Assignment on:

CARCINOMA OF BREAST
(Indications for adjuvant & neo-adjuvant radiation therapy)

Submitted to: Dr. Ndeem Zia

Prepared by: Abdul Rehman
2nd year(radiotherapy)

King Edward Medical University

 1) Neo-adjuvant Radiotherapy to breast cancer:

“Treatments given to weaken and destroy breast cancer

before surgery are called neo-adjuvant treatments.”
Indications of Neo-adjuvant Radiotherapy:
 Tumor size is too large for surgery
 N2 stage
 fixed or matted lymph node on ipsilateral side,
 Clinically apparent ipsilateral internal mammary nodes in the absence of axillary node, making the clinical staging at
least stage IIIA or above.

2) Adjuvant Radiotherapy to breast cancer:

Adjuvant therapy, also known as adjunct therapy, add-on therapy, and adjuvant care, is therapy that is given in addition to the
primary or initial therapy to maximize its effectiveness. The surgeries and complex treatment regimens used in cancer therapy have
led the term to be used mainly to describe adjuvant cancer treatments. An example of such adjuvant therapy is the additional
treatment usually given after surgery where all detectable disease has been removed, but where there remains a statistical risk of
relapse due to the presence of undetected disease. If known disease is left behind following surgery, then further treatment is not
technically adjuvant.

Indications of adjuvant Radiotherapy: (post MRM RT indications)

 T3,T4
 Matted nodes
  2 or more nodes positive
 Lymph vascular invasion (LVSI)
 High grade carcinoma
 Gross extra capsular tumor extensions

Adjuvant radiotherapy in four fields:

1) Tangential fields
2) Supraclavicular field
3) Axillary field
4) Internal memory field

Indications For chest wall:

 T3,I,e >5cm
 Residual disease
 Locally advanced breast cancer(LABC)
 Positive margins or close surgical margins < 2cm
 BCS
 Inflammatory carcinoma
 Incomplete resection
 Diffusely growing tumor in more than one field

Tangential fields indications:

There are two tangential fields which are given for chest wall radiotherapy:
 After chemotherapy
 T3,T4
 Matted nodes
 2 or more nodes positive
  Lymph vascular invasion (LVSI)
 High grade carcinoma

Indications for Axillary field:

 Greater than four nodes are positive
 Extra nodes spread
 Axillary status unknown
 Margins of surgery less than 5mm
 Inadequate axillary clearance
 Gross extra capsular tumor extensions

Indications for Supraclavicular field:

 If patient had received neo-adjuvant chemotherapy
 Lymph nodes positive

Indications for Internal Memory field:

 Internal memory lymph nodes are positive
 Macroscopic lesion present