Radiation treatment strategies in patients undergoing breast-conserving surgery

Breast-conserving therapy offers patients an oncologically sound opportunity to cure their cancer, preserve their breast, and maintain an excellent quality of life. Historically, radiation delivered as a component of breast-conserving therapy required up to 7 weeks of daily treatment after surgery, exacting a burden both on individual patients and the health-care system as a whole. In the past several years, new strategies have emerged which seek to retain the benefits of breast-conserving therapy but decrease the burden of protracted radiation courses. These strategies include omission of radiation in selected patients, hypofractionated whole-breast irradiation, and accelerated partial-breast irradiation, which can be delivered using multicatheter interstitial brachytherapy, single-entry catheter-based brachytherapy, external beam techniques, proton therapy, or intraoperative techniques. The promise and potential problems with these newer radiation strategies are discussed herein, with guidance provided as to the appropriate application of these techniques in clinical practice.