Partial breast irradiation versus whole breast radiotherapy for early breast cancer

Hickey, Brigid E; Lehman, Margot

doi:10.1002/14651858.cd007077.pub4

Cited by 21 publications

(14 citation statements)

References 161 publications

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“…It is a proven fact that post-BCS RT has noticeable positive effects on breast cancer patients, with both breast-cancer-specific survival and OS significantly improved even in elderly patients (age ≥ 70 years) [ 44 ]. Furthermore, the benefits of RT on OS were not dependent on irradiation volume, as similar benefits were observed in patients who underwent accelerated partial breast irradiation and those who received whole breast RT [ 46 ]. Despite the favorable outcomes associated with post-BCS RT, there remains uncertainty regarding the relationship between molecular subtypes of breast cancer and the benefits of OS from RT due to conflicting previous research [ 8 , 28 , 47 ].…”

Section: Discussionmentioning

confidence: 97%

Molecular subtypes of breast cancer predicting clinical benefits of radiotherapy after breast-conserving surgery: a propensity-score-matched cohort study

Hung,

Yang,

Lee

et al. 2023

Breast Cancer Res

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Background Based on the molecular expression of cancer cells, molecular subtypes of breast cancer have been applied to classify patients for predicting clinical outcomes and prognosis. However, further evidence is needed regarding the influence of molecular subtypes on the efficacy of radiotherapy (RT) after breast-conserving surgery (BCS), particularly in a population-based context. Hence, the present study employed a propensity-score-matched cohort design to investigate the potential role of molecular subtypes in stratifying patient outcomes for post-BCS RT and to identify the specific clinical benefits that may emerge. Methods From 2006 to 2019, the present study included 59,502 breast cancer patients who underwent BCS from the Taiwan National Health Insurance Research Database. Propensity scores were utilized to match confounding variables between patients with and without RT within each subtype of breast cancer, namely luminal A, luminal B/HER2-negative, luminal B/HER2-positive, basal-like, and HER2-enriched ones. Several clinical outcomes were assessed, in terms of local recurrence (LR), regional recurrence (RR), distant metastasis (DM), disease-free survival (DFS), and overall survival (OS). Results After post-BCS RT, patients with luminal A and luminal B/HER2-positive breast cancers exhibited a decrease in LR (adjusted hazard ratio [aHR] = 0.18, p < 0.0001; and, 0.24, p = 0.0049, respectively). Furthermore, reduced RR and improved DFS were observed in patients with luminal A (aHR = 0.15, p = 0.0004; and 0.29, p < 0.0001), luminal B/HER2-negative (aHR = 0.06, p = 0.0093; and, 0.46, p = 0.028), and luminal B/HER2-positive (aHR = 0.14, p = 0.01; and, 0.38, p < 0.0001) breast cancers. Notably, OS benefits were found in patients with luminal A (aHR = 0.62, p = 0.002), luminal B/HER2-negative (aHR = 0.30, p < 0.0001), basal-like (aHR = 0.40, p < 0.0001), and HER2-enriched (aHR = 0.50, p = 0.03), but not luminal B/HER2-positive diseases. Remarkably, when considering DM, luminal A patients who received RT demonstrated a lower cumulative incidence of DM than those without RT (p = 0.02). Conclusion In patients with luminal A breast cancer who undergo BCS, RT could decrease the likelihood of tumor metastasis. After RT, the tumor’s hormone receptor status may predict tumor control regarding LR, RR, and DFS. Besides, the HER2 status of luminal breast cancer patients may serve as an additional predictor of OS after post-BCS RT. However, further prospective studies are required to validate these findings.

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Section: Discussionmentioning

confidence: 97%

Molecular subtypes of breast cancer predicting clinical benefits of radiotherapy after breast-conserving surgery: a propensity-score-matched cohort study

Hung,

Yang,

Lee

et al. 2023

Breast Cancer Res

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“…PBI has been studied using a variety of techniques including intraoperative radiotherapy (IORT), multi-catheter brachytherapy and external-beam radiotherapy. Metaanalyses demonstrated comparable OS with an increased local recurrence risk compared to WBI [31][32][33]. This increase was due to recurrences outside of the original tumor bed and was driven by an increased risk of recurrence in trials of IORT.…”

Section: Radiotherapy Of the Breast In Early-stage Low-risk Bcmentioning

confidence: 91%

Real de-escalation or escalation in disguise?

Banys‐Paluchowski¹,

Rubio²,

Ditsch³

et al. 2023

The Breast

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“…Complementary breast irradiation has undergone numerous changes over time in order to reduce radiation side effects without affecting the tumor relapse rate. In particular, the traditional whole breast irradiation has been replaced in some selected cases by partial breast irradiation, which has the possibility of intraoperative administration [75]. In addition, several modalities have been designed that permit the reduction of dose fractionation [76], up to the administration of a single dose within clinical trials [77].…”

Section: The Rationale Of Margins Evaluationmentioning

confidence: 99%

Updates and Debate Concerning Margin Adequacy and Management following Breast-Conserving Surgery

Bertozzi¹,

Londero²,

Nanez³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Objective: Breast-conserving surgery (BCS) experienced a significant surge during the last decades due to the increase of early breast cancer detection. Central to the discussion is margin adequacy which represents one of the most significant predictive factors for local relapse. This paper aims to shed light on the problem of margins in breast surgery. Mechanism: We performed a systematic narrative review of the literature by conducting a search using Medline/PubMed, Scopus, and Embase. The following keywords were considered: "breast-conserving surgery" AND "margins"/"margin". Findings in Brief: In the case of invasive breast cancer, "no ink on tumor" can be considered an adequate margin, while for ductal carcinoma in situ (DCIS), a distance of 2 mm from tumor should be obtained. Many novel tools have been developed based both on the latest radiological imaging techniques and on the tissue expression of certain markers, with the aim of precise navigation of tumor excision and intraoperative evaluation of cavity excision margins. Oncoplastic surgery can be considered oncologically safe while improving the cosmetic outcome and patients' quality of life. The appropriate use of adjuvant treatments in the context of a multidisciplinary and personalized management of breast cancer is the only means to omit a second intervention in some carefully selected cases. Conclusions: Debate still exists concerning the definition of adequate clear margin following BCS for DCIS. Further studies are required to better assess multimodal treatment approaches in this condition.

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Partial breast irradiation versus whole breast radiotherapy for early breast cancer

Cited by 21 publications

References 161 publications

Molecular subtypes of breast cancer predicting clinical benefits of radiotherapy after breast-conserving surgery: a propensity-score-matched cohort study

Molecular subtypes of breast cancer predicting clinical benefits of radiotherapy after breast-conserving surgery: a propensity-score-matched cohort study

Real de-escalation or escalation in disguise?

Updates and Debate Concerning Margin Adequacy and Management following Breast-Conserving Surgery

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