Preoperative radiotherapy: A paradigm shift in the treatment of breast cancer? A review of literature

Stefanie Corradini; David Krug; Icro Meattini; Christiane Matuschek; Edwin Bölke; Giulio Francolini; René Baumann; Vanessa Figlia; Montserrat Pazos; Fabrizio Tonetto; Marco Trovò; Rosario Mazzola; Filippo Alongi

doi:10.1016/j.critrevonc.2019.06.003

Preoperative radiotherapy: A paradigm shift in the treatment of breast cancer? A review of literature

Crit Rev Oncol Hematol. 2019 Sep:141:102-111. doi: 10.1016/j.critrevonc.2019.06.003. Epub 2019 Jun 8.

Authors

Affiliations

¹ Department of Radiation Oncology, University Hospital, University of Munich, Munich, Germany. Electronic address: [email protected].
² Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany.
³ Department of Biomedical, Experimental, and Clinical Sciences, University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
⁴ Department of Radiotherapy and Radiation Oncology, Heinrich Heine University, Medical faculty, Düsseldorf, Germany.
⁵ Department of Biomedical, Experimental, and Clinical Sciences, University of Florence, Florence, Italy.
⁶ Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany; Department of Radiation Oncology, St. Marien Hospital Siegen, Siegen, Germany.
⁷ Department of Advanced Radiation Oncology, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy.
⁸ Department of Radiation Oncology, University Hospital, University of Munich, Munich, Germany.
⁹ Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata UD, Udine, Italy.
¹⁰ Department of Advanced Radiation Oncology, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy; University of Brescia, Brescia, Italy.

PMID: 31272045
DOI: 10.1016/j.critrevonc.2019.06.003

Abstract

The standard of care for early-stage breast cancer (BC) consists of breast-conserving surgery followed by postoperative irradiation. Recently, the concept of changing the usual sequence of treatment components in BC RT has been investigated. Potential advantages of preoperative RT in BC include a possible tumor downstaging with improved surgical cosmetic outcomes, accurate tumor site identification and better target volume delineation. Furthermore, preoperative RT could serve as a tool for treatment stratification for de-escalation of treatments in the event of pathological complete response. The present literature review analyzed the available clinical data regarding the potential impact of preoperative RT. Overall, available clinical evidence of preoperative RT in BC remains limited, deriving mostly from retrospective case series. Nevertheless, the experiences prove the feasibility of the preoperative RT approach and confirm the efficacy in almost all analyzed studies, including experiences using higher prescription RT doses or RT in combination with systemic therapy.

Keywords: Breast cancer; Local control; Neoadjuvant treatment; Outcome; Preoperative radiotherapy; Radiotherapy; Survival; pCR.

Publication types

Review

MeSH terms

Breast Neoplasms / epidemiology
Breast Neoplasms / pathology
Breast Neoplasms / radiotherapy*
Breast Neoplasms / surgery*
Combined Modality Therapy
Female
Humans
Mastectomy, Segmental / methods
Neoadjuvant Therapy
Preoperative Period
Radiotherapy, Adjuvant / methods*
Radiotherapy, Adjuvant / trends
Retrospective Studies