title: [Radiotherapy of breast cancer].
abstract: In breast cancer, radiotherapy is an essential component of the treatment. After conservative surgery for an infiltrating carcinoma, radiotherapy must be systematically performed, regardless of the characteristics of the disease, because it decreases the rate of local recurrence and by this way, specific mortality. Partial breast irradiation could not be proposed routinely but only in very selected and informed patients. For ductal carcinoma in situ, adjuvant radiotherapy must be also systematically performed after lumpectomy. After mastectomy, chest wall irradiation is required for pT3-T4 tumours and if there is an axillary nodal involvement, whatever the number of involved lymph nodes. After neo-adjuvant chemotherapy and mastectomy, in case of pN0 disease, chest wall irradiation is recommended if there is a clinically or radiologically T3-T4 or node positive disease before chemotherapy. Axillary irradiation is recommended only if there is no axillary surgical dissection and a positive sentinel lymph node. Supra and infra-clavicular irradiation is advised in case of positive axillary nodes. Internal mammary irradiation must be discussed case by case, according to the benefit/risk ratio (cardiac toxicity). Dose to the chest wall or the breast must be between 45-50Gy with a conventional fractionation. A boost dose over the tumour bed is required if the patient is younger than 60 years old. Hypofractionation (42.5 Gy in 16 fractions, or 41.6 Gy en 13 or 40 Gy en 15) is possible after tumorectomy and if a nodal irradiation is not mandatory. Delineation of the breast, the chest wall and the nodal areas are based on clinical and radiological evaluations. 3D-conformal irradiation is the recommended technique, intensity-modulated radiotherapy must be proposed only in case of specific clinical situations. Respiratory gating could be useful to decrease the cardiac dose. Concomitant administration of chemotherapy in unadvised, but hormonal treatment could be start with radiotherapy.
authors: Service de cancérologie-radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris, France. Electronic address: christophe.hennequin2@aphp.fr.
authors: C
authors: C
authors: Hennequin
authors: Centre universitaire de cancérologie Henry-S.-Kaplan, CHU de Tours, 37000 Tours, France.
authors: I
authors: I
authors: Barillot
authors: Institut régional du cancer, 208, avenue des Apothicaires Parc Euromédecine, 34298 Montpellier cedex 5, France.
authors: D
authors: D
authors: Azria
authors: CHU Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France.
authors: Y
authors: Y
authors: Belkacémi
authors: Institut Hartmann, 4, rue Kléber, CS 90004, 92309 Levallois-Perret cedex, France.
authors: M
authors: M
authors: Bollet
authors: Institut Saint-Catherine, 250, chemin de Baigne-Pieds, 84918 Avignon cedex 9, France.
authors: B
authors: B
authors: Chauvet
authors: CHU Nord, AP-HM, chemin des Bourrely, 13915 Marseille cedex 20, France.
authors: D
authors: D
authors: Cowen
authors: Clinique Courlancy, 38 bis, rue de Courlancy, 51100 Reims, France.
authors: B
authors: B
authors: Cutuli
authors: Institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors: A
authors: A
authors: Fourquet
authors: Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06100 Nice, France.
authors: J M
authors: JM
authors: Hannoun-Lévi
authors: Centre René-Gauducheau, boulevard Professeur-Jacques-Monod, 44805 Saint-Herblain, France.
authors: M
authors: M
authors: Leblanc
authors: Centre René-Gauducheau, boulevard Professeur-Jacques-Monod, 44805 Saint-Herblain, France.
authors: M A
authors: MA
authors: Mahé
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D002277:Carcinoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000532:radiotherapy / Q000601:surgery; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D006321:Heart / Q000528:radiation effects; D006801:Humans; D015182:Lymphatic Irradiation; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D008875:Middle Aged; D058958:Organs at Risk; D011832:Radiation Injuries / Q000517:prevention & control; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods / Q000592:standards; D061089:Radiotherapy, Image-Guided / Q000379:methods; D035441:Thoracic Wall / Q000528:radiation effects
keywords: Breast cancer; Cancer du sein; Practical guidelines; Radiotherapy; Radiothérapie; Recommandations pratiques