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Flashcards in Breast Deck (13):

What are the RToptions for post-lumpectomy patients?

1. whole breast RT
2. partial breast


What are the whole breast RT options?

1. standard fractionation 50Gy in 25# with boost of 16Gy in 8#
2. hypofractionation (42.5Gy in 16#)


What are the RT options for partial breast patients?

1. external beam 1 week
2. brachy --> interstitial or intracavitary


Why are patients treated prone/ problems with supine treatment for larger women?

- large separation, requiring the use of 10MV beams that resulted in skin sparing
- numerous tissue folds causing severe skin reactions
- large tangential cuts that resulted in increased lung doses and for left sided tangential fields increased dose to the heart


What are indications for prone?

- patients who breast, when lying supine, relaxes lateral-posteriorly causing an excessive amount of underlying lung to be included in the treatment volume
- when chest well coverage is not essential
- to reduce dose to the heart for left sided tangential fields
- for patients capable of lying prone in the treatment position for periods up to 30 minutes


What are some set-up considerations for prone?

- patient's torso is rotated into the treatment window for more lateral beam direction and to allow maximum amount of breast to extend into the treatment window without touching the couch top
- this may be limited by the amount of rotation that the patient can comfortably maintain
- minimise stomach folds by pulling by pulling abdomen inferioly
- the patient is straightened using the longitudinal laser inf of mid thorax


What are some planning considerations for prone?

- important to note that in the prone position it is not necessary to oppose the tangents
- angles dependent on patient contour
- the anterior oblique field can be angled to avoid coming through the breast board


What are the considerations for prone patients requiring electron boosts?

- patient will need to be treated supine for boost which requires separate CT scan
- breast may be required to be taped to reduce folds
- cannot create a composite plan (overlap of plans to see overall dose)


When are photon boosts used?

- due to the size of the breasts it is sometimes difficult to achieve the boost PTV coverage with an electron field
- possible to use photon boosts in the prone position


What are the consideration when the head is turned for supraclavicular fossa?

- moving the head brings the SC closer
- decreases neck folds and thus skin reactions


What are the side effects of RT?

- erythema
- dry and moist dequamation
- talengactasia
- skin dimpling
- swelling
- nipple changes


What is the skin care?

- loose cotton cothing
- dont scrub area
- avoid sun exposure
- aqueous creams
- mepitel
- cold clothes
- 1% hydrocortisone cream
- pure alovera on unbroken skin


What are the brachytherapy options for breast?

- HDR brachy intesitial which delivers RT from needles put inside the tumour
- mammosite balloon (34Gy in 5# over 5 days using iridium 192) uses balloon applicator filled with water
- SAVI (strut-adjusted volume implant) single entry breast brachy therapy device which goes into lumpectomy and then is expanded once inside the breast