Project Details
Description
Each year, over 8000 Swedish women are diagnosed with breast cancer (BC). In Sweden postoperative treatment today includes radiotherapy (RT) to the regional lymph nodes if lymph node metastases are found. However, although this has been shown to be beneficial on a group level [1, 2], the effect for the induvial is uncertain and treatment comes with more or less serious side-effects (increased arm morbidity, pneumonitis, increased risk of heart disease, and lung cancer). Hence, there is a great need to modernize and individualize adjuvant RT in relation to tumor biology and risk of recurrence.
There is increasing evidence that it is safe to refrain from axillary lymph node dissection in BC patients with limited axillary involvement [3, 4]. It is, however, still unclear whether regional RT is needed. This will be further investigated in the large randomized Nordic radiotherapy trial T-REX (Tailored regional external beam radiotherapy in clinically node-negative breast cancer patients with 1-2 sentinel node macrometastases). Clinically node-negative BC patients with 1-2 macrometastases in their sentinel lymph node biopsy, and an estrogen receptor positive, HER2-negative tumor, will be randomly assigned to either receive standard adjuvant RT, or no regional RT. For all patients gene expression profiling will be performed and related to risk of recurrence and benefit of treatment.
The main supervisor Sara Alkner is primary investigator for T-REX. During the project the PhD- student will in collaboration with co-supervisor medical physicist Elinore Wieslander collect and analyze RT data within the trial. This will be correlated to risk of recurrence, side effects and health economics.
A debated issue in regional BC RT, is which lymph node levels to include in the target volume. In 2018 it was decided in the Swedish national BC treatment guidelines, that the internal mammary nodes (IMN) should be added to the target volume in high-risk patients. We will evaluate how introduction of IMN-RT in our clinic has affected dose to organs at risk (heart and lung), and how well guidelines are followed. We will also evaluate the benefit of modern techniques – such as volumetric arc therapy (VMAT), and the use of breath hold techniques, in breast cancer radiotherapy. Co-supervisor Sofie Ceberg here has experience from similar trials, for example in hodgkins lymphoma, and is the main author for the national guidelines for use of breath hold techniques in BC RT.
In conclusion, the aim of this project is to optimize treatment techniques for adjuvant BC RT, and to individualize treatment in relation to anatomy and tumor biology.
There is increasing evidence that it is safe to refrain from axillary lymph node dissection in BC patients with limited axillary involvement [3, 4]. It is, however, still unclear whether regional RT is needed. This will be further investigated in the large randomized Nordic radiotherapy trial T-REX (Tailored regional external beam radiotherapy in clinically node-negative breast cancer patients with 1-2 sentinel node macrometastases). Clinically node-negative BC patients with 1-2 macrometastases in their sentinel lymph node biopsy, and an estrogen receptor positive, HER2-negative tumor, will be randomly assigned to either receive standard adjuvant RT, or no regional RT. For all patients gene expression profiling will be performed and related to risk of recurrence and benefit of treatment.
The main supervisor Sara Alkner is primary investigator for T-REX. During the project the PhD- student will in collaboration with co-supervisor medical physicist Elinore Wieslander collect and analyze RT data within the trial. This will be correlated to risk of recurrence, side effects and health economics.
A debated issue in regional BC RT, is which lymph node levels to include in the target volume. In 2018 it was decided in the Swedish national BC treatment guidelines, that the internal mammary nodes (IMN) should be added to the target volume in high-risk patients. We will evaluate how introduction of IMN-RT in our clinic has affected dose to organs at risk (heart and lung), and how well guidelines are followed. We will also evaluate the benefit of modern techniques – such as volumetric arc therapy (VMAT), and the use of breath hold techniques, in breast cancer radiotherapy. Co-supervisor Sofie Ceberg here has experience from similar trials, for example in hodgkins lymphoma, and is the main author for the national guidelines for use of breath hold techniques in BC RT.
In conclusion, the aim of this project is to optimize treatment techniques for adjuvant BC RT, and to individualize treatment in relation to anatomy and tumor biology.
Status | Active |
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Effective start/end date | 2023/03/01 → 2029/03/01 |