title: Adjuvant Radiotherapy in Early-Stage Breast Cancer: Evidence-Based Options.
abstract: Patients with a diagnosis of early-stage breast cancer are offered the option of either mastectomy or breast-conserving therapy (BCT) secondary to multiple randomized trials demonstrating equivalent long-term outcomes. Traditionally, BCT has used standard whole-breast irradiation (SWBI) after breast-conserving surgery, although several alternatives have emerged during the past few decades.
  
  
  
  This report reviews key studies supporting each radiation technique and its respective eligibility criteria to assist clinicians in deciding which adjuvant radiotherapy options are appropriate for their patients.
  
  
  
  In the past, completion of SWBI required 5-7 weeks of daily treatments. During the past two decades, alternatives to SWBI have emerged including hypofractionated whole-breast irradiation (3-4 weeks), accelerated partial-breast irradiation (1-3 weeks), and endocrine therapy alone. Multiple randomized trials have established the equivalence of these alternative strategies to SWBI for appropriately selected patients. Additionally, the current guidelines for patient selection demonstrate a large amount of overlap in the selection criteria for each technique.
  
  
  
  Clinicians must evaluate patient and pathologic criteria and engage in informed discussions with patients when determining which adjuvant radiation techniques are appropriate. Future strategies being explored include using tumor genetics to identify low-risk patients and switching from paradigms that omit radiotherapy to those that omit endocrine therapy.
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA. csshah27@hotmail.com.
authors.forename: Chirag
authors.initials: C
authors.lastname: Shah
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Tendulkar
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Smile
authors.affiliation: MedStar Shah Medical Group, Hollywood, MD, USA.
authors.forename: Anish
authors.initials: A
authors.lastname: Nanavati
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Bindu
authors.initials: B
authors.lastname: Manyam
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Balagamwala
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Pham
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Radhika
authors.initials: R
authors.lastname: Takiar
authors.affiliation: Department of Radiation Oncology, Ohio State University, Columbus, OH, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Wobb
authors.affiliation: Department of Radiation Oncology, Robert Wood Johnson Medical School and the Canter Institute of New Jersey, New Brunswick, NJ, USA.
authors.forename: Atif
authors.initials: A
authors.lastname: Khan
authors.affiliation: Department of Radiation Oncology, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Arthur
authors.affiliation: Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA, USA.|Department of Radiation Oncology, Brown University, Providence, RI, USA.
authors.forename: David
authors.initials: D
authors.lastname: Wazer
authors.affiliation: 21st-Century Oncology, Michigan Healthcare Professionals, Farmington Hills, MI, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Vicini
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D018714:Radiotherapy, Adjuvant / Q000379:methods*
chemical_list: D018931:Antineoplastic Agents, Hormonal