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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies

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When Can We Avoid Postmastectomy Radiation Following Primary Systemic Therapy?

Ángel Montero¹, Raquel Ciérvide¹, Philip Poortmans^2,3

¹Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain.

Current Oncology Reports

|October 31, 2019

Summary

This summary is machine-generated.

Postmastectomy radiation therapy (PMRT) reduces recurrence and improves survival in high-risk breast cancer. Research is exploring if PMRT can be omitted in select patients after primary systemic therapy.

Keywords:

Breast cancer Lymph node irradiation Mastectomy Postmastectomy radiation therapy Primary systemic therapy

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Area of Science:

Oncology
Radiation Oncology
Breast Cancer Research

Background:

Postmastectomy radiation therapy (PMRT) is established for high-risk locally advanced breast cancer, reducing locoregional recurrences (LRR) and distant metastases (DM).
Indications for PMRT in earlier stage tumors with risk factors like lymphovascular invasion (LVI) or specific tumor characteristics remain debated.
Advances in understanding breast cancer biology and primary systemic therapy (PST) are refining patient selection and treatment strategies.

Purpose of the Study:

To review the current evidence on the role of PMRT in breast cancer management.
To identify factors that may allow for the omission of PMRT in select patients, particularly after PST.
To evaluate the evolving landscape of PMRT indications in the context of modern systemic therapies.

Main Methods:

Literature review of studies evaluating PMRT in breast cancer.
Analysis of factors influencing treatment decisions, including tumor characteristics, molecular subtypes, and response to PST.
Synthesis of current controversies and emerging trends in PMRT application.

Main Results:

PMRT significantly reduces LRR, DM, and improves breast cancer-specific survival (BCSS) and overall survival (OS) in high-risk patients.
Ongoing research investigates PMRT's role in earlier stage cancers with risk factors and in patients treated with PST.
Factors influencing PMRT omission after PST are being identified, suggesting personalized treatment approaches.

Conclusions:

PMRT remains crucial for high-risk locally advanced breast cancer patients.
The decision to use PMRT is becoming more nuanced, especially following PST and in earlier-stage disease.
Further research is needed to define criteria for PMRT omission to optimize outcomes and minimize toxicity.