Radiation therapy and breast preservation: past achievements, current results, and future prospects

In this overview the historical development of breast-conserving therapy is sketched briefly from its origins in the second and third decades of this century, and current radiotherapeutic techniques are described. All randomized trials thus far conducted using modern radiotherapy indicate that total mastectomy provides no survival advantage compared with breast-conserving techniques. In patients suitable for such treatment, macroscopically complete local tumor excision followed by appropriate radiotherapy will lead to 90-96% local control in the breast at 5 years, and 81-93% at 10 years. It is likely that the strategy of reserving total mastectomy for treatment of intramammary failures will result in ultimate local control of disease on the chest wall which is superior to that provided by primary total mastectomy. Future prospects include the use of primary chemotherapeutic approaches for larger tumors, extending the possibilities of breast conservation to a majority of patients with tumors classically considered unsuitable for lumpectomy. In this context an increase in the use of radiotherapy in the primary treatment of breast cancer is anticipated.