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Cancers
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Local Management of Breast Cancer: The Evolving Relationship Between Radiotherapy...
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Local Management of Breast Cancer: The Evolving Relationship Between Radiotherapy and Surgery

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 30 June 2025 | Viewed by 2532

Special Issue Editor

Dr. Shengyang Peter Wu

E-Mail Website
Guest Editor
Arcadia Radiation Oncology, City of Hope Medical Center, Arcadia, CA 91007, USA
Interests: radiation therapy; breast cancer; artificial intelligence
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Breast cancer treatment is rapidly evolving with a growing emphasis on personalized care. The SOUND trial, for instance, is exploring whether ultrasound can safely replace axillary surgery in certain patients, potentially sparing them from unnecessary procedures. In the neoadjuvant setting, the NSABP B-51 trial suggests that radiotherapy could be reduced for patients who achieve a complete response to initial treatment. Other trials like IDEA, DEBRA, and MA.39 are investigating ways to reduce the intensity of treatment based on biological markers. Surgical advancements, such as targeted axillary dissection, focus on removing only specific cancerous lymph nodes, reducing complications like lymphedema. Meanwhile, radiotherapy is becoming more efficient with techniques that allow many patients to complete treatment in just five sessions, as seen in the FAST and FAST-FORWARD trials. Accelerated partial breast irradiation further personalizes care by targeting radiation to the tumor bed. These recent developments are reshaping breast cancer treatment and influencing guidelines like those from the National Comprehensive Cancer Network and the Choosing Wisely campaign, marking a significant shift towards more tailored, less invasive therapies.

Dr. Shengyang Peter Wu
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • biomarker-guided personalized breast treatment
  • targeted axillary dissection
  • neoadjuvant therapy
  • local therapy
  • radiotherapy reduction
  • ultrahypofractionated partial breast irradiation

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Published Papers (2 papers)

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Research

14 pages, 531 KiB  
Article
Efficacy of Metastasis-Directed Radiation Therapy to Prolong Systemic Therapy for Patients with Oligoprogressive Metastatic Breast Cancer
by Alexis LeVee, Hannah Young, Stephanie Yoon, Scott Glaser, Shengyang Wu, Joanne Mortimer and Jose G. Bazan
Cancers 2025, 17(13), 2153; https://doi.org/10.3390/cancers17132153 - 26 Jun 2025
Abstract
Background: Clinical trials have shown mixed results regarding the benefit of metastasis-directed radiation therapy (MDRT) in oligoprogressive (OP) metastatic breast cancer (MBC), leading to ongoing debate about its role. This study aimed to investigate whether MDRT can prolong the duration of systemic therapy [...] Read more.
Background: Clinical trials have shown mixed results regarding the benefit of metastasis-directed radiation therapy (MDRT) in oligoprogressive (OP) metastatic breast cancer (MBC), leading to ongoing debate about its role. This study aimed to investigate whether MDRT can prolong the duration of systemic therapy for ≥6 months in patients with OP MBC. Methods: This retrospective cohort study included patients with MBC who received MDRT for OP disease between December 2017 and March 2023. Patients who received MDRT to the brain were excluded. Medical records were reviewed through July 2024. The primary endpoint was the proportion of patients remaining on the same systemic therapy for ≥6 months post-MDRT. Results: In total, 52 patients with OP MBC treated with MDRT were included, with 36 (69%) with HR+/HER2- disease, 10 (19%) with HER2+ disease, and 6 (12%) with TNBC. Among the 47 patients with follow-up data available, 28 (60%) remained on their systemic therapy at 6 months, including 65% (22/34) of patients with HR+/HER2- disease, 56% (5/9) with HER2+ disease, and 25% (1/4) with TNBC (p = 0.30). Among the 38 patients with a follow-up time of at least 1 year post-MDRT, 47% (18/38) remained on the same systemic therapy. The median time to next systemic therapy and median PFS were 6.9 months (95% CI, 5.7–14.7) and 6.2 months (95% CI, 4.1–9.7), respectively. Conclusions: Over half of patients with OP MBC remained on the same systemic therapy for at least 6 months following MDRT, which suggests that MDRT may help prolong systemic therapy duration for select patients. Full article
(This article belongs to the Special Issue Local Management of Breast Cancer: The Evolving Relationship Between Radiotherapy and Surgery)
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19 pages, 2560 KiB  
Article
Effectiveness of FLASH vs. Conventional Dose Rate Radiotherapy in a Model of Orthotopic, Murine Breast Cancer
by Stavros Melemenidis, Vignesh Viswanathan, Suparna Dutt, Naviya Kapadia, Brianna Lau, Luis A. Soto, M. Ramish Ashraf, Banita Thakur, Adel Z. I. Mutahar, Lawrie B. Skinner, Amy S. Yu, Murat Surucu, Kerriann M. Casey, Erinn B. Rankin, Kathleen C. Horst, Edward E. Graves, Billy W. Loo, Jr. and Frederick M. Dirbas
Cancers 2025, 17(7), 1095; https://doi.org/10.3390/cancers17071095 - 25 Mar 2025
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Abstract
Introduction: Radiotherapy is effective for breast cancer treatment but often causes undesirable side effects that impair quality of life. Ultra-high dose rate radiotherapy (FLASH) has shown reduced normal tissue toxicity while achieving comparable tumor growth delay compared to conventional dose rate radiotherapy [...] Read more.
Introduction: Radiotherapy is effective for breast cancer treatment but often causes undesirable side effects that impair quality of life. Ultra-high dose rate radiotherapy (FLASH) has shown reduced normal tissue toxicity while achieving comparable tumor growth delay compared to conventional dose rate radiotherapy (CONV). This study evaluated whether FLASH could achieve similar tumor control as CONV with tumor eradication as the primary endpoint, in an orthotopic breast cancer model. Methods: Non-metastatic, orthotopic tumors were generated in the left fourth mammary fat pad using the Py117 mammary tumor cell line in syngeneic C57BL/6J mice. Two sequential irradiation studies were performed using FLASH (93–200 Gy/s) and CONV (0.08 Gy/s) electron beams. Single fractions of 20, 25, or 30 Gy were applied to tumors with varying abdominal wall treatment fields (~3.75 or 2.5 mm treatment margin to tumor). Results: Both FLASH and CONV demonstrated comparable efficacy. Small tumors treated with 30 Gy and larger abdominal wall treatment fields appeared to have complete eradication at 30 days but also exhibited the highest skin toxicity, limiting follow-up and preventing confirmation of eradication. Smaller abdominal wall treatment fields reduced skin toxicity and allowed for extended follow-up, which resulted in 75% tumor-free survival at 48 days. Larger tumors showed growth delay but no eradication. Conclusions: In this preclinical, non-metastatic orthotopic breast cancer model, FLASH and CONV demonstrated equivalent tumor control with single-fraction doses of 20, 25, or 30 Gy. Overall, 30 Gy achieved the highest eradication rate but also resulted in the most pronounced skin toxicity. Full article
(This article belongs to the Special Issue Local Management of Breast Cancer: The Evolving Relationship Between Radiotherapy and Surgery)
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