CARCINOMA da MAMA

Controvérsias

Hipofraccionamento.
Nova rotina?

Isabel Azevedo

RT a toda mama é tratamento standard
no carcinoma da mama após cirurgia
conservadora NSABP-
NSABP-B06

Fraccionamento 50Gy em 25
fraccões,2Gy/, 5x/semana durante 35dias.

Hipofraccionamento fracção>2Gy/d,com
fracção>2Gy/d,com
redução da dose total
Fig. 3. Probability of marked change in breast appearance late radiation effect ten years after radiotherapy by fractionation schedule.
Fig. 4. Probability of palpable breast induration ten years after radiotherapy by fractionation schedule.
Fig. 2. Probability of any change in breast appearance late radiation effect ten years after radiotherapy by fractionation schedule.
FAST

•Sem aumento efeitos laterais tardios aos 3 anos

5 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 curso
Once a week hypofractionationed breast irradiation
FRACTIONATION FOR WHOLE BREAST IRRADIATION: AN AMERICAN SOCIETY
FOR RADIATION ONCOLOGY (ASTRO) EVIDENCE-BASED GUIDELINE
Table 1. Evidence supports the equivalence of hypofractionated whole breast
irradiation with conventionally fractionated whole breast
irradiation for patients who satisfy all of these criteria*
____________________________________________________________________
_______
1. Patient is 50 years or older at diagnosis.
2. Pathologic stage is T1–2 N0 and patient has been treated with breast- conserving
surgery.
3. Patient has not been treated with systemic chemotherapy.
4. Within the breast along the central axis, the minimum dose is no less than 93% and
maximum dose is no greater than 107% of the prescription
dose (7%;) (as calculated with 2-dimensional treatment planning without
heterogeneity corrections).
____________________________________________________________________
________
* For patients who do not satisfy all of these criteria, the task force could not reach consensus and therefore
chose not to render a recommendation
either for or against hypofractionated whole breast irradiation in this setting. Please see the text for a thorough
discussion of tumor grade.
Patients receiving any type of whole breast irradiation should generally be suitable for breast-conserving
therapy with regards to standard selection
rules (e.g., not pregnant, no evidence of multicentric disease, no prior radiotherapy to the breast, no history of
certain collagen-vascular
diseases).
Todos os doentes podem ser tratados com esquema hipofraccionamento?

Astro Guidelines
Smith Beal, Int J Radiation Oncology Biophys, 2010
Astro Guidelines

•Baseado dado estudos randomizados

•Falta de evidência em subgrupos (não representados ou não incluídos

•Idade < 50
•Mastectomia
•RT gânglios regionais
•Boost??
•QT adjuvante
•Hipofraccionamento será seguro em doentes com factores de risco?

•Mulheres jovens

•Tumores de alto grau com taxa de proliferação alta

•Basal-like ou HER2+ fenótipos

Obrigado