Radiotherapy after breast-conserving surgery, (a) Indications: Postoperative radiation therapy is reserved for follow-up treatment of breast surgery, both the indications consistent.
(B) postoperative radiotherapy on the processing requirements of the primary tumor
1. Tumor resection (including the surrounding normal tissue 1 ~ 2cm).
2. Resection of the primary tumor should be the base of the surrounding normal breast, especially in and around (up, down, left, right, front and back) put silver clip (anti-magnetic material), for the accuracy of postoperative radiotherapy reduced fields positioning reference.
3. Need ideal surgical incision, if the primary tumor in the nipple to the top of the arc-shaped incision, if the bottom of the nipple was radial. Primary tumor and axillary incision apart.
4. Resection margin had residual focal microscope by increasing the area of the primary tumor radiation dose to remedy.
Radiotherapy after breast-conserving surgery (c) axillary lymph nodes after radiotherapy treatment requirements
1. On clinical untouched No lymph nodes can be used in patients with sentinel lymph node (SLN) detection.
2. On immunohistochemical examination or PT-PCR examination of sentinel lymph node-negative patients with axillary lymph node dissection can not do, and as if from axillary lymph node-negative and radiation therapy.
3. Sentinel axillary node-positive line of general propositions lymph node dissection (only for axillary I, II level dissection), if no clear line of axillary lymph node radiation therapy is given.
4. Axillary lymph node dissection, the general requirements to provide subjects for clinical 10 or more lymph nodes.
(D) the timing of radiotherapy
Present study shows that chemotherapy and radiotherapy there was no significant difference in the order, according to patient selection and treatment of habitual decision, when the lymph nodes, it can first chemotherapy. When the margin is low, can first radiotherapy. Patients receiving chemotherapy without first 6 weeks after starting radiotherapy (high-risk patients without recurrence). Patients receiving adjuvant chemotherapy should be in the early radiotherapy after chemotherapy (usually not more than 16 weeks). Patients before radiotherapy after surgery should make the necessary checks before the treatment.
Radiotherapy after breast-conserving surgery (e) radiation therapy and treatment target
In order to accurately determine a reasonable target and minimize the dose distribution of the affected lung and heart dose, retained breast after radiation therapy, should be selected to CT simulation in order to ensure, in CT imaging-based radiation therapy.
1. Without making clear the axillary lymph nodes are required to include the breast, chest wall, ipsilateral axillary and supraclavicular lymph node area.
2. Axillary lymph node removal were done without lymph node metastasis (detected at least 10 or more) only the breast and chest wall irradiation. Irradiated lymph node metastasis of breast, chest wall, axillary and supraclavicular.
3. Axillary lymph nodes who received only low-sampled lymph node metastasis with total axillary irradiation is required.