New Techniques in Radiation Oncology

The role of radiotherapy in the management of breast cancer has evolved in parallel with continued refinement of surgical and systemic therapies. Greater experience with breast-conserving surgery and axillary sentinel lymph node biopsy has necessitated further development of clear guidelines for regional nodal irradiation in the treatment of early-stage breast cancer, particularly in the setting of limited axillary involvement. As surgical management shifts to a more targeted approach, adjuvant radiation therapy becomes ever more important in maximizing disease control while minimizing morbidity. Similarly, in this era of increasingly effective systemic therapy, clarification of the most appropriate indications and optimal target regions remains warranted. In this chapter, we will discuss the radiotherapeutic management of the regional nodes with regard to the extent of axillary involvement, surgical management of the breast, nodal regions of interest, and neoadjuvant systemic therapy.