Evidence based radiation oncology: breast cancer.
OBJECTIVE
Radiotherapy is, similar to surgery, a local treatment. In the case of breast cancer, it is generally given after conservative or after more extensive, tumour and patient adapted, surgery. The target volumes can be the breast and/or the thoracic wall and/or the regional lymph node areas. The integration and the extent of radiotherapy as part of the comprehensive treatment of the breast cancer patient, including the amount of surgery and the sequencing with the systemic treatments, has to be well discussed with all medical specialists involved in treating breast cancer on a multidisciplinary basis. Guidelines for the appropriate prescription and execution of radiotherapy are of utmost importance. However, individualisation based on the individual patients' and tumours' characteristics should always be envisaged.


METHODS
Based on a review of the literature the level of evidence that is available for the indications for radiotherapy is summarised, as well as the main clinical questions that are unanswered today. An overview of the recent and ongoing clinical trails in breast cancer will highlight some of the current ongoing debates.


CONCLUSIONS
In the case of breast cancer, radiotherapy, given after as well conservative as extensive risk-adapted surgery, significantly reduces the risk of local and regional recurrences. Especially for patients with an intermediate to high absolute risk for local recurrences, a positive influence on overall survival has been shown, notably when appropriate radiotherapy techniques are used. Most important is that the best results that we can offer to our breast cancer patients for all clinical endpoints (local and regional control; quality of life; cosmetic results; survival) can be obtained by a multidisciplinary and patient-oriented approach, involving all those involved in the treatment of breast cancer patients.
Poortmans
Philip
P
Dr. Bernard Verbeeten Instituut, Radiotherapy, Tilburg, Netherlands. poortmans.ph@bvi.nl
D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D002278:Carcinoma in Situ / Q000532:radiotherapy; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018787:Radiation Oncology; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic