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Adjuvant Radiotherapy

  • Ian Kunkler
Chapter

Abstract

There is a dearth of level 1 (randomised controlled trial) evidence on adjuvant radiotherapy confined to older patients but it is slowly accumulating and influencing guidelines and practice. There are wide international variations in the application of adjuvant radiotherapy after breast conserving surgery and mastectomy in this age group. There are conflicting data on the effect of age on risk of local recurrence. Local recurrence rates have been falling in older patients treated by breast conserving therapy, reflecting the impact of screening, closer attention to surgical margins, better systemic therapy and radiotherapy. Recent trials support the use of hypofractionation and selected forms of partial breast irradiation. Breast boost is recommended in higher risk patients after breast conserving surgery. There is growing support for selective omission of postoperative radiotherapy in ‘low risk’ older patients. Trials of biomarker- assisted selection of such subgroups are ongoing. There is no level 1 evidence on postmastectomy radiotherapy (PMRT) confined to older patients. PMRT remains standard for patients with 4 or more positive nodes. For patients with 1–3 involved nodes, the role of PMRT remains controversial.

Keywords

Breast cancer Adjuvant radiotherapy, radiation, older Elderly 

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ian Kunkler
    • 1
  1. 1.Edinburgh Cancer Research Centre, Institute of Genetic and Molecular MedicineUniversity of EdinburghEdinburghUK

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