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Radiotherapy Radiation Therapy in Male Breast Cancer Hilary P Bagshaw, MD, 1 Jordan M Cloyd, MD, 2 Matthew M Poppe, MD 3 and Irene L Wapnir, MD 4 1. Resident Physician, Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, US; 2. Resident Physician, Department of Surgery, Stanford University, California, US; 3. Assistant Professor, Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, US; 4. Professor, Department of Surgery, Stanford University, California, US Abstract Male breast cancer (MBC) is a relatively rare disease and because the dedicated literature on MBC is limited, management typically follows guidelines established for female breast cancer (FBC). Although radiation therapy (RT) constitutes a critical role in the treatment of MBC, several unique challenges influence its use. Most men with breast cancer present at an older age with more extensive and advanced stage disease than women. In contrast to the predominance of breast conservation therapy in women with breast cancer, the majority of men are treated with mastectomy, with or without post-mastectomy radiation. Although no prospective or randomized trials are available, retrospective data suggests that surgery followed by adjuvant RT significantly improves locoregional control (LRC) in men. This article reviews the utilisation, efficacy, and complications associated with adjuvant RT in MBC. Keywords Male breast cancer, radiotherapy, adjuvant, outcomes, locoregional control, survival Disclosure: The authors have no conflicts of interest to declare. Received: November 1, 2013 Accepted: November 22, 2013 Citation: Oncology & Hematology Review, 2014;10(1):61–5 Correspondence: Jordan M Cloyd, MD, Department of Surgery, Stanford University, 300 Pasteur Dr, MC5641, Stanford, CA, US. E: jcloyd@stanford.edu In the US, approximately 1 % of all breast cancer cases and less than 1 % of all male cancers are male breast cancer (MBC) cases. An estimated 2,240 cases of MBC will be diagnosed in the US in 2013 compared with 232,340 cases of female breast cancer (FBC). 1 Due to its rarity, large prospective studies and randomized controlled trials focused on treatment options for MBC are not available. Management, therefore, has been largely dependent on results from large trials in women with breast cancer. Several unique challenges exist in men with breast cancer that influence the role of adjuvant radiotherapy (RT). Men are not screened for breast cancer and commonly present at an older age and higher stage than women, and are more likely to present with a palpable mass that is centrally located. 2,3 Due to the location and the low volume of normal breast tissue in men, there is a high propensity for nipple, chest wall, and nodal involvement 3,4 resulting in more advanced stage at diagnosis and possibly greater need for post-mastectomy radiation (PMRT). 2 Based on data from randomized clinical trials, adjuvant RT improves locoregional control (LRC) following lumpectomy and radiation in many circumstances. 5–8 In this article, we review the literature associated with the role of adjuvant RT in MBC. Role of Radiation Therapy in Locoregional Control Post-mastectomy Radiotherapy In the US, PMRT has traditionally been indicated in women with four or more positive lymph nodes, T3 tumours, or stage III disease. 9,10 Multiple randomized trials have demonstrated improvement in LRC and overall survival (OS) with the addition of PMRT (see Table 1). The Danish 82b trial © To u ch MEd ica l MEdia 201 4 demonstrated the use of PMRT, in conjunction with systemic chemotherapy, reduced local failure (LF) by 23 % and improved disease-free survival (DFS) and OS by 14 % and 9 %, respectively. 7 In the Danish 82c trial the use of PMRT, in addition to hormonal therapy, reduced LF by 27 % and improved OS by 9 %. 8 The British Columbia trial similarly demonstrated a reduction in LF of 16 % with an OS improvement of 10 % with the addition of PMRT to adjuvant chemotherapy. 11 For women with one to three positive nodes, the indications for PMRT are more controversial. A subgroup analysis of the Danish 82b and 82c trials included only patients with eight or more nodes removed, demonstrating that PMRT improved 15-year survival in all patients, and reduced LF rates in both groups of women with one to three positive nodes and four or more positive nodes. 12 The presence of high-risk features including young age, nodal ratio (number of positive nodes compared with number of nodes examined), lymphovascular invasion, extracapsular extension, margin status, and histological grade 13 also influence physician recommendations for PMRT. The standard treatment for PMRT is currently 30 treatments to the chest wall, level I–III axillary nodes, supraclavicular nodes and, in certain cases, internal mammary nodes, delivered 5  days per week. Hypofractionated regimens, or shorter treatment courses with larger doses of RT per treatment, are not commonly offered post-mastectomy due to limited data. Breast Conservation Therapy Breast conservation therapy (BCT) is defined as partial mastectomy (e.g. lumpectomy, segmentectomy, quandrectomy) followed by RT with 61