Cancer of the breast — Primary irradiation

62

Radiation

Oncology, Biology,

Physics

October

1987,

Volume

13, Supplement

1

Withthenon-Hozlgkin~slyqAmmas, advances inmarkerstudiesnowdirectourappmaches. almtheram programs are important, whilethe role of radiotherapy inbothearlyandadvanaed stage disease is controversial. LIataareprovidedtohelp clarifythecontraversialissues. Inthemanagementofleukemia amajorcmcern remains the prophylaxis andtreatmentofleuJcem.ia inthe oentralnervousqstemandoth~sanctuarysites. This subject is reviewed with discussion of the neurotoxicity associatedwiththerapy.

209 CANCER

OF THE BREAST

Barbara L. Fowble, Pennsylvania School

- PRIMARY

IRRADIATION

M.D. and Robert L. Goodman, of Medicine and The Fox Chase

M.D., Cancer

Departments of Radiation Therapy, Center, Philadelphia, Pennsylvania

University 19104

of

In the last 10 years both prospective randomized clinical trials and retrospective series have established the role of conservative surgery and radiotherapy as an alternative to mastectomy in the treatment of early breast cancer. This presentation will review the available data from these studies. Points of discussion will include the role of patient selection (patient age, histology and mammographic findings), the extent of the surgical procedure in the breast (incisional versus excisional biopsy, wide the role and extent of the axillary staging procedure (sampling versus excision versus quadrantectomy), limited axillary dissection versus complete axillary dissection), the extent of radiotherapy (breast versus breast and regional node irradiation), and the role of the boost. Each of these issues will be The data from both addressed and current treatment policies and recommendations will be outlined. retrospective as well as prospective studies will be presented and compared to those results achieved with Local recurrence rates and predictors of breast recurrence will be discussed. The ability to mastectomy. combine adjuvant chemotherapy with primary radiotherapy for patients with histologically positive axillary nodes will be reviewed in terms of selection and sequencing of agents, the ability to deliver optimal doses of chemotherapy and the effect of chemotherapy on cosmesis and complications. Long term effects of radiation therapy will be discussed including the incidence of contralateral breast cancer and second malignancy. Finally, the role of conservative surgery and radiotherapy in the treatment of non-invasive breast cancer will be presented.

210 BLADDER CARCINOMA: THE POSSIBLE CHEMOTHERAPY William Medical

SELECTION

OF PATIENTS

Medicine U. Shipley, M.D., Radiation School, Boston, Massachusetts 02114

FOR RADIATION

Service,

THERAPY,

Mass.

TRANSURETHRAL

General

Hospital

OR RADICAL

Cancer

SURGERY

Center,

AND

Harvard

This presentation will emphasize radiotherapy approaches that offer cure with preservation of bladder function and selection of patients who are likely to benefit from full-dose radiation. Patients with superficial bladder carcinoma: Prognostic factors influencing recurrence rate A. following transurethtal resection will be highlighted. The excellent results of special forms of radiation These include intraoperative radiation therapy for a superficial bladder carcinoma will also be reviewed. therapy (both open interstitial implantation reported from Rotterdam and open electron beam single dose irradiation reported from Tokyo) as well as trans-Foley intravesicle brachytherapy techniques and external beam radiation theraov. Patients with muscle-invading bladder carcinoma: I. Full-dose radiation therapy. The overall B. survival rates have been low (17% to 39% at 5 vears) for oatients with clinical staqes T2 and T3. However, many of the reported patients had limited"surviva1 potential of ab initio due to-advanced stage Treatment results strongly suggest that transitional cell carcinoma is a or serious medical conditions. heterogeneous grouping of several subtypes with differences in malignant potential and therapeutic The goal in selecting patients for full-dose radiation is to achieve local cure with response. maintenance of bladder function and without increasing the probability of a cancer-related death (relative to cystectomy). Treatment results will be reviewed indicating that patients who are selected for full-dose radiation therapy should be those with a satisfactory pretreatment bladder capacity and with clinical Within clinical stages T2 and T3, the prognostic factors stages T2 and T3 tumors rather than T4 tumors. 1: those patients in whom predicting improved 5 year survival from bladder cancer to be reviewed are 2: those in whom a "visibly complete" transurethral resection is ureteral obstruction is absent, The possible, and 3: those whose muscle-invading tumors have a papillary surface histologic pattern. results suggest that patients in the favored subcategories can be offered full-dose radiotherapy following a thorough initial transurethral tumor resection as a reasonable alternative to planned cystectomy. Adjuvant radiation therapy and radical cystectomy. Preoperative external beam and radical II. bladder cancer cystectomy is the present standard treatment in the U.S. for patients with muscle-invading who can and will accept the therapy. The rationale and treatment results for various treatment schedules will be reviewed as well as randomized trials comparing this treatment to radiation alone or cystectomy alone.