Abstract ES1-3: Advanced technologies to optimize outcomes and minimize toxicities

Abstract

Abstract Advances in radiation technology offer substantial promise for improving the therapeutic ratio in breast cancer management, both by improving tumor control and by reducing toxicity. Multiple historical randomized trials and their meta-analysis have demonstrated that the benefits of radiation therapy have been accompanied by toxicity to incidentally irradiated structures, including the heart. However, the past two decades have witnessed a dramatic revolution in technological capabilities to allow greater sparing of normal tissues while simultaneously improving the ability to identify and target areas at greatest risk. Intended for the general audience, this presentation will provide an overview of transformative technological advances in radiation oncology in recent years, including three-dimensional conformal treatment planning, intensity modulation, prone positioning, and devices that allow reproducible deep inspiration to facilitate cardiac sparing. It will review the evidence from historical trials that have established the importance of minimizing dose to normal tissues and the heart in particular, as well as more recent data demonstrating excellent dose distributions and promising outcomes with new technologies, motivating their increased utilization. The presentation will include consideration of advances such as the development of contouring atlases to facilitate greater consistency and quality of care. It will also reflect on cost considerations and concerns about rapid uptake of certain technologies prior to studies establishing evidence of benefit, along with a description of ongoing endeavors to assess value. After summarizing new professional society guidelines on whole breast irradiation, it will identify the current consensus recommendations regarding the most appropriate uses of technology to optimize outcomes of whole breast and boost radiotherapy in the modern era. Finally, it will close with a mention of ongoing and future trials evaluating the potential role of even more advanced technologies, such as proton therapy, true inverse-planned intensity modulated radiotherapy, and stereotactic body radiotherapy, in the management of breast cancer. Citation Format: Jagsi R. Advanced technologies to optimize outcomes and minimize toxicities [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr ES1-3.