Breast Cancer and Radiotherapy
Application of radiation to treat breast cancer was first performed in 1949. However, radiation, caused by the level of mortality due to cardiac side effects, reduces the appearance of survival after doubts emerged in RT. In 1997. Studies, after mastectomy or lymph node metastases in patients with tumors larger than 5 cm, and survival in the adjuvant radiotherapy reduces local recurrence, 9% increase in absolute value has caused the notice appeared in a re-RT treatment planning. The new meta-analysis also confirmed that this works.
Today, the early stage (Stage 1 and Stage 2) RT after breast conserving surgery in breast cancer treatment, is considered a component of the absolute. Adjuvant RT reduces the risk of local recurrence in patients with more advanced stages and is shown to increase survival in patients with axillary metastases. In locally advanced disease, neoadjuvant systemic therapy after modified radical mastectomy to achieve local control is needed in conjunction with the absolute RT. Local regional duplication in the utilized. Provide local control of distant metastasis outside the RT showed that the positive contributions. Purpose in the implementation of RT after mastectomy, post-operative chest wall, skin, breast tissue, and the rest of the tumor cells is the elimination of the regional lymphatics. For this reason, all patients underwent breast conserving surgery in the postoperative period the implementation of all breast RT has been a standard practice routine for today.
a) The chest wall irradiation: the limits of this field is determined clinically. Mastectomy scar after mastectomy should be within target volume entirely. Area of the chest wall RT; middle line of the sternum medially, laterally extends from the mid-axillary line. The breast tissue was palpable breast intact 1 cm is sufficient to limit the lateral edge. The upper limit of the clavicle at the level of per-pass. Lower boundary of the breast against the ends of the region 1 - 2 cm conforms to the bottom. Lung volume 2 - 3 cm tangential to be included in the field.
b) The peripheral lymphatic irradiation: only the front area FNA-axillary area.
Sternum and the medial border of cricoid cartilage FNA passes at the level of mid-line neck braces (as it protects the spinal cord and esophagus). Crossing outside of the field as the head of the humerus (humeral head because of protection) axillae curve fits. The middle of the second rib axilla be treated all the cases the lower limit, only the first rib in the mid-axillary apex passes. In addition to this area by giving 12-15 ° angle to the trachea, esophagus and spinal cord protection is provided.
Rear axillary area, the dose may be added to complete. Rear-axilla medial clavicle superiorly, inferiorly jeans, superior lateral bracing of the humeral head
c) the dose of radiation therapy: clinical practice today of all breast tumor dose of 50 Gy, 25 fractions are given and the application is done once a day 5 times a week. Breast bed addition to the dose increase local control, especially in patients under 50 years of age. 16 Gy to the tumor bed following breast general approach is to give an additional dose. Additional doses of photon, electron or brachytherapy may be granted.