Radiotherapy in the management of early breast cancer: a review.
Breast conserving therapy with adequate radiotherapy results in similar local control and survival in patients with early breast cancer. Radiotherapy has proven to be an integral part of this treatment as in the NSABP trial a significant reduction of breast recurrences occurred after irradiation, compared with tumorectomy alone. The entry criteria of the performed randomized trials were initially limited to patients with tumours up to 2 cm diameter, but even patients with incompletely excised tumours up to 5 cm have been accepted in the recently closed EORTC trial 10801. This means that this conservative approach is now accessible for a much larger group of patients with breast cancer. A few factors related to a somewhat higher recurrence rate in the breast are: extensive ductal carcinoma in situ, younger age and incomplete excision. These factors are, however, not absolute contra-indications for breast conserving therapy because wide reexcision of the primary tumour or a high booster dose are likely to correct for these unfavourable factors. Future clinical research is required to optimize the irradiation with reduction of side-effects and maintaining a high local control rate.
Bartelink
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The Netherlands Cancer Institute, Antoni van Leeuwenhoekhuis, Amsterdam.
D000328:Adult; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control