[Current status of radiation therapy--evidence-based medicine (EBM) of radiation therapy. Breast cancer].
Evidenced-based medicine(EBM) is undergoing rapid acceptance as a principle of decision making in radiation oncology clinics. Adjuvant therapy for breast cancer is one of the most actively researched areas, and there is a great deal of clinical evidence of high-quality treatment of breast cancer. The case of 47-year-old premenopausal woman who underwent consultation for postmastectomy radiotherapy (PMRT) is presented, and the course of practice using EBM is described. Because she had one positive axillary lymph node, she received systemic chemotherapy with doxorubicin, cyclophosphamide, and paclitaxel. She is also receiving trastuzumab and tamoxifen. She underwent immediate reconstruction with a TRAM flap. Existing guidelines point out that PMRT significantly reduces the risk of local recurrence; however, none of them recommend PMRT for a patient with < 4 positive lymph nodes because of the lack of firm evidence for improvement of overall survival. There is also some evidence that PMRT after immediate reconstruction reduces the cosmetic result and that paclitaxel might increase the risk of radiation pneumonitis even in sequential administration. She chose PMRT, although our recommendation was not to do so. Expertise in the area of breast cancer as well as high-level evidence developed in Japan is essential to effectively implement EBM.
Mitsumori
Michihide
M
Department of Therapeutic Radiology and Oncology, Graduate School of Medicine, Kyoto University.
D001943:Breast Neoplasms / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008875:Middle Aged