Radiation therapy and breast cancer. Past, present, and future.

After radical mastectomy, postoperative irradiation unquestionably diminishes the incidence of local-regional failures, and there are series in which the survival rates are improved for a subset of patients. The comparative survival rates shown in Table 6 suggest that adjuvant postoperative irradiation produces survival benefits. For more advanced tumors, simple mastectomy and axillary dissection with chemotherapy and irradiation is effective, with the optimal sequence still to be determined. In selected patients, tumorectomy and irradiation produce survival rates equivalent to radical mastectomy with very satisfactory cosmetic results. In all situations, gross masses in the breast and axilla should be removed leaving for irradiation only subclinical disease that is controlled with doses that do not produce significant sequelae.