Breast Cancer: Intact and Post Mastectomy

  • Elizabeth S. Bloom
  • Philip Poortmans
  • Marianne Aznar
  • Thomas A. Buchholz
  • Eric A. Strom
Part of the Medical Radiology book series (MEDRAD)


In most industrialized countries, breast cancer constitutes a very important part of the number of patients referred for radiation therapy. There has been a transition from simulator-based 2D techniques to modern, highly individualized CT-based techniques. It is therefore not surprisingly that measures are being undertaken to diminish the workload by introducing altered fractionation schedules including the simultaneous integrated boost technique and hypofractionation. Regarding this, it should be recognized that this is only possible when applying modern techniques to optimize dose homogeneity. In addition, there is an increased awareness of the risk for late toxicity due to irradiation of cardiovascular structures, lung tissue, and the contralateral breast, as the number of breast cancer survivors increase. Whereas technical solutions including respiratory control offer very promising dosimetric results, the acceptance of consensus based guidelines on target volume delineation as well as target volume selection remains a challenge for current investigators.


Chest Wall Axillary Node Dissection Inflammatory Breast Cancer Breast Magnetic Resonance Imaging Internal Mammary Chain 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors would like to thank Mr. Lionel Santibañez, from the Department of Scientific Publications, The University Texas, MD Anderson Cancer Center, as well as their colleagues for their support and providing clinical material and experience.


  1. Al Uwini S, Antonini N, Poortmans PM, Boersma L, Hurkmans C, Leer JW, Horiot JC, Struikmans H, Bartelink H (2009) The influence of the use of CT-planning on the irradiated boost volume in breast conserving treatment. Radiother Oncol 93(1):87–93. doi: 10.1016/j.radonc.2009.05.002 PubMedCrossRefGoogle Scholar
  2. Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, Werner-Wasik M, Demas W, Ryu J, Bahary JP, Souhami L, Rotman M, Mehta MP, Curran WJ Jr (2004) Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the rtog 9508 randomised trial. Lancet 363(9422):1665–1672. doi: 10.1016/S0140-6736(04)16250-8 PubMedCrossRefGoogle Scholar
  3. Ballo MT, Strom EA, Prost H, Singletary SE, Theriault RL, Buchholz TA, McNeese MD (1999) Local-regional control of recurrent breast carcinoma after mastectomy: does hyperfractionated accelerated radiotherapy improve local control? Int J Radiat Oncol Biol Phys 44(1):105–112. S0360-3016(98)00545-8[pii]PubMedCrossRefGoogle Scholar
  4. Barker JL, Nelson AJ, Montague ED (1976) Inflammatory carcinoma of the breast. Radiology 121(1):173–176PubMedGoogle Scholar
  5. Bartelink H, Horiot JC, Poortmans PM, Struikmans H, Van den Bogaert W, Fourquet A, Jager JJ, Hoogenraad WJ, Oei SB, Warlam-Rodenhuis CC, Pierart M, Collette L (2007) Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881–10882 trial. J Clin Oncol 25(22):3259–3265. doi: 10.1200/JCO.2007.11.4991 PubMedCrossRefGoogle Scholar
  6. Bentzen SM, Agrawal RK, Aird EG, Barrett JM, Barrett-Lee PJ, Bliss JM, Brown J, Dewar JA, Dobbs HJ, Haviland JS, Hoskin PJ, Hopwood P, Lawton PA, Magee BJ, Mills J, Morgan DA, Owen JR, Simmons S, Sumo G, Sydenham MA, Venables K, Yarnold JR (2008a) The uk standardisation of breast radiotherapy (start) trial a of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol 9(4):331–341. doi: 10.1016/S1470-2045(08)70077-9 CrossRefGoogle Scholar
  7. Bentzen SM, Agrawal RK, Aird EG, Barrett JM, Barrett-Lee PJ, Bliss JM, Brown J, Dewar JA, Dobbs HJ, Haviland JS, Hoskin PJ, Hopwood P, Lawton PA, Magee BJ, Mills J, Morgan DA, Owen JR, Simmons S, Sumo G, Sydenham MA, Venables K, Yarnold JR (2008b) The UK standardisation of breast radiotherapy (start) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet 371(9618):1098–1107. doi: 10.1016/S0140-6736(08)60348-7 CrossRefGoogle Scholar
  8. Borghero YO, Salehpour M, McNeese MD, Stovall M, Smith SA, Johnson J, Perkins GH, Strom EA, Oh JL, Kirsner SM, Woodward WA, Yu TK, Buchholz TA (2007) Multileaf field-in-field forward-planned intensity-modulated dose compensation for whole-breast irradiation is associated with reduced contralateral breast dose: a phantom model comparison. Radiother Oncol 82(3):324–328PubMedCrossRefGoogle Scholar
  9. Bourgier C, Khodari W, Vataire AL, Pessoa EL, Dunant A, Delaloge S, Uzan C, Balleyguier C, Mathieu MC, Marsiglia H, Arriagada R (2010) Breast radiotherapy as part of loco-regional treatments in stage iv breast cancer patients with oligometastatic disease. Radiother Oncol 96(2):199–203. doi: 10.1016/j.radonc.2010.02.028 PubMedCrossRefGoogle Scholar
  10. Briasoulis E, Karavasilis V, Kostadima L, Ignatiadis M, Fountzilas G, Pavlidis N (2004) Metastatic breast carcinoma confined to bone: portrait of a clinical entity. Cancer 101(7):1524–1528. doi: 10.1002/cncr.20545 PubMedCrossRefGoogle Scholar
  11. Buchholz TA (2000) Internal mammary lymph nodes: to treat or not to treat. Int J Radiat Oncol Biol Phys 46(4):801–803. S0360-3016(99)00482-4[pii]PubMedCrossRefGoogle Scholar
  12. Buchholz TA, Tucker SL, Masullo L, Kuerer HM, Erwin J, Salas J, Frye D, Strom EA, McNeese MD, Perkins G, Katz A, Singletary SE, Hunt KK, Buzdar AU, Hortobagyi GN (2002) Predictors of local-regional recurrence after neoadjuvant chemotherapy and mastectomy without radiation. J Clin Oncol 20(1):17–23PubMedCrossRefGoogle Scholar
  13. Carlson RWAD, Anderson BO et al (2010) NCCN practice guidelines in oncology—v.2.2010: Invasive breast cancer. Accessed 06/18/2010
  14. Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG, Arbuckle RB, Swint JM, Shiu AS, Maor MH, Meyers CA (2009) Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 10(11):1037–1044. doi: 10.1016/S1470-2045(09)70263-3 PubMedCrossRefGoogle Scholar
  15. Chargari C, Kirova YM, Cottu P, Salmon RJ, Fourquet A (2009) Progressive inflammatory breast cancer in patient receiving chemotherapy: the importance of radiotherapy as a part of locoregional treatment. Radiother Oncol 90(1):160–161. doi: 10.1016/j.radonc.2008.08.001 PubMedCrossRefGoogle Scholar
  16. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, Godwin J, Gray R, Hicks C, James S, MacKinnon E, McGale P, McHugh T, Peto R, Taylor C, Wang Y (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106. doi: 10.1016/S0140-6736(05)67887-7 PubMedGoogle Scholar
  17. Correa C, McGale P, Taylor C, Wang Y, Clarke M, Davies C, Peto R, Bijker N, Solin L, Darby S (2010) Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr 2010(41):162–177. doi: 10.1093/jncimonographs/lgq039
  18. Dijkema IM, Hofman P, Raaijmakers CP, Lagendijk JJ, Battermann JJ, Hillen B (2004) Loco-regional conformal radiotherapy of the breast: delineation of the regional lymph node clinical target volumes in treatment position. Radiother Oncol 71(3):287–295. doi: 10.1016/j.radonc.2004.02.017 PubMedCrossRefGoogle Scholar
  19. Donovan E, Bleakley N, Denholm E, Evans P, Gothard L, Hanson J, Peckitt C, Reise S, Ross G, Sharp G, Symonds-Tayler R, Tait D, Yarnold J (2007) Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol 82(3):254–264. doi: 10.1016/j.radonc.2006.12.008 PubMedCrossRefGoogle Scholar
  20. Dunne C, Burke JP, Morrow M, Kell MR (2009) Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ. J Clin Oncol 27(10):1615–1620. doi: 10.1200/JCO.2008.17.5182 PubMedCrossRefGoogle Scholar
  21. Edge S, Byrd DR, Compton CA (ed) (2010) AJCC cancer staging manual. 7th edn. Springer, New YorkGoogle Scholar
  22. Fisher ER, Dignam J, Tan-Chiu E, Costantino J, Fisher B, Paik S, Wolmark N (1999) Pathologic findings from the national surgical adjuvant breast project (nsabp) eight-year update of protocol b-17: Intraductal carcinoma. Cancer 86(3):429–438. doi: 10.1002/(SICI)1097-0142(19990801)86:3<429:AID-CNCR11>3.0.CO;2-Y PubMedCrossRefGoogle Scholar
  23. Fisher B, Land S, Mamounas E, Dignam J, Fisher ER, Wolmark N (2001) Prevention of invasive breast cancer in women with ductal carcinoma in situ: an update of the national surgical adjuvant breast and bowel project experience. Semin Oncol 28(4):400–418. S0093775401001531[pii]PubMedCrossRefGoogle Scholar
  24. Fourquet A, Stoppa-Lyonnet D, Kirova YM, Sigal-Zafrani B, Asselain B (2009) Familial breast cancer: clinical response to induction chemotherapy or radiotherapy related to brca1/2 mutations status. Am J Clin Oncol 32(2):127–131. doi: 10.1097/COC.0b013e31817f9e1c PubMedCrossRefGoogle Scholar
  25. Freedman GM, Fowble BL, Nicolaou N, Sigurdson ER, Torosian MH, Boraas MC, Hoffman JP (2000) Should internal mammary lymph nodes in breast cancer be a target for the radiation oncologist? Int J Radiat Oncol Biol Phys 46(4):805–814. S0360-3016(99)00481-2[pii]PubMedCrossRefGoogle Scholar
  26. Garg AK, Frija EK, Sun TL, Strom EA, Perkins GH, Oh JL, Yu TK, Woodward WA, Tereffe WA, Salehpour M, Buchholz TA (2009) Effects of variable placement of superior tangential/supraclavicular match line on dosimetric coverage of level iii axilla/axillary apex in patients treated with breast and supraclavicular radiotherapy. Int J Radiat Oncol Biol Phys 73(2):370–374. doi: 10.1016/j.ijrobp.2008.04.045 PubMedCrossRefGoogle Scholar
  27. Haagensen CD (1971) Disease of the breast, 2nd edn. Saunders, PhiladelphiaGoogle Scholar
  28. Haagensen CD (1986) Diseases of the breast, 3rd edn. Saunders, PhiladelphiaGoogle Scholar
  29. Holland R, Veling SH, Mravunac M, Hendriks JH (1985) Histologic multifocality of Tis, T1–2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer 56(5):979–990PubMedCrossRefGoogle Scholar
  30. Hughes KS, Schnaper LA, Berry D, Cirrincione C, McCormick B, Shank B, Wheeler J, Champion LA, Smith TJ, Smith BL, Shapiro C, Muss HB, Winer E, Hudis C, Wood W, Sugarbaker D, Henderson IC, Norton L (2004) Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med 351(10):971–977. doi: 10.1056/NEJMoa040587 PubMedCrossRefGoogle Scholar
  31. Hughes LL, Wang M, Page DL, Gray R, Solin LJ, Davidson NE, Lowen MA, Ingle JN, Recht A, Wood WC (2009) Local excision alone without irradiation for ductal carcinoma in situ of the breast: A trial of the eastern cooperative oncology group. J Clin Oncol 27(32):5319–5324. doi: 10.1200/JCO.2009.21.8560 PubMedCrossRefGoogle Scholar
  32. Katz A, Strom EA, Buchholz TA, Thames HD, Smith CD, Jhingran A, Hortobagyi G, Buzdar AU, Theriault R, Singletary SE, McNeese MD (2000) Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implications for postoperative irradiation. J Clin Oncol 18(15):2817–2827PubMedGoogle Scholar
  33. Katz A, Buchholz TA, Thames H, Smith CD, McNeese MD, Theriault R, Singletary SE, Strom EA (2001) Recursive partitioning analysis of locoregional recurrence patterns following mastectomy: implications for adjuvant irradiation. Int J Radiat Oncol Biol Phys 50(2):397–403. S0360-3016(01)01465-1[pii]PubMedCrossRefGoogle Scholar
  34. Khan SA, Stewart AK, Morrow M (2002) Does aggressive local therapy improve survival in metastatic breast cancer? Surgery 132(4):620–626. S003960600200140X[pii] (discussion 626–627)PubMedCrossRefGoogle Scholar
  35. Khatcheressian JL, Wolff AC, Smith TJ, Grunfeld E, Muss HB, Vogel VG, Halberg F, Somerfield MR, Davidson NE (2006) American society of clinical oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting. J Clin Oncol 24(31):5091–5097. doi: 10.1200/JCO.2006.08.8575 PubMedCrossRefGoogle Scholar
  36. King TA, Bolton JS, Kuske RR, Fuhrman GM, Scroggins TG, Jiang XZ (2000) Long-term results of wide-field brachytherapy as the sole method of radiation therapy after segmental mastectomy for T(is, 1, 2) breast cancer. Am J Surg 180(4):299–304. S0002-9610(00)00454-2[pii]PubMedCrossRefGoogle Scholar
  37. Kirby AM, Evans PM, Donovan EM, Convery HM, Haviland JS, Yarnold JR (2010) Prone versus supine positioning for whole and partial-breast radiotherapy: a comparison of non-target tissue dosimetry. Radiother Oncol 96(2):178–184. doi: 10.1016/j.radonc.2010.05.014 Google Scholar
  38. Kiricuta IC, Gotz U, Schwab F, Fehn M, Neumann HH (2000) Target volume definition and target conformal irradiation technique for breast cancer patients. Acta Oncol 39(3):429–436PubMedCrossRefGoogle Scholar
  39. Kirova YM, Servois V, Campana F, Dendale R, Bollet MA, Laki F, Fournier-Bidoz N, Fourquet A (2006) Ct-scan based localization of the internal mammary chain and supra clavicular nodes for breast cancer radiation therapy planning. Radiother Oncol 79(3):310–315. doi: 10.1016/j.radonc.2006.05.014 PubMedCrossRefGoogle Scholar
  40. Kirova YM, Castro Pena P, Dendale R, Servois V, Bollet MA, Fournier-Bidoz N, Campana F, Fourquet A (2010) Simplified rules for everyday delineation of lymph node areas for breast cancer radiotherapy. Br J Radiol 83(992):683–686. doi: 10.1259/bjr/28834220 Google Scholar
  41. Kirova YM, Campana F, Fournier-Bidoz N, Stilhart A, Dendale R, Bollet MA, Fourquet A (2007) Postmastectomy electron beam chest wall irradiation in women with breast cancer: a clinical step toward conformal electron therapy. Int J Radiat Oncol Biol Phys 69(4):1139–1144. doi: 10.1016/j.ijrobp.2007.05.007 PubMedCrossRefGoogle Scholar
  42. Kocher M, Soffietti R, Abacioglu U, Villa S, Fauchon F, Baumert BG, Fariselli L, Tzuk-Shina T, Kortmann RD, Carrie C, Hassel MB, Kouri M, Valeinis E, van den Berge D, Collette S, Collette L, Mueller RP (2010) Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol doi: 10.1200/JCO.2010.30.1655
  43. Korreman SS, Pedersen AN, Josipovic M, Aarup LR, Juhler-Nottrup T, Specht L, Nystrom H (2006) Cardiac and pulmonary complication probabilities for breast cancer patients after routine end-inspiration gated radiotherapy. Radiother Oncol 80(2):257–262. doi: 10.1016/j.radonc.2006.07.020 PubMedCrossRefGoogle Scholar
  44. Kunkler I (2010) Adjuvant chest wall radiotherapy for breast cancer: black, white, shades of grey. Eur J Surg Oncol 36(4):331–334. doi: 10.1016/j.ejso.2009.11.004 PubMedCrossRefGoogle Scholar
  45. Lanitis S, Behranwala KA, Al-Mufti R, Hadjiminas D (2009) Axillary metastatic disease as presentation of occult or contralateral breast cancer. Breast 18(4):225–227. doi: 10.1016/j.breast.2009.07.002 PubMedCrossRefGoogle Scholar
  46. Le Scodan R, Stevens D, Brain E, Floiras JL, Cohen-Solal C, De La Lande B, Tubiana-Hulin M, Yacoub S, Gutierrez M, Ali D, Gardner M, Moisson P, Villette S, Lerebours F, Munck JN, Labib A (2009) Breast cancer with synchronous metastases: survival impact of exclusive locoregional radiotherapy. J Clin Oncol 27(9):1375–1381. doi: 10.1200/JCO.2008.19.5396 PubMedCrossRefGoogle Scholar
  47. Leer JW, Caspers RJ, van Lonkhuijzen LR, van Raaij TM, Elkhuizen PH, Zwinderman AH, van de Velde CJ (1997) Selective avoidance of postoperative locoregional radiotherapy in breast cancer seems to be justified. Eur J Surg 163(11):815–822PubMedGoogle Scholar
  48. Lehman CD, DeMartini W, Anderson BO, Edge SB (2009) Indications for breast MRI in the patient with newly diagnosed breast cancer. J Natl Compr Canc Netw 7(2):193–201PubMedGoogle Scholar
  49. Liao Z, Strom EA, Buzdar AU, Singletary SE, Hunt K, Allen PK, McNeese MD (2000) Locoregional irradiation for inflammatory breast cancer: effectiveness of dose escalation in decreasing recurrence. Int J Radiat Oncol Biol Phys 47(5):1191–1200. S0360-3016(00)00561-7[pii]PubMedCrossRefGoogle Scholar
  50. Liengsawangwong R, Yu TK, Sun TL, Erasmus JJ, Perkins GH, Tereffe W, Oh JL, Woodward WA, Strom EA, Salephour M, Buchholz TA (2007) Treatment optimization using computed tomography-delineated targets should be used for supraclavicular irradiation for breast cancer. Int J Radiat Oncol Biol Phys 69(3):711–715. doi: 10.1016/j.ijrobp.2007.05.075 PubMedCrossRefGoogle Scholar
  51. Lievens Y, Poortmans P, Van den Bogaert W (2001) A glance on quality assurance in EORTC study 22922 evaluating techniques for internal mammary and medial supraclavicular lymph node chain irradiation in breast cancer. Radiother Oncol 60(3):257–265. S0167814001003516[pii]PubMedCrossRefGoogle Scholar
  52. Livraghi T, Goldberg SN, Solbiati L, Meloni F, Ierace T, Gazelle GS (2001) Percutaneous radio-frequency ablation of liver metastases from breast cancer: initial experience in 24 patients. Radiology 220(1):145–149PubMedGoogle Scholar
  53. Ly BH, Nguyen NP, Vinh-Hung V, Rapiti E, Vlastos G (2010) Loco-regional treatment in metastatic breast cancer patients: Is there a survival benefit? Breast Cancer Res Treat 119(3):537–545. doi: 10.1007/s10549-009-0610-z PubMedCrossRefGoogle Scholar
  54. Mann RM, Loo CE, Wobbes T, Bult P, Barentsz JO, Gilhuijs KG, Boetes C (2010) The impact of preoperative breast mri on the re-excision rate in invasive lobular carcinoma of the breast. Breast Cancer Res Treat 119(2):415–422. doi: 10.1007/s10549-009-0616-6 PubMedCrossRefGoogle Scholar
  55. Mannino M, Yarnold J (2009) Accelerated partial breast irradiation trials: diversity in rationale and design. Radiother Oncol 91(1):16–22. doi: 10.1016/j.radonc.2008.12.011 PubMedCrossRefGoogle Scholar
  56. Matzinger O, Heimsoth I, Poortmans P, Collette L, Struikmans H, Van Den Bogaert W, Fourquet A, Bartelink H, Ataman F, Gulyban A, Pierart M, Van Tienhoven G (2010) Toxicity at three years with and without irradiation of the internal mammary and medial supraclavicular lymph node chain in stage l to III breast cancer (EORTC trial 22922/10925). Acta Oncol 49(1):24–34. doi: 10.3109/02841860903352959 PubMedCrossRefGoogle Scholar
  57. Milano MT, Zhang H, Metcalfe SK, Muhs AG, Okunieff P (2009) Oligometastatic breast cancer treated with curative-intent stereotactic body radiation therapy. Breast Cancer Res Treat 115(3):601–608. doi: 10.1007/s10549-008-0157-4 PubMedCrossRefGoogle Scholar
  58. Moon SK, Kim YS, Kim SY, Lee MJ, Keum HS, Kim SJ, Youn SM (2010) A dosimetric analysis of imrt and multistatic fields techniques for left breast radiotherapy. Med Dosim. doi: 10.1016/j.meddos.2010.05.003
  59. Morrow M, Strom EA, Bassett LW, Dershaw DD, Fowble B, Giuliano A, Harris JR, O’Malley F, Schnitt SJ, Singletary SE, Winchester DP (2002) Standard for breast conservation therapy in the management of invasive breast carcinoma. CA Cancer J Clin 52(5):277–300PubMedCrossRefGoogle Scholar
  60. Offersen BV, Overgaard M, Kroman N, Overgaard J (2009) Accelerated partial breast irradiation as part of breast conserving therapy of early breast carcinoma: a systematic review. Radiother Oncol 90(1):1–13. doi: 10.1016/j.radonc.2008.08.005 PubMedCrossRefGoogle Scholar
  61. Okaro AC, Durkin DJ, Layer GT, Kissin MW, Karanjia ND (2005) Hepatic resection for breast cancer metastases. Ann R Coll Surg Engl 87(3):167–170. doi: 10.1308/1478708051711 PubMedCrossRefGoogle Scholar
  62. Osborn M (1987) Breast development and anatomy. Breast disease. Lippincott, PhiladelphiaGoogle Scholar
  63. Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, Kjaer M, Gadeberg CC, Mouridsen HT, Jensen MB, Zedeler K (1997) Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish breast cancer cooperative group 82b trial. N Engl J Med 337(14):949–955. doi: 10.1056/NEJM199710023371401 PubMedCrossRefGoogle Scholar
  64. Overgaard M, Jensen MB, Overgaard J, Hansen PS, Rose C, Andersson M, Kamby C, Kjaer M, Gadeberg CC, Rasmussen BB, Blichert-Toft M, Mouridsen HT (1999) Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish breast cancer cooperative group DBCG 82c randomised trial. Lancet 353(9165):1641–1648. doi: 10.1016/S0140-6736(98)09201-0 PubMedCrossRefGoogle Scholar
  65. Overgaard M, Nielsen HM, Overgaard J (2007) Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes, as recommended in international consensus reports? A subgroup analysis of the DBCG 82 b&c randomized trials. Radiother Oncol 82(3):247–253. doi: 10.1016/j.radonc.2007.02.001 PubMedCrossRefGoogle Scholar
  66. Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ, Markesbery WR, Foon KA, Young B (1998) Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 280(17):1485–1489. doi: 10.1001/jama.280.17.1485 PubMedCrossRefGoogle Scholar
  67. Pentheroudakis G, Lazaridis G, Pavlidis N (2010) Axillary nodal metastases from carcinoma of unknown primary (cupax): a systematic review of published evidence. Breast Cancer Res Treat 119(1):1–11. doi: 10.1007/s10549-009-0554-3 PubMedCrossRefGoogle Scholar
  68. Pierce LJ, Phillips KA, Griffith KA, Buys S, Gaffney DK, Moran MS, Haffty BG, Ben-David M, Kaufman B, Garber JE, Merajver SD, Balmana J, Meirovitz A, Domchek SM (2010) Local therapy in BRCA1 and BRCA2 mutation carriers with operable breast cancer: comparison of breast conservation and mastectomy. Breast Cancer Res Treat 121(2):389–398. doi: 10.1007/s10549-010-0894-z PubMedCrossRefGoogle Scholar
  69. Pinero-Madrona A, Nicolas-Ruiz F, Galindo-Fernandez PJ, Illana-Moreno J, Canteras-Jordana M, Parrilla-Paricio P (2007) Technical features of interest in lymphatic basin localization in breast cancer sentinel lymph node biopsy. Cir Esp 81(5):264–268. 13101822[pii]PubMedCrossRefGoogle Scholar
  70. Pocard M, Pouillart P, Asselain B, Falcou MC, Salmon RJ (2001) hepatic resection for breast cancer metastases: results and prognosis (65 cases). Ann Chir 126(5):413–420. S0003394401005260[pii]PubMedCrossRefGoogle Scholar
  71. Poortmans P (2007) Evidence based radiation oncology: breast cancer. Radiother Oncol 84(1):84–101. doi: 10.1016/j.radonc.2007.06.002 PubMedCrossRefGoogle Scholar
  72. Poortmans PM, Venselaar JL, Struikmans H, Hurkmans CW, Davis JB, Huyskens D, van Tienhoven G, Vlaun V, Lagendijk JJ, Mijnheer BJ, De Winter KA, Van der Hulst MH, Van den Bogaert WF (2001) The potential impact of treatment variations on the results of radiotherapy of the internal mammary lymph node chain: a quality-assurance report on the dummy run of EORTC phase III randomized trial 22922/10925 in stage I–III breast cancer(1). Int J Radiat Oncol Biol Phys 49(5):1399–1408. S0360301600015492[pii]PubMedCrossRefGoogle Scholar
  73. Poortmans P, Kouloulias VE, Venselaar JL, Struikmans H, Davis JB, Huyskens D, van Tienhoven G, Hurkmans C, Mijnheer B, Van den Bogaert W (2003) Quality assurance of EORTC trial 22922/10925 investigating the role of internal mammary–medial supraclavicular irradiation in stage I-III breast cancer: the individual case review. Eur J Cancer 39(14):2035–2042. S0959804903004556[pii]PubMedCrossRefGoogle Scholar
  74. Poortmans P, Bartelink H, Horiot JC, Struikmans H, Van den Bogaert W, Fourquet A, Jager J, Hoogenraad W, Rodrigus P, Warlam-Rodenhuis C, Collette L, Pierart M (2004) The influence of the boost technique on local control in breast conserving treatment in the EORTC ‘boost versus no boost’ randomised trial. Radiother Oncol 72(1):25–33. doi: 10.1016/j.radonc.2004.03.007 PubMedCrossRefGoogle Scholar
  75. Ragaz J, Olivotto IA, Spinelli JJ, Phillips N, Jackson SM, Wilson KS, Knowling MA, Coppin CM, Weir L, Gelmon K, Le N, Durand R, Coldman AJ, Manji M (2005) Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the british columbia randomized trial. J Natl Cancer Inst 97(2):116–126. doi: 10.1093/jnci/djh297 PubMedCrossRefGoogle Scholar
  76. Rapiti E, Verkooijen HM, Vlastos G, Fioretta G, Neyroud-Caspar I, Sappino AP, Chappuis PO, Bouchardy C (2006) Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis. J Clin Oncol 24(18):2743–2749. doi: 10.1200/JCO.2005.04.2226 PubMedCrossRefGoogle Scholar
  77. Reed VK, Cavalcanti JL, Strom EA, Perkins GH, Oh JL, Tereffe W, Yu TK, Yeung H, Whitman GJ, Bedrosian I, Macapinlac HA, Buchholz TA, Woodward WA (2008) Risk of subclinical micrometastatic disease in the supraclavicular nodal bed according to the anatomic distribution in patients with advanced breast cancer. Int J Radiat Oncol Biol Phys 71(2):435–440. doi: 10.1016/j.ijrobp.2007.10.025 Google Scholar
  78. Ruiterkamp J, Voogd AC, Bosscha K, Tjan-Heijnen VC, Ernst MF (2010) Impact of breast surgery on survival in patients with distant metastases at initial presentation: a systematic review of the literature. Breast Cancer Res Treat 120(1):9–16. doi: 10.1007/s10549-009-0670-0 PubMedCrossRefGoogle Scholar
  79. Schnitt SJ, Abner A, Gelman R, Connolly JL, Recht A, Duda RB, Eberlein TJ, Mayzel K, Silver B, Harris JR (1994) The relationship between microscopic margins of resection and the risk of local recurrence in patients with breast cancer treated with breast-conserving surgery and radiation therapy. Cancer 74(6):1746–1751PubMedCrossRefGoogle Scholar
  80. Shahar KH, Buchholz TA, Delpassand E, Sahin AA, Ross MI, Ames FC, Kuerer HM, Feig BW, Meric-Bernstam F, Babiera GV, Singletary SE, Akins JS, Mirza NQ, Hunt KK (2005) Lower and central tumor location correlates with lymphoscintigraphy drainage to the internal mammary lymph nodes in breast carcinoma. Cancer 103(7):1323–1329. doi: 10.1002/cncr.20914 PubMedCrossRefGoogle Scholar
  81. Sherry MM, Greco FA, Johnson DH, Hainsworth JD (1986) Metastatic breast cancer confined to the skeletal system. An indolent disease. Am J Med 81(3):381–386. doi: 10.1016/0002-9343(86)90286-X PubMedCrossRefGoogle Scholar
  82. Sickles EA (1995) Management of probably benign breast lesions. Radiol Clin North Am 33(6):1123–1130PubMedGoogle Scholar
  83. Smith BD, Arthur DW, Buchholz TA, Haffty BG, Hahn CA, Hardenbergh PH, Julian TB, Marks LB, Todor DA, Vicini FA, Whelan TJ, White J, Wo JY, Harris JR (2009) Accelerated partial breast irradiation consensus statement from the american society for radiation oncology (astro). Int J Radiat Oncol Biol Phys 74(4):987–1001. doi: 10.1016/j.ijrobp.2009.02.031 PubMedCrossRefGoogle Scholar
  84. Straver ME, Loo CE, Rutgers EJ, Oldenburg HS, Wesseling J, Vrancken Peeters MJ, Gilhuijs KG (2010a) MRI-model to guide the surgical treatment in breast cancer patients after neoadjuvant chemotherapy. Ann Surg 251(4):701–707. doi: 10.1097/SLA.0b013e3181c5dda3 CrossRefGoogle Scholar
  85. Straver ME, Meijnen P, van Tienhoven G, van de Velde CJ, Mansel RE, Bogaerts J, Duez N, Cataliotti L, Klinkenbijl JH, Westenberg HA, van der Mijle H, Snoj M, Hurkmans C, Rutgers EJ (2010b) Sentinel node identification rate and nodal involvement in the EORTC 10981–22023 amaros trial. Ann Surg Oncol 17(7):1854–1861. doi: 10.1245/s10434-010-0945-z CrossRefGoogle Scholar
  86. Strom EA, Woodward WA, Katz A, Buchholz TA, Perkins GH, Jhingran A, Theriault R, Singletary E, Sahin A, McNeese MD (2005) Clinical investigation: regional nodal failure patterns in breast cancer patients treated with mastectomy without radiotherapy. Int J Radiat Oncol Biol Phys 63(5):1508–1513. doi: 10.1016/j.ijrobp.2005.05.044 PubMedCrossRefGoogle Scholar
  87. Tanis PJ, Nieweg OE, Valdes Olmos RA, Kroon BB (2001) Anatomy and physiology of lymphatic drainage of the breast from the perspective of sentinel node biopsy. J Am Coll Surg 192(3):399–409. S1072-7515(00)00776-6[pii]PubMedCrossRefGoogle Scholar
  88. Urban JA, Marjani MA (1971) Significance of internal mammary lymph node metastases in breast cancer. Am J Roentgenol Radium Ther Nucl Med 111(1):130–136PubMedGoogle Scholar
  89. van den Broek N, van der Sangen MJ, van de Poll-Franse LV, van Beek MW, Nieuwenhuijzen GA, Voogd AC (2007) Margin status and the risk of local recurrence after breast-conserving treatment of lobular breast cancer. Breast Cancer Res Treat 105(1):63–68. doi: 10.1007/s10549-006-9431-5 PubMedCrossRefGoogle Scholar
  90. van der Laan HP, Dolsma WV, Maduro JH, Korevaar EW, Hollander M, Langendijk JA (2007) Three-dimensional conformal simultaneously integrated boost technique for breast-conserving radiotherapy. Int J Radiat Oncol Biol Phys 68(4):1018–1023. doi: 10.1016/j.ijrobp.2007.01.037 PubMedCrossRefGoogle Scholar
  91. van der Laan HP, Dolsma WV, Schilstra C, Korevaar EW, de Bock GH, Maduro JH, Langendijk JA (2010) Limited benefit of inversely optimised intensity modulation in breast conserving radiotherapy with simultaneously integrated boost. Radiother Oncol 94(3):307–312. doi: 10.1016/j.radonc.2010.01.024 Google Scholar
  92. van der Zee J, van der Holt B, Rietveld PJ, Helle PA, Wijnmaalen AJ, van Putten WL, van Rhoon GC (1999) Reirradiation combined with hyperthermia in recurrent breast cancer results in a worthwhile local palliation. Br J Cancer 79(3–4):483–490. doi: 10.1038/sj.bjc.6690075 PubMedCrossRefGoogle Scholar
  93. van Mourik AM, Elkhuizen PH, Minkema D, Duppen JC, van Vliet-Vroegindeweij C (2010) Multiinstitutional study on target volume delineation variation in breast radiotherapy in the presence of guidelines. Radiother Oncol 94(3):286–291. doi: 10.1016/j.radonc.2010.01.009 PubMedCrossRefGoogle Scholar
  94. Veronesi U, Luini A, Galimberti V, Marchini S, Sacchini V, Rilke F (1990) Extent of metastatic axillary involvement in 1446 cases of breast cancer. Eur J Surg Oncol 16(2):127–133PubMedGoogle Scholar
  95. Voogd AC, Nielsen M, Peterse JL, Blichert-Toft M, Bartelink H, Overgaard M, van Tienhoven G, Andersen KW, Sylvester RJ, van Dongen JA (2001) Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large european randomized trials. J Clin Oncol 19(6):1688–1697PubMedGoogle Scholar
  96. Whelan TJ, Pignol JP, Levine MN, Julian JA, MacKenzie R, Parpia S, Shelley W, Grimard L, Bowen J, Lukka H, Perera F, Fyles A, Schneider K, Gulavita S, Freeman C (2010) Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 362(6):513–520. doi: 10.1056/NEJMp1002985 PubMedCrossRefGoogle Scholar
  97. Whitman GJ, Strom EA (2009) Workup and staging of locally advanced breast cancer. Semin Radiat Oncol 19(4):211–221. doi: 10.1016/j.semradonc.2009.05.006 PubMedCrossRefGoogle Scholar
  98. Yarnold J, Bentzen SM, Coles C, Haviland J (2010) Hypofractionated whole-breast radiotherapy for women with early breast cancer: myths and realities. Int J Radiat Oncol Biol Phys. doi: 10.1016/j.ijrobp.2010.08.035
  99. Yoshimoto M, Tada K, Nishimura S, Makita M, Iwase T, Kasumi F, Okumura S, Sato Y, Nakagawa K (2008) Favourable long-term results after surgical removal of lung metastases of breast cancer. Breast Cancer Res Treat 110(3):485–491. doi: 10.1007/s10549-007-9747-9 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Elizabeth S. Bloom
    • 1
  • Philip Poortmans
    • 2
  • Marianne Aznar
    • 3
  • Thomas A. Buchholz
    • 1
  • Eric A. Strom
    • 1
  1. 1.Division of Radiation OncologyThe University of Texas M. D. Anderson Cancer CenterHoustonUSA
  2. 2.Department of Radiation OncologyInstitute VerbeetenTilburgThe Netherlands
  3. 3.Department of Radiation OncologyRigshospitalet/Copenhagen University HospitalCopenhagenDenmark

Personalised recommendations