1. Radiotherapy in Carcinoma of the Breast Patrick S Swift, MD Director, Radiation Oncology Alta Bates Comprehensive Cancer Center Berkeley, CA

3. Distant Failure 34% 32% 6 859 1983-89 Denmark 82TM 30% 34% 10 903 1980-86 EORTC 10801 39% 34% 20 279 1979-89 US NCI 40% 33% 20 1406 1976-84 NSABP06 54% 51% 20 701 1973-80 Milan I 23% 24% 22 yrs 179 1972-79 WHO BCT Mast. Time pt. # Trial

4. Overall Survival 67% 67% 6 859 1983-89 Denmark 82TM 82% 79% 10 903 1980-86 EORTC 10801 65% 66% 20 279 1979-89 US NCI 53% 58% 20 1406 1976-84 NSABP06 46% 47% 20 701 1973-80 Milan I 42% 41% 22 yrs 179 1972-79 WHO BCT Mast. Time pt. # Trial

10. Treatment by Stage

18. Van Nuys Prognostic Index Scores of 3-4 - 98% local control without RT Scores of 5-7 - 32% failed without RT, 16% with RT Scores of 8-9 - 100% failure without RT, 60% with RT

20. ASTRO 2008 Plenary 42.5 Gy in 16 fractions v. 50 Gy in 25 fractions

28. Full SCLV Field

29. IM Nodal Radiation Technique

32. Post-MRM RT Trials (all with chemo and modern RT) 36% 35% No RT 45% 8% RT 1375 Danish 82c 46% 33% No RT 54% 13% RT 318 Vancouver 45% 32% No RT 54% 9% RT 1708 Danish 82b Overall Survival Local failure