Jay R. Harris, MD

Given their greater convenience and, in most cases, decreased costs, APBI and AWBI are becoming increasingly popular alternatives to conventional WBI for early-stage breast cancer patients who desire BCT. However, given the protracted time to local recurrence and complications following BCT, definitive results from randomized clinical trials comparing conventional WBI vs AWBI or APBI are limited.

Breast cancer is the most commonly diagnosed cancer among women in the United States.[1] Since the early 1990s, breast cancer mortality has steadily declined,[2] and statistical modeling using a Bayesian approach attributes these declining mortality rates to both earlier diagnosis and more effective treatments.[3]

Drs. Lannin and Haffty’s comprehensiveand thoughtful reviewof breast cancer recurrencefollowing breast-conservingtherapy details the risk factors forlocal recurrence, factors predictive ofoutcome at the time of a breast recurrence,and prognosis after recurrence.The complex interaction betweenlocal and distant recurrence is alsoexplored; the authors argue thatlocally recurrent disease is both amarker of a more aggressive primarycancer, as well as a potential sourcefor seeding distant sites. Strategiesfor managing local recurrences arealso discussed. We are in agreementwith this excellent review and willtake this opportunity to expand on afew points.

The role of radiation therapy in the management of breast cancer has continued to evolve over the past several years, in both the breast-conserving and postmastectomy settings. In this issue of ONCOLOGY, Dr. William Small provides a thorough yet concise review of current practices in radiation therapy for ductal carcinoma in situ (DCIS), early-stage invasive breast cancer managed conservatively, and postmastectomy situations. These discussions are supported by a well-selected group of publications on each topic. In addition, the author summarizes the available data and some of the controversies surrounding the use of nodal irradiation, especially in this era of sentinel node biopsy. We would like to mention a few points that warrant further discussion.

The article written by Chadha and Axelrod provides a timely discussion of several critical issues in the current debate over the use of axillary lymph node dissection in early-stage breast cancer. As new information and techniques become available, they and others have reassessed the value of axillary lymph node dissection in four key areas: