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ForwardBreast
This session provides a global overview of breast radiotherapy indications, approaches and techniques, informed by the latest clinical trials and relevant research. By the completion of the session, attendees should be able to identify which patients are suitable for ultrahypofractionated radiation therapy, accelerated partial breast irradiation, omission of radiation therapy, and current indications for postmastectomy radiation therapy/comprehensive regional nodal irradiation. Particular emphasis is placed on risk stratification using tumor biology/multi-gene assays and on modern radiation techniques (concomitant boost, volumetric modulated arc radiotherapy, protons).
Learning Objectives
Upon completion of this activity, participants should be able to do the following:
- Describe standard and hypofractionated whole-breast irradiation regimens, including conventional (50 Gy in 25 fractions), moderate hypofractionation (40 Gy in 15 fractions), and ultra-hypofractionation (26 Gy in 5 fractions).
- Explain clinical factors influencing the choice of fractionation schedule.
- Identify appropriate candidates for omission of radiation therapy after lumpectomy.
- Identify patient and tumor characteristics that warrant a tumor bed boost (e.g., age ≤50, high-grade tumors, close or positive margins, lymphovascular invasion).
- Discuss available lumpectomy cavity boost techniques.
- Define eligibility criteria for APBI based on ASTRO guidelines.
- List absolute and conditional indications for PMRT after upfront surgery and after neoadjuvant therapy.
- Explain scenarios where PMRT may be omitted or limited.
- Describe recommended target volumes (chest wall and regional nodes) and preferred fractionation schedules.
Course summary
Moderator
- Megan E. Daly, MD, University of California Irvine, Chao Family Comprehensive Cancer Center
Speaker
- Jose G. Bazan, MD, MS, City of Hope Comprehensive Cancer Center