Locoregional Management of Breast Cancer: A Chronological Review

Abstract

Locoregional management of breast cancer is founded on evidence generated over a vast time period, much longer than the career span of many practicing physicians. Oncologists rely on specific patient and tumour characteristics to recommend modern-day treatments. However, some of this information may not have been available during prior periods in which the evidence was generated. For example, the comprehensive Early Breast Cancer Trialists' Collaborative Group (EBCTCG) meta-analyses published in the 2000s typically included older trials accruing patients between the 1960s and 1980s. This raises some uncertainty about whether conclusions from studies conducted in prior eras are as relevant or applicable to modern-day patients and treatments. Reviewing the chronological order and details of the evidence can be beneficial to understanding these nuances. This review discusses the evolution of locoregional management through some key clinical trials. We aim to highlight the time period in which the evidence was generated and emphasize the 10-year outcomes for the comparability of results. Evidence supporting surgical management of the breast and axilla, as well as details of radiotherapy are discussed briefly for all stages of breast cancer.

Keywords: axilla; breast cancer; locoregional; management; radiotherapy; surgery.

Figure 1

A timeline illustrating the evolution of breast management. Abbreviations: BCS, Breast Conserving Surgery; CA, Cancer; HER2, Human Epidermal Growth Factor 2; RT, Radiotherapy. Note: This figure represents a broad overview of the evolution of breast management. However, it does not represent the exact time of the adoption of the measure in the trial. Trials are reported by end accrual dates.