Levitt S H
Department of Therapeutic Radiology, University of Minnesota Hospital, Minneapolis 55455.
Strahlenther Onkol. 1991 Sep;167(9):505-8.
Irradiation is a local treatment which must be delivered to the appropriate areas, with appropriate dosage and careful attention to avoiding excess dosage to normal tissues. Despite the negative reports of meta analyses of randomized adjuvant radiation trials, there has recently been a renewed interest in local regional irradiation by a number of factors: adjuvant chemotherapy fails to affect the incidence of locoregional recurrences in patients with four or more positive nodes; the benefits in prospective randomized and non randomized trials of large numbers of patients who were not treated with chemotherapy are well documented; analysis of the Cuzick meta-analysis and the recent long-term reports of the CRC and Manchester studies have demonstrated that they are not reliable. Locoregional recurrences following adjuvant chemotherapy alone are in the chest wall, internal memory and supraclavicular areas. We recommend no nodal irradiation in node negative patients and internal mammary and supraclavicular irradiation in node positive patients. However, irradiation to the axilla is indicated in patients in whom the axilla has not been dissected, the nodes are large and/or the tumor has extended from the nodes into the axilla. 50 Gy target dose is to be delivered in 1.8-2.0 Gy fractions and an additional 10 Gy boost to areas with possible tumor invasion in more advanced cancers.
