Overview on the Role of Breast Conservative Treatments for Early Breast Cancer with Low Risk of Recurrence: History, Standard and Controversies

Abstract

The HistoryOne third of breast cancer cases occurs in patients over the age of 65 years, and in more developed countries this proportion rises to more than 47% after 70 years according to the updated Surveillance, Epidemiology, and End Results (SEER) database [1]. AbstractBackground: breast-conserving therapy is the mainstay for early-stage breast cancer, but this concept required a long process because comprehension of tumor biology was first necessary. In the last century several studies conducted to a progressive limitation of surgery and a progressive increase of complementary therapy, thanks to the early diagnosis of the screening in high-risk groups. The radiotherapy of the whole breast remains the gold standard after quadrantectomy, but new technical devices are leading to a modification of this approach. The advantage of breast conservative therapy is a conserved quality of life, but principal questions remain on the long term effects of these therapies and the risk of recurrences. Methods:We conducted an overview on the breast-conserving therapy for early-stage breast cancer with low risk of recurrences searching articles in the Pubmed literature with care on the role of intraoperative radiotherapy.Conclusions: nowadays it become important to establish a correct therapeutic timing, adapting it to the characteristics of the individual patient and to the biology of the tumor. Radiotherapy and chemotherapy programs should be able to embrace according to modulable times and take into account the differences of each individual case. The reduction of post actinic toxicity represents an objective to be pursued, also for the possible overlap with the toxicity of the chemotherapeutic treatment and in this a fundamental role could be played by IORT. Moreover, considering the increase in patient survival that will inevitably lead to an increase in local recurrences, the possibility of a re-irradiation will be more and more frequent. Recent studies on the modulation of inflammation factors induced by the use of drugs during surgery could lead to new considerations on chemotherapy treatment. In conclusion, It could be useful to limit the field of action of complementary treatments for selected patients, like in the past it was proposed for surgical treatment, to allow any future therapy or reinterventions in case of recurrences, even with reconstructive intent.Keywords: Intraoperative radiotherapy (IORT), breast conservative surgery (BCS), accelerated partial breast irradiation (APBI).Fabbri Nicolò et al.