11

• erythema
• dry and moist dequamation
• talengactasia
• skin dimpling
• swelling
• nipple changes

Question 12

What is the skin care?

Answer 12

• loose cotton cothing
• dont scrub area
• avoid sun exposure
• aqueous creams
• mepitel
• cold clothes
• 1% hydrocortisone cream
• pure alovera on unbroken skin

Question 13

What are the brachytherapy options for breast?

Answer 13

• HDR brachy intesitial which delivers RT from needles put inside the tumour
• mammosite balloon (34Gy in 5# over 5 days using iridium 192) uses balloon applicator filled with water
• SAVI (strut-adjusted volume implant) single entry breast brachy therapy device which goes into lumpectomy and then is expanded once inside the breast