Postmastectomy Irradiation in High-Risk Breast Cancer Patients: Present status of the Danish Breast Cancer Cooperative Group trials

Accelerated Hypofractionated Radiation in Carcinoma Breast

“…Due to this long course, adjuvant treatment is sequenced so as to start radiation therapy after completion of adjuvant chemotherapy. Radiobiological models predict that ∞/ß ratio for breast cancer is low [2,3]. Tissues with low ∞/ß ratio have been shown to be more sensitive to the radiotherapy fraction size.…”

“…Breast carcinoma is treated with multimodal ap proach including surgery, chemotherapy, radiotherapy, hormonal therapy and immunotherapy [2]. Locoregional radiation therapy after modified radical mastectomy (MRM) not only significantly reduces locoregional recurrence rates but also leads to better survival outcome patients with high risk breast cancer [3][4][5]. Conventional course of radiation therapy {50 Gray (Gy) over 5 weeks} often leads to poor compliance of patients.…”

Fibroblast Differentiation in Subcutaneous Fibrosis after Postmastectomy Radiotherapy

“…At the molecular level, TGFi1 induces expression of interstitial collagens type I and III and modulates the activity of collagenase and of metalloproteinase inhibitors (22,23). Clinically, the twice weekly fractionation scheme used to treat the patients in the present study, produced a wide spectrum of subcutaneous fibrosis and was subsequently replaced by a five times weekly fractionation, which greatly reduced the risk of fibrosis (1,11,12). Thus, using the current fractionation scheme, severe fibrosis is likely to affect mainly the axillary field in a fraction of patients (1).…”

“…The irradiation technique consisted of an anterior 8 MV photon field to the supraclavicular/infraclavicular region with a wax bolus over the scar in the axillary region, and an electron field to the thoracic wall over the lung, as described (1,11,12). Subcutaneous fibrosis was scored clinically by palpation in the three fields.…”

Breast Cancer

“…Several studies have demonstrated significantly better relapse-free survival after radiotherapy compared to surgery alone (eg, 3,41). Most studies have been unable to individually show that radiotherapy has a significant effect on overall survival.…”