Breast conservation + radiotherapy: a combined effort to preserve the "beauty" of breast cancer patients!

1. What is breast-conserving surgery?

Experts from Yiyang Central Hospital said that breast-conserving surgery for breast cancer is different from the traditional one-size-fits-all approach. Instead, it removes the breast tumor and some normal tissue around it, while maintaining the integrity of the breast shape as much as possible while ensuring a negative margin. This can not only improve the quality of life of female patients, but also enhance their self-esteem and sense of happiness.

2. Why is radiotherapy necessary after breast-conserving surgery?

Breast cancer is like a pest on a branch of a tree. Traditional surgery is like uprooting the tree and clearing away the soil, which is simple, crude but effective.

Breast-conserving surgery is aimed at preserving the breast tree. Simply pruning a branch that is infested with insects cannot ensure that hidden/scattered pests are removed. Therefore, there is a risk of reinfestation or even spread of the infestation, which is a risk of local recurrence.

At this time, radiotherapy to the breast can eliminate hidden dangers and kill cancer cells that may have been missed, thereby reducing the risk of recurrence and prolonging survival.

As early as the 1980s, many foreign studies have shown that breast conservation + radiotherapy can achieve the same survival benefit as modified radical mastectomy , and breast conservation + radiotherapy can reduce the risk of local recurrence by 2/3 compared with breast conservation alone, thereby further reducing the risk of death. Since then, radiotherapy has become a routine treatment method after breast conservation surgery. Breast conservation and radiotherapy are like a combination of punches, neither of which can be missing.

3. When should radiotherapy begin after breast-conserving surgery?

If there is no indication for chemotherapy after surgery, it is recommended to start radiotherapy within 8 weeks after surgery;

If chemotherapy is indicated, the order of chemoradiotherapy should be determined by comprehensively considering the patient's tumor condition;

If the tumor margin is positive or the margin is close or unknown, radiotherapy followed by chemotherapy is recommended;

If there are high-risk factors such as axillary lymph node metastasis and negative progesterone receptor, chemotherapy is recommended followed by radiotherapy.

There is no conflict between targeted therapy, endocrine therapy and radiotherapy, and they can be performed simultaneously or sequentially.

4. Is radiotherapy necessary after breast-conserving surgery for ductal carcinoma in situ?

Ductal carcinoma in situ is the earliest stage of breast cancer, also known as stage zero breast cancer. It is a tumor that theoretically will not metastasize and is usually treated with breast-conserving surgery. However, studies have shown that the risk of local recurrence of ductal carcinoma in situ after 10 years of breast-conserving surgery alone is as high as 15%, while breast-conserving surgery plus radiotherapy can reduce the risk of local recurrence by 50% .

At present, both foreign and domestic official guidelines recommend radiotherapy for ductal carcinoma in situ after breast-conserving surgery. Postoperative radiotherapy can only be considered for exemption if the comprehensive assessment shows that the risk of recurrence is low or there are contraindications to radiotherapy.

5. Which patients do not need radiotherapy after breast-conserving surgery?

Only patients who are older (≥65 years old), have early stage (primary lesion ≤3cm without vascular invasion and histological grade III, or primary lesion ≤2cm with negative margin), have good molecular typing (hormone receptor positive) and can receive a full course of endocrine therapy, and who meet the above requirements, can be considered for not receiving radiotherapy after breast-conserving surgery . Therefore, for patients who undergo breast-conserving surgery, the vast majority of them must receive postoperative radiotherapy.

References

[1] Guidelines for Radiotherapy of Breast Cancer (Chinese Medical Association 2020 Edition)

[2] Chinese Anti-Cancer Association (CACA) Breast Cancer Diagnosis and Treatment Guidelines (2024 Edition)

Hunan Medical Chat Special Author: Yao Xiaoyi, Yiyang Central Hospital

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(Edited by YT)