As the number of patients with early detection and diagnosis of breast cancer continues to increase and patients’ demands for quality of life continue to improve, the number of breast-conserving treatments for early-stage breast cancer patients continues to increase.
Breast-conserving treatment is a major development in the treatment process of breast cancer and a major change in the concept of treatment. Breast conservation is not only for aesthetic purposes, but also to preserve the function of the affected upper limb and relieve the patient’s psychological stress. Radiation therapy is an important part of breast-conserving treatment. A large number of clinical trials have confirmed that the local area recurrence rate, tumor-free survival rate and overall survival rate of the affected breast with breast-conserving surgery + postoperative radiation therapy are not significantly different from those of radical surgery.
Indications for breast-conserving surgery.
Single lesion with T ≤ 3 cm (varies depending on breast volume) Clinical lymph nodes N0 or N1 can be obtained with negative incision margins located outside the areolar area No history of collagen vascular disease Willingness for breast conservation.
Absolute contraindications.
Two or more tumors in different quadrants or persistent positive cut margins for diffuse malignant microcalcifications History of previous breast or chest radiotherapy during pregnancy.
Relative contraindications.
Excessive tumor/breast volume ratio History of connective tissue disease (scleroderma, SLE) Excessive breast size or ptosis (which would result in poor repetition of radiation therapy positions).
Radiation therapy after breast-conserving surgery.
All patients undergoing breast-conserving surgery should be treated with postoperative radiotherapy
Only patients older than 70 years with T1N0M0 and positive ER can be considered for post-breast-conserving surgery with endocrine therapy alone without postoperative radiotherapy.
Scope of radiotherapy.
Whole breast irradiation on the affected side is required for all patients.
Patients with T3 or T4 or ≥4 axillary lymph node metastases (≥10 axillary lymph node clearances) or <10 axillary lymph node detections or axillary lymph node positivity ratio >20-25% require radiotherapy to the supraclavicular region.
Patients whose axillary lymph nodes have not been cleared or whose positive anterior lymph nodes have not been cleared need to undergo axillary radiotherapy.
Advantages of Intensity Modulated Radiation Therapy (IMRT) after breast-conserving surgery.
Improved uniformity of irradiation dose within the breast target area.
Reduces the dose and volume of irradiation to the lungs and heart.
Avoid the presence of cold and hot spots at the intersection of the irradiated fields in conventional radiotherapy, and improve the dose distribution in the inner breast region.
IMRT also allows for simultaneous whole-breast irradiation with bed-in-breast supplementation (SIB), which shortens treatment time and avoids repeated over-irradiation of normal breast tissue caused by sequential whole-breast irradiation and bed-in-breast supplementation in conventional radiotherapy.
Side effects of radiotherapy.
They mainly cause local skin pigmentation and dry and wet peeling of the breast, but can gradually recover after the end of radiotherapy.
IMRT can control the dose and volume of radiation exposure to the heart and lungs within a certain range.