Irradiation techniques are described which are adapted according to the types and extent of surgery which have been performed for operable breast cancer. Following a radical or modified radical mastectomy, the technique varies depending on the need to irradiate the axilla. Irradiation to the axilla is unnecessary if the axilla contained operable disease without histologic evidence of extranodal disease, and if the axillary dissection was surgically adequate. T h e chest wall is irradiated in those patients with a significant risk of recurrent disease in the chest wall. Following a total mastectomy or a wedge excision, the whole axilla must be irradiated. The chest wall or the retained breast is, of course, irradiated.
E ARE NOT CONCERNED HERE WITH THE
treatment of technically inoperable advanced local disease, and also not basically concerned with clinically inoperable cancers, using criteria similar to those of Haagensen. However, patients are sent to the radiotherapist after clinically contraindicated surgery, and the treatment must be adjusted to the original tumor situation. Even in patients with clinically operable tumors, the anatomic areas most likely to be involved vary with the characteristics of the disease and the surgical procedure. The adjustment of the postoperative irradiation techniques to the various types of surgical procedures which are now being used in the management of breast cancer are discussed here. They are:
- Wedge excision of a small tumor.