Radiation therapy and early breast cancer: current controversies

Boyages, John

doi:10.5694/mja16.01020

Topics

Neoplasms

Surgical procedures, operative

Summary

Radiation therapy (RT) is an important component of breast cancer treatment.
RT reduces local recurrence and breast cancer mortality after breast conservation for all patients and for node-positive patients after a mastectomy.
Short courses of RT over 3–4 weeks are generally as effective as longer courses.
A patient subgroup where RT can be avoided after conservative surgery has not been consistently identified.
A radiation boost reduces the risk of a recurrence in the breast but may be omitted for older patients with good prognosis tumours with clear margins.
Axillary recurrences can take a long time to appear, with 35% occurring after 5 years.
Leaving disease untreated in regional nodes is associated with reduced survival.
Not all patients require radiation after neoadjuvant chemotherapy and a subsequent mastectomy.
Modern RT equipment and techniques will further improve survival rates.

Macquarie University, Sydney, NSW

Correspondence: john.boyages@mq.edu.au

Acknowledgements:

I thank Ellen Tailby for research assistance, Philippa Sutton for editing and managing earlier versions of the manuscript, and Sergio Duque and Lesley Baker for the volumetric modulated arc therapy plan of the patient shown in Box 5.

Competing interests:

No relevant disclosures.

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