1. HSC 340
11-18-2010
Breast Cancer
Hodgkin's
Lung Cancer

2. Breast Cancer
• Most common cancer in women
• Ductal carcinoma most common
• Treatment options:
– Surgery + radiation
– Surgery + radiation + chemo
– Surgery alone (mastectomy)

3. Breast anatomy
• Superior border- 2nd
costal cartilage
• Inferior border- 6th
costal cartilage
• Medial border- Sternal edge
• Lateral border- anterior axillary line

5. Routes of Spread
• Lymph nodes:
– Axillary
– Internal Mammary
– Transpectoral
• Lung, Bone, Brain, Liver

6. Immobilization and Positioning
• First concern is the movement of the arm
• Custom molds
• Wingboards
• Breast board
• Headrest
• Knee wedge

7. Simulation set-up
• Disrobe from waist up
• Lie supine, straighten patient
• 3pt set-up
• Both arms or ipsilateral arm only raised into
position
• Head straight or turned to contralateral side
• Wires and BBs

8. Treatment techniques
• Tangentials
• Tangentials + Sclav
• Tangentials + Sclav + PAB
• Tangentials + Sclav + PAB + Internal
Mammary
• FinF
• IGRT

10. Whole Breast IGRT 4860cGy @ 180cGy/fx

11. Breast Boost 1620cGy @ 180cGy/fx

12. Tangential Breast 4860cGy @ 180cGy/fx
followed by a boost

14. Sclav:
5040cGy
PAB: 720cGy
Tangents:
6120cGy

15. Doses
• Tangents: 4680cGy-5040cGy
• Boost: to 6000cGy
• Sclav: 4680cGy
• PAB: whatever dose brings midline dose to
4680cGy

16. Hodgkins
• Very radiosensitive
• Bi-modal age range 15-24 yrs & 50+
• Cervical or supraclavicular 75%
• Mediastinal 60%
• Fever, night sweats, weight loss

17. Treatment
• Surgery to diagnose and stage
• Radiation alone
• Chemo alone
• Radiation and Chemo

18. Immobilization and Positioning
• Patient supine
• No headrest, chin extended
• Arms above head or akimbo
• Custom molds
• Site specific custom blocks

19. Treatment techniques
• AP:PA mantle
• AP:PA inverted Y

20. Dose
• 3600cGy-4400cGy

21. Lung Cancer
• Leading cause of cancer death in males and
females
• Chemo, surgery and radiation
• Routes of spread
– Cervical L.N
– Liver, brain, bones

22. Lung Anatomy
• Rt. Lung- 3
Lobes
• Lt. Lung- 2
Lobes
• Carina @ T5

23. Immobilization and Positioning
• Supine
• Headrest
• Wingboard
• Arms above head holding poles
• Be aware of respiratory problems

24. Simulation
• 3 pt set-up
• Contrast?
• Gating
• Breath hold technique

25. Treatment techniques
• AP:PA
• Off cord obliques
• IGRT

26. Doses
• SCLC 4500cGy-5400cGy
• NSCLC 6000cGy-7500cGy

27. IGRT Rt. Upper Lobe 4500cGy @ 180 cGy/fx.
Concurrent chemo

30. IGRT Rt. Lung with Nodes 4500cGy @ 180cGy/fx with
concurrent chemo