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Survival and toxicity after breast-conserving surgery and external beam reirradiation for localized ipsilateral breast tumour recurrence: A population-based study.

Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique·2024
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Radiotherapy of breast cancer.

C Hennequin1, Y Belkacémi2, C Bourgier3

  • 1Service de cancérologie-radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.

Cancer Radiotherapie : Journal De La Societe Francaise De Radiotherapie Oncologique
|December 27, 2021
PubMed
Summary

Adjuvant radiotherapy is crucial for breast cancer treatment, reducing local recurrence and mortality after surgery. Specific techniques and doses are recommended based on tumor characteristics and patient factors for optimal outcomes.

Keywords:
Breast cancerCancer du seinFrench society for radiation oncologyGuidelinesRadiation therapyRadiothérapieRecommandationsSociété française de radiothérapie oncologique

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Surgical Oncology

Background:

  • Adjuvant radiotherapy is a cornerstone in breast cancer management following surgery.
  • Its role is critical in reducing local recurrence rates and improving breast cancer-specific survival.
  • Current guidelines address its application in various scenarios, including conservative surgery, mastectomy, and ductal carcinoma in situ.

Purpose of the Study:

  • To provide a comprehensive overview of adjuvant radiotherapy indications and techniques in breast cancer treatment.
  • To outline specific recommendations for radiotherapy based on tumor stage, nodal status, and treatment context.
  • To discuss modern radiotherapy approaches, including hypofractionation and advanced delivery techniques.

Main Methods:

  • Systematic review of current clinical practice and evidence for adjuvant radiotherapy in breast cancer.
  • Analysis of recommendations for radiotherapy after conservative surgery, mastectomy, and for ductal carcinoma in situ.
  • Evaluation of indications for boost irradiation, partial breast irradiation, and nodal irradiation.

Main Results:

  • Radiotherapy is mandatory after conservative surgery for infiltrating carcinoma to reduce recurrence and mortality.
  • Boost doses are indicated for patients under 50. Partial breast irradiation is an option for selected patients.
  • Chest wall irradiation is required for specific tumor sizes and nodal involvement after mastectomy. Hypofractionation is equivalent to conventional fractionation in selected cases.

Conclusions:

  • Adjuvant radiotherapy strategies must be tailored to individual patient and disease characteristics.
  • Standardization of techniques like 3D-conformal radiotherapy and consideration of respiratory gating are important.
  • Hormonal therapy can be initiated with or after radiotherapy, while concomitant chemotherapy is generally not advised.