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Response to Gutierrez et al. concerning the 5-year local recurrence-free survival (L-RFS) rate after a second breast conserving surgery and intraoperative radiotherapy (IORT).

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Radiotherapy of breast cancer: 2025 update.

Youssef Ghannam1, Romuald Le Scodan2, Sofia Rivera1

  • 1Radiotherapy Department, institut Gustave-Roussy, Villejuif, France.

Cancer Radiotherapie : Journal De La Societe Francaise De Radiotherapie Oncologique
|November 21, 2025
PubMed
Summary

Adjuvant radiotherapy is crucial for breast cancer management, reducing recurrence and improving survival after surgery. Hypofractionation techniques are now standard, offering equivalent efficacy with shorter treatment times for various breast cancer scenarios.

Keywords:
Breast cancerCancer du seinGuidelinesRadiotherapyRadiothérapieRecommandationsSFROSociété française de radiothérapie oncologique

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Breast Cancer Management

Background:

  • Adjuvant radiotherapy is a cornerstone in breast cancer treatment following surgery, significantly reducing local recurrence and enhancing survival rates.
  • Current guidelines recommend irradiation after breast-conserving surgery for invasive carcinoma and after lumpectomy for ductal carcinoma in situ.
  • Radiotherapy indications after mastectomy depend on tumor size, nodal involvement, and prior neoadjuvant chemotherapy, with specific considerations for chest wall and nodal irradiation.

Purpose of the Study:

  • To outline the current indications and evolving techniques for adjuvant radiotherapy in breast cancer management.
  • To discuss the role of hypofractionation and advanced delivery methods in optimizing treatment efficacy and safety.
  • To provide a comprehensive overview of radiotherapy strategies based on surgical and pathological findings.

Main Methods:

  • Systematic review of current clinical practice and evidence-based guidelines for adjuvant radiotherapy in breast cancer.
  • Analysis of data from randomized trials evaluating hypofractionation, partial breast irradiation, and target volume delineation techniques.
  • Discussion of treatment planning considerations, including imaging, dose fractionation, and organ-at-risk sparing strategies.

Main Results:

  • Moderate hypofractionation is the standard for whole-breast and chest wall irradiation, demonstrating equivalent efficacy to conventional fractionation.
  • Ultra hypofractionation shows non-inferiority to moderate hypofractionation for whole-breast irradiation.
  • Hypofractionation is feasible for nodal irradiation without increased toxicity, and advanced techniques like intensity-modulated radiotherapy and respiratory gating can optimize target coverage and minimize organ-at-risk exposure.

Conclusions:

  • Adjuvant radiotherapy remains essential in breast cancer care, with hypofractionation becoming the standard of care for improved patient convenience and equivalent outcomes.
  • Careful patient selection and individualized treatment planning are crucial for optimizing radiotherapy benefits while minimizing risks, particularly cardiac toxicity.
  • Ongoing research and technological advancements continue to refine radiotherapy techniques, enhancing efficacy and patient safety in breast cancer management.