Breast implant and lung RT

[Ray D. Ayshun]

Have a T4N0 lung ca abutting the chest wall just behind an implant. Anybody have any anecdotes or data re the risk of affecting the implant? Right now the max dose to the capsule/chest wall interface is about 54 Gy/30 fx.

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[Bequerel]

I would just make sure the PTV is adequately covered and minimize hot spots in implant. I’ve never given a second thought to an implant when treating a T4 lung cancer for risk of marginal miss.

 

[Ray D. Ayshun]

I would just make sure the PTV is adequately covered and minimize hot spots in implant. I’ve never given a second thought to an implant when treating a T4 lung cancer for risk of marginal miss.

Of course. Just wondering what if anything to tell the patient. Naturally, she's consented for blah, blah, blah, but I've never been in a situation with a non breast cancer with a PTv overlapping/abutting an implant.

 

[ramsesthenice]

I would just make sure the PTV is adequately covered and minimize hot spots in implant. I’ve never given a second thought to an implant when treating a T4 lung cancer for risk of marginal miss.

I agree. If you don't control the lung tumor she either dies (worst case) or needs a composite chest wall resection ("best" case) or some combination of the two. I mean, if you are that worried about it you can have the implant removed and then replace it post-treatment.

 

[TheWallnerus]

Have a T4N0 lung ca abutting the chest wall just behind an implant. Anybody have any anecdotes or data re the risk of affecting the implant? Right now the max dose to the capsule/chest wall interface is about 54 Gy/30 fx.

Based on description you should be able to spare >1/2 the implant capsule, no? If there's capsular retraction in just one part of the capsule, it will likely be unnoticeable to the patient.

 

[thecarbonionangle]

Treat the cancer brotha. Don’t miss.

 

[Ray D. Ayshun]

Again, not planning on missing. Curiosity. Yes, most of the capsule is <30 Gy.

 

[ramsesthenice]

Based on description you should be able to spare >1/2 the implant capsule, no? If there's capsular retraction in just one part of the capsule, it will likely be unnoticeable to the patient.

Assuming there is no baseline dysmorphia. Which is a big assumption in this population.

 

[Haybrant]

Again, not planning on missing. Curiosity. Yes, most of the capsule is <30 Gy.

pretty poor responses to the question overall, you dont tell a patient oh well youre screwed because of this lung cancer dont think about the rest of your body. Would be good to speak with the plastic surgeon just as a head up and let the patient know that you did and certainly worth consenting about it

 

[evilbooyaa]

Counsel on risk of capsular contracture, although with IMRT and not reating the whole implant, the rate should be lower than what it would be in standard PMRT.