Loco-Regional Therapy for Early and Advanced Breast Cancer in the Molecular Era

Abstract

The decision of using a treatment modality is essentially based on the benefit it can offer. This can be further refined to identify a subset that stand to benefit the most. This has been successful in planning systemic therapy; unfortunately for loco-regional treatment (LRT) there has been association with numerous risk predictors but no response predictors have been identified. In this review we discuss the evidence of efficacy for LRT based on various risk predictors matched with effective targeted treatment (Hormone therapy and Her2 targeted therapy) and its impact on local control. The largest risk predictors known are the triple negative (TNBC) subset and it is not surprising that postmastectomy radiotherapy has shown a remarkable benefit in TNBC, irrespective of lymph node status. Similarly, one could advocate conservatism in low risk patients who stand to benefit maximum from systemic therapy (ER+ve) and avoid radiotherapy with minimal trade off.