Current status of radiation in the treatment of breast cancer

Radiation therapy in combination with lumpectomy and axillary dissection has remained standard therapy for early-stage disease since the 1970s. Although there has been no definitive trial in patients with ductal carcinoma in situ, the data suggest that excision plus radiation therapy is a viable option. The local management of early-stage breast cancer includes modified radical mastectomy, with or without reconstruction, or breast-conserving therapy. Six prospective randomized trials compared mastectomy with breast-conserving therapy, and all have shown equivalent survival. Despite efforts to identify subgroups of patients with invasive disease who do not require breast irradiation, based on current data, this modality remains standard treatment after conservative surgery in all patients. Ongoing multicenter studies may clarify the role of brachytherapy, which may provide advantages in some patients after breast-conserving therapy. Axillary radiation is a viable option for patients who fail to undergo sampling of the axilla and may be a future option for patients who have a positive sentinel node but no further dissection. The ability of postmastectomy radiation to affect survival has long been controversial.