An argument against routine use of radiotherapy for XXXX .

@entity1 @entity3821 @entity0 @entity5
Three prospective randomized trials have shown that postexcisional radiation therapy can reduce the relative risk of local recurrence by about 50% in conservatively treated @entity1 with @entity3821 ( @entity3821 ). In an era of evidence-based medicine, how then can one possibly take a stand against the routine use of radiation therapy after local excision? Surprisingly, the rationale is straightforward. In some low-risk @entity3821 @entity1 , the costs may far outweigh the potential benefits. In spite of a relative 50% reduction in the probability of local recurrence, the absolute reduction may only be a few percentage points. In addition, the prospective trials focus on local recurrence as their primary end point because it is, by far, the most common untoward event following conservative treatment. Local recurrence is clearly important, but @entity0 -specific survival is, in fact, an even more important end point, and no trial in @entity1 with @entity3821 has ever shown a survival benefit with the use of radiation. Moreover, radiation therapy is not without financial and physical cost. So, if there is no difference in @entity0 -specific survival regardless of the treatment and in some subgroups the absolute benefit from radiation therapy is extremely small, it seems reasonable to attempt to develop a system to select @entity1 with @entity3821 who could be safely treated in the least aggressive way. The University of Southern California/Van Nuys Prognostic Index (USC/VNPI) uses five independent predictors of local recurrence to do exactly that. The combination of @entity5 size, margin width, nuclear grade, age, and the presence or absence of comedonecrosis can be used to identify subgroups of @entity1 with an extremely low probability of developing a local recurrence after excision alone. When accurate measurements of @entity5 size cannot be made, margin width can be used as a surrogate parameter for the USC/VNPI. New oncoplastic techniques that allow more extensive excisions can be used to achieve both acceptable cosmesis and widely clear margins, helping to alleviate the need for radiation therapy in many cases.
