Evaluation of radiotherapy in high-risk breast cancer patients given adjuvant systemic therapy.

The Danish Breast Cancer Cooperative Groups DBCG 82b and c randomized trials are analyzed in order to illustrate the influence of radiotherapy after modified radical mastectomy in high-risk pre- and postmenopausal patients also receiving systemic therapy with respect to loco-regional tumor control, disease-free and overall survival and cardiac mortality. The results from the present randomized studies indicate that adjuvant systemic treatment does not sufficiently prevent local recurrence. An effective loco-regional treatment is therefore required in order to achieve maximal survival benefit from systemic therapy. However the temporary and persistent toxicity following each treatment modalities have to be weighed against the outcome of obtaining an optimum quality of life.