Radiotherapeutic Malignancies

Ductal carcinoma in situ (DCIS)

abnormal cells in the ducts of the breast, which may develop into invasive breast cancer

Lobular carcinoma in situ (LCIS)

abnormal cells in the lobules of the breast, which increases the risk of developing breast cancer

• Ductal carcinoma in situ (DCIS)

• Lobular carcinoma in situ (LCIS)

Non-invasive breast carcinomas

• Invasive ductal carcinoma (IDC)

• Invasive lobular carcinoma (ILC)

Invasive breast carcinomas

Invasive ductal carcinoma (IDC)

which starts in the ducts and accounts for 80% of breast cancers

Invasive lobular carcinoma (ILC)

which starts in the lobules and accounts for 10% of breast cancers

Triple-negative breast cancer

It is an aggressive type of invasive breast cancer in which the cancer cells don’t have estrogen or progesterone receptors (ER or PR) and also don’t make any or too much of the protein called HER2.

Triple-negative breast cancer is an aggressive form of invasive breast cancer. It is characterized by the absence of estrogen receptors (ER) and progesterone receptors (PR), as well as the lack or underproduction of which protein?

HER2

Triple-negative breast cancer

It accounts for about 15% of all breast cancers and can be a difficult cancer to treat

Inflammatory breast cancer

is an aggressive type of invasive breast cancer in which cancer cells block lymph vessels in the skin, causing the breast to look "inflamed."

Inflammatory breast cancer

It is rare and accounts for about 1% to 5% of all breast.

Paget disease of the breast

is rare, accounting for only about 1-3% of all cases of breast cancer.

Paget disease of the breast

It starts in the breast ducts and spreads to the skin of the nipple and then to the areola (the dark circle around the nipple).

● Mammograms

● Breast Ultrasound

● Breast MRI

● Biopsy

Detection and diagnosis of breast cancers

Which type of breast cancer treatment specifically targets the tumor directly without affecting the rest of the body, with surgery being a primary example?

Local treatment

Systemic treatments

Drugs used to treat breast cancer are considered systemic therapies because they can reach cancer cells almost anywhere in the body

When treating breast cancer with radiation, why are the treatment beams angled in different directions across the multiple adjacent fields?

To spare the underlying normal tissues from excessive radiation

According to standard protocols for treating breast cancer with adjacent radiation fields, which areas are typically target structures for irradiation?

The breast/chest wall and regional lymph nodes

Which field arrangement is most frequently utilized to treat the breast and chest wall in radiation therapy?

Opposed Tangential Fields

When planning radiation therapy for the supraclavicular and axillary lymph nodes, which field orientation is typically chosen?

Anterior Oblique field

The anterior oblique field used for regional lymph nodes is designed to sit adjacent to which specific breast treatment field?

Medial Tangential Field

Cervical cancer

develops in a woman's cervix (the entrance to the uterus from the vagina)

high-risk human papillomaviruses (HPV)

Almost all cervical cancer cases (99%) are linked to infection with ___, an extremely common virus transmitted through sexual contact

What is the direct clinical consequence of a small patient misalignment with the sagittal alignment line during breast cancer radiation therapy?

The beam orientations with respect to the patient will change.

A small rotation of the patient's body relative to the lateral or horizontal alignment lines during setup will lead to which of the following?

A change in the planned beam angles relative to the patient

Cervical Cancer

When diagnosed, ___ is one of the most successfully treatable forms of cancer, as long as it is detected early and managed effectively

appropriate treatment and palliative care

Cancers diagnosed in late stages can also be controlled with ___

endometrium

More than 90% of uterine cancers occur in the

increase in obesity

The number of people diagnosed with endometrial cancer is increasing, mostly because of an___, which is an important risk factor for this disease

Total Dose Prescription: 5040 cGy

Dose per day: 180 cGy for 28 days

EBRT for Cervical and Uterine Cancer

Total Dose Prescription:

Dose per day:

Total Dose Prescription: 6040 cGy

Dose per day: 180 cGy for 28 days

External Beam Radiation Therapy (EBRT) for Breast Cancer

Total Dose Prescription:

Dose per day:

200 cGy for 5 days

External Beam Radiation Therapy (EBRT) for Breast Cancer

Dose per day for the quadrant boost/scar boost

Quadrant boost

External Beam Radiation Therapy (EBRT) for Breast Cancer

Applicable for patients who underwent lumpectomy

Scar boost

External Beam Radiation Therapy (EBRT) for Breast Cancer

Applicable for patients who underwent mastectomy

Presence of abnormal vaginal bleeding

early symptom for uterine cancer

supine position

Supine Position for Cervical and Uterine Cancer

Patients are mostly treated in ____ because it is usually considered easier and more comfortable

under the knees

Supine Position for Cervical and Uterine Cancer

A support ___ helps to relax the lower back which is especially important when lying on a rigid treatment couch.

foot position

Supine Position for Cervical and Uterine Cancer

Changes in the ___ also change the relative position of bony reference points that are used to determine the accuracy of the set-up – an important consideration when port films are reviewed.

belly board

The purpose of the ___ is to keep the intestines of the patient out of the radiation fields for treating malignancies in the pelvis area

Pelvicast thermoplastic masks

are used to reduce the cranial caudal and rotational movements of the patients

Skin folds can be reduced in what position?

prone position

What is the standard body orientation for a patient undergoing External Beam Radiation Therapy (EBRT) for cervical and uterine cancer according to these guidelines?

Prone with hands placed under the base plate

What is the primary anatomical advantage of placing a patient in the prone position for cervical or uterine cancer radiation therapy?

Gravity naturally displaces the small bowel superiorly out of the pelvis.

Thin patients

To which patient is the belly board more beneficial?

four box-field technique

The treatment technique for Cervical and Uterine Cancer

When planning the AP/PA fields using a four-box technique, how does the superior border change when a patient progresses from early-stage disease (without vaginal involvement) to an advanced stage with vaginal disease?

It shifts superiorly from the L5-S1 interspace up to the L4-L5 interspace.

For advanced stages of cervical or uterine cancer that include vaginal disease, what specific adjustment must be made to the inferior boundary of the AP/PA treatment field?

It extends past the mid-obturator foramen inferiorly by at least 1.5 to 2 cm.

When planning the lateral fields of a four-field box technique for cervical or uterine cancer, how far should the field borders extend laterally to ensure adequate coverage of the regional lymph nodes?

1.5 to 2 cm beyond the widest section of the pelvis

According to the provided criteria, what are the standard anterior and posterior margins utilized for the lateral treatment fields in pelvic radiation?

The anterior margin includes the symphysis pubis and the posterior margin extends to the S2-S3 interspace.

Supine both arms raised with neck hyperextended

EBRT for Lung Cancer Usual Body position

EBRT for Lung Cancer

The treatment is usually delivered via opposed anterior and posterior field to a dose that does not exceed the spinal cord tolerance, usually about 4500 cGy at conventional fractionation.

Total Dose Prescription: 3000 cGy

Dose per day: 200 cGy for 15 days

Hyperfractionated EBRT for Lung Cancer

Total Dose Prescription:

Dose per day:

When initiating External Beam Radiation Therapy (EBRT) for lung cancer, what is the standard initial field arrangement and its typical dose limit to avoid exceeding spinal cord tolerance?

Opposed anterior and posterior (AP/PA) fields up to a dose of about 4500 cGy

Following the initial treatment phase, a boost of 1000 to 1500 cGy is typically delivered to the ipsilateral lymph nodes. Which technique is used to deliver this boost safely?

Utilizing a spinal cord-sparing technique, such as oblique or lateral fields

Why is it often clinically impossible to deliver exceptionally high doses of radiation to large target volumes that include the bilateral mediastinal lymph nodes in lung cancer patients?

Because of severe toxicity concerns regarding the tolerance limits of the spinal cord and healthy lung tissue.