Radiation management of advanced breast cancer

INTRODUCTION Two modalities of treatment for breast cancer, surgery and irradiation, have demonstrated consistent and predictable control of local-regional disease; long-term follow-up data support their use. A third modality, chemotherapy or chemo-immunotherapy, requires further study and evaluation. There is an unfortunate tendency to regard irradiation and chemotherapy in opposition to each other. In the treatment of locally advanced cancer of the breast, it is imperative to stop the theatrical prejudices of pros and cons, and to amalgamate all of the modalities into successful treatment, hopefully prolonging survival and improving the lives of afflicted patients. Although irradiation is successful in controlling large tumor masses in breasts and regional nodes, the sheer number of cells and the anoxic tumor compartment necessitate large doses. A 2-3 cm axillary lymph node will require 7000rad while a breast mass of 5 cm will require SOOO-10,000 rad in lo-12 weeks. Although local and regional control is achieved in more than 75% of the treated patients, the resulting fibrosis secondary to the high doses may be crippling with increasing necroses in the long-term survivors.