Version 1
: Received: 2 July 2024 / Approved: 3 July 2024 / Online: 3 July 2024 (06:36:54 CEST)
How to cite:
Gruber, G. Escalation and De-escalation of Adjuvant Radiotherapy in Early Breast Cancer: Strategies for Risk-Adapted Optimization. Preprints2024, 2024070305. https://doi.org/10.20944/preprints202407.0305.v1
Gruber, G. Escalation and De-escalation of Adjuvant Radiotherapy in Early Breast Cancer: Strategies for Risk-Adapted Optimization. Preprints 2024, 2024070305. https://doi.org/10.20944/preprints202407.0305.v1
Gruber, G. Escalation and De-escalation of Adjuvant Radiotherapy in Early Breast Cancer: Strategies for Risk-Adapted Optimization. Preprints2024, 2024070305. https://doi.org/10.20944/preprints202407.0305.v1
APA Style
Gruber, G. (2024). Escalation and De-escalation of Adjuvant Radiotherapy in Early Breast Cancer: Strategies for Risk-Adapted Optimization. Preprints. https://doi.org/10.20944/preprints202407.0305.v1
Chicago/Turabian Style
Gruber, G. 2024 "Escalation and De-escalation of Adjuvant Radiotherapy in Early Breast Cancer: Strategies for Risk-Adapted Optimization" Preprints. https://doi.org/10.20944/preprints202407.0305.v1
Abstract
Postoperative RT is recommended after breast conserving surgery and mastectomy (with risk factors). Consideration of pros and cons including potential side effects demands for optimization of adjuvant RT and a risk-adapted approach. There is clear de-escalation in fractionation - hypofractionation should be considered standard. For selected low risk situations PBI only or even the omission of RT might be appropriate. In contrast, tendencies in escalating RT are obvious. Preoperative RT seems attractive for patients in whom breast reconstruction is planned or for defining the tumor location more precisely with the potential of giving ablative doses. Dose escalation by a (simultaneous integrated) boost or the combination with new compounds/systemic treatments may increase antitumor efficacy but also toxicity. Despite low evidence, RT for oligometastatic disease is becoming increasingly popular. The omission of axillary dissection in node-positive disease led to an escalation of regional RT. Studies are ongoing to test if any axillary treatment can be omitted and which oligometastatic patients do really benefit from RT. Besides technical improvements the incorporation of molecular risk profiles but also the response to neoadjuvant systemic therapy have the potential to optimize the decision-making if and how local and/or regional RT should be administered.
Keywords
Adjuvant radiotherapy; omission of radiotherapy; partial breast irradiation; de-escalation; escalation; loco-regional irradiation; optimization
Subject
Medicine and Pharmacology, Oncology and Oncogenics
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
