Radiation Therapy in Male Breast Cancer

Abstract

Male breast cancer (MBC) is a relatively rare disease and because the dedicated literature on MBC is limited, management typically follows guidelines established for female breast cancer (FBC). Although radiation therapy (RT) comprises a critical role in the treatment of MBC, several unique challenges influence its use. Most men with breast cancer present at an older age with more extensive and advanced stage disease than women. In contrast to the predominance of breast conservation therapy in women with breast cancer, the majority of men are treated with mastectomy, with or without post-mastectomy radiation. Although no prospective or randomised trials are available, retrospective data suggests that surgery followed by adjuvant RT significantly improves locoregional control (LRC) in men. This article reviews the utilisation, efficacy and complications associated with adjuvant RT in MBC. KeywordsMale breast cancer, radiotherapy, adjuvant, outcomes, locoregional control, survival cancer that influence the role of adjuvant radiotherapy (RT). Men are not screened for breast cancer and commonly present at an older age and higher stage than women, and are more likely to present with a palpable mass that is centrally located.2,3 Due to the location and the low volume of normal breast tissue in men, there is a high propensity for nipple, chest wall and nodal involvement 3,4 resulting in more advanced stage at diagnosis and possibly greater need for post-mastectomy radiation (PMRT).2 Based on data from randomised clinical trials, adjuvant RT improves locoregional control (LRC) following lumpectomy and radiation in many circumstances. [5][6][7][8] In this article, we review the literature associated with the role of adjuvant RT in MBC. Role of Radiation Therapy in Locoregional Control Post-mastectomy RadiotherapyIn the US, PMRT has traditionally been indicated in women with four or more positive lymph nodes, T3 tumours or stage III disease.9,10 Multiple randomised trials have demonstrated improvement in LRC and overall survival (OS) with the addition of PMRT (see Table 1 Breast Conservation TherapyBreast conservation therapy (BCT) is defined as partial mastectomy (e.g. lumpectomy, segmentectomy, quandrectomy) followed by RT with or without adjuvant hormonal or systemic chemotherapy. Since the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-04 trial demonstrated equivalent survival outcomes among women with breast cancer undergoing radical mastectomy, total mastectomy with PMRT or simple mastectomy with axillary node dissection (ALND), there has been a shift to less extensive surgery.6 NSABP B-06 compared