Locoregional therapy of breast cancer: maximizing control, minimizing morbidity

The goal of locoregional therapy in breast cancer has remained unchanged for a century: the eradication of all malignant cells from the breast and draining lymph nodes, hopefully prior to them having spread to distant organs. However, how we accomplish this goal has changed dramatically over this time period and our success in achieving this goal has been greatly enhanced by improvements in breast imaging and systemic therapies. The therapeutic importance of surgery and radiation has been underestimated in recent years and is thought to have minimal impact on long-term outcome. More recent data have reputed this contention and the relationship between local control and survival in breast cancer is becoming increasingly apparent. This article will review the importance of attaining optimum local control with minimum morbidity and examine where the future of locoregional therapy of breast cancer may lie.