Recent Developments in Radiation Oncology: An Overview of Individualised Treatment Strategies in Breast Cancer

Abstract

Radiation therapy (RT) for breast cancer has dramatically changed over the past years, leading to individualized risk-adapted treatment strategies. Historically, the choice of RT regimen was limited to conventional fractionation protocols using standard tangential fields. Nowadays, technological and technical improvements in modern RT have added a variety of other RT modalities, different fractionation schedules, and individualised treatment volumes to the portfolio of breast RT. This review aims to give a short overview on the main topics which have recently found their way into clinical practice: hypofractionated treatment protocols, accelerated partial breast irradiation (APBI) for low-risk patients, deep inspiration breath hold (DIBH) for maximal heart protection, extent of regional nodal irradiation for high-risk patients, and the implementation of new radiation techniques such as intensity modulated RT (IMRT) and volumetric modulated RT (VMAT).

Recent advances in radiotherapy of breast cancer

“…Overall, it remains unclear if the mean heart dose is the optimal parameter to predict the risk of cardiac events. Nevertheless, in modern breast RT, the mean heart dose can be kept at reasonable levels [45], even if subvolumes of the heart (e.g. heart apex) and the left anterior descending artery (LAD) can still be exposed to much higher doses.…”

Stability and reproducibility of 6013 deep inspiration breath-holds in left-sided breast cancer

“…Deep Inspiration Breath-hold (DIBH) is a well-established radiation technique to achieve a significant cardiac dose reduction during adjuvant radiotherapy (RT) in left-sided breast cancer [1][2][3][4]. Relative dose reductions of the mean heart dose (MHD) or the left anterior descending (LAD) artery by more than 50% as compared to free breathing (FB) have been reported [4][5][6].…”

Adjuvant regional nodal irradiation did not improve outcomes in T1-2N1 breast cancer after breast-conserving surgery: A propensity score matching analysis of BIG02/98 and BCIRG005 trials

“…Adjuvant radiation therapy (RT) plays a vital role in the multidisciplinary management of breast cancer after breast conserving surgery (BCS) [ 1 , 2 ]. Twenty-year follow-up of the National Surgical Adjuvant Breast and Bowel Project (NSABP)-04 study demonstrates that BCS followed by breast irradiation significantly decrease the incidence of a recurrence in the ipsilateral breast as compared with BCS alone (14.3% vs. 39.2%, p < 0.001) [ 3 ].…”