Postoperative Radiotherapy in Early and Operable Breast Cancer

Breast radiotherapy (RT) has changed over the passed few decades mainly due to changes in locoregional treatment of the breast cancer and improvements in technology of radiotherapy equipment. It has now become the standard part of the breast conserving procedure, as well as in patients who underwent mastectomy with T3 and/or 4 or more positive nodes in axilla. In treatment of ductal carcinoma in situ, postoperative RT after lumpectomy is almost always required, because it reduces ipsilateral invasive and DCIS recurrence by approximately 50-60%. For invasive breast cancer RT decreases the locoregional relapse rate by 70%. The indication for postoperative RT and the definition of the target volumes depend on the prognostic factors and surgical procedures. The overview by the Early Breast cancer Trialists’ Collaborative Group (EBCTCG) demonstrates for the first time, that postoperative RT is not only important in achieving loco-regional control, but also has significant influence on long-term survival. This benefit of postoperative RT is achieved by proper indication of RT and more importantly by using modern RT techniques that can avoid the serious late side-effects