d104 carcinoma da mama controvérsias

8/7/2019 D104 CARCINOMA da MAMA Controvrsias

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CARCINOMA da MAMACARCINOMA da MAMA

ControvrsiasControvrsias

Hipofraccionamento.Hipofraccionamento.Nova rotina?Nova rotina?

Isabel Azevedo


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RT a toda mama tratamento standardRT a toda mama tratamento standard

no carcinoma da mama aps cirurgiano carcinoma da mama aps cirurgiaconservadora NSABPconservadora NSABP--B06B06

fracces,2Gy/, 5x/semana durante 35dias.fracces,2Gy/, 5x/semana durante 35dias.

HipofraccionamentoHipofraccionamento fraco>2Gy/fraco>2Gy/d,comd,com

reduo da dose totalreduo da dose total


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Fig. 3. Probability of marked change in breast appearance late radiation effect ten years after radiotherapy by fractionation schedule.


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Fig. 4. Probability of palpable breast induration ten years after radiotherapy by fractionation schedule.


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Fig. 2. Probability of any change in breast appearance late radiation effect ten years after radiotherapy by fractionation schedule.


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FAST

Sem aumento efeitos laterais tardios aos 3 anos5 fx DT 28.5 Gy .... 5 sem (5,7 Gy 1 x / semana)

Aumento toxicidade 30Gy / 5 f/ 5 sem

Follow-up curto

Estudo em cursoOnce a week hypofractionationed breast irradiation


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FRACTIONATION FOR WHOLE BREAST IRRADIATION: AN AMERICAN SOCIETY


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Table 1. Evidence supports the equivalence of hypofractionated whole breast

irradiation with conventionally fractionated whole breastirradiation for patients who satisfy all of these criteria*___________________________________________________________________________1. Patient is 50 years or older at diagnosis.2. Pathologic stage is T12 N0 and patient has been treated with breast- conservingsurgery.3. Patient has not been treated with systemic chemotherapy.4. Within the breast alon the central axis the minimum dose is no less than 93% and

FRACTIONATION FOR WHOLE BREAST IRRADIATION: AN AMERICAN SOCIETYFOR RADIATION ONCOLOGY (ASTRO) EVIDENCE-BASED GUIDELINE

maximum dose is no greater than 107% of the prescriptiondose (7%;) (as calculated with 2-dimensional treatment planning withoutheterogeneity corrections).____________________________________________________________________________

* For patients who do not satisfy all of these criteria, the task force could not reach consensus and thereforechose not to render a recommendationeither for or against hypofractionated whole breast irradiation in this setting. Please see the text for a thoroughdiscussion of tumor grade.Patients receiving any type of whole breast irradiation should generally be suitable for breast-conservingtherapy with regards to standard selection

rules (e.g., not pregnant, no evidence of multicentric disease, no prior radiotherapy to the breast, no history ofcertain collagen-vasculardiseases).


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Todos os doentes podem ser tratados com esquema hipofraccionamento?

Smith Beal, Int J Radiation Oncology Biophys, 2010


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Astro Guidelines

Baseado dado estudos randomizados

Falta de evidncia em subgrupos (no representados ou no includos

Idade < 50

RT gnglios regionaisBoost??QT adjuvante


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d104 carcinoma da mama controvérsias

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