[Breast irradiation: ready to wear or customized?]

Irradiation after conservative breast surgery (CBS) for DCIS (ductal carcinoma in situ) and infiltrating ductal and lobular carcinoma is considered "standard". However, radiation oncologists are raising the question whether for a well defined cohort of patients this adjuvant treatment can be individualized. The published evidence indicates that individualization should be carefully evaluated, as in no single scenario radiotherapy was not able to significantly reduce the cumulative incidence of local recurrence. Even if adjuvant radiation after CBS should be applied to virtually all patients, radiation oncologists are raising questions about the modalities of breast irradiation which could potentially be adapted to patient- and tumor-characteristics. In an ideal world, we should be able to perform robust prognostic and predictive tests to define a sub cohort of patients which really benefits from this adjuvant treatment. It might be possible that in a near future, we will rely on gene signatures to make these choices. However, the research in the field raises a lot of discussion in the scientific community and there is no real consensus nowadays on their added clinical value.