Improving radiotherapy after breast-conserving surgery.

Drs. Mouw and Harris have reviewed data from randomized clinical trials (RCTs) and from selected institutional experiences with whole breast irradiation (WBI), usually delivered with tangent pair radiation therapy (RT) over 5 to 7 weeks, accelerated whole-breast irradiation (AWBI), usually delivered over 3 to 4 weeks, and accelerated partial-breast irradiation (APBI), usually delivered in a single treatment or via up to a week of twice-daily treatments.[1] The authors conclude that the RCTs demonstrate that AWBI is equivalent to “standard” WBI in terms of 5and 10-year local control, cosmetic outcomes, and breast cancer–specific and overall survival. There is much less long-term data supporting the equivalence of APBI and WBI. The authors are correct to advise caution in selecting patients for APBI, and they emphasize that true rates of long-term morbidity will only be known as a result of ongoing follow-up of patients treated with various APBI techniques.