“Simplicity is complexity resolved”: the case of postoperative radiation therapy after breast conservation

Omission of postoperative radiation after breast conserving surgery: A progressive paradigm shift towards precision medicine

“…Overall, the side-effects of adjuvant systemic therapy may outweigh those of WBI, especially considering that hypofractionation, accelerated partial breast irradiation and refined delivery techniques have consistently decreased the radiation-burden in breast cancer patients [66][67][68][69]. Composite endpoints evaluating not only IBTR rate and OS but also the toxicity profile of treatments, patient quality of life, psychosocial issues, and cost-effectiveness would be indicated to better tailor the clinical decision-making process in low-risk EBC patients [70]. A cautionary statement should finally be pointed out, whenever considering the omission of a well-established and effective treatment option, as the recent data on surgery omission in case of complete response after primary systemic therapy in breast cancer patients do confirm [71].…”

Simulation modeling for clinical trials evaluating radiotherapy omission in low-risk early breast cancer

“…For this setting of patients, different approaches were set up to decrease the burden associated to radiation treatment including the use of hypofractionation, the selective employment of the boost to the lumpectomy cavity, accelerated partial breast irradiation and selective omission of WBI after BCS (5)(6)(7)(8)(9). Prospective trials investigated the hypothesis that radiotherapy omission after BCS would not be harmful to patients, but the correct selection of the population subset at 'low risk' is still open (9,10). In this sense, new generation trials are presently ongoing to clarify this point, using either immunohistochemistry, genomic expression or signature assays (11).…”