Radiation therapy is a key component of breast conservation therapy for breast cancer. There is great interest in safety and long-term outcome issues for this still underutilized approach.
Methods
The author reviews a series of factors that may affect the end results of conservation therapy and highlights those that are likely to be of clinical significance.
Results
Daily dose fractions are usually less than 2 Gy and a homogeneous whole-breast dose is used. Care is needed with patients with collagen vascular diseases, large breasts, breast trauma, and prior infections, but these factors are not absolute contraindications to breast conservation therapy. Acute skin reactions are not predictive of long-term complications.
Conclusions
With adherence to proper surgical and radiation techniques, most patients presenting with localized breast cancer can be managed safely and effectively with breast conservation.
Get full access to this article
View all access options for this article.
References
1.
AtkinsH., HaywardJ.L., KlugmanD.J.Treatment of early breast cancer: a report after ten years of a clinical trial. Br Med J.1972; 2: 423–429.
2.
BaclesseF.Roentgen therapy as the sole method of treatment of cancer of the breast. Am J Roentgenol Radium Ther.1949; 62: 311–319.
3.
BartelinkH., BorgerJ.H., van DongenJ.A.The impact of tumor size and histology on local control after breast-conserving therapy. Radiother Oncol.1988; 11: 297–303.
4.
CalleR., VilcoqJ.R., ZafraniB.Local control and survival of breast cancer treated by limited surgery followed by irradiation. Int J Radiat Oncol Biol Phys.1986; 12: 873–878.
5.
FisherB., BauerM., MargoleseR.Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med.1985; 312: 665–673.
6.
AbramsJ., ChenT., GiustiR.Special communication from the National Cancer Institute. Survival after breast-sparing surgery versus mastectomy. J Natl Cancer Inst.1994; 86: 1672–1673.
7.
SmallW.Jr, MorrowM.Local management of primary breast cancer. Cancer Cont: JMCC.1997; 4: 201–210.
8.
Consensus Statement: treatment of early-stage breast cancer.National Institutes of Health Consensus Development Panel. Monogr Natl Cancer Inst.1992; 11: 1–5.
9.
CoxC.E., GreenbergH., ClarkR.Trends in breast cancer management in Florida. Submitted to American Cancer Society, 17th Annual Seminar, March 1994.
10.
SchnittS.J., ConnollyJ.L.Processing and evaluation of breast excision specimens. A clinically oriented approach. Am J Clin Pathol.1992; 98: 125–137.
11.
GageI., SchnittS.J., NixonA.J.Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy. Cancer.1996; 78: 1921–1928.
12.
YeatmanT.J., CantorA.B., SmithT.J.Tumor biology of infiltrating lobular carcinoma. Implications for management. Ann Surg.1995; 222: 549–561.
13.
EberleinT.J., ConnollyJ.L., SchnittS.J.Predictors of local recurrence following conservative breast surgery and radiation therapy. The influence of tumor size. Arch Surg.1990; 125: 771–775.
14.
WinchesterD.P., CoxJ.D.Standards for breast-conservation treatment. CA Cancer J Clin.1992; 42: 134–162.
15.
RobertsonJ.M., ClarkeD.H., PevznerM.M.Breast conservation therapy. Severe breast fibrosis after radiation therapy in patients with collagen vascular disease. Cancer.1991; 68: 502–508.
16.
FleckR., McNeeseM.D., EllerbroekN.A.Consequences of breast irradiation in patients with pre-existing collagen vascular diseases. Int J Radiat Oncol Biol Phys.1989; 17: 829–833.
17.
RossJ.G., HusseyD.H., MayrN.A.Acute and late reactions to radiation therapy in patients with collagen vascular diseases. Cancer.1993; 71: 3744–3752.
18.
ColeJ., ArlettC.F., GreenM.H.Comparative human cellular radiosensitivity. II. The survival following gamma-irradiation of unstimulated (G0) T-lymphocytes, T-lymphocyte lines, lymphoblastoid cell lines and fibroblasts from normal donors, from ataxia-telangiectasia patients and from ataxia-telangiectasia heterozygotes. Int J Radiat Biol.1988; 54: 929–943.
19.
ElyanS.A., WestC.M., RobertsS.A.Use of an internal standard in comparative measurements of the intrinsic radiosensitivities of human T-lymphocytes. Int J Radiat Biol.1993; 64: 385–391.
20.
WestC.M.Invited review: intrinsic radiosensitivity as a predictor of patient response to radiotherapy. Br J Radiol.1995; 68: 827–837.
21.
HarrisJ.R., LeveneM.B., SvenssonG.Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys.1979; 5: 257–261.
22.
RobersonP.L., LichterA.S., BodnerA.Dose to lung in primary breast irradiation. Int J Radiat Oncol Biol Phys.1983; 9: 97–102.
23.
LichterA.S., FraassB.A., FredricksonH.A.Computed tomography in treatment planning: primary breast cancer. In: LingC.C., RogersC.C., MortonR.J., eds. Computed Tomography in Radiation Therapy.New York, NY: Raven Press; 1983: 99–107.
24.
LichterA.S.Application of computerized tomography in radiotherapy treatment planning. In: PhillipsT.L., PistenmaaD.A., eds. Radiation Oncology Annual.New York, NY: Raven Press; 1984: 179–203.
25.
HarrisJ.R., BeadleG.F., HellmanS.Clinical studies on the use of radiation therapy as primary treatment of early breast cancer. Cancer.1984; 53: 705–711.
26.
LarsonD., WeinsteinM., GoldbergI.Edema of the arm as a function of the extent of axillary surgery in patients with stage I-II carcinoma of the breast treated with primary radiotherapy. Int J Radiat Oncol Biol Phys.1986; 12: 1575–1582.
27.
van LimbergenE., van den BogaertW., van der SchuerenE.Tumor excision and radiotherapy as primary treatment of breast cancer. Analysis of patient and treatment parameters and local control. Radiother Oncol.1987; 8: 1–9.
28.
LevineJ.F., ColemanC.N., CoxR.S.The effect of postoperative and primary radiation therapy on delivered dose of adjuvant cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) chemotherapy in breast cancer. Cancer.1984; 53: 237–241.
29.
LippmanM.E., LichterA.S., EdwardsB.K.The impact of primary irradiation treatment of localized breast cancer on the ability to administer systemic adjuvant chemotherapy. J Clin Oncol.1984; 2: 21–27.
30.
LichterA.S., PadikalT.N.Treatment planning in primary breast cancer. In: BleehenN.M., GlatsteinE., HaybittleJ.L., eds. Radiation Therapy Planning.New York, NY: Marcel Dekker; 1983: 639–661.
31.
SvenssonG.K., ChinL.M., SiddonR.L.Breast treatment techniques at the Joint Center for Radiation Therapy. In: HarrisJ.R., HellmanS., SilenW., eds. Conservative Management of Breast Cancer.Philadelphia, Pa: JB Lippincott; 1983: 239–255.
32.
LichterA.S., FraassB.A., van de GeijnJ.A technique for field matching in primary breast irradiation. Int J Radiat Oncol Biol Phys.1983; 9: 263–270.
33.
SvenssonG.K., BjarngardB.E., LawsonR.D.A modified three-field technique for breast treatment. Int J Radiat Oncol Biol Phys.1980; 6: 689–694.
34.
HaagensenC.D.Lymphatics of the breast. In: HaagensenC.D., FeindC.R., HerterF.P., eds. The Lymphatics in Cancer.Philadelphia, Pa: WB Saunders Co; 1972: 319–327.
35.
RoseC.M., KaplanW.D., MarckA.Parasternal lymphoscintigraphy: implications for the treatment planning of internal mammary lymph nodes in breast cancer. Int J Radiat Oncol Biol Phys.1979; 5: 1849–1853.
36.
Velez-GarciaE., CarpenterI.T.Jr, MooreM.Postsurgical adjuvant chemotherapy with or without radiotherapy in women with breast cancer and positive axillary nodes: a Southeastern Cancer Study Group (SEG) trial. Eur J Cancer.1992; 28A: 1833–1837.
37.
BuzdarA.U., KauS.W., HortobagyiG.M.Clinical course of patients with stage I-II breast cancer with 10 or more positive nodes who were treated with doxorubicin-containing adjuvant therapy. Cancer.1992; 69: 448–452.
38.
Lara JimenezP., Garcia PucheJ., PedrazaV.Adjuvant combined modality treatment in high-risk breast cancer patients: ten-year results. Fifth EORTC Breast Cancer Working Conference, Leuven, Belgium, 1991. Abstract A293.
39.
KlefstromP., NuortioL., TaskinenE.Postoperative radiation therapy and adjuvant chemoimmunotherapy in breast cancer: aspects of timing and immune competence. Acta Radiol.1986; 25: 161–166.
40.
BuzdarA.U., KauS.W., SmithT.L.The order of administration of chemotherapy and radiation and its effect on the local control of operable breast cancer. Cancer.1993; 71: 3680–3684.
41.
BuchholzT.A., Austin-SeymourM.M., MoeR.E.Effect of delay in radiation in the combined modality treatment of breast cancer. Int J Radiat Oncol Biol Phys.1993; 26: 23–35.
42.
DelanianS., BailletF., HuartJ.Successful treatment of radiation-induced fibrosis using liposomal Cu/Zn superoxide dismutase: clinical trial. Radiother Oncol.1994; 32: 12–20.
43.
BeadleG.F., SilverB., BotnickL.Cosmetic results following primary radiation therapy for early breast cancer. Cancer.1984; 54: 2911–2918.
CoxC.E., GreenbergH., FleisherD.Natural history and clinical evaluation of the lumpectomy scar. Am Surg.1993; 59: 55–59.
46.
ClarkeD.H., LeM.G., SarrazinD.Analysis of local-regional relapses in patients with early breast cancers treated by excision and radiotherapy: experience of the Institut Gustave-Roussy. Int J Radiat Oncol Biol Phys.1985; 11: 137–145.
47.
MontagueE.D.Conservation surgery and radiation therapy in the treatment of operable breast cancer. Cancer.1984; 53: 700–704.
48.
MontagueE.D., AmesF.C., SchellS.R.Conservation surgery and irradiation as an alternative to mastectomy in the treatment of clinically favorable breast cancer. Cancer.1984; 54: 2668–2672.
49.
RechtA., SilenW., SchnittS.J.Time-course of local recurrence following conservative surgery and radiotherapy for early stage breast cancer. Int J Radiat Oncol Biol Phys.1988; 15: 255–261.
50.
OsborneM.P., OrmistonN., HarmerC.L.Breast conservation in the treatment of early breast cancer. A 20-year follow-up. Cancer.1984; 53: 349–355.
51.
WebsterD.J., ManselR.E., HughesL.E.Immediate reconstruction of the breast after mastectomy: is it safe?Cancer.1984; 53: 1416–1419.
52.
EberleinT.J., CrespoL.D., SmithB.L.Prospective evaluation of immediate reconstruction after mastectomy. Ann Surg.1993; 218: 29–36.
53.
DeloucheG., BachelotF., PremontM.Conservation treatment of early breast cancer: long-term results and complications. Int J Radiat Oncol Biol Phys.1987; 13: 29–34.
54.
KurtzJ.M., SpitalierJ.M., AmalricR.Results of salvage surgery for local failure following conservative therapy of operable breast cancer. Front Radiat Ther Oncol.1983; 17: 84–90.
55.
LeungS., OtmezguineY., CalitchiE.Locoregional recurrences following radical external beam irradiation and interstitial implantation for operable breast cancer: a twenty-three year experience. Radiother Oncol.1986; 5: 1–10.
