J Korean Med Assoc.  2003 Jun;46(6):503-511. 10.5124/jkma.2003.46.6.503.

Radiotherapy for Breast Cancer

Affiliations
  • 1Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Korea. cosuh317@yumc.yonsei.ac.kr

Abstract

Radiation plays an important role in the management of breast cancer. The role of radiotherapy in the management of breast cancer can be defined in four categories as follows : (1) primary radiotherapy in breast-conserving treatment(BCT) for early breast cancer including ductal carcinoma in situ(DCIS). (2) Adjuvant radiotherapy after mastectomy for high-risk patients. (3) Radiotherapy with or without surgery after neo-adjuvant chemotherapy in locally advanced breast cancers. (4) Palliative radiotherapy for metastatic disease, mostly bone and brain metastases, and locoregional recurrences. Recently, the application of radiotherapy in the management of breast is increasing. The increased use of mammographic screening have dramatically increased the percentage of cases of breast cancer diagnosed at noninvasive or early stages of disease. As BCT has become the standard treatment for woman with DCIS and a preferred treatment method for early invasive cancers, the proportion of patients who need a radiotherapy is increasing. Also, post-mastectomy radiotherapy(PMRT) is re-appraised because some studies proved that PMRT not only decreased local recurrence but also improved survival rate. Many patients live for decades after treatment. Therefore, technical excellence in irradiating the intact breast or chest wall is very important to reduce long-term complications as well as to control the disease. Rationale, indications, and technical aspects of primary radiotherapy in breast-conserving therapy for early breast cancer and PMRT for operable breast cancer wareas reviewed.

Keyword

Breast cancer; Breast-conserving treatment; Radiotherapy; Post-mastecetomy radiotherapy

MeSH Terms

Brain
Breast Neoplasms*
Breast*
Carcinoma, Ductal
Carcinoma, Intraductal, Noninfiltrating
Drug Therapy
Female
Humans
Mass Screening
Mastectomy
Neoplasm Metastasis
Radiotherapy*
Radiotherapy, Adjuvant
Recurrence
Survival Rate
Thoracic Wall

Figure

  • Figure 1

  • Figure 2

  • Figure 3

  • Figure 4

  • Figure 5

  • Figure 6


Reference

1. Fisher B, Redmond C, Poisson R, Margolese R, Wolmark N, Pilch Y, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1989. 320:822–828.
Article
2. Early Breast Cancer Trialists' Collaborative Group. Favorable and unfavorable effects on long-term survival of radiotherapy for early breast cancer : an overview of the randomized trials. Lancet. 2000. 355:1757–1770.
3. Morris AD, Morris RD, Wilson JF, White J, Steinberg S, Van Dongen JA, et al. Breast-conserving therapy vs mastectomy in early-stage breast cancer : a meta-analysis of 10-year survival. Cancer J Sci Am. 1997. 3:6–12.
4. Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995. 333:1456–1461.
Article
5. Veronesi U, Luini A, Del Vecchio M, Greco M, Galimberti V, Salvadori B, et al. Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Engl J Med. 1993. 328:1587–1591.
Article
6. Liljegren G, Lindgren A, Bergh J, Nordgren H, Tabar L, Holmberg L. Risk factors for local recurrence after conservative treatment in stage I breast cancer. Definition of a subgroup not requiring radiotherapy. Ann Oncol. 1997. 8:235–241.
Article
7. Schnitt SJ, Hayman J, Gelman R, Eberlein TJ, Love SM, Harris JR, et al. A prospective study of conservative surgery alone in the treatment of selected patients with stage I breast cancer. Cancer. 1996. 77:1094–1100.
Article
8. Forrest AP, Stewart HJ, Everington D, Prescott RJ, McArdle CS, George WD, et al. Randomized controlled trial of conservation therapy for breast cancer: 6-year analysis of the Scottish Cancer Trials Breast Group. Lancet. 1996. 348:708–713.
Article
9. Wolmark N, Dignam J, Margolese R, Wickerham DL, Fisher B. The role of radiotherapy in the management of node negative invasive breast cancer < 1.0 cm treated with lumpectomy : preliminary results of NSABP Protocol B-21. Proc Am Soc Clin Oncol. 2000. 19:71a. (abstr 271).
10. Peterson ME, Schultz DJ, Reynolds C, Solin LJ. Outcomes in breast cancer patients relative to margin status after treatment with breast-conserving surgery and radiation therapy : the University of Pennsylvania experiance. Int J Radiat Oncol Biol Phys. 1999. 43:1029–1035.
Article
11. Fletcher GH, Mcneese MD, Osward MJ. Long-range results for breast cancer patients treated by radical mastectomy and postoperative radiation without adjuvant chemotherapy : An update. Int J Radiat Oncol Biol Phys. 1989. 17:11–14.
Article
12. Uematsu M, Bornstein BA, Recht A, Abner A, Come SE, Harris JR, et al. Long-term results of post operative radiation therapy following mastectomy with or without chemotherapy in stage I-III breast cancer. Int J Radiat Oncol Biol Phys. 1993. 25:765–770.
Article
13. Cuzick J, Stewart H, Peto R, Fisher B, Kaae S, Wallgren A, et al. Overview of randomized trials of post-operative adjuvant radiotherapy in breast cancer. Cancer Treat Rep. 1987. 71:15.
Article
14. Cuzick J, Stewart H, Rutqvist L, Houghton J, Edwards R, Host H, et al. Cause-specific mortality in long term survivors of breast cancer who participated in trials of radiotherapy. J Clin Oncol. 1994. 12:447. 453.
Article
15. Overgaard M, Hansen PS, Overgaard J, Rose C, Andrsson M, Zedeler K, et al. Postopeative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med. 1997. 337:949–955.
Article
16. Ragaz J, Jackson SM, Le M, Plenderleith IH, Spinelli JJ, Olivotto IA, et al. Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med. 1997. 337:956–962.
Article
17. Recht A, Edge SB, Solin LJ, Robinson DS, Estabrook A, Pfister DG, et al. Postmastectomy radiotherapy: Clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2001. 19:1539–1569.
Article
18. Pezner RD, Lipsett JA, Forell B, Vora NL, Desai KR, Luk KH, et al. The reverse hockey stick technique : Postmastectomy radiation therapy for breast cancer patients with locally advanced tumor presentation or extensive locoregional recurrence. Int J Radiat Oncol Biol Phys. 1989. 17:191–197.
Article
19. Britton RC, Nelson PA. Causes and treatment of postmastectomy radiotherapy lymphedema of the arm. JAMA. 1962. 180:95–102.
Article
20. Swedborg I, Wallgren A. The effect of pre-and post-mastectomy radiotherapy on the degree of edema, shoulder joint mobility, and gripping force. Cancer. 1981. 47:877.
Article
21. Larson D, Weinstein M, Goldberg I, Silver B, Recht A, Harris JR, et al. Edema of the arm as a function of the extent of axillary surgery in patients with stage I and II carcinoma of the breast treated with primary radiotherapy. Int J Radiat Oncol Biol Phys. 1986. 12:1575–1582.
Article
22. Pierce S, Recht A, Lingos T, Abner A, Vicini F, Harris JR, et al. Long-term radiation complication following conservatice surgery and radiation therapy(RT) in patients with early stage breast cancer. Int J Radiat Oncol Biol Phys. 1992. 23:915.
Article
Full Text Links
  • JKMA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr