Radiation Therapy for Inflammatory Breast Cancer

Jennifer R. Bellon, M.D.

Dana-Farber Cancer Institute / Brigham and Women’s Hospital

Harvard Medical School

1st Annual IBC Patient Forum

Dana Farber Cancer Institute

May 13, 2017

Unique Features of IBC

• Predilection for skin involvement, particularly dermal lymphatics

• High rate of nodal involvement

• Axillary, supraclavicular and internal mammary

• These features help define the radiation fields

Tri-modality Therapy

• Systemic therapy• Kills cells that may have spread from the breast to other parts of

the body

• Helps decrease the burden of disease in the breast, and nearby lymph nodes

• Surgery• Removes residual gross disease in the breast and axilla

• Radiation treats the residual skin/chest wall and nodes that aren’t operated upon

What is the Process of Radiation?CT-Simulation

• Standard CT

• Lasers to make sure patient is straight

• Tiny (freckle-like) tattoos to help with reproducibility

Immobilization

Chest Wall Tangents

Digitally Reconstructed Radiograph

Axillary Nodes

Heart

Nodal Field

Bolus

• Tissue equivalent plastic that ‘fools’ the radiation to deposit its dose at the surface

• Commonly used after mastectomy (not typically to the intact breast)

Dynamic Multi-Leaf Collimator

Isodose Curves

Side Effects of Treatment: Short Term

• Skin• Redness

• Possible peeling/blistering

• Chest• Tenderness

• Pruritus

• Fatigue

Side Effects: Long Term

• Cardiac• Long-term coronary artery disease

Heart Movement with Respiration

Chest Monitoring During Radiation

Respiratory Trace During Radiation

Time (sec)

Chest

Excursion Chest

Excursion

Window

dsfjksljfkldsjlkjkjsfdkljfklsd

Side Effects: Long Term

• Cardiac• Long-term coronary artery disease

• Pulmonary• Pneumonitis

• Lymphedema

• Impact on Reconstruction

Future Directions

• Ongoing studies looking at improving effectiveness of radiation• In large part, this will come from improvements in systemic

therapy

• Concurrent veliparib (PARP-inhibitor)• Phase I study from U of M

• Soon to be launched Phase II randomized trial

Radiation with or without veliparib

Conclusions

• Radiation, when combined with surgery and systemic therapy is increasingly effective at achieving long-term local control

• Efforts are ongoing to ensure maximal safety, with minimal long-term sequelae