The radiotherapy of advanced breast cancer.

Abstract

The authors discuss the indications for radiotherapy in late breast cancer, retrospectively analysing the experience of the Radiotherapy Department of the Portuguese Institute of Oncology in Lisbon. Treatment results of locally advanced cancer (T4a-b-c) with megavoltage machines (telecobalt therapy) using two different types of fractionation regimes are discussed. They conclude that conventional fractionation remains the best option. In elderly patients, those with ulcerated and bleeding lesions and those with socio-economic problems, it is acceptable to use non-conventional fractionation regimes with a high dose per fraction for the first part of the treatment. Advantages are overall shortening of treatment time without an increase in morbidity although survival is somewhat lower (30% versus 40% at 5 years). The authors also discuss the role of radiotherapy in disseminated disease which, in combination with systemic treatment, may be extremely useful in improving the patient's quality of life--as a way of stopping haemorrhage in bleeding lesions, for pain relief in secondary deposits, to treat superior vena cava syndrome and spinal cord compression, to prevent pathological fractures and last, but not least, to relieve or prevent symptoms such as those caused by brain metastases. The results presented in this paper are in agreement with current literature. Finally, the authors mention the most frequent complications of radiotherapy in late breast cancer as well as the guidelines for supportive care of the irradiated patient with the aim of a complete re-habilitation.