Radiation Therapy for Invasive Lobular Carcinoma of the Breast

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Considerations for radiation therapy (RT) in locoregional control, once more generally common among the ductal and lobular cancer types, are summarized here (Figure)
  • Adjuvant whole breast RT:
    • Reduces the risk of both local regional recurrence (LRR) and death from breast cancer after BCS and is a necessary element of BCT
  • Additional regional nodal irradiation:
    • May also be indicated for those with involved lymph nodes or high-risk tumors
  • It is noteworthy that it may be acceptable to omit RT:
    • Among elderly women with select low-risk, ER-positive tumors:
      • Data to support this include the Cancer and Leukemia Group B (CALBG) 9343 randomized trial of women age 70 years or older with stage I ER-positive cancers treated with lumpectomy and tamoxifen with or without RT:
        • Which demonstrated no advantage in
          overall survival          :
          • Although there was a small improvement in LRR among those treated with RT
  • Accelerated partial breast irradiation (APBI):
    • Is a newer technique involving more focused RT
      delivered in higher doses over a shorter time span
    • Notably, the recent American Society for
      Radiation Oncology (ASTRO) guideline update cites lobular histology as a criterion for “cautionary” use of APBI outside of a clinical trial
  • Postmastectomy RT:
    • May also benefit selected patients, a decision generally made by consideration of the presence of:
      • Macrometastatic nodal involvement
      • Large tumor size
      • High-risk disease features
    • It is important to note that the implications of margins at mastectomy remain controversial among radiation oncologists, and there are no data to support a definite benefit of postmastectomy RT in patients with close margins
    • Similar to surgical and systemic therapy trials, ILC patients comprise a minority in postmastectomy RT trials
    • A recent study using Survival, Epidemiology, and End Results (SEER) data including 12,703 ILC patients treated from 2004 to 2009, of which 26% had a definite indication for postmastectomy RT:
      • Found an improvement in 5-year overall survival and disease-specific survival from 80.9% to 84.7% (p = .0003) among ILC patients, a benefit to the same degree as IDC:
        • These data support continued decision
          making for radiotherapy using existing criteria, regardless of cancer histology
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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