HSC 340 11-18-2010

Breast Cancer

Hodgkin's

Lung Cancer

Breast Cancer

• Most common cancer in women

• Ductal carcinoma most common

• Treatment options:– Surgery + radiation– Surgery + radiation + chemo– Surgery alone (mastectomy)

Breast anatomy

• Superior border- 2nd costal cartilage

• Inferior border- 6th costal cartilage

• Medial border- Sternal edge

• Lateral border- anterior axillary line

Routes of Spread

• Lymph nodes:– Axillary– Internal Mammary– Transpectoral

• Lung, Bone, Brain, Liver

Immobilization and Positioning

• First concern is the movement of the arm

• Custom molds

• Wingboards

• Breast board

• Headrest

• Knee wedge

Simulation set-up

• Disrobe from waist up

• Lie supine, straighten patient

• 3pt set-up

• Both arms or ipsilateral arm only raised into position

• Head straight or turned to contralateral side

• Wires and BBs

Treatment techniques

• Tangentials

• Tangentials + Sclav

• Tangentials + Sclav + PAB

• Tangentials + Sclav + PAB + Internal Mammary

• FinF

• IGRT

Whole Breast IGRT 4860cGy @ 180cGy/fx

Breast Boost 1620cGy @ 180cGy/fx

Tangential Breast 4860cGy @ 180cGy/fx followed by a boost

Sclav: 5040cGy

PAB: 720cGy

Tangents: 6120cGy

Doses

• Tangents: 4680cGy-5040cGy

• Boost: to 6000cGy

• Sclav: 4680cGy

• PAB: whatever dose brings midline dose to 4680cGy

Hodgkins

• Very radiosensitive

• Bi-modal age range 15-24 yrs & 50+

• Cervical or supraclavicular 75%

• Mediastinal 60%

• Fever, night sweats, weight loss

Treatment

• Surgery to diagnose and stage

• Radiation alone

• Chemo alone

• Radiation and Chemo

Immobilization and Positioning

• Patient supine

• No headrest, chin extended

• Arms above head or akimbo

• Custom molds

• Site specific custom blocks

Treatment techniques

• AP:PA mantle

• AP:PA inverted Y

Dose

• 3600cGy-4400cGy

Lung Cancer

• Leading cause of cancer death in males and females

• Chemo, surgery and radiation

• Routes of spread– Cervical L.N– Liver, brain, bones

Lung Anatomy

• Rt. Lung- 3 Lobes

• Lt. Lung- 2 Lobes

• Carina @ T5

Immobilization and Positioning

• Supine

• Headrest

• Wingboard

• Arms above head holding poles

• Be aware of respiratory problems

Simulation

• 3 pt set-up

• Contrast?

• Gating

• Breath hold technique

Treatment techniques

• AP:PA

• Off cord obliques

• IGRT

Doses

• SCLC 4500cGy-5400cGy

• NSCLC 6000cGy-7500cGy

IGRT Rt. Upper Lobe 4500cGy @ 180 cGy/fx. Concurrent chemo

IGRT Rt. Lung with Nodes 4500cGy @ 180cGy/fx with concurrent chemo