早期乳腺癌的部分乳腺照射辅助放疗PPT课件.ppt

,T.KuanYu,M.D.,Ph.D.DepartmentofRadiationOncologyTheUniversityofTexasM.D.AndersonCancerCenter(Jan07),AdjuvantRadiotherapyaspartofBreastConservationinEarlyBreastCancer:,TheAnnualSino-USClinicalOncologySeminarSeriesGuangzhou,China,1,EarlyBreastCancer:Adjuvantradiotherapy(RT)inBreastConservationTherapy(BCT),OverallroleofadjuvantRTinBCTReducesLocalRecurrenceImprovesOverallSurvivalYoungAgeIndependentpoorpredictorforLRRSimilarsurvivalwithmastectomyorBCTSpecialconsiderationofpotentialside-effectsOldAgeWhatisoldage?ReduceLRonly?,2,EarlyBreastCancer:AdjuvantradiotherapyreducesLRaspartofBreastConservationTherapy(BCT),NSABP-B06StageI/II,Tsize20yearsordied60%age50yo,(Fisher,NEJM347,2002),39.2%,14.3%,CumulativeLR,3,EarlyBreastCancer:OverallsurvivalafterBCTissimilartoMastectomy,(Fisher,NEJM347,2002),4,EarlyBreastCancer:AdjuvantradiotherapyreducesLRaspartofBreastConservationTherapy(BCT),Milantrial(1973-80)cTsize50yo,8.8%,2.3%,CumulativeLR,(Veronesi,NEJM347,2002),5,EarlyBreastCancer:Youngwomen(50,70,80,90Co-morbidity?Performancestatus?,31,Dowomenover50yearsoldneedbreastRT?AdjuvantRTreducesLR,Canadianrandomizedtrial1992-2000679patientsearlybreastcancer(T50yearsold42%patientsage70yearsoldLumpectomyplusTamoxifenwithorwithoutRTtobreastRT:40Gy/16fx+12.5GyBoostAxR:2.5%vs0.5%(p=0.049)MedianF/U:5.6yrs,CumulativeLR,(Fyles,NEJM351,2004),5yr:7.7%vs0.6%,Greaterdiffw/longerF/U,32,Dowomenover50yearsoldneedbreastRT?AdjuvantRTreducesimprovesDFS,5yrDFS91%84%,(Fyles,NEJM351,2004),DiseaseFreeSurvival,NodifferenceinDMorOS,33,Dowomenover70yearsoldneedbreastRT?AdjuvantRTreducesLRR,CALGB(Intergroup)studyRandomizedtrial1994-1999,636patients70yearsoldclinicalstageI.ER+lumpectomyplustamoxifenwithorwithoutRTRT:45Gy/25fx+14GyBoostMedianF/U:5yrs,(Hughes,NEJM351,2004),FreedomfromLRR,5yrLC99%96%,34,Dowomenover70yearsoldneedbreastRT?NoeffectonoverallsurvivalwithadjuvantRT,(Hughes,NEJM351,2004),OverallSurvival,NoOSdifferencePoweredtodetectLRRdifferenceof16%vs9%Then,expectedOSdiffwouldbe2%(If3.5%LCgaingives1%OSgain)Therefore,notenoughpatientstodetectexpecteddifference,35,Dowomenover70yearsoldneedbreastRT?AdjuvantradiotherapyreducesLRRbutnotoverallsurvivalinwomen70yearsold,ABCSG(Austrian)Randomizedtrial1996-2004875patientswithearlybreastcancer(T50yearswithLNneg,ER+,andT50?NO70?Maybe,trialswithshortF/UConsider“physiologicage”Considercomorbidityor“competingrisk”LongertheexpectedlifeafterbreastcancerlongeratriskforLRRanddeath80yowithexpectedtolivefor20yrsareatgreaterriskforLRRthan70yowithexpectedlifeofadditional5yearsduetocomorbidconditions,39,EarlyBreastCancer:ContraindicationsforBCTwithadjuvantradiotherapy,PregnancyPriorRTtobreastDiffusediseaseUnacceptablecosmesiswithBCTSLEorScleraderma,40,Conclusion:,AdjuvantradiationimprovesLRRriskafterbreastconservationsurgerySmalloverallsurvivalbenefitwithadjuvantradiation(3.5%LCgain1%OverallSurvival)BettercurrenttechnologyreducespotentialradiationtoxicityAgeasconsiderationYoungagewomenOldagewomen:ConsiderphysiologicageComorbidconditionsPerform