Newer Technologies for treatment breast cancer

The primary intention of cancer treatment is to achieve cure and improve survival. Radiotherapy has an important role in breast cancer as it helps in the attainment of both these objectives of cancer treatment.Does radiotherapy improve survival?Treatment of breast cancer has been an evolving process over the years. In those days, extensive surgical removal of the breast and surrounding areas was considered to be the standard of breast cancer care. The addition of local radiotherapy in those days managed to decrease the local recurrence of disease but did not show any impact on increasing survival.Improvement in survival was attained by addition of systemic chemotherapy into the management protocol of breast cancer.Oncologists were faced with a puzzling question: HOW COULD RADIOTHERAPY IMPROVE LOCAL CONTROL AND YET NOT IMPACT SURVIVAL IN BREAST CANCER PATIENTS? The answer was given in an elegant analysis by The Early Breast Cancer Trialists' Collaborative Group (EBCTCG) the Authority in breast cancer research worldwide. The EBCTCG performed an extensive meta analysis using the raw data from every randomized prospective trial investigating post mastectomy radiation. The major cause of non breast cancer deaths was found to be heart disease meaning that radiation being delivered inadvertently to the heart was causing an increased incidence of heart disease. An important additional observation noted by this group warrants consideration - the increase in non-breast cancer deaths was noted primarily in patients for whom older radiotherapy techniques and equipment had been used without a clear distinction of treatment volume and organs at risk like the heart, lungs and the opposite breast.Modern radiation treatments might be associated with less cardiovascular morbidity and mortality than earlier radiation techniques. Currently, a large number of centers utilize computed tomography (CT) treatment planning and shape radiation dose using 3-dimensional conformal radiotherapy and IMRT to avoid treating the underlying heart. Furthermore, integration of electron beam therapy into breast cancer radiotherapy protocols has allowed safe delivery of higher radiation doses to patients.
Breast conservation: Importance of Radiotherapy
Another area of active development in breast cancer is the establishment of breast conservation as the standard of care in early breast cancer. The National Institutes of Health (NIH) Consensus Development Conference on the treatment of patients with early stage invasive breast carcinoma, held in June 1990, recommended breast conservation therapy for the majority of women with Stage I or II breast carcinoma.

• Local Control: Local control is a major goal of breast conservation treatment. The incidence of local recurrence is low in appropriately selected patients receiving optimal breast conservation treatment.
• Cosmetic Result: A goal of primary breast cancer treatment is to produce the best cosmetic result consistent with achievement of local/regional control. Optimal long-term cosmetic outcome requires integration of careful surgical excision and precise radiotherapy techniques.
• Radiation Therapy: The conference laid out Radiation Therapy Recommendations after breast conservation surgery.

As is evident, the availability of proper radiotherapy facilities is considered as an essential prerequisite for breast conservation as providing adequate doses of radiation becomes necessary to prevent disease recurrence in the conserved breast. The boost is delivered either using electron beam therapy, 3-D Conformal Radiotherapy,Intensity Modulated Radiotherapy, Interstitial brachytherapy, or Intra-Operative radiotherapy.
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