The Fellow on Call: The Heme/Onc Podcast Episode 053: Breast Cancer Series, Pt. 2-Fundamentals of Radiation Oncology in Breast Cancer
Apr 19, 2023
In this engaging discussion, Dr. Ryan Miller, a radiation oncology resident at Thomas Jefferson University Hospital, dives into the essential role of radiation therapy in breast cancer treatment. He explains the significance of radiation boosts and regional nodal irradiation, clarifying when they are needed. Dr. Miller also addresses the interplay between concurrent systemic therapies and radiation. Plus, he highlights scenarios for omitting radiation and the specifics of treating DCIS, making this a valuable listen for anyone interested in oncology insights.
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Radiation Essential After Breast Conservation
- Radiation after breast-conserving surgery significantly reduces ipsilateral breast recurrence and can improve survival in early-stage disease.
- No patient undergoing breast conservation should skip a radiation consultation because radiation provides important local control and survival benefits.
Plan Simulation After Healing; Use Hypofractionation
- Schedule CT simulation roughly 4–6 weeks after surgery to allow swelling and wounds to heal before planning radiation.
- Use hypofractionation (15–16 fractions) as standard for most early-stage patients to shorten treatment to ~3 weeks.
Use Boost For Younger Or High-Risk Patients
- Consider a surgical-cavity boost for younger patients and those with high-risk pathology to further lower local recurrence.
- Deliver boosts as 5–8 extra fractions or integrate them into the hypofractionated whole-breast plan.