guidelines in focus
Treatment with intensity-modulated radiation therapy (IMRT) for
Sociedade Brasileira de Radioterapia
Marta GN, Hanna SA, Gadia R
February 27, 2014http://dx.doi.org/10.1590/1806-9282.60.06.005
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standar-
dize procedures to assist the reasoning and decision-making of doctors.
The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, de-
pending on the conditions and the clinical status of each patient.
Through the development of four relevant clinical ques-
tions related with the proposed subject, we tried to present
the main evidence for safety, toxicity and effectiveness using
different radiotherapy techniques. The study population
consisted of female patients of all ages with primary breast
cancer treated with radiation therapy to the whole breast,
regardless of histological type, staging, context of treat-
ment (radical, adjuvant or palliative) and whether comor-
bidities were present or not. For this, a systematic review
of the literature was performed in primary scientific re-
search databases (Medline - Pubmed; Embase - Elsevier; Li-
lacs - Bireme; Cochrane Library - Central Register of Con-
trolled Trials). All articles available until July 22, 2013, were
included. The search strategy used for Medline research is
described in Appendix. Articles were selected based on cri-
tical evaluation in search of the best available evidence. Re-
commendations were prepared based on discussion with
the writing group, composed of three members of the Bra-
zilian Society of Radiotherapy. The guideline was reviewed
by an independent group specializing in evidence-based
clinical guidelines. After completion, the guideline was
made available for public consultation for 15 days and the
suggestions forwarded to the writers for evaluation and
consideration into the final text.
Experimental or observational studies of higher con-
Experimental or observational studies of lower consis-
Case reports (non-controlled studies).
Opinions without critical evaluation, based on con-
sensus, physiological studies, or animal models.
To assess the most appropriate method of radiation the-
rapy for treating patients with primary breast tumors.
No conflict of interest informed.
Breast cancer is the most common malignancy (except for
non-melanoma skin tumors) and the leading cause of can-
cer death among women(
According to data from the
National Cancer Institute, in Brazil, for the year 2012,
52,680 new cases were estimated, which corresponds to an
estimated risk of 52 new cases per 100,000 women(
Radical mastectomy, as proposed by Halsted in 1894,
has been the standard treatment for breast cancer regar-
dless of any associated factor. However, in the last 50 years,
there has been a change in surgical approach, following
the trend of breast conservation, whilst continuing to
offer oncological safety. According to this rationale, ad-
juvant radiotherapy (RT) is fundamental to treat all pa-
tients with initial
and invasive tumors who undergo
conservative surgery, as well as those with locally advan-