Less aggressive surgery and radiotherapy is the way forward

Conserving the breast is one of the main objectives in treating patients affected by carcinoma. This objective should be compatible with good local control to keep the risk of local failures low. The progressive reduction of the extension of surgery in the breast and in the axilla is now accompanied by a reduction of the radiation field. This article provides an update on conservative therapy for breast cancer.

After the development of quadrantectomy, the effectiveness of sentinel node biopsy was demonstrated in the axillary staging of breast carcinoma. The situation took another step forward with partial breast irradiation. The highest incidence of local relapse after breast-conserving surgery is observed in the same area as the primary tumor. This factor provides the rationale for reducing the radiation field to a limited area of the breast primarily affected by carcinoma.

The Milan I trial on breast conservative surgery provided definitive confirmation of the equivalence of quadrantectomy, followed by radiotherapy, to mastectomy in terms of local control of disease. The randomized trial on sentinel node biopsy demonstrated the effectiveness of this procedure in axillary staging of breast carcinoma. Radiotherapy is currently under investigation in terms of limiting the radiation field to the affected quadrant of the breast by means of various techniques.