Radiation in Early-Stage Breast Cancer: Moving beyond an All or Nothing Approach

Radiotherapy omission is increasingly considered for selected patients with early-stage breast cancer. However, with emerging data on the safety and efficacy of radiotherapy de-escalation with partial breast irradiation and accelerated treatment regimens for low-risk breast cancer, it is necessary t...

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Bibliographic Details
Published in:Current oncology (Toronto) 2022-12, Vol.30 (1), p.184-195
Main Authors: Purswani, Juhi M, Hardy-Abeloos, Camille, Perez, Carmen A, Kwa, Maryann J, Chadha, Manjeet, Gerber, Naamit K
Format: Article
Language:English
Subjects:
APBI
Breast Neoplasms - pathology
Combined Modality Therapy
early-stage breast cancer
Female
Humans
Mastectomy, Segmental
partial breast irradiation
Patient Selection
radiotherapy de-escalation
radiotherapy omission
Review
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Summary:Radiotherapy omission is increasingly considered for selected patients with early-stage breast cancer. However, with emerging data on the safety and efficacy of radiotherapy de-escalation with partial breast irradiation and accelerated treatment regimens for low-risk breast cancer, it is necessary to move beyond an all-or-nothing approach. Here, we review existing data for radiotherapy omission, including the use of age, tumor subtype, and multigene profiling assays for selecting low-risk patients for whom omission is a reasonable strategy. We review data for de-escalated radiotherapy, including partial breast irradiation and acceleration of treatment time, emphasizing these regimens' decreasing biological and financial toxicities. Lastly, we review evidence of omission of endocrine therapy. We emphasize ongoing research to define patient selection, treatment delivery, and toxicity outcomes for de-escalated adjuvant therapies better and highlight future directions.
ISSN:1718-7729
1198-0052
1718-7729
DOI:10.3390/curroncol30010015