Although radiation had been shown to be effective in the treatment of breast cancer as far back as 1936 when Sir Geoffrey Keynes first published his series from England, the randomized controlled studies by surgeons Umberto Veronese in Italy and Bernard Fisher in the USA in the early 1980's caused this treatment to be seen to be more widely accepted. Indeed, the most recent NCI Consensus Conference in 1989 states that conservative management with radiation and partial mastectomy is the preferred alternative for most women with early breast cancer.
Conservative management is safe and equivalent to mastectomy for most women.
Also, patients with T3 tumors can be irradiated if the lumpectomy does not result in significant breast asymmetry. Patients with multiple gross tumors in the breast widely spread apart in two quadrants probably are best managed with mastectomy. Patients with associated ductal or lobular carcinoma in situ can be treated with radiation as long as the microscopic margins can be cleared surgically, or there is no more than focal marginal involvement. Patients with axillary involvement are also acceptable candidates, though the nodal involvement implies that they will need chemotherapy first, if they are premenopausal. The technique of radiation therapy for early breast cancer is conceptually simple.