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402 Cancer of the breast — Primary irradiation
Proceedings of the 37th Annual ASTRO Meeting
131
WEDNESDAY, OCTOBER 11, 1995 7:15-8:45 A.M. 401
RADIATION RESISTANCE: MECHANISMS AND CLINICAL STRATEGIES W. Gillies McKenna, M.D., Ph.D., Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104 P u r p o s e : This refresher course will review the clinical evidence that radiosensitivity is a determinant of outcome in the radiotherapy of cancer and will also examine some of the methods that have been used to try to determine the impact of this factor on cancer management. The data from established human cell lines which first suggested the link of radiosensitivity to outcome will be reviewed as well as more recent prospective trials in squamous cell carcinomas of the head and neck, cervix and brain tumors. These data will be compared to data on other factors which impact radiocurability such as rate of tumor proliferation or hypoxia. The course will also review the current data on the molecular mechanisms which tmderlie radioresistance to attempt to define targets for manipulation of radiosensitivity in the clinic. C o u r s e C o n t e n t : Prospective and retrospective analysis of the sensitivity of h u m a n tumors and normal tissues linking radiosensitivity to outcome both in terms of acute and late toxicity and tumor control. Molecular mechanisms in radiosensitivity: DNA damage and repair, chromosome damage and repair and tolerance of chromosome aberrations, early and late response genes and radiation induced gene expression, growth factors, cytokines, and oncogenes, cell cycle perturbations and checkpoints, apoptosis and necrosis.
Key Words: Radioresistance, Molecular Biology, Predictive Assays
402 C A N C E R OF THE BREAST - - PRIMARY IRRADIATION
Abram Recht, M.D. Joint Center for Radiation Therapy, Department of Radiation Oncology, Harvard Medical School, Boston, MA 02115 P u r o o s e / O b i e c t i v e : The combination of breast-conserving surgery (CS) and radiotherapy (RT) is now accepted as a standard treatment option for most women with clinical Stage I or II invasive breast cancer. However, numerous controversies remain concerning the optimal means of selecting patients for such treatment and the details of treatment technique. These include:
1) Whether some patients can be treated by CS without RT with a low risk of local recurrence. 2) The meaning and use of patient-related and histologic factors, such as patient age, the status of the microscopic resection margins, and the presence of an extensive intraductal component (EIC). 3) Techniques of RT of the breast (e.g., is a boost dose needed, and how to give it). 4) The role of treatment of the regional lymph nodes, both by surgery and RT. 5) The integration of adjuvant systemic therapy with RT and surgery. 6) The management of patients with noninvasive ductal carcinoma. 7) The detection, prognosis, and management of breast recurrences after breast-conserving therapy. In this refresher course we will examine several of these issues.
403 MANAGEMENT
H O D G K I N ' S D I S E A S E - P A R T 2: OF A D V A N C E D D I S E A S E , R E L A P S E D D I S E A S E , A N D
LONG-TERM COMPLICATIONS OF TREATMENT Joachim Yahalom, M.D. 1 Peter Mauch, M.D. 2 Memorial Sloan Kettering Cancer Center, New York, NY 1 Joint Center/or Radiation Therapy, Boston, MA 2 Over the past 25 years there have been dramatic improvements in our understanding of the epidemiology, biology, natural history, and treatment of Hodgkin's disease. Hodgkin's disease is one of the few cancers where both chemotherapy and radiation therapy have provided dramatic improvements in the cure of this once uniformly fatal disease. Part 2 of the refresher course on Hodgkin's disease will include a review of: 1) Treatment of stage I11 and IV disease including the role of radiation therapy alone for stage III disease 2) The role of adjuvant radiation therapy in advanced Hodgkin's disease 3) The use of different chemotherapy regimens including MOPP vs ABVD, ABVD vs hybrid chemotherapy, and the development of new chemotherapy regimens 4) Treatment of refractory and relapsed Hodgkin's disease including prognostic factors and role of salvage chemotherapy vs. high dose therapy and hematopoietic stem cell rescue and 5) An overview of the long-term complications of treatment and their impact on new strategies for treatment for Hodgkin's disease.
131
WEDNESDAY, OCTOBER 11, 1995 7:15-8:45 A.M. 401
RADIATION RESISTANCE: MECHANISMS AND CLINICAL STRATEGIES W. Gillies McKenna, M.D., Ph.D., Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104 P u r p o s e : This refresher course will review the clinical evidence that radiosensitivity is a determinant of outcome in the radiotherapy of cancer and will also examine some of the methods that have been used to try to determine the impact of this factor on cancer management. The data from established human cell lines which first suggested the link of radiosensitivity to outcome will be reviewed as well as more recent prospective trials in squamous cell carcinomas of the head and neck, cervix and brain tumors. These data will be compared to data on other factors which impact radiocurability such as rate of tumor proliferation or hypoxia. The course will also review the current data on the molecular mechanisms which tmderlie radioresistance to attempt to define targets for manipulation of radiosensitivity in the clinic. C o u r s e C o n t e n t : Prospective and retrospective analysis of the sensitivity of h u m a n tumors and normal tissues linking radiosensitivity to outcome both in terms of acute and late toxicity and tumor control. Molecular mechanisms in radiosensitivity: DNA damage and repair, chromosome damage and repair and tolerance of chromosome aberrations, early and late response genes and radiation induced gene expression, growth factors, cytokines, and oncogenes, cell cycle perturbations and checkpoints, apoptosis and necrosis.
Key Words: Radioresistance, Molecular Biology, Predictive Assays
402 C A N C E R OF THE BREAST - - PRIMARY IRRADIATION
Abram Recht, M.D. Joint Center for Radiation Therapy, Department of Radiation Oncology, Harvard Medical School, Boston, MA 02115 P u r o o s e / O b i e c t i v e : The combination of breast-conserving surgery (CS) and radiotherapy (RT) is now accepted as a standard treatment option for most women with clinical Stage I or II invasive breast cancer. However, numerous controversies remain concerning the optimal means of selecting patients for such treatment and the details of treatment technique. These include:
1) Whether some patients can be treated by CS without RT with a low risk of local recurrence. 2) The meaning and use of patient-related and histologic factors, such as patient age, the status of the microscopic resection margins, and the presence of an extensive intraductal component (EIC). 3) Techniques of RT of the breast (e.g., is a boost dose needed, and how to give it). 4) The role of treatment of the regional lymph nodes, both by surgery and RT. 5) The integration of adjuvant systemic therapy with RT and surgery. 6) The management of patients with noninvasive ductal carcinoma. 7) The detection, prognosis, and management of breast recurrences after breast-conserving therapy. In this refresher course we will examine several of these issues.
403 MANAGEMENT
H O D G K I N ' S D I S E A S E - P A R T 2: OF A D V A N C E D D I S E A S E , R E L A P S E D D I S E A S E , A N D
LONG-TERM COMPLICATIONS OF TREATMENT Joachim Yahalom, M.D. 1 Peter Mauch, M.D. 2 Memorial Sloan Kettering Cancer Center, New York, NY 1 Joint Center/or Radiation Therapy, Boston, MA 2 Over the past 25 years there have been dramatic improvements in our understanding of the epidemiology, biology, natural history, and treatment of Hodgkin's disease. Hodgkin's disease is one of the few cancers where both chemotherapy and radiation therapy have provided dramatic improvements in the cure of this once uniformly fatal disease. Part 2 of the refresher course on Hodgkin's disease will include a review of: 1) Treatment of stage I11 and IV disease including the role of radiation therapy alone for stage III disease 2) The role of adjuvant radiation therapy in advanced Hodgkin's disease 3) The use of different chemotherapy regimens including MOPP vs ABVD, ABVD vs hybrid chemotherapy, and the development of new chemotherapy regimens 4) Treatment of refractory and relapsed Hodgkin's disease including prognostic factors and role of salvage chemotherapy vs. high dose therapy and hematopoietic stem cell rescue and 5) An overview of the long-term complications of treatment and their impact on new strategies for treatment for Hodgkin's disease.