Indications, Integration, and Technical Aspects of Local-Regional Irradiation in the Management of Advanced Breast...

This article reviews the indications for radiotherapy in advanced stage disease and discusses the recent prospective trials demonstrating a survival benefit by the addition of radiotherapy. Various treatment plans are reviewed with and without internal mammary node coverage. Although it is not clear whether internal mammary node irradiation can have a favorable impact on survival, it is clear that inadequate treatment planning of the parasternal region can result in excess cardiac morbidity and mortality. Careful planning using computed tomographic systems is required to optimize chest wall planning. With individualized treatment planning, it is hoped that the next generation of trials will show improved survival from further reduction in breast cancer deaths and significantly decreased cardiac toxicity.