Partial breast irradiation: when less could be more
Breast cancer is the most commonly diagnosed cancer in Brazilian women and the leading causing of cancer death among them. Breast-conserving surgery (BCS) followed by whole breast radiotherapy has become the standard care for early breast cancer. Although the omission of adjuvant breast radiotherapy has been associated with worse oncological outcomes, distance from treatment centers directly affects the employment of adjuvant breast irradiation. In addition to distance, patients from low- and middle-incoming countries suffers from a paucity of radiotherapy centres. It was estimated that 46.6% of the oncological patients requiring radiation therapy for a new primary cancer in 2016 did not received this treatment in the Brazilian public health system. Accelerated partial breast irradiation significantly reduces the treatment time and have the potential to overcome the logistics and social barriers related to adjuvant breast irradiation. During the lasts 30 years, 8 randomized phase III clinical trials showed that partial breast irradiation is a safe, effective, and convenient treatment for selected early breast cancer patients. At AC Camargo Cancer Center experience, for selected patients, partial breast irradiation achieved a 10 years local control of 95.6%. At Angelina Caron Hospital, a regional reference for cancer treatment in the state of Paraná, the median traveled distance from patients home to the radiotherapy department is 24 Km (11–287 Km). The implementation of partial breast irradiation, specially the intraoperative technique, could save patients a median of 1,440 traveled distance.