BREAST CANCER BASE

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The 26th San Antonio Breast Cancer Conference, in the radiotherapy of breast cancer has many important studies, the specific details related to the following areas :
(1) early breast cancer after breast-conserving surgery to reduce the size of the target — part of the breast irradiation;
(2) breast cancer intensity modulated radiotherapy (IMRT);
(3) synchronization of breast cancer radiotherapy of breast cancer and non-conventional radiotherapy so.

In view of early breast cancer after breast-conserving local recurrence, and more primary tumor location, so in recent years abroad in some breast irradiation has carried out a series of clinical studies. The conference also have more coverage, mainly for breast cancer radiotherapy, radiotherapy after implantation, and the use of IMRT technology part of the breast irradiation three aspects.

Vaidya in the other breast of early breast cancer patients, intraoperative radiotherapy (Targit), the use of 50Kv X-ray, a single dose of 20Gy (applicator surface dose). Earlier consisting of 185 patients, the median follow-up of 22 months, only 2 cases of recurrence, the cosmetic results were satisfactory, the authors believe intraoperative radiotherapy security easy, ongoing multi-center randomized study (TARGIT).

Vicini so on 199 cases - conserving surgery in patients with early breast cancer, brachytherapy methods part of the breast irradiation, for the mass CTV after the residual cavity, and peritumoral 1-2cm organizations. The median follow-up period of 65 months, the cumulative local recurrence rate was only 1%, matching the results with the same period in the whole breast irradiation accept the same patients (P = 0.65), to achieve a good cosmetic results and excellent proportion is as high as 98%. The author considers that the choice patients after resection of the tumor, residual cavity area was Brachytherapy for its five-year efficacy and radiotherapy whole milk equivalent.

LaCombe used IMRT technology such as the partial breast irradiation accelerate research. Patients income group criteria : postmenopausal, invasive ductal carcinoma, tumor less than 2 cm, node-negative, but negative margin of at least 2 mm away from tumor. Exclusion criteria : multi-center cancer, invasive lobular carcinoma, extensive intraductal component, positive lymph nodes, skin involvement, or bilateral breast cancer. Target to send to 2cm tumor bed. Dose 43.2Gy/16f. Of 35 patients with the treatment results showed that with conventional milk than wild tangent, heart, lung and the contralateral breast irradiation dose significantly decreased and positioning repeatability, and acute reaction particularly acute skin reactions. The author considers that the choice of breast cancer patients, using IMRT accelerated partial breast irradiation feasible to reduce the surrounding tissue reaction, and shorten the treatment time.

Because of the target dose uniformity of the region's advantages, IMRT might become the future of breast cancer radiotherapy "gold standard." The meeting of the progress of breast cancer IMRT including two major aspects, namely, breast-conserving surgery plus the amount of synchronous radiation, and includes breast and lymph drainage area of IMRT Ono irradiation. McCauley used as IMRT inverse planning design and operation of dose distribution than other breast tissue, within six weeks of whole breast dose of 45Gy of operation for the 50 districts, and then surgery to increase the volume 100034 / a week. The authors report 90 cases of patients with the treatment results, and the absence of tumor recurrence and overall treatment time shorter than a conventional irradiation weeks, but the skin tolerance good, the rate of breast edema compared with conventional irradiation markedly lower. Cavey put other breast, and supraclavicular area as a target axillary for IMRT irradiation of 14 patients, the study found that irradiation with the conventional plan, the target is particularly subclavian and axillary areas on the dose uniformity (CD95-5) was significantly improved, from the hot dose reduction to 120% 109%, PTV within 95% -107% of the prescribed dosage volume fraction has been significantly improved.

Therefore, the author believes that IMRT technology for breast and lymphatic drainage of Ono exposure can increase the dose uniformity, lower doses of hot, improving target dose coverage, which will reduce the acute skin reaction and the brachial plexus injury rate. IMRT course of breast cancer, there are still some major problems with the performance of precision placed on the higher, and by the low-dose irradiation of normal tissue volume increased significantly. Its potential hazards is not yet known. In addition, the breast cancer IMRT dose strengths, would bring the clinical benefits, the need for further clinical study confirmed.

Although many chemotherapy drugs right radiotherapy increase sensitivity, but in view of synchronization of breast cancer radiotherapy may damage the cosmetic results, while increasing the Cardiopulmonary toxicity, synchronization radiotherapy for breast cancer rarely. This Vishnubhotla such a study, a total of 19 patients with local recurrence in patients with lesions income group. Radiotherapy dose of 45-60 Gy, Monday to Friday in the course of radiotherapy, combined oral capecitabine dose of 1300-1600mg / (m2.d). The results showed that only seven cases of patients with chest wall recurrence after treatment in three cases CR, and the remaining four cases are PR. The major side effects of radiation dermatitis site (1 / 5, 2 / 5 and 3 / 5 cases of dermatitis were few two cases) and hand-foot syndrome (2 cases), one in four patients for nausea.

Berger and other right neoadjuvant chemotherapy failure of the 11 patients, but also for this experiment. Treatment programs for the 5-FU 750mg / (m2.d), d1 - Nf6 continuous intravenous injection, the Thai-85mg / (m2.d), repeated every 3 weeks for a total of four cycles. The former two-cycle synchronization application radiotherapy Gy total dose, the tumor bed dose 60-RT. Results of 10 patients completed as planned treatment, only 1 stomatitis reduced by 5-FU used in patients with no interruption due to side effects of radiotherapy. Evidently, the choice for patients with breast cancer, radiotherapy synchronization is not only well tolerated, but also may increase the efficacy of radiotherapy and deserves further clinical trials.

The low breast cancer radiotherapy, radiation therapy can reduce the frequency, shorten the course of treatment, thereby reducing the financial burden on patients and improve efficiency in the use of equipment, so this was more domestic and foreign studies. The meeting, de Lafontan reported as low segmentation of the treatment results of the study. A total of 152 regular-conserving surgery in elderly patients into groups, the median age reached 79 years of age (70-95 years), radiotherapy program 32.5Gy/5f, 1f / w, of which 82 cases receptor-positive patients received tamoxifen treatment. This study median follow-up period of 67.6 months, the five-year overall survival and tumor-specific survival rates were 85.6% and 93.9%, the result is encouraging, but unfortunately the lack of detailed side effects reported.

In short, this session of radiotherapy for breast cancer have a more comprehensive report, we should learn from, especially some of the unique ideas and innovative design of clinical studies, to broaden their horizons and to further improve breast cancer treatment.

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