Radiotherapy occupies a specific and prominent place in the palliative care of local skin and subcutaneous recurrences and for the focal treatment of distant metastases, particularly bone, in patients with breast cancer. The general and systemic management of the cancer patient with disseminated disease is covered elsewhere in this Symposium. Local Skin and Subcutaneous Recurrences The appearance of a local skin recurrence in the operative field generally heralds the failure of the primary therapeutic attempt. It may precede by a long period the development of other metastases, but these may be anticipated sooner or later. Of 250 patients with involved axillary lymph nodes who were treated by radical mastectomy and postoperative irradiation at The University of Texas M. D. Anderson Hospital and Tumor Institute, 32 returned with chest wall recurrences; all of these died of widespread disease. Although cure may not be possible, we advocate treatment to avoid or relieve ulceration and to provide local control of the tumor. A. External Applicator (Mold): For recurrences in an area of thin chest-wall skin flaps, an external applicator (mold) containing radium or an equivalent isotope, at a short treatment distance, is a most effective method. The radioactive material is distributed according to Paterson-Parker rules, and a surface dose of 5,000 to 5,500 rads in one week is given (1). B. Radium or Radioactive Isotope Implant: When the flaps are thicker, a radium or radioactive-isotope implant is called for, since an external applicator will not deliver sufficient depth dose within the limits of skin tolerance. With either of these means, as much of the chest wall as possible should be included to forestall the appearance of new tumor nodules outside the treated area. C. Orthovoltage Irradiation: Tangential fields with orthovoltage irradiation may be employed, but the radiation dose that can be delivered is less, and the chances of controlling the disease locally are diminished. D. Superficial X-Irradiation: Direct fields with low kilovoltage and short treatment distance could also be used, but, again, the dose that can be given will be limited. Nevertheless, in the presence of distressing ulcerations of the chest wall and concomitant evidence of distant metastases, this type of simple treatment may be preferable. If the chest wall is divided into small areas, these will get a better dose distribution and there will be less radiation to the lungs. To avoid the effects of possible overlapping or gaps, the “moving” technic was devised by Batley (2) to imitate the dose gradient delivered by mold. Briefly, this method involves division of the whole area into squares. Doctor Batley starts by irradiating one square while shielding the surrounding areas with lead foil. The next two squares are then treated and so on until all squares have been treated the same number of times. A uniform reaction (deep erythema—moist desquamation) is obtained over the whole area with a skin dose of 4,500 rad in four weeks.