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 1804

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Arcadia Radiation Oncology, City of Hope Medical Center, Arcadia, CA 91007, USA
Interests: radiation therapy; breast cancer; artificial intelligence
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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

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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 (1 paper)

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Research

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
Viewed by 1527
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
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