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Review
. 2024 Feb 24;31(3):1207-1220.
doi: 10.3390/curroncol31030090.

The Role of Adjuvant Radiotherapy in the Treatment of Breast Cancer

Iveta Kolářová  1   2 , Bohuslav Melichar  3 , Igor Sirák  1 , Jaroslav Vaňásek  2   4 , Jiří Petera  1 , Kateřina Horáčková  2 , Denisa Pohanková  1 , Filip Ďatelinka  1 , Zuzana Šinkorová  5 , Milan Vošmik  1
Affiliations
Review

The Role of Adjuvant Radiotherapy in the Treatment of Breast Cancer

Iveta Kolářová et al. Curr Oncol. .

Abstract

The role of postmastectomy radiotherapy and regional nodal irradiation after radical mastectomy is defined in high-risk patients with locally advanced tumors, positive margins, and unfavorable biology. The benefit of postmastectomy radiotherapy in intermediate-risk patients (T3N0 tumors) remains a matter of controversy. It has been demonstrated that radiotherapy after breast-conserving surgery lowers the locoregional recurrence rate compared with surgery alone and improves the overall survival rate. In patients with four or more positive lymph nodes or extracapsular extension, regional lymph node irradiation is indicated regardless of the surgery type (breast-conserving surgery or mastectomy). Despite the consensus that patients with more than three positive lymph nodes should be treated with radiotherapy, there is controversy regarding the recommendations for patients with one to three involved lymph nodes. In patients with N0 disease with negative findings on axillary surgery, there is a trend to administer regional lymph node irradiation in patients with a high risk of recurrence. In patients treated with neoadjuvant systemic therapy and mastectomy, adjuvant radiotherapy should be administered in cases of clinical stage III and/or ≥ypN1. In patients treated with neoadjuvant systemic therapy and breast-conserving surgery, postoperative radiotherapy is indicated irrespective of pathological response.

Keywords: adjuvant radiotherapy; breast cancer; breast-conserving surgery; mastectomy; neoadjuvant chemotherapy; regional node irradiation; whole breast irradiation.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
3D computed tomography deep learning-based organ at risk auto-contouring (Siemens Healthineers AG, Erlangen, Germany) with manual target volume (CTV, PTV) delineation. ETB = Estimated Tumor Bed.
Figure 2
Figure 2
2D megavoltage electronic portal imaging (EPID) as a daily IGRT online setup of breast carcinoma radiotherapy: before (left) and after (right) alignment.
Figure 3
Figure 3
External-beam whole breast irradiation (WBI) and partial breast irradiation (PBI) with and without deep inspiration breath hold (DIBH)—comparison of the same target volume CT slice.
Figure 4
Figure 4
Multicatheter interstitial accelerated partial breast irradiation (APBI): prescribed dose distribution.
Figure 5
Figure 5
Postmastectomy radiotherapy (PMRT) with axillary, internal mammary, and medial supraclavicular lymph node irradiation.
See this image and copyright information in PMC

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