Evolution of radiotherapy techniques in breast conservation treatment

John Boyages*, Lesley Baker

*Corresponding author for this work

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

Radiation therapy (RT) is an important component of breast cancer treatment that reduces local recurrence and improves survival after breast conservation. Breast conservation rates have increased significantly since the late 1980s and techniques have improved with greater awareness of the impact of radiation on the heart. An overview of randomized controlled trials of breast conservation using standard whole breast irradiation, whole breast hypofractionation, accelerated partial breast irradiation (APBI) and intraoperative radiation are reviewed. Selection criteria for breast conservation and the utility of adding a boost dose to the primary tumor site are reviewed. Modern dose constraints are documented and 10 different radiation techniques from the 1980s through to modern volumetric modulated arc therapy (VMAT) are compared for a patient where the breast and internal mammary nodes are treated. A radiation boost reduces the risk of a recurrence for most, but not all patients. Short courses of RT over 3-4 weeks are generally as effective as longer courses. Short-term follow-up of trials of APBI show promise for selected good prognosis subgroups. The role of intraoperative radiation remains controversial. In the last 30 years, there have been significant advances in radiation techniques. Modern radiotherapy equipment and techniques will reduce complications and improve survival rates.

Original languageEnglish
Pages (from-to)576-595
Number of pages20
JournalGland Surgery
Volume7
Issue number6
DOIs
Publication statusPublished - 1 Dec 2018

Keywords

  • Breast neoplasms
  • Local
  • Mastectomy
  • Neoplasm recurrence
  • Radiotherapy
  • Segmental
  • Survival

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