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417 Breast conserving therapy for early stage invasive cancer and ductal carcinoma in-situ
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1. J. Radiation Oncology~Biology*Physics
Volume 39, Number 2, Supplement, 1997
417 Breast Conserving Therapy for Early Stage Invasive Cancer and Ductal Carcinoma In-Situ Barbma L. Fowble, M.D. Fox Chase Cancer Center, Philadelphia, PA m: To discuss a number of clinical, pathologic, and treatment related issues in the management of early stage invasive breast cancer and ductal carcinoma in sihl. In the last 10 years, prospective randomized trials as well as retrospective series have established the role of conservative surgery and radiation in the treatment of early stage invasive breast cancer. This course will focus on some of the unresolved issues in breast conservation therapy including patient selection, the extent of surgery in the breast, and the importance of microscopic resection margins. The impact of adjuvant systemic therapy (chemotherapy or tamoxifen) on breast recurrence will be presented. Factors predicting for an increased risk of recurrence in the treated breast will be presented. Potential candidates for conservative surgery alone with minimally invasive breast cancer will be identified. The impact of improved local control on survival will be discussed. Treatment options for ductal carcinoma in situ (DCIS) including observation, radiation and mastectomy. Results from prospective randomized trials as well as retrospective series will be presented in an attempt to identify appropriate treatment strategies for the different clinical presentations and histologic subtypes of DCIS. As cost effective strategies are developed, the role of conservative surgery and radiation in minimally invasive breast cancer and DAIS must be defined.
501 Fetal Dose from Radiotherapy Photon Beams: Physical Basis, Techniques to Estimate Radiation Dose Outside of the Treatment Field, Biological Effects and Professional Considerations Marilyn Stovell, Ph.D.1 C. Robert BLckwell, MS.2 M.D. Anderson Cancer Center, Houston, TX1 Mayo Clinic, Rochester, MN2 Puroose/Ob~ : The presentation will review: 1. The physical basis of radiation dose outside of the treatment field. 2. Techniques to estimate and reduce fetal dose. 3. Clinical examples of fetal dose estimation and reduction. 4. Biological effects of fetal irradiation. 5. Professional considerations. Approximately 4000 women per year in the United States require radiotherapy during pregnancy. This report presents data and techniques that allow the medical physicist to estimate the radiation dose the fetus will receive and to reduce this dose with appropriate shielding. Out-of-beam data are presented for a variety of photon beams, including cobalt-60 gamma rays and x rays from 4 to 18 MV. Designs for simple and inexpensive to more complex and expensive types of shielding equipment are described. Clinical examples show that proper shielding can reduce the radiation dose to the fetus by 50%. In addition, a review of the biological aspects of irradiation enables estimates of the risks of lethality, growth retardation, mental retardation, malformation, sterility, cancer induction, and genetic defects to the fetus. A summary of professional considerations/recommendations is also provided as a guide for the radiation oncologist and medical physicist.
502 Radiotherapy in the Management of Non-Metastatic Prostate Cancer. Current Standards and Future Opportunities Jeffrey D. Forman, M.D. Professor of Radiation Oncology, Wayne State University School of Medicine, Barbara Ann Karmanos Cancer Institute, Detroit, MI ObjectiveS: The intent of this course is to review issues involved in the management of non-metastatic prostate cancer and to clarify the role of external beam radiotherapy, the use of neo-adjuvant and adjuvant hormonal therapy in conjunction with the radiation, the management of patients with regional m&stases and recurrent disease following swgeq and radiation. At the end of this course, participants should be able to fluently discuss management issues and strategies across the entire spectrum of non-m&static prostate cancer. Pre-treatment prognostic factors including clinical stage, grade, and pre-treatment PSA, will be presented and their relative value in determining therapeutic strategies will be discussed. Strategies to be discussed include standard dose radiation, escalated dose radiation, particle radiation and the use of adjuvant and neo-adjuvant hormonal therapy. The process of simulation and field design will be presented, the value of CT-based treatment pianning, beams~ye view design and the relative value of three-dimensional treatment planning will be discussed. The significance of prostate and patient movement and strategies for dealing with this will also be presented so that what constitutes an adequate simulation and margin of treatment can be clarified. The management of newly diagnosed patients, covering the range of low stage / low grade to locally advanced prostate cancer will be discussed. The relative value of increasing dose, the relative value of using neo-adjuvant and/or adjuvant hormone therapy and the indications for escalated dose will be presented. Strategies for managing post-prostatectomy patients will be reviewed. Data on adjuvant and therapeutic irradiation for biochemical failure will be presented and a strategy for management will be discussed. How to deal with patients with residual disease post radiation will be discussed and the relative value of cryotherapy, salvage prostatectomy or hormonal therapy will be clarified.
1. J. Radiation Oncology~Biology*Physics
Volume 39, Number 2, Supplement, 1997
417 Breast Conserving Therapy for Early Stage Invasive Cancer and Ductal Carcinoma In-Situ Barbma L. Fowble, M.D. Fox Chase Cancer Center, Philadelphia, PA m: To discuss a number of clinical, pathologic, and treatment related issues in the management of early stage invasive breast cancer and ductal carcinoma in sihl. In the last 10 years, prospective randomized trials as well as retrospective series have established the role of conservative surgery and radiation in the treatment of early stage invasive breast cancer. This course will focus on some of the unresolved issues in breast conservation therapy including patient selection, the extent of surgery in the breast, and the importance of microscopic resection margins. The impact of adjuvant systemic therapy (chemotherapy or tamoxifen) on breast recurrence will be presented. Factors predicting for an increased risk of recurrence in the treated breast will be presented. Potential candidates for conservative surgery alone with minimally invasive breast cancer will be identified. The impact of improved local control on survival will be discussed. Treatment options for ductal carcinoma in situ (DCIS) including observation, radiation and mastectomy. Results from prospective randomized trials as well as retrospective series will be presented in an attempt to identify appropriate treatment strategies for the different clinical presentations and histologic subtypes of DCIS. As cost effective strategies are developed, the role of conservative surgery and radiation in minimally invasive breast cancer and DAIS must be defined.
501 Fetal Dose from Radiotherapy Photon Beams: Physical Basis, Techniques to Estimate Radiation Dose Outside of the Treatment Field, Biological Effects and Professional Considerations Marilyn Stovell, Ph.D.1 C. Robert BLckwell, MS.2 M.D. Anderson Cancer Center, Houston, TX1 Mayo Clinic, Rochester, MN2 Puroose/Ob~ : The presentation will review: 1. The physical basis of radiation dose outside of the treatment field. 2. Techniques to estimate and reduce fetal dose. 3. Clinical examples of fetal dose estimation and reduction. 4. Biological effects of fetal irradiation. 5. Professional considerations. Approximately 4000 women per year in the United States require radiotherapy during pregnancy. This report presents data and techniques that allow the medical physicist to estimate the radiation dose the fetus will receive and to reduce this dose with appropriate shielding. Out-of-beam data are presented for a variety of photon beams, including cobalt-60 gamma rays and x rays from 4 to 18 MV. Designs for simple and inexpensive to more complex and expensive types of shielding equipment are described. Clinical examples show that proper shielding can reduce the radiation dose to the fetus by 50%. In addition, a review of the biological aspects of irradiation enables estimates of the risks of lethality, growth retardation, mental retardation, malformation, sterility, cancer induction, and genetic defects to the fetus. A summary of professional considerations/recommendations is also provided as a guide for the radiation oncologist and medical physicist.
502 Radiotherapy in the Management of Non-Metastatic Prostate Cancer. Current Standards and Future Opportunities Jeffrey D. Forman, M.D. Professor of Radiation Oncology, Wayne State University School of Medicine, Barbara Ann Karmanos Cancer Institute, Detroit, MI ObjectiveS: The intent of this course is to review issues involved in the management of non-metastatic prostate cancer and to clarify the role of external beam radiotherapy, the use of neo-adjuvant and adjuvant hormonal therapy in conjunction with the radiation, the management of patients with regional m&stases and recurrent disease following swgeq and radiation. At the end of this course, participants should be able to fluently discuss management issues and strategies across the entire spectrum of non-m&static prostate cancer. Pre-treatment prognostic factors including clinical stage, grade, and pre-treatment PSA, will be presented and their relative value in determining therapeutic strategies will be discussed. Strategies to be discussed include standard dose radiation, escalated dose radiation, particle radiation and the use of adjuvant and neo-adjuvant hormonal therapy. The process of simulation and field design will be presented, the value of CT-based treatment pianning, beams~ye view design and the relative value of three-dimensional treatment planning will be discussed. The significance of prostate and patient movement and strategies for dealing with this will also be presented so that what constitutes an adequate simulation and margin of treatment can be clarified. The management of newly diagnosed patients, covering the range of low stage / low grade to locally advanced prostate cancer will be discussed. The relative value of increasing dose, the relative value of using neo-adjuvant and/or adjuvant hormone therapy and the indications for escalated dose will be presented. Strategies for managing post-prostatectomy patients will be reviewed. Data on adjuvant and therapeutic irradiation for biochemical failure will be presented and a strategy for management will be discussed. How to deal with patients with residual disease post radiation will be discussed and the relative value of cryotherapy, salvage prostatectomy or hormonal therapy will be clarified.