Post on 21-Jan-2018
Radiation Therapy for Inflammatory Breast Cancer
Jennifer R. Bellon, M.D.
Dana-Farber Cancer Institute / Brigham and Women’s Hospital
Harvard Medical School
1st Annual IBC Patient Forum
Dana Farber Cancer Institute
May 13, 2017
Unique Features of IBC
• Predilection for skin involvement, particularly dermal lymphatics
• High rate of nodal involvement
• Axillary, supraclavicular and internal mammary
• These features help define the radiation fields
Tri-modality Therapy
• Systemic therapy• Kills cells that may have spread from the breast to other parts of
the body
• Helps decrease the burden of disease in the breast, and nearby lymph nodes
• Surgery• Removes residual gross disease in the breast and axilla
• Radiation treats the residual skin/chest wall and nodes that aren’t operated upon
What is the Process of Radiation?CT-Simulation
• Standard CT
• Lasers to make sure patient is straight
• Tiny (freckle-like) tattoos to help with reproducibility
Bolus
• Tissue equivalent plastic that ‘fools’ the radiation to deposit its dose at the surface
• Commonly used after mastectomy (not typically to the intact breast)
Side Effects of Treatment: Short Term
• Skin• Redness
• Possible peeling/blistering
• Chest• Tenderness
• Pruritus
• Fatigue
Respiratory Trace During Radiation
Time (sec)
Chest
Excursion Chest
Excursion
Window
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Side Effects: Long Term
• Cardiac• Long-term coronary artery disease
• Pulmonary• Pneumonitis
• Lymphedema
• Impact on Reconstruction
Future Directions
• Ongoing studies looking at improving effectiveness of radiation• In large part, this will come from improvements in systemic
therapy
• Concurrent veliparib (PARP-inhibitor)• Phase I study from U of M
• Soon to be launched Phase II randomized trial
Radiation with or without veliparib