Part of the 2017 Metastatic Breast Cancer Forum, held by Dana-Farber Cancer Institute.

1. Radiation Therapy for
Inflammatory Breast Cancer
Jennifer R. Bellon, M.D.
Dana-Farber Cancer Institute / Brigham and Women’s Hospital
Harvard Medical School
1st Annual IBC Patient Forum
Dana Farber Cancer Institute
May 13, 2017

2. Unique Features of IBC
• Predilection for skin involvement, particularly dermal
lymphatics
• High rate of nodal involvement
• Axillary, supraclavicular and internal mammary
• These features help define the radiation fields

3. Tri-modality Therapy
• Systemic therapy
• Kills cells that may have spread from the breast to other parts of
the body
• Helps decrease the burden of disease in the breast, and nearby
lymph nodes
• Surgery
• Removes residual gross disease in the breast and axilla
• Radiation treats the residual skin/chest wall and nodes that
aren’t operated upon

4. What is the Process of Radiation?
CT-Simulation
• Standard CT
• Lasers to make sure
patient is straight
• Tiny (freckle-like)
tattoos to help with
reproducibility

5. Immobilization

7. Chest Wall Tangents

8. Digitally Reconstructed Radiograph
Axillary Nodes
Heart

9. Nodal Field

10. Bolus
• Tissue equivalent plastic that ‘fools’ the
radiation to deposit its dose at the surface
• Commonly used after mastectomy (not
typically to the intact breast)

11. Dynamic Multi-Leaf Collimator

12. Isodose Curves

13. Side Effects of Treatment: Short Term
• Skin
• Redness
• Possible peeling/blistering
• Chest
• Tenderness
• Pruritus
• Fatigue

14. Side Effects: Long Term
• Cardiac
• Long-term coronary artery disease

15. Heart Movement with Respiration

16. Chest Monitoring During Radiation

17. Respiratory Trace During Radiation
Time (sec)
Chest
Excursion Chest
Excursion
Window
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18. Side Effects: Long Term
• Cardiac
• Long-term coronary artery disease
• Pulmonary
• Pneumonitis
• Lymphedema
• Impact on Reconstruction

19. Future Directions
• Ongoing studies looking at improving effectiveness of
radiation
• In large part, this will come from improvements in systemic
therapy
• Concurrent veliparib (PARP-inhibitor)
• Phase I study from U of M
• Soon to be launched Phase II randomized trial
Radiation with or without veliparib

20. Conclusions
• Radiation, when combined with
surgery and systemic therapy is
increasingly effective at achieving
long-term local control
• Efforts are ongoing to ensure maximal
safety, with minimal long-term
sequelae