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M

arta

GN

et

al

.

508

R

ev

A

ssoc

M

ed

B

ras

2014; 60(6):508-511

guidelines in focus

Treatment with intensity-modulated radiation therapy (IMRT) for

breast cancer

T

ratamento

com

radioterapia

de

intensidade modulada

(IMRT)

para

câncer

de mama

Authorship:

Sociedade Brasileira de Radioterapia

Participants:

Marta GN, Hanna SA, Gadia R

Final draft:

February 27, 2014

http://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.

D

escription

of

the

evidence

collection

method

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.

G

rade

of

recommendation

and

strength

of

evidence

A.

Experimental or observational studies of higher con-

sistency.

B.

Experimental or observational studies of lower consis-

tency.

C.

Case reports (non-controlled studies).

D.

Opinions without critical evaluation, based on con-

sensus, physiological studies, or animal models.

O

bjective

To assess the most appropriate method of radiation the-

rapy for treating patients with primary breast tumors.

C

onflict

of

interest

No conflict of interest informed.

I

ntroduction

Breast cancer is the most common malignancy (except for

non-melanoma skin tumors) and the leading cause of can-

cer death among women(

D

).

1

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(

D

).

2

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

in situ

and invasive tumors who undergo

conservative surgery, as well as those with locally advan-