Fighting Breast Cancer with Radiotherapy
Radiotherapy is a targeted and effective way to destroy cancer cells. It is one of the key treatment pillars of Breast Cancer and is often used after Breast Conserving Surgery to help prevent recurrence. Radiotherapy to the regional lymph nodes also helps prevent recurrences whenever the lymph nodes are involved by tumour.
In recent years, technology as well as medical advances have allowed for customisation of individual treatment techniques, so that it is possible for patients to have the best control with the least side effects.
Our Treatment Techniques
Hypofractionated Breast Radiotherapy
Hypofractionated Breast Radiotherapy refers to a shorter treatment course of 15 sessions.
This reduces the treatment sessions by 2 weeks compared to the conventional 25 session treatments.
This has been shown to be equally effective in terms of control rates and side effects. A few additional boost sessions may be added to the tumor bed according to individual’s condition.
Volumetric Arc Therapy (VMAT)
This is an advanced treatment technique for breast radiotherapy which uses arc therapy and beam modulation to ensure a homogenous dose distribution in patients with complex chest wall anatomy.
The benefits include shorter daily treatment time, sparring of the organs at risk and reduction of side effects.
In the picture, the portion highlighted in red shows the dose coverage area on the entire breast.
Regional Nodal Irradiation
The Regional Nodal Irradiation technique targets the surrounding lymph nodes of the affected breast based on the stage of breast cancer.
This is to reduce the possibility of future recurrence in these nodal drainage areas.
In the picture, the highlighted area in the scan shows where the radiation dose is used. This method reduces stray dose exposure to the heart.
External Beam Partial Breast Breast Irradiation (PBI)
For selected patients, especially those with early stage disease, Accelerated Partial Breast Irradiation (APBI) can be given with similar outcomes as whole breast irradiation. As the name suggests, only the area around the tumor is treated and the treatment course is even shorter.
Only 10 treatments are required and the treatment is completed within 2 weeks.
Previously, this was done using invasive methods using needles and applicators such as brachytherapy or intra-operative radiotherapy (IORT). Now, APBI can be effectively delivered using external beam radiation therapy technology. CIH is proud to offer this treatment using MDACC’s protocol to suitable patients.
Our Facilities and Equipment
Active Breathing Coordinator™
Picture (A) shows the heart outside the range of the radiation beam when the patient holds her breath with the help of the ABC.
Picture (B) shows part of the heart falling within the radiation beam when the patient breathes freely without the ABC.
The Active Breathing Coordinator™ (ABC) device helps the patient to hold her breath during radiotherapy treatment.
With the ABC, the patient can achieve comfortable and consistent breath-holds during treatment. Used during left-sided breast radiotherapy, the chest wall is expanded away from the heart so that it receives only very low doses.
Breast Compression Plate
In certain cases, a compression plate is added to the treatment setup and serves to compress the target breast tissue and reduce the thickness of the area to be treated.
This allows a lower beam energy to be selected which results in lesser stray radiation to the underlying organs. More healthy surrounding tissues and organs are spared, such as the heart in left-sided breast treatment.
Mould Room (Workshop)
CIH is the only private hospital in Singapore with mould room facilities.
This facility allows for fabrication of customised lead plaques which are used to shape the radiation beam for Tumor Bed Boost treatments.
These plaques are shaped according to each individual patient’s treatment plan, and allow for sparing of surrounding healthy tissues from unnecessary radiation exposure.
Breast Board
At CIH, an additional head mask is used to keep the neck straight during treatment to the supraclavicular lymph node area just as in MD Anderson Cancer Center (MDACC).
This helps to ensure that the central organs are kept away from the radiation field.
A Dedicated Team who Cares for You
From left to right: Dr David Tan, Radiation Oncologist, Dr Daniel Tan, Head of Radiation Oncology, and Dr Jonathan Teh, Radiation Oncologist.
Through our collaboration with MD Anderson Cancer Center (MDACC), CIH has designed a Breast Radiation Therapy programme which is based on MDACC’s treatment protocols and practices. At CIH, we use similar equipment and devices as MDACC to help customise the patient’s individual radiation treatment plan. By adhering to international protocols and a strict quality assurance programme, patients are assured of the best possible outcomes.
At CIH, all patients receiving radiation therapy will have their history and treatment plans reviewed by MDACC. This means that the Breast Radiotherapy team in CIH and MDACC, comprising of Radiation Oncologists, Medical Physicists and Dosimetrists, will agree with the treatment strategy and radiation plan before it is being incorporated into the actual treatment which is delivered by the Radiation Therapists.
As such, our patients can have the assurance that the treatment they received in CIH is very similar to what they will receive at MDACC.
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