The radiation oncologist is involved in the management of breast cancer patients throughout the spectrum of the disease: fromadjuvant treatment of early and locally advanced stage to palliative treatment of metastasis. In the adjuvant setting there are two distinct clinical situations; (1) treatment of the breast only following breast conserving surgery for early stage disease and (2) treatment to the breast|chest wall and regional nodes for locally advanced disease. The use of radiotherapy in these clinical settings has been shown to improve local, local-regional control and overall survival [1-4]. When radiotherapy was first introduced into these clinical settings, broad field designs were used. These original broad fields were simplistic in design, and limited by the planning and treatment delivery systems available. However, because of their simplicity, success in reducing disease recurrence, and ease of implementation, these treatment techniquesquicklybecamewidely adopted. In fact, themajorityof treatment centers today continue the same general disease management principles and treatment approaches originally designed and practiced in the 1970s and 1980s. Although upgraded field matching techniques and CT based treatment planning have been incorporated in many centers, minimal modifications have been made until recentlywith the emergence of image based treatment planning and advanced, intensity modulated radiotherapy delivery techniques. Intensity Modulated Radiotherapy (IMRT) in the treatment of breast cancer offers improved dose conformality and homogeneity. Only through appropriate investigation will we be able to determine whether this improvement in dose delivery actually translates into a clinical benefit and, therefore, justify widespread adoption of this treatment technology.
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