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Pre-operative Irradiation in the Treatment of Breast Cancer: A Critical Appraisal

  • A. De Schryver
Part of the Handbuch der Medizinischen Radiologie / Encyclopedia of Medical Radiology book series (HDBRADIOL, volume 19 / 2)

Abstract

Ever since Gocht (1897) published his first — if somewhat questionable — observations concerning the effect of the “Roentgen rays” on two cases of advanced breast cancer, radiologists have endeavoured to make a meaningful contribution to the treatment of this disease. Those were the days of the breakthrough of radical surgery pioneered by Halsted (1894), Meyer (1894) and others, and it is just possible that the enthusiasm created in the wake of their first surgical reports may have contributed to the delay in exploration of the still untested, but anticipated possibilities of the new method. Understandably perhaps, we have to wait for more than a quarter of a century before reports concerning the pre-operative use of radiation treatment in breast cancer make their appearance in the literature. Whereas it would not have been difficult for most surgeons to adopt this new adjuvant therapeutic modality (whose cancericidal properties had been documented for a number of different tumours at a very early date, e.g. in the Béclère report of 1907) after their intervention, they would have been more hesitant about letting it interfere beforehand with the organs they would have to operate upon afterwards. And yet there were some plausible reasons to expect some benefit from the pre-operative use of radiation. In the words of Laborde (1925), one of the pioneers of French radiotherapy,

… in view of the extensive and potentially involved area of lymphatic drainage, no surgical operation, however large, can guarantee against recurrence... It would therefore seem logical to apply the radiation pre-operatively with the aim of preventing any spread of the tumour to both skin and lymph nodes, because adequately irradiated cancer cells should no longer be capable of forming colonies.

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