Radiation therapy is used to treat early, locally advanced, recurrent and metastatic breast cancer in conjunction with surgery and/or systemic treatments, depending on patient and disease factors.

In most cases, radiation therapy is recommended for patients with early breast cancer after breast-conserving surgery.

Hypofractionated radiation therapy (a three- to four-week course) should be considered for most patients with early breast cancer undergoing breast-conserving therapy.

Radiation therapy following mastectomy should be considered for selected patients.

Partial breast irradiation (including intraoperative radiation therapy or linac-based) can be considered for selected patients with early breast cancer.

Discussion at an MDM is essential.

Timeframe for starting treatment

• For patients who do not have adjuvant chemotherapy, radiation therapy should begin within eight weeks of surgery.
• For patients who have adjuvant chemotherapy, radiation therapy should begin three to four weeks after chemotherapy.

Training and experience required of the appropriate specialists

Radiation oncologist (FRANZCR or equivalent) with adequate training and experience that enables institutional credentialing and agreed scope of practice within this area.

The training and experience of the radiation oncologist should be documented.

Health service unit characteristics

To provide safe and quality care for patients having radiation therapy, health services should have these features:

• linear accelerator (LINAC) capable of image-guided radiation therapy (IGRT)
• dedicated CT planning
• access to MRI and PET imaging
• automatic record-verify of all radiation treatments delivered
• a treatment planning system
• trained medical physicists, radiation therapists and nurses with radiation therapy experience
• coordination for combined therapy with systemic therapy, especially where facilities are not co-located
• participation in Australian Clinical Dosimetry Service audits
• an incident management system linked with a quality management system.