Radiotherapy for Early Breast Cancer

Despite improved systemic treatments, locoregional treatment remains a critical component of the management of early breast cancer, with proven effects on local control and survival. This special issue of Clinical Oncology focuses on the important subject of radiotherapy for breast cancer. There is little doubt that postoperative irradiation after surgery for early breast cancer is the most common application of radiotherapy with ‘curative’ intent. It is likely that the increased use of radiotherapy for breast cancer has significantly contributed to the substantial excess of demand over available treatment capacity, which many UK radiotherapy departments currently face. An appreciation of the relationship between locoregional and systemic recurrence risk, provided by thoughtful analysis of the many trials of postoperative radiotherapy, lies at the core of an understanding of the natural history of this fascinating and common disease. The ‘paradigm’ of the (exclusively) systemic nature of breast cancer is now rendered obsolete largely because of these trials. I would urge you all (even those who are not breast cancer ‘aficionados’) to read John Kurtz’s incisive article. No single volume in this area can claim to be comprehensive, but technical developments, new indications, avoidance of unnecessary radiotherapy and treatmentrelated morbidity are covered. A review of our emerging understanding of radiobiology (perhaps challenging some existing dogma) is included, and important issues of sequencing and treatment delay are discussed. Finally, the problems of the use of a limited resource and how new developments may affect available capacity are addressed. I would like to acknowledge the hard work of all of the contributors to this volume, and hope that they will forgive me for my frequent (but gentle) encouragements over the last year.