Evolution of radiotherapy techniques in breast conservation treatment

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.

Radiotherapy after breast‐conserving surgery for elderly patients with early‐stage breast cancer: A national registry‐based study

“…34,35 Besides, some de-escalating RT strategies which deliver a lower dose of RT and, consequently, fewer side effects, have been developed or are under evaluation among low-risk patients. 34,36 Thus, de-escalating RT, rather than omitting RT, may be an alternative for these "low-risk" elderly patients to gain a better benefit/risk balance.…”

“…Some ongoing clinical trials designed to tailor RT in elderly patients based on biomarkers, including RS, Prosigna Breast Cancer Assay and IHC4+ clinical approaches, may help answer this question 34,35 . Besides, some de‐escalating RT strategies which deliver a lower dose of RT and, consequently, fewer side effects, have been developed or are under evaluation among low‐risk patients 34,36 . Thus, de‐escalating RT, rather than omitting RT, may be an alternative for these “low‐risk” elderly patients to gain a better benefit/risk balance.…”

The use of moderately hypofractionated post-operative radiation therapy for breast cancer in clinical practice: A critical review

“…Over the last decades, RT techniques have improved considerably for the treatment of breast cancer patients [ 62 ]. Two-dimensional field-based treatment set-up was routinely used in the prior decades, with limited options to estimate the predicted radiation effect on the organs at risk (e.g.…”

Future perspectives for breast conservation treatment: science & art

“…Several authors in this issue have offered insights into the science of BCT, its historical development and how it is applied in treatment today (11)(12)(13). However, the science continues to evolve as evidence is presented to allow best practice according © Gland Surgery.…”