ESTRO 2024 - Abstract Book

S132

Invited Speaker

ESTRO 2024

David J Dodwell

The University of Oxford, Oxford Population Health, Oxford, United Kingdom

Abstract:

Management of the axilla and other regional lymph nodes has long been a source of uncertainty and variable opinion in the management of early breast cancer. Recent meta-analyses from EBCTCG on the management of the axilla and other regional node areas along with results from other large trials have provided important results to inform clinical practice. The lack of any benefit on breast cancer mortality from more, as opposed to less, axillary treatment and the very low overall rates of axillary recurrence have prompted efforts to reduce morbidity by reducing the extent of axillary surgery, considering avoidance of all axillary intervention or recommending radiotherapy instead of surgery in different patient groups. In contrast, the mortality benefits of regional radiotherapy have been confirmed in a number of large studies and recently by EBCTCG, and these results encourage escalation of radiotherapy. This apparent paradox will be discussed. Large well-conducted randomised trials and meta-analyses are useful for determining the presence or absence of a treatment effect but are often less useful in helping to identify which sub-groups of patients gain most benefit and which may gain none. Great care is needed in applying trial results to the clinic and in the design of treatment guidelines written to support this process. The identification of which patients need more nodal radiotherapy is complex. A careful review of information from large trials and the relevant EBCTCG meta-analyses is the most appropriate way to inform this question and to develop ways of addressing current uncertainties in management.

3552

Working within the framework of MDR in clinical radiotherapy

Eva Onjukka

Karolinska University Hospital, Medical Radiation Physics and Nuclear Medicine, Stockholm, Sweden. Karolinska Institutet, Oncology-Pathology, Stockholm, Sweden

Abstract:

Radiotherapy has a rich history of in-house devices (including software) improving treatments through greater complexity and greater patient safety. There are countless examples of such innovations which have later been made available commercially and become essential tools for modern radiotherapy. While patients have greatly benefitted from the technical revolution resulting from this culture of innovation, there are also examples of unintended consequences from the use of in-house devices which may cause harm to patients. Therefore, the conditions under which such devices can be developed and used, established by the EU 2017/745 regulation on medical devices, need to be understood by any clinic engaged in in-house development. There are increasing opportunities for automation through scripts tailored to local treatment practice, which may offer increased efficiency, quality of service and reduce the risk of human errors. In-house devices vary greatly in complexity, and it is the responsibility of the clinic to establish whether they classify as a medical devices, and to perform risk analyses regarding their use. The planning, documentation and risk-mitigation strategies required by