Radiation therapy (also called radiotherapy) uses high energy rays from X-rays, protons or other sources to kill cancer cells. Rapidly growing cells, such as cancer cells, are more susceptible to the effects of radiation therapy than are normal cells.
Two main kinds of radiation therapy for breast cancer are:
Radiotherapy in DCIS (Ductal carcinoma in situ) or Breast Cancer:
Breast-Conserving Surgery has become a standard treatment option for DCIS or Breast Cancer.
All patients post BCS require:
Very select group of patients can be kept under observation after BCS:
Post Mastectomy Radiation in DCIS: In the routine, there is no role except close/+ve margins*.
Partial Breast Irradiation
Inclusion criteria for APBI: (All criteria should meet)
Exclusion criteria for APBI:
Positive margins, Extensive Intraductal Component/ Extensive LVSI, Post NACT ,N2/N3 Disease , Multicentric Disease.
The issue of fractionation (WBRT): Standard or Hypofractionated
Sequencing of CT/RT:
For patients with BCS: RT —> CT+/- HT+/- Targeted therapy
For patients with MRM: CT+/- Targeted therapy—> RT—> HT
PMRT in patients with 1-3 LN +ve:
1-3 LN +ve with high-risk features (Patients will receive chest wall/WBRT + supraclavicular RT):
No routine Axillary RT in adequately dissected axilla
Axillary RT to be considered in:
Supraclavicular RT in:
Clinical N2/N3 Disease , >4+ LN after axillary dissection ,1-3 LN +ve with high risk features (Young patients (<40 years), TNBC Patients, LVSI
No IMN Irradiation routinely. Can be considered in:
IMN +ve by SLNB, clinically +ve IMN, Isolated recurrence in IMN
Axillary RT in case of SLNB +ve with no dissection: Not recommended.
RT after NACT
All patients planned for NACT (Clinical stage decided by combined team and documented in file clearly)
Definitive/PMRT in MBC
A subset of Patients offered definitive RT:
Inoperable after NACT but still meeting criteria as mentioned
Sub-optimal response to NACT
Patient having good response but not desirous of surgery