Breast Cancer Radiotherapy

Question 1

When is Raditherapy used?

Answer 1

• Invasive breast cancer where margins are clear after BCS
• DCIS where margines are clear OR involved after BCS
• Invasive breast cancer post mastectomy where disease is >5cm or is node positive

Question 2

When is radiotherapy NOT used?

Answer 2

• If invasive breast cancer with clear margines, T1N0, over 65, ER+ve, HER2-, and will take hormones for 5 years (low recurrence rate PRIME II trial)
• Invasive, post mastectomy, T1,T2 and node negative (over treatment)

Question 3

Breast cancer to the breast/chest wall?

Answer 3

• 4-6 weeks after chemo, not if pregnant
• If metastatic disease, unless mets can be included in treatment beam
• ANC shows <4 positive nodes
• Whole breast is treated sometimes with a boost to tumour bed.
• Tangential pair, 6/10MV, one or two arms up
• 40Gy in 15#
• DIBH if left breat

Question 4

Breast radiotherapy if node negative?

Answer 4

• Whole breast only (unless OMIT or partial criteria)
• Boost if margins are close, <40 or <50 with high risk features
• whole breast with or without boost
• tangential pair, 6/10MV, one or both arms up
• 26Gy in 5# (not if implants or boost), if not 40Gy in 15#
• DIBH if left breast

Question 5

Breast radiotherapy, node negative, post mastectomy

Answer 5

• T3,T4
• Treat chest wall
• Tangential pair, 6/10MV, one or both arm up
• 26 in 5# or 40 in 15#
• DIBH if left

Question 6

Partial Breast requirements

Answer 6

>50 years old
- Tumour <3cm
- Node -ve
- ER/PR+ve
-LVI-ve
-HER2-ve
-non-lobular
-clear margins
(will have 5 years of hormones)

Question 7

OMIT requirements

Answer 7

• clear margins and low risk
• > 70 years old
• ER/PR +ve
  -HER2 -ve
• Grade 1/2
  (will have 5 years of hormones)
  (10 yearly mammogram)

Question 8

Nodal Irradiation to the Axilla

Answer 8

• Choose between further surgery or RT if positive SNB or ANS
• Not needed if isolated tumour cells or micrometastasis
• Not needed if 1-2 SN if good prognostic factors
• > 3 macrometastases, TREAT
• if +ve SNB and no further surgery, Breast, CW, Axilla and SCF
• if <4 nodes positive in ANC and poor prognostic factos, breast, SCF, CW
• If <4 +ve and no poor prognostic factors, Breast and CW only