Tumorectomy plus Radiotherapy in the Management of Breast Cancer

Treatment of Breast Cancer in Elderly Women: Retrospective Analysis of 111 Wide Lumpectomies Performed in a Day Hospital Regimen between 1982 and 1988

Between 1982 and 1988, 111 elderly women with breast cancer but without clinical involvement of the axillary lymph nodes underwent wide lumpectomy in a Day Hospital regimen at the National Cancer Institute of Milan. The patients ranged in age from 70 to 92 years (median, 79). An adjuvant treatment was carried out in all but 9 cases: tamoxifen only in 84 cases, tamoxifen plus radiotherapy in 6 cases, radiotherapy alone in 12 cases. The median duration of follow-up was 44 months (range, 30–109 months). Four patients (3.6%) were lost to follow-up. In the remaining 107 patients, 10 local-regional relapses (9.1 %) and 7 distant metastases (6.5 %) occurred. Six patients died from the disease, 14 from unrelated conditions. This retrospective study showed that selected elderly patients with breast cancers can be treated successfully under local anesthesia on an outpatient basis. The treatment guarantees local control of the disease, meets the favor of elderly women and consequently improves their quality of life.

A technique for evaluating cast foam positioning and immobilization devices used in breast cancer radiotherapy

Patient setup reproducibility when Alpha Cradles* are used is not well documented. A simple technique is described that localizes longitudinal and transverse planes in breast setups utilizing 4 mm lead-sphere markers embedded in a modified HS-2 Alpha Cradle. The markers are positioned in the cradle coincident with the projected simulator central axis crosshair when the x-ray beam is directed vertically down through a setup point on the patient. A reference film recording patient position relative to the Alpha Cradle is taken through the setup point at the end of the simulation procedure. On the treatment machine, the images of the lead markers on the portal film, taken through the same setup point, indicate longitudinal and transverse planes. These planes are then used to correlate and quantitate the reproducibility of the original reference planes. This technique is easily initiated, and when used in conjunction with a careful analysis of conventional treatment portal films, is very useful in determining the accuracy of patient repositioning in the Alpha Cradle, and precise field placement. Results of a study utilizing a modified HS-2 Alpha Cradle will be presented.

Three-field isocentric technique for breast irradiation using individualized shielding blocks

The three-field technique is the most common method used for breast and regional node treatment after conservative surgery. Several variants of this technique, which are characterized by complex geometrical problems, have been described. A possible simplification of this technique and the use of individualized shielding blocks both for anterior and for tangential fields is proposed, thus allowing for the simultaneous shielding of the half beam and the critical areas. Advantages of isocentrical techniques are thereby maintained, but the number of mechanical movements required is minimized and collimators and couch rotations are not needed. Patient set-up time is also greatly shortened. The accuracy of this technique has been verified using both photographic methods and thermoluminescent dosimetry.