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Recent Advances in Optimizing Radiation Therapy Decisions in Early Invasive Breast Cancer

Authors :
Nazia Riaz
Tiffany Jeen
Timothy J. Whelan
Torsten O. Nielsen
Source :
Cancers, Vol 15, Iss 4, p 1260 (2023)
Publication Year :
2023
Publisher :
MDPI AG, 2023.

Abstract

Adjuvant whole breast irradiation after breast-conserving surgery is a well-established treatment standard for early invasive breast cancer. Screening, early diagnosis, refinement in surgical techniques, the knowledge of new and specific molecular prognostic factors, and now the standard use of more effective neo/adjuvant systemic therapies have proven instrumental in reducing the rates of locoregional relapses. This underscores the need for reliably identifying women with such low-risk disease burdens in whom elimination of radiation from the treatment plan would not compromise oncological safety. This review summarizes the current evidence for radiation de-intensification strategies and details ongoing prospective clinical trials investigating the omission of adjuvant whole breast irradiation in molecularly defined low-risk breast cancers and related evidence supporting the potential for radiation de-escalation in HER2+ and triple-negative clinical subtypes. Furthermore, we discuss the current evidence for the de-escalation of regional nodal irradiation after neoadjuvant chemotherapy. Finally, we also detail the current knowledge of the clinical value of stromal tumor-infiltrating lymphocytes and liquid-based biomarkers as prognostic factors for locoregional relapse.

Details

Language :
English
ISSN :
20726694
Volume :
15
Issue :
4
Database :
Directory of Open Access Journals
Journal :
Cancers
Publication Type :
Academic Journal
Accession number :
edsdoj.1e6f9c73e7d14adc94599a39a04c73e5
Document Type :
article
Full Text :
https://doi.org/10.3390/cancers15041260