Regional lymph node irradiation in breast cancer

A recent meta-analysis, published by the Early Breast Cancer Trialists' Collaborative Group, demonstrated a clear survival advantage of post-operative radiotherapy on the breast, chest wall and regional lymphatics in node-positive disease. The extensive target volume in locoregional irradiation of breast cancer, in close proximity to the heart and lungs, complicates treatment planning. The breast or chest wall fields need to match the supraclavicular/axillary and parasternal fields, at the subclavicular and parasternal matchline, respectively. Dose distribution near the junction area is often inhomogeneous, and under- and over-dosage can occur, which can lead to recurrences and complications. This paper describes briefly the indications, complications and target localization concerning regional lymph node radiotherapy and discusses more extensively the advantages and disadvantages of the most frequently used treatment techniques.