Controversies regarding the Use of radiation therapy after surgery in breast cancer

Abstract

Despite years of clinical study, there are still many unanswered questions regarding post mastectomy radiation. It is clear that radiation therapy plays a critical role in the multidisciplinary management of patients with locally advanced or inflammatory breast cancer . It is also accepted that post mastectomy radiation is not required for most women with noninvasive disease or stage I disease. Randomized clinical trials studying radiation treatment for women with stage II or III breast cancer have shown that the addition of radiation after mastectomy can reduce local-regional recurrence rates, which then improves survival however, other data have indicated that the risk of local- regional recurrence after mastectomy and chemotherapy is low for patients with small tumors, zero, and one to three positive lymph nodes, leading some to question whether postmastectomy radiation is useful for this group. The strategy combining radiation with mastectomy has been investigated since the 1950s Despite this, there is no accepted standard of care concerning radiation use for a patients treated with modified radical mastectomy and systemic therapy for stage II breast cancer with one to three positive lymph nodes some would strongly advocate that such patient receive radiation and cite randomized prospective data support its use. Others show that the risk of local-regional recurrence (LRR) for such patients is low and argue that the potential toxicity and the cost associated with post mastectomy radiation in these patients may not be warranted