Hype or Hope? A Review of Challenges in Balancing Tumor Control and Treatment Toxicity in Breast Cancer from the Perspective of the Radiation Oncologist

Overview

Journal Clin Transl Oncol

Specialty Oncology

Date 2023 Jul 28

PMID 37505372

Authors

Javier Gonzalez-Viguera

Evelyn Martinez-Perez

Hector Perez-Montero

Marina Aranguena

Ferran Guedea

Cristina Gutierrez-Miguelez

Affiliations

Soon will be listed here.

Abstract

The aim of this article is to discuss the challenges and new strategies in managing breast cancer patients, with a specific focus on radiation oncology and the importance of balancing oncologic outcomes with quality of life and post-treatment morbidity. A comprehensive literature review was conducted to identify advances in the management of breast cancer, exploring de-escalation strategies, hypofractionation schemes, predictors and tools for reducing toxicity (radiation-induced lymphocyte apoptosis, deep inspiration breath-hold, adaptive radiotherapy), enhancer treatments (hyperthermia, immunotherapy) and innovative diagnostic modalities (PET-MRI, omics). Balancing oncologic outcomes with quality of life and post-treatment morbidity is crucial in the era of personalized medicine. Radiotherapy plays a critical role in the management of breast cancer patients. Large randomized trials are necessary to generalize some practices and cost remains the main obstacle for many innovations that are already applicable.

References

Hong R, Xu B . Breast cancer: an up-to-date review and future perspectives. Cancer Commun (Lond). 2022; 42(10):913-936. PMC: 9558690. DOI: 10.1002/cac2.12358. View

Offersen B, Alsner J, Nielsen H, Jakobsen E, Nielsen M, Krause M . Hypofractionated Versus Standard Fractionated Radiotherapy in Patients With Early Breast Cancer or Ductal Carcinoma In Situ in a Randomized Phase III Trial: The DBCG HYPO Trial. J Clin Oncol. 2020; 38(31):3615-3625. DOI: 10.1200/JCO.20.01363. View

Whelan T, Pignol J, Levine M, Julian J, MacKenzie R, Parpia S . Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010; 362(6):513-20. DOI: 10.1056/NEJMoa0906260. View

Meattini I, Becherini C, Boersma L, Kaidar-Person O, Marta G, Montero A . European Society for Radiotherapy and Oncology Advisory Committee in Radiation Oncology Practice consensus recommendations on patient selection and dose and fractionation for external beam radiotherapy in early breast cancer. Lancet Oncol. 2022; 23(1):e21-e31. DOI: 10.1016/S1470-2045(21)00539-8. View

Meattini I, Guenzi M, Fozza A, Vidali C, Rovea P, Meacci F . Overview on cardiac, pulmonary and cutaneous toxicity in patients treated with adjuvant radiotherapy for breast cancer. Breast Cancer. 2016; 24(1):52-62. DOI: 10.1007/s12282-016-0694-3. View

Darby S, Cutter D, Boerma M, Constine L, Fajardo L, Kodama K . Radiation-related heart disease: current knowledge and future prospects. Int J Radiat Oncol Biol Phys. 2010; 76(3):656-65. PMC: 3910096. DOI: 10.1016/j.ijrobp.2009.09.064. View

Roychoudhuri R, Robinson D, Putcha V, Cuzick J, Darby S, Moller H . Increased cardiovascular mortality more than fifteen years after radiotherapy for breast cancer: a population-based study. BMC Cancer. 2007; 7:9. PMC: 1784099. DOI: 10.1186/1471-2407-7-9. View

Haussmann J, Corradini S, Nestle-Kraemling C, Bolke E, Njanang F, Tamaskovics B . Recent advances in radiotherapy of breast cancer. Radiat Oncol. 2020; 15(1):71. PMC: 7106718. DOI: 10.1186/s13014-020-01501-x. View

Fastner G, Reitsamer R, Gaisberger C, Stana M, Sedlmayer F . [Intraoperative partial breast irradiation with electrons (ELIOT) compared to conventionally fractionated whole-breast irradiation of early-stage invasive breast cancer after breast-conserving surgery: long-term data from a prospective randomised...]. Strahlenther Onkol. 2021; 197(11):1032-1036. DOI: 10.1007/s00066-021-01848-4. View

10.

Liu G, Dong Z, Huang B, Liu Y, Tang Y, Li Q . Efficacy and safety of accelerated partial breast irradiation: a meta-analysis of published randomized studies. Oncotarget. 2017; 8(35):59581-59591. PMC: 5601757. DOI: 10.18632/oncotarget.19225. View

11.

Fastner G, Gaisberger C, Kaiser J, Scherer P, Ciabattoni A, Petoukhova A . ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy with electrons (IOERT) in breast cancer. Radiother Oncol. 2020; 149:150-157. DOI: 10.1016/j.radonc.2020.04.059. View

12.

Schafer R, Strnad V, Polgar C, Uter W, Hildebrandt G, Ott O . Quality-of-life results for accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation in early breast cancer after breast-conserving surgery (GEC-ESTRO): 5-year results of a randomised, phase 3 trial. Lancet Oncol. 2018; 19(6):834-844. DOI: 10.1016/S1470-2045(18)30195-5. View

13.

Guinot J, Gonzalez-Perez V, Meszaros N, Major T, Najjari-Jamal D, Gutierrez-Miguelez C . Very accelerated partial breast irradiation Phase I-II multicenter trial (VAPBI): Feasibility and early results. Brachytherapy. 2020; 20(2):332-338. DOI: 10.1016/j.brachy.2020.10.010. View

14.

Hannoun-Levi J, Montagne L, Sumodhee S, Schiappa R, Boulahssass R, Gautier M . APBI Versus Ultra-APBI in the Elderly With Low-Risk Breast Cancer: A Comparative Analysis of Oncological Outcome and Late Toxicity. Int J Radiat Oncol Biol Phys. 2021; 111(1):56-67. DOI: 10.1016/j.ijrobp.2021.03.052. View

15.

Guidolin K, Yaremko B, Lynn K, Gaede S, Kornecki A, Muscedere G . Stereotactic image-guided neoadjuvant ablative single-dose radiation, then lumpectomy, for early breast cancer: the SIGNAL prospective single-arm trial of single-dose radiation therapy. Curr Oncol. 2019; 26(3):e334-e340. PMC: 6588073. DOI: 10.3747/co.26.4479. View

16.

Li Y, Barry P . Pre-operative partial breast irradiation: revolutionizing radiation treatment for women with early stage breast cancer. Ann Breast Surg. 2023; 6. PMC: 9837822. DOI: 10.21037/abs-20-133. View

17.

de Wild S, de Munck L, Simons J, Verloop J, van Dalen T, Elkhuizen P . De-escalation of radiotherapy after primary chemotherapy in cT1-2N1 breast cancer (RAPCHEM; BOOG 2010-03): 5-year follow-up results of a Dutch, prospective, registry study. Lancet Oncol. 2022; 23(9):1201-1210. DOI: 10.1016/S1470-2045(22)00482-X. View

18.

Boughey J, Suman V, Mittendorf E, Ahrendt G, Wilke L, Taback B . Factors affecting sentinel lymph node identification rate after neoadjuvant chemotherapy for breast cancer patients enrolled in ACOSOG Z1071 (Alliance). Ann Surg. 2015; 261(3):547-52. PMC: 4324533. DOI: 10.1097/SLA.0000000000000551. View

19.

Fayanju O, Ren Y, Suneja G, Thomas S, Greenup R, Plichta J . Nodal Response to Neoadjuvant Chemotherapy Predicts Receipt of Radiation Therapy After Breast Cancer Diagnosis. Int J Radiat Oncol Biol Phys. 2019; 106(2):377-389. PMC: 6957225. DOI: 10.1016/j.ijrobp.2019.10.039. View

20.

Daveau C, Stevens D, Brain E, Berges O, Villette S, Moisson P . Is regional lymph node irradiation necessary in stage II to III breast cancer patients with negative pathologic node status after neoadjuvant chemotherapy?. Int J Radiat Oncol Biol Phys. 2010; 78(2):337-42. DOI: 10.1016/j.ijrobp.2009.08.053. View