Is Breast Irradiation Routinely Necessary Following Conservation Therapy of Breast Cancer?

INTRODUCTION The gradual acceptance of Fisher’s “Alternative Hypothesis” of the biology of breast cancer, as confirmed by numerous prospective trials of the past twenty years, has served to support the validity of breast conservation therapy, Appropriate questions are being raised as to whether irradiation is always necessary, especially in view of current evidence that local recurrence of breast cancer does not appear to adversely affect survival rates. We need to investigate the costslbenefit of accepting a higher rate of local breast cancer occurrence in order to avoid the expense, morbidity, and inconvenience of adjuvant radiation therapy following conservation surgery. Is there a subset of women with a specific group of tumors in whom the omission of radiation would be acceptable? There is no clear answer at present, but the following essays by Drs. Pierce, Lichter, and Nemoto strive to summarize the available data and add clarity to the issue. Eric R. Frykberg, M.D., F.A.C.S. Section Editor