Douglas W. Arthur, MD

The prospect of even more compressed radiotherapy options for women requiring adjuvant breast radiotherapy is exciting. However, we urge readers to be cautious in their interpretation of the current intraoperative literature as they implement their programs.

With the publication of mature experiences using accelarated partial breast irradiation (APBI) and accelerated whole breast irradiation (AWBI), the use of shortened courses of radiotherapy has become increasingly popular.

Conventional radiotherapeutic treatment for early and advancedbreast cancer has been based on broad-field radiation treatment principlesthat date back several decades. Although these strategies havebeen successful, newer techniques now offer the ability to incorporateimproved target imaging, dosimetric planning, and treatment deliveryinto the treatment design. These newer techniques include acceleratedpartial-breast irradiation and hypofractionated whole-breast irradiationfor early-stage breast cancer, and intensity-modulated radiotherapy(IMRT) for both early and advanced breast cancer. Accelerated partial-breast irradiation and hypofractionated whole-breast radiotherapyare treatment approaches that promise both reduced overall treatmenttimes and the potential for increased use of breast-conservation therapy.IMRT offers unparalleled dose homogeneity and conformality thatenables dose reduction to normal structures with the potential to reducetreatment toxicity and improve cosmesis. Based on the publishedliterature, an increasing number of treatment facilities are offering treatmentwith these techniques. However, further clinical study remainsimportant to thoroughly define the appropriate clinical setting, patientselection criteria, and limitations for each of these innovative treatmentapproaches.

Whole-breast external-beam radiation therapy (EBRT) involves a 6-week course of fractionated treatments. In