Role of electron beam treatment in postoperative management of carcinoma of the breast.
The aim of post operative radiotherapy to chest wall and drainage areas in advanced breast cancer is to sterilize the possible microscopic disease. Fifty cases of post surgical breast cancers were evaluated in a prospective study of chest wall radiation therapy by electrons. Fifty women of histologically proved post operative invasive breast cancers underwent simple mastectomy with axillary dissection followed by post-operative radiotherapy (Electron) to chest wall +/- drainage area. The chest wall and IMC was treated by a direct electron beam (9/12 MeV and 12 MeV) at fixed angle. 6 MV X-ray beam was used to treat axillary apex and supraclavicular area. In some cases, supplement RT was given by 6 MV X-rays through small posterior axillary portal. The energy of electron beam was 9 MeV or 12 MeV depending on the thickness of treated area. The supraclavicular and axillary lymphatic regions were treated, by direct custom shaped anterior portal. The dose delivered was 50 Gy over 5 weeks at 2 Gy per fraction. Adjuvant chemotherapy was given to patients who were pre-menopausal with histologically proved axillary node involvement as Cyclophosphamide, Methotrexate and 5-Fluorouracil (CMF) after radiotherapy. Post menopausal patients received adjuvant tamoxifen 10 mg.bid. The overall time varied from 26 to 87 days with a median of 41.5 days (SD 11.7). The followup period varied from 4-32 months with a mean of 22 months (SD 6.4). All the fifty patients developed dense pigmentation towards the end of radiation therapy, along with patchy dry desquamation. Moist desquamation occurred in 6 patients. The median OTT in the patients who developed moist desquamation was 34.5 days. The moist reaction healed over 10-15 days after completion of radiotherapy. Lung Fibrosis (Apical lobe) occurred in four patients. The fibrosis was evident at a median of 12 months of follow up. Lymphoedema of the ipsilateral arm occurred in six patients. None of 50 patients developed late sequalae like Cardiac effects, Rib fracture, Brachial Plexopathy, Shoulder joint impairement and Soft tissue effects. Local control in this study was 96% (48 patients). The two year actuarial overall survival was 80%. In early stages survival was significantly better compared to late stages. The actuarial two year DFS was 72%. In early stages DFS was significantly better compared to late stages.
Vishwanathan
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N
Department of Radiation Therapy, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India.
Bhaskar
N
N
Supe
S S
SS
Swamy
K
K
Ravichandran
R
R
Kannan
V
V
Ramesh
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D004583:Electrons; D005260:Female; D006801:Humans; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies