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RO Clinical Boards > Breast > Flashcards

Breast Flashcards

1
Q

Most common breast cancer genetic syndrome

A

BRCA1/BRCA2

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2
Q

Syndromes associated with Breast Cancer

A

BRCA1/2
TP53 (Li-Fraumeni)
STK11 / Peutz-Jeghers Syndrome
NF1

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3
Q

Other cancers associated with BRCA2

A

prostate (most common gene alteration in early onset PCA)

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4
Q

Is BRCA mutation associated with higher RT toxicity?

A

no

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5
Q

Risk factors for breast cancer

A
  1. Personal history of BCA
  2. Genetic syndromes
  3. Endogenous hormone production (increases ovulatory cycle)
  4. Exogenous hormone usage
  5. Lifestyle (alc, obesity, physical activity)
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6
Q

What percentage of IHC required for ER/PR status

A

1%

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7
Q

Strategy to confirm Her2 status

A

IHC –> FISH if equivocal
If 0 or 3 no FISH
If 1 on IHC –> negative
If 2 on IHC –> FISH

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8
Q

Screening guidelines

A

For women 45-54 with average risk of BC, annual mammogram +/- clinical breast exam recommended

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9
Q

Confirming adequate mammo

A

MLO/CC views, confirm strip of pec major and inframammary fold

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10
Q

If architectural distortion –> next step

A

diagnostic mammo

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11
Q

BIRADS 0

A

need additional imaging info

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12
Q

BIRADS 1

A

Negative –> annual mammo

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13
Q

BIRADS 2

A

Benign –> annual mammo

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14
Q

BIRADS 3

A

Probably benign –> 6 month FU mammo

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15
Q

BIRADS 4

A

Suspicious –> biopsy considered

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16
Q

BIRADS 5

A

Highly suggestive of cancer –> bx required

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17
Q

BIRADS 6

A

Cancer confirmed

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18
Q

Options to reduce contralateral risk

A
  1. Antiestrogens
    Tamoxifen if premenopausal (20 mg/day) x 5 years
    Raloxifene 60 mg/day x 5 years
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19
Q

Risks of tamoxifen

A

VTE, endometrial ca

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20
Q

Risks of AI

A

bone issues

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21
Q

BRCA1

A

Risk depends on penetrance, ~65% with contralateral risk of 60%

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22
Q

BC type associated with BRCA1

A

TNBC

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23
Q

BRCA2

A

Lifetime risk 45-84%, ovarian risk if 15-20%

More prevalent in men, associated with prostate and panc as well

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24
Q

BC type associated with BRCA2

A

ER+

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25
Q

Lateral extent of breast

A

mid axillary line (lat dorsi)

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26
Q

Rotter’s nodes

A

Intrapectoral (Level 2)

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27
Q

Level 3

A

infraclav/subclav nodes (medial or superior to pec minor)

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28
Q

Internal mammary nodes most often involved with which tumors

A

LIQ

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29
Q

Why use breast MRI

A

multicentric disease –> ineligible for breast conservation

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30
Q

Path features associated with risk of local recurrence

A
  1. Size
  2. ER status
  3. Ki67
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31
Q

Path features associated with risk of DM

A
  1. LVSI

2. Nodal mets

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32
Q

% of clinically node negative pts who have nodal mets

A

20-30%

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33
Q

Luminal A

A

ER+
PR+
Her2-

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34
Q

Luminal B

A

Triple positive

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35
Q

Basal

A

Aka Her2+

ER/PR negative

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36
Q

Oncotype Dx

A

21 gene panel to prognosticate and predict response to chemo [16 cancer-related genes, 5 comparator]

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37
Q

Margins for IDC

A

no tumor on ink

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38
Q

Margins for DCIS

A

> 2 mm

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39
Q

T1

A

<2 cm

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40
Q

T2

A

2-5cm

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41
Q

T3

A

> 5cm

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42
Q

T4a

A

extension to chest wall

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43
Q

T4b

A

ulceration or ipsi satellite nodules / edema of skin (including peau d’orange) which do not meet inflammatory criteria

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44
Q

T4c

A

both T4a and T4b

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45
Q

T4d

A

Inflammatory (changes involving one-third or greater of the skin of the breast)

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46
Q

LCIS

A

benign entity

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47
Q

Mgmt of LCIS

A
  • -Observe classical LCIS
  • -Resect nonclassical LCIS
  • -Consider chemoreduction with Tamoxifen 20 mg/day
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48
Q

In breast tumor recurrence risk for DCIS

A

1% per year (30% at 30 years)

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49
Q

IBTR for low grade DCIS

A

1% per year

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50
Q

IBTR for high grade DCIS

A

2% per year

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51
Q

Mix of invasive/DCIS recurrence

A

50/50

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52
Q

Local risk reduction from RT for DCIS

A

50%

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53
Q

How is DCIS diagnosed

A

90% by routine mammo –> calcs –> spot compression –> mag views

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54
Q

Path feature of DCIS

A

E-cadherin+

70% are ER+

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55
Q

Pagets of breast association with malignancy

A

Underlying breast malignancy is present in 85 to 88 percent of cases, and a palpable mass is present in approximately one-half.

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56
Q

Treatment of low risk Paget

A

BCT followed by whole breast RT (local control >85%)

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57
Q

Treatment of high risk Paget

A

Mastectomy (diffuse with positive margins)

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58
Q

General treatment of DCIS

A

excision with negative margins followed by whole breast RT

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59
Q

NSABP B-17

A

RCT of local excision +/- RT

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60
Q

B-17 findings

A

Reduce local failure from 35% to 20%

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61
Q

Reduction of DCIS with tamoxifen

A

3% if ER+

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62
Q

Role of RT for DCIS

A

reduced local recurrence by 50%, no diff in OS

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63
Q

RTOG 9804

A

Low risk DCIS (grade 1-2, wide margins >3mm) randomized to BCS vs. BCS+RT

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64
Q

When is APBI ok for DCIS

A
  1. Age >50
  2. screening detected
  3. grade 1-2
  4. size <2.5 cm
  5. margins >3mm
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65
Q

grade 1 dermatitis

A

faint erythema or dry desquamation

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66
Q

grade 2 dermatitis

A

moderate/brisk erythema, patchy moist d in skin folds

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67
Q

grade 3 dermatitis

A

moist d in areas other than skin folds, bleeding with minor abrasions

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68
Q

grade 4 dermatitis

A

life threatening consequences, skin necrosis/ulceration, skin graft indicated

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69
Q

NSABP B-04

A

clinically node negative randomized to
1. radical mastectomy
2. simple mastectomy and nodal irradiation
3. simple mastectomy, no nodal treatment with salvage ALND
NO differences between the arms

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70
Q

Rate of axillary relapse in B-04 for no axillary mgmt

A

23%

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71
Q

Who can receive hypofractionated WBRT

A

Anyone over 50 (266 x 15) if sep <25

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72
Q

Trials showing equivalence of hypofrac to standard frac

A
  1. Canadian

2. UK START B

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73
Q

Dose from Canadian hypofrac trial

A

50/25 vs. 42.5 in 16

No significant differences in 10 year local, distant, OS or cosmesis

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74
Q

Dose from UK START B

A

50/25 vs. 40/15
Demonstrated improved cosmesis with hypofrac
No diff in locoregional outcomes

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75
Q

Candidates for boost

A

Age <50
LN+
LVSI+
Margin+

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76
Q

Boost doses

A

Younger patients: 250 x 4

Older (50-60): 250 x 2

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77
Q

Study showing benefit to boost

A

EORTC
Pts <70 with T1-T2N0 with complete resection and ALND decrease in IBRT with boost
Biggest benefit in YOUNGER patients

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78
Q

Candidates for APBI

A
  1. Age 60+
  2. No BRCA mutation
  3. T1 IDC or other favorable histology
  4. Negative margins >2mm
  5. No LVSI
  6. ER+, unifocal, no EIC, node negative
  7. no neoadjuvant chemo
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79
Q

What dose for APBI for prior RT

A

45 in 1.5 Gy BID

Last BCT >1 year prior with negative margins

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80
Q

Techniques for APBI

A
  1. Brachytherapy (LDR, HDR)
  2. Intracavitary
  3. EBRT
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81
Q

GEC-ESTRO brachy study findings

A

Better cosmesis with APBI

More fat necrosis

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82
Q

Mammosite - how much space between balloon surface and skin

A

1 cm

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83
Q

Trial for intracavitary APBI

A

TARGIT Trial

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84
Q

Findings of TARGIT

A

Similar LF between IORT and EBRT but IORT LF increased on 5 year FU

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85
Q

Margins for EBRT APBI

A 
CTV= seroma + 1cm
PTV = CTV + 0.8 cm trim from chest wall
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86
Q

Goal for ratio of PTV to breast volume

A

<20%

Non target breast getting 50% of dose <50%

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87
Q

APBI doses

A
  1. Formenti: 6x5 QOD
  2. Vicini 3.85 x 10 BID
  3. MGH 3.4-4 BID (34-40)
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88
Q

ASTRO suitable criteria for PBI [IDC]

A
  1. Age >50
  2. 2mm margins
  3. Tis or T1
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89
Q

ASTRO suitable criteria for PBI [DCIS]

A
  1. screen detected
  2. low-int grade
  3. <2.5 cm
  4. 3mm margins
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90
Q

ASTRO unsuitable criteria for PBI

A

Age <40
+margin
DCIS >3cm

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91
Q

TAILORx trial

A

RCT of ER/PR+Her2- women who had midrange Oncotype score (11-25) and randomized to receive either:

a) chemo-endocrine therapy
b) endocrine therapy

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92
Q

Findings of TAILORx

A

Overall, endocrine therapy alone non-inferior to chemo-endocrine therapy in terms of BC recurrence and OS

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93
Q

Which TAILORx group possibly benefits from chemo

A

Young women (<50) with score 16-25

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94
Q

Low Oncotype score

A

<11

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95
Q

Mid range Oncotype score

A

11-25

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96
Q

PERSPEHONE Trial

A

RCT of 6 vs. 12 months of trastuzumab for women with early stage Her2+ BC with primary outcome of DFS

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97
Q

Findings of PERSEPHONE

A

6 mos was non-inferior to 12 mos of herceptin, better toxicity profile

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98
Q

N1

A

1-3 nodes (axillary or IMN only on SLNB)

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99
Q

N2

A

4-9 axillary nodes or IMN

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100
Q

N3

A

> 10 axillary nodes OR
infraclav node
axillary and IMN
supraclav

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101
Q

Does chest wall invasion count pec invasion

A

no

102
Q

what causes peau d’orange

A

dermal lymphatic disruptions

103
Q

Difference between radical mastectomy and modified radical mastectomy

A

modified does not remove the pecs or chest wall muscles

104
Q

Extended radical mastectomy

A

breast, axilla, chest wall muscles, IMNs

105
Q

Absolute contraindications to BCT

A

Prior breast/thoracic RT
Persistently positive margin after re-excisions
Diffuse disease/multicentric
Pregnancy prior to 3rd trimester

106
Q

Relative contraindications to BCT

A
  1. BRCA+
  2. Large tumor relative to breast size
  3. Anticipated poor cosmesis
  4. Connective tissue disease
107
Q

What is benefit of PMRT

A

10% OS benefit

108
Q

EBCTCG Meta analysis

A

22 randomized studies of women who received mastectomy and ALND found benefit for
1-3 nodes
4+ nodes

109
Q

PMRT benefit for 1-3 nodes

A

Lower RR of any recurrence (LRFS and DFS for TNBC)

110
Q

SUPREMO trial

A

Stage II breast cancer with 1-3 N+ following MRM + ALND with adjuvant or neoadjuvant chemo: PMRT or no PMRT

111
Q

NCIC TailorRT

A

RCT of PMRT vs,. none in biomarker low risk node positive (1-3+) BC

112
Q

Z0011 trial design

A

RCT of cT1-2N0 with 1-2 sentinel nodes randomized to whole breast RT and adjuvant chemo or ALND + chemo

113
Q

Findings of Z0011

A

No difference in 10 year DFS between arms, no need for ALND

114
Q

MA-20 study design

A

Node positive or high risk node negative women who got BCT to receive WBRT alone or WBRT + RNI with adjuvant chemo

115
Q

MA-20 findings

A

WBRT+RNI had improved DFS (82% at 10 years vs. 77%); no diff in OS

116
Q

B-51 design

A

cT1-3N1 BC who get 8-12 weeks of neoadjuvant chemo with negative nodes by SLNB/ALND randomized to

  1. mastectomy: PMRT vs. systemic therapy
  2. bCT: whole breast RT plus RNI vs. whole breast alone
117
Q

B-51 allowed surgeries

A

mastectomy or BCT

118
Q

Most powerful predictor of DFS and OS

A

LN involvement

119
Q

Indications for chemo

A
  1. axillary disease
  2. multicentric
  3. inflammatory
  4. T3/T4
120
Q

Standard regimen

A

Adriamycin+Cytoxan –> Taxol

121
Q

B18 design

A

neoadjuvant chemo vs. adjuvant

122
Q

Benefits of neoadjuvant chemo

A

downstaging to permit BCT

123
Q

How did MA-20 handle the axilla

A

completion ALND if SLNB+ (levels 1 and 2)

124
Q

AMAROS design

A

RCT of unifocal invasive cancer cN0 with SLNB+ randomized to

  1. ALND
  2. axillary RT
125
Q

AMAROS findings

A

similar axillary recurrence and overall outcomes but > risk of lymphedema in the ALND arm

126
Q

Role of RT for phylloides tumor

A
  1. > 2cm tumor size post lumpectomy

2. >10 cm tumor size post mastectomy

127
Q

MONALEESA-3

A

Trial for MBC ER+ who received endocrine therapy: Ribociclib + fulvestrant vs. fulvestrant –> improved PFS and OS

128
Q

Side effect of CDK 4/6 inhibitors

A

leukopenia

129
Q

Most common site of metastatic spread

A

Bone > brain, liver, lungs, nodes

130
Q

What are the UK START studies testing

A

Hypofractionation

131
Q

UK START A

A

50/25 vs. 41.6/13 or 39/13 over 5 weeks. Boost allowed not required

132
Q

UK START B

A

50/25 vs. 40/15 over 3 weeks. Boost allowed not required

133
Q

UK FAST Study

A

Ultra hypofractionation: cT1-2N0 >50 with 50/25 vs. 30/5 or 28.5/5 (once weekly).

134
Q

FAST findings

A

No IBTR differences, worse cosmesis with 30/5

135
Q

UK FAST Forward trial

A

pT1-3N0-1 s/p mastectomy or BCS getting 40/15 or 27/5 or 26/5 [over 1 week]

136
Q

Findings off FAST foward

A

5 fractions non-inferior to 40/15 but possible higher late toxicity with 27/5

137
Q

Dose in Chinese PMRT study

A

43.5/15

138
Q

What percentage of male breast cancers ER+

A

80%

139
Q

Mechanism of exemestane

A

irreversible steroidal AI

140
Q

Mechanism of anastrozole/letrozole

A

reversible competitors for aromatase [non-steroidal]

141
Q

Objective of B17 trial

A

RCT of BCS followed by RT for DCIS. Dose of RT was 50/25

142
Q

Risks of breast and ovarian Ca with BRCA1

A

60% each, endometrial as well

143
Q

Risks of breast and ovarian Ca with BRCA2

A

55% breast, 17% ovarian

144
Q

Type of BC associated with Li-Fraumeni

A

ER+/HER2+

145
Q

How many TNBC patients have BRCA mutation

A

20%

146
Q

Systemic therapy for HER2+

A

Neoadjuvant AC T + trastuzumab –> adjuvant T-DM1 (per KATHERINE trial)

147
Q

Inflammatory paradigm

A

Neoadjuvant chemo (+herceptin) –> mastectomy/ALND –>

148
Q

Lymphedema rates after ALND

A

23% per AMAROS

149
Q

Lymphedema rates after SLNB+RNI

A

11% per AMAROS

150
Q

SUPREMO trial for PMRT (which groups included)

A

Intermediate risk post mastectomy

  1. T3N0
  2. pT1-2N1
  3. N0 but grade 3 or LVSI
151
Q

Impact of breast size on cosmesis after hypofrac WBRT

A

Potentially better in large breasts and should not dissuade from using shorter course

152
Q

Mechanism of tamoxifen

A

selective estrogen receptor modulator (antagonist in breast, agonist in bone)

153
Q

Cautionary age for PBI

A

40-49

154
Q

Unsuitable tumor size for PBI

A

> 3

155
Q

Suitable tumor size for PBI

A

<2

156
Q

Suitable margin status for PBI

A

> 2mm

157
Q

Cautionary LVSI for PBI

A

limited/focal

158
Q

What is negative ER status considered for PBI

A

cautionary

159
Q

What is ILC considered for PBI

A

cautionary

160
Q

How much DCIS is unsuitable for PBI

A

> 3 cm

161
Q

What is required axillary testing prior to PBI

A

SLNB or ALND

162
Q

What is neoadjuvant therapy considered for PBI

A

unsuitable

163
Q

Chinese PMRT study design

A

RCT of PMRT to CW/RNI randomizing 50/25 or 43.5/15, primary endpoint of 5y LRR, noninferiority

164
Q

Finding of Chinese PMRT study

A

Hypofractionation non-inferior, ~8% risk of 5 year LRR

165
Q

Design of B-21 study

A

cN0, tumors < 1 cm underwent lumpectomy and randomized to either:

  1. Tamoxifen
  2. WBRT alone
  3. WBRT + Tamoxifen
166
Q

Finding of B21

A

RT improved IBTR and possibly better even with RT+Tamoxifen but this is less clear

167
Q

Differences between preop/postop chemo

A

No difference in outcomes

Decreases size of primary tumor leading to smaller surgical resections and better cosmesis

168
Q

Role of HER2 testing for DCIS

A

No role and high false + rate. Patients should not get adjuvant herceptin

169
Q

Risks of tamoxifen

A

Increased risk of endometrial ca, PE/VTE, cataracts

170
Q

Role of SLNB for DCIS

A

Not routinely performed, can be considered as second procedure if invasive cancer found

171
Q

Situations where SLNB NOT recommended

A
  1. Large and/or locally advanced disease
  2. IBC
  3. DCIS when BCS is performed
  4. Pregnancy
172
Q

Benefit of addition of docetaxel to AC chemo

A

Significantly improved cCR and pCR rates, but no difference in outcomes or BCS rates

173
Q

PRIME II study

A

RCT of lumpectomy randomized to receive either WBRT or observation [older women, 65+]

174
Q

Surgery required by PRIME II study

A

lumpectomy plus path axillary staging (SLNB or ALND)

175
Q

Current guidelines of which lumpectomy patients can avoid RT

A

Per Hughes trial

  1. Age >70
  2. pT1
  3. ER+
  4. Receiving hormonal therapy
176
Q

B-39 trial

A

APBI trial - randomizes patients to receive either 50 Gy to whole breast with boost to 60-66.6 Gy vs PBI

177
Q

Options for APBI on B-39 trial

A
  1. Interstitial brachy (3.4 x 10 BID)
  2. Intracavitary brachy (3.4 x 10 BID)
  3. 3DCRT (3.85 x 10 BID)
178
Q

Dose prescription for interstitial APBI

A

1.5 cm from lumpectomy cavity, PTV >5mm from skin surface

179
Q

Dose prescription for intracavitary APBI

A

1.0 cm from lumpectomy cavity, PTV >5mm from skin surface

180
Q

Dose prescription for EBRT APBI

A

1.5 cm from lumpectomy cavity, PTV 1.0 cm expansion and PTV >5 mm from skin surface

181
Q

B-17 IBTR rates

A

31% with lumpectomy vs. 15.7% with RT

182
Q

Bottom line of Z11

A

Patients with 1-2 positive nodes on SLNB do not need completion ALND

183
Q

How many risk factors justifies PMRT for T1-2 tumors

A 
3
Age <50
Tumor size >2
LVSI
Close or positive margins
No systemic therapy
184
Q

What histologic subtype of DCIS has worst prognosis

A

comedo

185
Q

Danish 82b study design

A

T3-4 disease or N+

RCT of mastectomy + chemo or mastectomy +PMRT + chemo

186
Q

Difference between 82b and 82c

A

82b: premenopausal, got chemo
82c: postmenopausal, got tamoxifen

187
Q

Criticisms of Danish studies

A

insufficient ax dissection

188
Q

Findings of Danish studies

A

Benefit in locoregional failure and OS if >8 or >4 nodes removed

189
Q

When should PMRT be offered if neoadjuvant therapy given

A

If residual axillary disease

190
Q

What features of DCIS on mammo

A

microcalcs, linear branching are high grade

191
Q

What feature of LCIS on mammo

A

cannot see it

192
Q

UK IMPORT LOW trial design

A

3 arm non-inferiority - randomized to

  1. WBRT to 40/15
  2. WBRT to 36 Gy with boost to 40 Gy
  3. PBI to 40/15
193
Q

Findings of IMPORT LOW

A

5 year local relapse rate same

Possible advantage in terms of breast appearance for PBI

194
Q

What axillary staging should occur for Phylloides tumor

A

none

195
Q

10 year BC mortality risk for woman treated with DCIS

A

1-5%

196
Q

5 year locoregional control for IBC

A

~85%

197
Q

Dose used in repeat BCT

A

3DCRT to PBI to 45 Gy in 30 fx BID

198
Q

Inferior border for tangent

A

1 cm below inframammary fold

199
Q

Superior border for tangent

A

1 cm above palpable breast tissue (inferior edge of sternoclavicular junction)

200
Q

Lateral border for tangent

A

1 cm margin on breast tissue (mid-axillary line)

201
Q

Medial border for tangent

A

mid sternal line

202
Q

Anterior border for tangent

A

2cm flash on breast tissue

203
Q

Usage of boost in B-17

A

Very low <10%, most got 50/25

204
Q

From Z11, how many women had additional positive nodes in ALND arm after SLNB

A

27%

205
Q

Rate of locoregional recurrence in Z11

A

5-6% at 10 years [1.5% in ipsi axilla]

206
Q

Role of preop RT for IBC

A

if no response to chemo

207
Q

What does T2 reflect for PBI

A

cautionary

208
Q

RAPID trial design

A

RCT for whole breast (50/25 or 42.5/16) vs. APBI (38.5/10), endpoint was cosmesis at 3 and 5 years assessed by trained nurses

209
Q

RAPID results

A

At 3 years APBI had significantly more adverse cosmesis, more telangiectasia and fat necrosis with APBI

210
Q

DCIS criteria to allow PBI off protocol

A
  1. low intermediate grade (1-2)
  2. screen detected
  3. size <2.5 cm
  4. > 3mm margins
211
Q

Mechanism of lapatinib

A

TKI which interrupts HER2 and EGFR pathway

212
Q

Bevacizumab works against

A

VEGF-A

213
Q

T1mi definition

A

<1 mm

214
Q

T1a definition

A

1-5 mm

215
Q

T1b definition

A

5-10

216
Q

T1c

A

1-2 cm

217
Q

pN1mic

A

0.2mm to 2 mm

218
Q

Multifocal definition

A

multiple lesions same quadrant

219
Q

Multicentric definition

A

multiple lesions different quadrant

220
Q

Goal of MA-20 study

A

Determine if RNI improves survival for N+ or high risk node negative breast cancer

221
Q

Which subgroup had improved OS in MA-20

A

ER- patients

222
Q

Two arms in MA-20

A
  1. WBRT

2. Comprehensive

223
Q

What axillary treatment did patients get in MA-20

A

All got SLNB or ALND

Mandated ALND if SLNB+

224
Q

Which outcomes were improved in MA-20 with RNI

A
  1. DFS
  2. locoregional DFS
  3. Distant DFS
225
Q

What outcome improved with IMN radiation in Danish study

A

OS (3% improvement)

226
Q

How much of breast affected to be considered IBC

A

> 1/3

227
Q

Anatomic borders for IMN coverage

A

First 3 intercostal spaces

Superior to first rib to superior to 4th rib

228
Q

Side effects of taxanes

A

Peripheral neuropathy, allergic reactions, myalgias/arthralgias

229
Q

Side effects of 5-FU

A

Mucositis/stomatitis

230
Q

Cancers elevated risk in BRCA2 vs BRCA1

A

Prostate, pancreas, uveal melanoma, male breast cancer

231
Q

Most common out of field nodal failure location for high risk patients getting RNI

A

SCV – consider posterior and lateral SCV nodes

232
Q

EORTC 22922 trial

A

RNI improved DFS, distant met free survival and BC-specific mortality but not OS

233
Q

Expected false negative rate of SLNB

A

~10%, can be improved in era of neoadjuvant chemo by clipping involved nodes and ensuring removed

234
Q

4:1 rule

A

Comes from EBCTG meta-analysis demostrating 20% reduction in IBTR (26–>7%) at 5 years corresponds to 5% absolute reduction in breast cancer survival at 15 years (35.9% –> 30%)

235
Q

Purpose of wedge

A

decrease hot spot

236
Q

Rates of capsular contraction for irradiating tissue expander

A

20% grade III/IV but not higher rates of implant revision

237
Q

Difference between APBI and WBRT in B-39

A

10 year IBTR risk favored WBRT and APBI did not meet equivalence threshold, but difference is small (<1%)

238
Q

In Chinese hypofractionated PMRT trial, what was better for hypofrac arm

A

Less acute skin toxicity

239
Q

Dose used in Chinese hypofrac trial

A

43.5/15

240
Q

Rate of lymphedema after SLNB and RNI

A

5-15%

241
Q

How do outcomes compare for same stage given neoadjuvant vs. adjuvant chemo

A

LRR is worse in patients given neoadjuvant chemo likely due to downstaging from higher stages

242
Q

Risk reduction of LR for RT after BCS

A

70% (26% –> 7%)

243
Q

Difference between RAPID and B-39

A

RAPID did not allow N+, B-39 did

244
Q

Dose used in RAPID trial

A

38.5 ./ 10 fx

245
Q

Conclusions of RAPID study: IBTR

A

APBI is non inferior

246
Q

Conclusions of RAPID study: acute tox

A

APBI is better (less dermatitis/edema)

247
Q

Conclusions of RAPID study: late tox

A

APBI is worse (telangietasia)

248
Q

OS benefit for PMRT from meta analysis

A

5% (lower than studies) mainly in N+ patients

249
Q

Characteristics of supraclav field

A
  1. Single anterior oblique beam
  2. Angled 5-10 degrees from cervical spine
  3. Prescribed to depth 3 cm
250
Q

SCV field for L

A

Right Anterior oblique

251
Q

What bony landmark can be used to define axillary stations

A

coracoid process (origin of pec minor)

RO Clinical Boards (13 decks)

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