Indications for radiation

Indications for radiation treatment are constantly evolving. Patients treated in Europe have been more likely in the past to be recommended adjuvant radiation after breast cancer surgery. Radiation therapy is usually recommended for all patients who had (lumpectomy, quadrant-resection). Radiation therapy is usually not indicated in patients with advanced (stage IV disease) except for palliation of symptoms like bone pain.

In general recommendations would include:

• As part of breast conserving therapy when the whole breast is not removed (lumpectomy or wide local excision)

• After mastectomy: Patients with higher chances of cancer recurring because of conditions such as a large primary tumor or involvement of four or more lymph nodes.

Other factors which may influence adding adjuvant radiation therapy:

• Tumor close to or involving the margins on pathology specimen

• Multiple areas of tumor (multicentric disease)

• Microscopic invasion of lymphatic or vascular tissues

• Microcopic invasion of the skin, nipple/areola, or underlying pectoralis major muscle

• Patients with <4 LN involved, but extension out of the substance of a LN

• Inadequate numbers of axillary LN sampled
  

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