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Adjuvant Radiotherapy in Early-Stage Breast Cancer: Evidence-Based Options

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Patients with a diagnosis of early-stage breast cancer are offered the option of either mastectomy or breast-conserving therapy (BCT) secondary to multiple randomized trials demonstrating equivalent long-term outcomes. Traditionally, BCT has used standard whole-breast irradiation (SWBI) after breast-conserving surgery, although several alternatives have emerged during the past few decades.

Methods

This report reviews key studies supporting each radiation technique and its respective eligibility criteria to assist clinicians in deciding which adjuvant radiotherapy options are appropriate for their patients.

Results

In the past, completion of SWBI required 5–7 weeks of daily treatments. During the past two decades, alternatives to SWBI have emerged including hypofractionated whole-breast irradiation (3–4 weeks), accelerated partial-breast irradiation (1–3 weeks), and endocrine therapy alone. Multiple randomized trials have established the equivalence of these alternative strategies to SWBI for appropriately selected patients. Additionally, the current guidelines for patient selection demonstrate a large amount of overlap in the selection criteria for each technique.

Conclusion

Clinicians must evaluate patient and pathologic criteria and engage in informed discussions with patients when determining which adjuvant radiation techniques are appropriate. Future strategies being explored include using tumor genetics to identify low-risk patients and switching from paradigms that omit radiotherapy to those that omit endocrine therapy.

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Authors and Affiliations

  1. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA

    Chirag Shah MD, Rahul Tendulkar MD, Timothy Smile MM, Bindu Manyam MD, Ehsan Balagamwala MD, Yvonne Pham MD & Radhika Takiar BS

  2. MedStar Shah Medical Group, Hollywood, MD, USA

    Anish Nanavati MD

  3. Department of Radiation Oncology, Ohio State University, Columbus, OH, USA

    Jessica Wobb MD

  4. Department of Radiation Oncology, Robert Wood Johnson Medical School and the Canter Institute of New Jersey, New Brunswick, NJ, USA

    Atif Khan MD

  5. Department of Radiation Oncology, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA

    Douglas Arthur MD

  6. Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA, USA

    David Wazer MD

  7. Department of Radiation Oncology, Brown University, Providence, RI, USA

    David Wazer MD

  8. 21st-Century Oncology, Michigan Healthcare Professionals, Farmington Hills, MI, USA

    Frank Vicini MD

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  1. Chirag Shah MD
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Shah, C., Tendulkar, R., Smile, T. et al. Adjuvant Radiotherapy in Early-Stage Breast Cancer: Evidence-Based Options. Ann Surg Oncol 23, 3880–3890 (2016). https://doi.org/10.1245/s10434-016-5503-x

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