Synopsis
Select breast, chest-wall and regional radiotherapy after surgery, apply current hypofractionated schedules accurately, and prevent avoidable cardiac, pulmonary and reconstructive harm.
- Offer whole-breast radiotherapy after breast-conserving surgery for invasive cancer unless a defined low-risk omission pathway is agreed; consider radiotherapy after conservation for DCIS.
- Offer postmastectomy radiotherapy for invasive cancer with macrometastatic node positivity or involved resection margins; consider it for node-negative T3 or T4 disease. Reassess both baseline and residual burden after neoadjuvant treatment.
- NICE offers 26 Gy in 5 fractions over 1 week for partial-breast, whole-breast or chest-wall radiotherapy without regional nodal irradiation after conservation or mastectomy.
Investigation priorities
Define tumour size, margins, nodal burden and response that determine radiotherapy indication and fields.
Management branches
A patient has completed breast-conserving surgery for invasive cancer with clear margins and requires whole-breast radiotherapy without nodal irradiation.
- In this illustrative case, a 48-year-old has a healed left-sided conservation wound after excision of a 22 mm invasive cancer with clear radial margins and negative sentinel nodes. The postoperative team confirms an indication for whole-breast treatment and no regional nodal target. Age and other findings are considered explicitly; the older low-risk omission pathway is not assumed to apply.
- Assessment finds no implant reconstruction, significant radiosensitivity diagnosis or positioning limitation that would favour the longer schedule. The patient compares the relevant options and accepts 26 Gy total in five fractions over one week. The team explains that the total is divided into five treatments, not 26 Gy at each attendance.