ESTRO Multidisciplinary Management of Breast Cancer 2017

Cosmetic results after breast conserving therapy

• Which factors play a role ? Several RCTs to investigate impact of: Factor studied Impact on cosmesis Conclusion Hypofx No change in breast appearance Alfa/beta 3.5 Gy  No boost vs low boost No boost better than boost Dose-effect relation present

Prone vs Supine

Tendency for better outcome prone than supine Only benefit if scored by physician at 5 yr, and if patients are selected

Due to better dose homogeneity ?

2D CRT vs IMRT

Partial breast vs WBRT

Results conflicting

Probably due to DVH parameters and dose per fraction; not clear

Hypofx: Whelan 2008; Haviland 2013, Valle 2017; Prone vs supine: Veldeman 2016; 2D CRT vs IMRT: Pignol 2016; Mukesh 2014; No vs low boost: Vrieling 1999 & 2000, Hau 2013; Low vs high boost : Brouwers in preparation; PBI vs WBRT: Polgar 2017, Coles 2017, Peterson 2015