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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