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Local control by radiotherapy: is that all there is?

DOI: 10.1186/bcr2160

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Abstract:

Local control by radiotherapy has been associated with significantly improved breast cancer-specific survival.The Early Breast Cancer Trialists meta-analysis of the data available from 42,000 breast cancer patients who had participated in 78 contemporary prospective randomized trials (that had started after 1995) has provided invaluable information on the relationship between local control and patients' overall and breast cancer-specific survival [1]. Over a time span of 15 years, for every four local recurrences avoided through optimal application of local treatment, one death from breast cancer could be prevented – with the consequent reduction on 15-year overall mortality. Noticeably the proportional benefit derived by receiving radiotherapy was detected in all patient subsets, independently of patient and tumor characteristics or type of primary surgery (breast conservation versus mastectomy).This evidence has generated among the breast cancer research community a new wave of reflection on the biology of breast cancer and the effects of available treatment. An example is Dr Punglia and coworkers' editorial in the New England Journal of Medicine, which engages in a comprehensive analysis to interpret the consequences of local control on breast cancer survival [2]. These authors, however, suggest that achieving optimization of systemic therapy will eventually remove the benefit derived by adding radiotherapy to the management of breast cancer.We propose a different view, which attributes to radiotherapy unique biological effects capable of directly and specifically interfering with metastasis of breast cancer.The fact that the benefit occurred only in the context of successful local control suggests that events within the irradiated field are implicated. Until recently, however, the underlying mechanism of this connection remained elusive. A commonly accepted hypothesis is that optimization of local control, by adding radiotherapy to complement surgery, recruits i

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