ABSTRACT
A boost of irradiation to the site of tumor excision has been shown to improve local control at 10 years in both younger and older women, although reduction in rates of local recurrence was <5% for women aged >60 years. Breast conservative surgery followed by whole breast irradiation remains the standard treatment for early breast cancer: randomized trials conducted during the 1970s to the 1990s established the efficacy of breast-conservation therapy as an alternative to mastectomy. Oncoplastic breast surgery has become widespread, with a variety of plastic surgery techniques employed to provide an aesthetically improved breast shape. Oncoplastic breast-conserving surgical techniques with parenchymal rearrangement present fresh challenges in terms of localization of the tumor bed and subsequent delivery of a local radiotherapy boost. Brachytherapy delivers a high dose over a short time period within a reduced volume and can be adapted for treatment of deeply placed target volumes in large voluminous breasts.
