Developments in radiotherapy

Abstract

There is a rather negative attitude towards the role of radiotherapy in breast cancer and over the years it has acquired a somewhat poor image despite 50 years of clinical research. Historically, the first randomized trial to assess radiotherapy was the ovarian ablation study performed at the Christie Hospital in Manchester (1). The second study assessing post-mastectomy radiotherapy (1) was also from the Christie where percentage mortality up to the fifth year was 42% in the control group (n = 305), and 35% in treated (n = 293) patients. A significant improvement in local control was demonstrated although the overall message was that long-term radiotherapy was harmful. This trial has had an inordinate influence in the U.K. over the years and is still influencing perception of adjuvant radiotherapy. Despite this, data from the Scottish Cancer Therapy Network, who have audited all patients diagnosed with breast cancer in Scotland, in 1987 and in 1993 indicate that radiotherapy is being used increasingly frequently (2). Following wide local excision (lumpectomy) or mastectomy the numbers of patients that received radiotherapy were found to have increased by 20% and 38%, respectively, between these two years.