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TM-Radiation Therapy 2 > Breast Technique > Flashcards

Breast Technique Flashcards

1
Q

Signs and symptoms of breast cancer?

A

Breast/Axilla lump
Changes in breast shape and size
Skin changes
Nipple changes (inverted, discharge, crusting)

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2
Q

What are the common skin changes of the breast?

A

Peau’d orange
Redness and swelling
Itching

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3
Q

What may be an indicator for inflammatory breast cancer?

A

Warm breast

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4
Q

Factors associated with BC?

A 
Being female
Personal/family history
Gene mutation-BRCA1/2
IR
Obesity
first child at young age
Period at yg age
Menopause at an old age
Postmenopausal hormone therapy
Alcohol
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5
Q

What are the late signs and symptoms?

A 
Bone pain
Nausea
Loss of appetite
Weight loss
Pleural effusion
Headache
Double vision
Muscle weakness
Jaundice
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6
Q

What is the patient setup position?

A 
reproducible/stable
supine with immobilisation
breast superiorly to reduce cardiac dose
sternum flat to reduce lung dose
Reduce folds
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7
Q

What are the two inclination angles for CT

A

7-15 degrees for 75cm and 17-20 degrees for 85cm

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8
Q

What is a common CT protocol?

A 
Record all board settings
RO mark up med, lat, sup and Inf limits
RO to mark on electron boost
Using readout on scanner find central axis
Place radio opaque markers on
Three reference tattoos on central slice
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9
Q

What are the benefits of a breast cast?

A 
For large or pendulous breasts
Loss of skin sparing effect
Reduces skin reactions
Moves lateral and inferior part of breast anteriorly to reduce lung and cardiac dose.
Cannot use for LN
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10
Q

Limits of CT sim?

A

SUP- above shoulders to include neck

INF- cover the whole ipsilateral lung and 5cm below.

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11
Q

Critical structures for breast?

A

Heart
Lungs
Spinal cord
Contralateral breast

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12
Q

Planning considerations for breast?

A 
Seeds
CLD less 2cm
MHD less 1cm
Contour LAD separately
Shielding
large separation may require higher energy
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13
Q

What are common radiotherapy volumes?

A

Whole breast after BCS
Chest wall after mastectomy
Nodal irradiation

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14
Q

How can you heat your plan up?

A

Move reference point to chest wall higher MU required more breast tissue

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15
Q

Common isocentre placement?

A

mid separation

Sup limit of SCF

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16
Q

What are DRR used for in breast cancer?

A

Show lung present in field

Med and lat tangent

17
Q

SCF technique?

A 
Monoisocentric
Sup limit-cricoid cartilage
Lat limit-coracoid process
Inf limit-2nd costal cartilage
Med limit-1-2cm off midline
18
Q

prognostic factors of SCF RT

A

Lymphovascular invasion
Extracapsular extension
4 or more axillary LN more the worse

19
Q

What is the maximum field wedge of SCF field?

A

15-20cm may require divergent sup jaw if larger.

20
Q

Electron boost rationale?

A

Primary recurrence around tumour bed

Benefits of trials

21
Q

Electron boost prescriptions?

A

10 in 5
14 in 5
16 in 10
4-15MeV used may use small MV beams with wedges

22
Q

What is the common tangent+boost prescription?

A

50 in 25 with 10 in 5 to the tumour bed

23
Q

What are the benefits of hypofractionation?

A

Decreased treatment time
More patients treated
Reduction in waiting times

24
Q

Hypofraction prescriptions?

A

42.5 in 16
41.6 in 13 over 5 weeks
40 in 15 over 3 weeks +/- boost

25
Q

Criteria for 42.5 in 16?

A

No nodes
Invasive cancer treated with lumpectomy
Tumour under 5cm
Breast under 25cm sep

26
Q

Partial radiation therapy can include?

A 
Brachytherapy
Mammosite
TARGIT
ELIOT
3DCRT
27
Q

Accelerated partial irradiation criteria?

A

Over 60 age
Less than 2cm in size
No LN
T1

28
Q

What is the image verification process?

A

First three fractions then weekly
orthogonal images and DRR
5mm tolerance in CLD and isocentre position

29
Q

What are acute side effects?

A

Skin changes

30
Q

What are late/chronic side effects

A

Breast oedema, shrinkage, pain, skin talengiectasia, symptomatic lung fibrosis, arm lymphoedema

31
Q

Grading of skin reactions?

A

1- erythema
2-Dry desquamation
3-mois desquamation
4Exfoliative desquamation

32
Q

What is the patient care for skin reactions?

A

Avoid abrasion when washing
Use simple soap
Aqueous cream applied before and after XRT
One percent hydrocortisone cream
May stop XRT if severe use hydrogel sheet
Loose garments
No gentian violet (antiseptic)

33
Q

Management of skin reactions?

A 
Soap
Aqueous cream
Corticosteroid and non steroidal cream
Flamazine
R1 R2
Strata XRT

TM-Radiation Therapy 2 (2 decks)

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