[Radiotherapy and breast conserving therapy: past, present and future]

Area of Science:

• Oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Early breast cancer (Stage I-II, 0-5 cm) survival rates with breast conserving therapy (BCT) were established as equivalent to radical mastectomy in 1970s-80s clinical trials.
• Significant reductions in local recurrence and late toxicity following BCT have been achieved since the 1980s.
• Increasingly, research focuses on identifying low-risk breast cancer patient subgroups who may not require further radiation treatment.

Purpose of the Study:

• To review the evolution and current status of breast conserving therapy (BCT) for early breast cancer.
• To highlight advancements in systemic therapies and genetic profiling for personalized loco-regional treatment strategies.
• To discuss the trend towards de-escalating treatment in select patient populations.

Main Methods:

• Review of historical clinical trial data comparing BCT and mastectomy.
• Analysis of recent studies on BCT outcomes, including local recurrence and toxicity.
• Examination of emerging systemic therapy options and genetic profiling advancements.

Main Results:

• BCT demonstrates equal survival rates to mastectomy for early-stage breast cancer.
• Modern BCT techniques have markedly decreased risks of local recurrence and late toxicity.
• Systemic therapies have improved recurrence risk reduction.
• Genetic profiling promises further individualized loco-regional treatment approaches.

Conclusions:

• Breast conserving therapy is a safe and effective option for early breast cancer, with outcomes comparable to mastectomy.
• Ongoing research and technological advancements are refining BCT, reducing treatment burden, and personalizing care.
• Future directions emphasize genetic profiling for tailored loco-regional treatment decisions, further improving patient outcomes and minimizing toxicity.