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<p>Radiotherapy is an integral part of multidisciplinary adjuvant treatment for early breast cancer and is recommended in a&#xa0;high percentage of patients following breast-conserving surgery or mastectomy, particularly those with specific risk factors. Due to diagnostic and clinical developments, tumour characteristics and the risk of relapse can now be assessed more precisely, putting the era of ‘one-size-fits-all’ radiotherapy treatments behind us. Consideration of all the advantages and disadvantages of breast radiotherapy, including acute and long-term side effects, makes risk-adapted and tailored treatment necessary. Continuous technical improvements allow better dose distribution in the target and better sparing of organs at risk with a&#xa0;possible de-escalation in treatment time with moderate and ultrahypofractionation. Incorporating molecular markers for better estimation of the local recurrence risk facilitates decision-making for the use of partial breast irradiation or even the complete omission of irradiation. In this short review, modern strategies of de-escalation in early breast radiotherapy are discussed without a&#xa0;claim of completeness and reflects the personal choice of the author.</p>

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SGBCC 2025: strategies of risk-adapted modern radiotherapy in early breast cancer

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  • 发表日期：

    2025年8月5日

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  • Daniela Kauer-Dorner

摘要

Radiotherapy is an integral part of multidisciplinary adjuvant treatment for early breast cancer and is recommended in a high percentage of patients following breast-conserving surgery or mastectomy, particularly those with specific risk factors. Due to diagnostic and clinical developments, tumour characteristics and the risk of relapse can now be assessed more precisely, putting the era of ‘one-size-fits-all’ radiotherapy treatments behind us. Consideration of all the advantages and disadvantages of breast radiotherapy, including acute and long-term side effects, makes risk-adapted and tailored treatment necessary. Continuous technical improvements allow better dose distribution in the target and better sparing of organs at risk with a possible de-escalation in treatment time with moderate and ultrahypofractionation. Incorporating molecular markers for better estimation of the local recurrence risk facilitates decision-making for the use of partial breast irradiation or even the complete omission of irradiation. In this short review, modern strategies of de-escalation in early breast radiotherapy are discussed without a claim of completeness and reflects the personal choice of the author.