Primary therapy for limited breast cancer. Radiation therapy techniques

Available data show that breast conserving surgery followed by radiation therapy results in freedom of breast cancer recurrence rates that range from 86% at 10 years to 80% at 20 years for Stage I and II carcinoma. Breast cancer recurrence may be reduced further by the administration of systemic chemotherapy. Mastectomy and breast conserving therapy give equal tumor control and survival, but the latter results in superior quality of life. To achieve the best tumor control with optimal cosmesis, certain generally accepted principles of surgical and radiotherapeutic management need to be followed. The surgeon must use a neat technique that avoids excessive removal of breast and axillary tissue, improper placement of the surgical scar in the breast, and the formation of seromas or hematomas, which result in breast or arm edema. The radiation oncologist must use supervoltage energy, fields that avoid excessive irradiation of the lungs and other sensitive structures, proper field matching, whole breast doses ranging from 4500 to 5000 cGy with fractions of 180 to 200 cGy per day, and brachytherapy or electron beam boost to achieve a total dose of approximately 6000 cGy in the tumor area. These principles should result in good to excellent cosmesis in more than 80% of treated breasts. Breast conserving management offers women an incentive to achieve early detection. Early detection is the most promising approach to reduce mortality from breast cancer.