Management and Workflow

Radiation therapy (RT) is an important modality of breast cancer patients, regardless of disease stage. In breast cancer, in addition to curative indications, RT is a major modality for palliation or symptom control and, recently, used as an ablative non-invasive treatment to oligometastatic patients or in case of oligo-progression. New RT techniques and protocols (limited number of fractions) allow for minimal morbidity and minimal interference with quality of life (QOL) and other cancer treatments. There are a number of RT techniques, and different RT doses and fractionation, which are used according to the clinical indication. In some cases, concomitant treatment of systemic therapy and RT is indicated. However, RT is a complex modality, and there is a need for a multidisciplinary team of radiation oncologists, nurses, radiation technicians, dosimetrists and physicists to plan and apply treatments. These new indications for RT, together with the global increase in cancer incidence and higher need for RT, put much higher demands on efficient treatment management and workflow. Therefore, this section will discuss workflow adjustment and optimisation processes and give additionally some practical hints that are based on experience at several radiation oncology departments.