Radiotherapy has withstood the test of time and has become an indispensable part of the multimodality treatment of carcinoma breast. Radiotherapy adds onto the benefit both in terms of progression free survival and overall survival. That is a well-established fact amongst scientific community on the backdrop of numerous well conducted research work spanning over decades.
Since the inception of radiotherapy in the cancer management in general, there has been a constant cynicism with regard to the use of ionizing radiation and the side effects associated with the treatment done using them. Radiation oncology has been in a constant melee to fend off the stigma attached to the use of ionizing radiation in oncology clinics. Riding on the astounding technological progress made in the way radiation treatment is being planned and delivered, radiation community has been able to mitigate most of the doubts with regard to the safety of radiotherapy. Radiation treatment now a days is meticulously planned on planning CT scans and delivered with daily imaging confirmations of the planned areas to be treated leaving very little chances for toxicities. Techniques like DIBH (deep inspiratory breath hold) have only cemented the safety profile of the breast radiotherapy further by minimizing the dose to the heart. With the addition of protons and other heavy particles to the ever-evolving armamentarium of radiation oncologists the delivery of radiation has only become safer in breast cancer patients with several trials being underway to substantiate these early results.
Radiation oncologists have been able to take note of the unique radiobiological properties of breast tissue and utilize that to squeeze the treatment to 3 weeks rather than the conventional 5 weeks with equivalent results both in terms of tumour control as well as from toxicity point of view. Newer trials have taken a major leap in shortening of the overall treatment time to only a week with sustained benefit and acceptable long-term sequelae.
With the technology involved in the radiation treatment making enormous strides stepping into the future, the effectivity and safety involved in the radiation treatment of breast cancer is only going to get better than ever and it will continue to be an inseparable part of the management of this malignancy whose incidence is on the rise.
Dr. Kundan Singh Chufal
Sr. Consultant & Chief of Breast & Thoracic Radiation Oncology