[Impact of radiotherapy modalities on local control and survival in adjuvant breast cancer treatment].
Conventional radiotherapy (RT) in breast cancer treatment includes a total dose of 50Gy with a 16Gy-boost in a smaller volume. After mastectomy, radiotherapy of all node-positive patients seems to be applied whatever the positive node number. Modulation of RT technique uses the fraction dose, namely through accelerated hypofractionation regimen in a constant volume. A group of patient with a low risk of recurrence may benefit from this technique. In a smaller irradiated volume, accelerated hypofractionation still belongs to intensive clinical research evaluating intraoperative RT, brachytherapy, Mammosite, and external partial breast irradiation. Intensity-modulated radiotherapy decreases the risk of moist desquamation. The development of the gating offers greater protection of certain critical organs including lung, heart, and chest/ribs. Finally, predictive tests identifying patients at high risk of developing late effects led us to adapt RT technique to some of them and therefore increase long term therapeutic ratio.
Azria
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Département d'oncologie-radiothérapie, CRLC Val d'Aurelle Paul-Lamarque, rue Croix-Verte, 34298 Montpellier cedex 05, France. David.Azria@valdorel.fnclcc.fr
Hennequin
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C
D017209:Apoptosis; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018414:CD8-Positive T-Lymphocytes / Q000528:radiation effects; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D015182:Lymphatic Irradiation / Q000379:methods; D008408:Mastectomy; D011836:Radiation Tolerance; D018714:Radiotherapy, Adjuvant / Q000379:methods / Q000401:mortality; D020266:Radiotherapy, Conformal / Q000379:methods; D012119:Respiration; D047368:Tumor Burden / Q000528:radiation effects