Radiotherapy after breast surgery

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This page describes the decisions why patients receive radiotherapy after breast surgery. For specific information on the techniques and side effects of radiotherapy after breast surgery - click here

Following Wide Local Excision

Treatment usually starts within 6-8 weeks of surgery unless there is a specific medical contraindication. After conservative surgery it is recommended that all patients receive radiotherapy to the breast unless an adverse medical condition. Radiotherapy reduces the risk of relapse from 40% - <5%. The side effects, what to expect, and risks are described on a separate page. 

To the chest wall after mastectomy:-

• The axillary nodes are involved
• The size of the tumour down the microscope was > 5 cm.
• Aggressive looking tumour down the microscope - poorly differentiated (high grade).
• Tumour seen in the blood or lymphatic vessels. 
• Tumour seen close to the edge of the specimen.
• Skin or muscle involvement pre- excision.

To the armpit & supraclavicular area (just above the collar bone)

Again there are no hard and fast rules and every case is considered individually but there is a trend to offer radiotherapy in the following situations, as the risk of local and systemic relapse is improved:-

If Biopsy Proven node positive:-

• If clearance is to level II and the highest nodes are involved and the upper axillary nodes are involved a small supraclavicular field treating the apical nodes may be added.
• If the axilla has been sampled then patients should have radiotherapy to the breast and regional nodes using an anterior supraclavicular field and post axillary boost.

If Node Unknown (including inconclusive sampling). The prognostic factors of the original tumour should be used. Radiotherapy is recommended to be given to the breast and to the regional nodes if:-

• pT2-T4, (Tumour > 5cm)
• pT1 10 mm or more & G3. (tumours greater than 1cm but looks aggressive)
• Lymphatic/vascular invasion. (cancer cells seen in the vessel within the tumour)
• pTc 40mm or more at presentation e.g. primary medical therapy patients. (patients who had chemotherapy alone who's tumours were clinically before chemotherapy but achieved complete remission > 4 cm)