Recent advances in radiotherapy of breast cancer

Abstract

Radiation therapy is an integral part of the multidisciplinary management of breast cancer. Regional lymph node irradiation in younger trials seems to provide superior target coverage as well as a reduction in long-term toxicity resulting in a small benefit in the overall survival rate. For partial breast irradiation there are now two large trials available which support the role of partial breast irradiation in low risk breast cancer patients. Multiple randomized trials have established that a sequentially applied dose to the tumor bed improves local control with the cost of worse cosmetic results.

Fig. 1

Modern treatment plan of a female patient undergoing left-sided breast and regional nodal radiotherapy using a 4-field sliding window technique. Prescription dose was 50.4 Gy in 28 fractions

Fig. 2

Female patient undergoing right-sided breast and regional nodal radiotherapy including supra−/infraclavicular and internal mammary lymph nodes after breast-conserving surgery using a 5-field sliding window IMRT

Fig. 3

Postmastectomy patient with immediate implant-based reconstruction undergoing right sided breast and regional nodal radiotherapy including supra−/infraclavicular and internal mammary lymph nodes using a 6-field sliding window IMRT

Fig. 4

Female patient undergoing left-sided partial breast radiotherapy using a 3-field sliding window IMRT technique for a low risk tumor. Moreover, the patient had a pectus excavatum

Fig. 5

Anatomic position of the breast target volume and heart in free-breathing (left picture) and deep inspiration breath-hold (right picture)