Medial breast case

[Pointless]

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Just wanted to run a case by everyone to see how different people handle this situation. Essentially, a young (low 50's) woman with an early stage left-sided breast cancer, post-lumpectomy, with an extremely medial lesion. Standard tangents end up covering a little bit of the contralateral breast in order to include the entire lumpectomy cavity in the field... its either that or treating with more laterally displaced tangents and a match electron field to cover the medial portion.

What does everyone do in practice for this situation?

 

[BraggPeak]

I would probably favor the matched electron field approach, but it's hard to say without seeing the plans myself. How's your heart dose looking?

 

[deleted4401]

Match has uncertainty. I'd probably split the difference and make sure heart/lung dose are reasonable. But, I think the purist approach would be to do match technique, instead of having lump cavity slightly underdosed.

On the other hand, maybe it's a good case for aPBI?

S

 

[ShirleyT]

yes, for these cases i have definitely been pushing the patients towards APBI if they are a candidate. In my residency program, for cases like this we would often add a medial electron patch, but due to the uncertainty, we would double treat the junction and also feather the junction as well. Fortunately for me, all of the cases i have seen like this so far in private practice have been APBI candidates. Since my therapists are not used to this technique with the e patch i would be a bit hesitant to use it. I would probably try to minimize contra breast as much as possible, treat whole breast to 46 instead of my usual 50, then boost tumor bed to 60 Gy.

 

[Pointless]

Great points. We actually settled on a IMRT plan that resulted in surprisingly acceptable heart and lung doses. We are catching the medial contralateral breast, however. APBI would be an excellent option in theory, but we don't do much of it at the place that I am rotating through.

Thanks for the input.