Radiation therapy and early breast cancer: current controversies

Summary

• Radiation therapy (RT) is an important component of breast cancer treatment.
• RT reduces local recurrence and breast cancer mortality after breast conservation for all patients and for node-positive patients after a mastectomy.
• Short courses of RT over 3–4 weeks are generally as effective as longer courses.
• A patient subgroup where RT can be avoided after conservative surgery has not been consistently identified.
• A radiation boost reduces the risk of a recurrence in the breast but may be omitted for older patients with good prognosis tumours with clear margins.
• Axillary recurrences can take a long time to appear, with 35% occurring after 5 years.
• Leaving disease untreated in regional nodes is associated with reduced survival.
• Not all patients require radiation after neoadjuvant chemotherapy and a subsequent mastectomy.
• Modern RT equipment and techniques will further improve survival rates.