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Locoregional Therapy in Breast Cancer

Published Online: June 3rd 2011 European Oncology, 2009;5(1):45-7 DOI: https://doi.org/10.17925/EOH.2009.05.1.45
Authors: Lorenzo Livi
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Breast cancer is the most common cancer in women. In 2004, estimates were that about 215,990 women and approximately 1,500 men in the US would be diagnosed with invasive breast cancer. Surgery and radiotherapy, either alone or combined, remain the most effective techniques to treat cancer. Surgical procedures have been clearly defined by several randomised clinical trials that demonstrated equivalent survival with breast-conservation surgery combined with radiotherapy versus mastectomy. In the last few years, in order to avoid the risk of lymphoedema caused by axillary dissection, in patients free from axillary lymph node metastases sentinel lymph node biopsy has been widely accepted as a standard of care. The use of whole-breast irradiation with or without a boost is the standard of care at present. The value of adding nodal irradiation to the breast irradiation is unproven. Local control is influenced not only by treatment modalities but also by screening programmes, allowing the possibility of identifying smaller and smaller lesions. Nowadays, local control for breast cancer is a fundamental part of treatment. The surgical approach is tailored towards conservation of the breast and good-looking cosmesis, while radiotherapy is tailored towards reduction of treated volume to reduce damage and to spare time and cost.

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At the beginning of the third millennium, one in three EU citizens will have to deal with cancer in the course of his or her life. Worldwide, the estimated number of new cancer cases is expected to rise from 10 million in 2000 to 15 million by 2020. Currently, cancer is the cause of 12% of all deaths worldwide. In the EU, over 1.5 million new cancer cases are diagnosed every year, and over 920,000 people die of cancer, the most common cancer sites being the breast and the prostate. About 90% of cured patients recover because of locoregional control; 18% of all patients die because of a primary tumour without metastases. This means that local treatment is as important as systemic therapy.

Breast cancer is the most common cancer in women. In 2004 it was estimated that 215,990 women and 1,500 men in the US would be diagnosed with invasive breast cancer. In the last decade there has been a 21% decrease in age-adjusted mortality from breast cancer.1 The decline in mortality has been attributed to early detection of the disease and to the use of aggressive multimodality treatment leading to improved clinical outcomes.

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