Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Jan 22:15:1175.
doi: 10.3332/ecancer.2021.1175. eCollection 2021.

A systematic review of neo-adjuvant radiotherapy in the treatment of breast cancer

Muneer Ahmed  1 , Felix Jozsa  1 , Michael Douek  2
Affiliations
Review

A systematic review of neo-adjuvant radiotherapy in the treatment of breast cancer

Muneer Ahmed et al. Ecancermedicalscience. .

Abstract

Introduction: The use of neo-adjuvant radiotherapy (NRT) has been proven effective at improving cancer related outcome measures, including overall-survival (OS) in the management of solid cancers. However, its utilisation in breast cancer has not been explored to the extent of neo-adjuvant chemotherapy (NAC). The evidence for the application of NRT in breast cancer is evaluated.

Methods: PubMed, Embase and the Cochrane Library databases were searched systematically in August 2020 for studies that addressed the role of NRT in the treatment of breast cancer. Studies were deemed eligible if they reported on objective outcome measurements of OS, disease free-survival (DFS) or pathological complete response (pCR) and attained a satisfactory quality assessment.

Findings: A total of 23 studies reported upon 3,766 patients who had received NRT of which 3,233 also received NAC concurrently (neo-adjuvant chemo-radiotherapy (NCRT)). The pCR values ranged from 14% to 42%, 5-year DFS 61.4% to 81% and 5-year OS 71.6% to 84.2%. Complications were confined to radiation dermatitis with no cases of implant loss reported during breast reconstruction. The application of NRCT alone showed no significant difference in OS or DFS compared to NCRT followed by surgery.

Interpretation: Numbers of patients receiving exclusively NRT is small. However, NCRT is oncologically safe with a low side-effect profile including preceding breast reconstruction. Potential benefits include precise cancer volume targeting, chemosensitisation, elimination of delays in adjuvant therapies and alternatives to chemotherapy in oestrogen receptor positive patients. These factors warrant further exploration within randomised controlled-trials.

Keywords: breast cancer; chemo-radiotherapy; neo-adjuvant; radiotherapy.

PubMed Disclaimer

Conflict of interest statement

The authors have no disclosures to make concerning financial or personal relationships that could inappropriately influence their work.

Figures

Figure 1.
Figure 1.. PRISMA flow diagram.
See this image and copyright information in PMC

References

    1. Bui DL, Yu JB. Trends in adjuvant and neoadjuvant radiotherapy for cancer treatment from 1973 to 2011. Cancer J. 2015;21(3):147–149. doi: 10.1097/PPO.0000000000000114. - DOI - PubMed
    1. Colorectal Cancer Collaborative G. Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials. Lancet. 2001;358(9290):1291–1304. doi: 10.1016/S0140-6736(01)06409-1. - DOI - PubMed
    1. Bosset JF, Calais G, Mineur L, et al. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer: preliminary results--EORTC 22921. J Clin Oncol. 2005;23(24):5620–5627. doi: 10.1200/JCO.2005.02.113. - DOI - PubMed
    1. Gerard JP, Conroy T, Bonnetain F, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol. 2006;24(28):4620–4625. doi: 10.1200/JCO.2006.06.7629. - DOI - PubMed
    1. Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for locoregionally advanced head and neck cancer: 5-year survival data from a phase 3 randomised trial, and relation between cetuximab-induced rash and survival. Lancet Oncol. 2010;11(1):21–28. doi: 10.1016/S1470-2045(09)70311-0. - DOI - PubMed

LinkOut - more resources