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Advances in Breast Cancer Radiotherapy: Implications for Current and Future Practice

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: closed (31 August 2024) | Viewed by 11033

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Special Issue Editor

Prof. Dr. Michael J. McKay

E-Mail Website1 Website2
Guest Editor

1. Northern Cancer Service, North West Cancer Centre, Burnie, TAS 7320, Australia
2. Rural Clinical School, Northwest Regional Hospital, University of Tasmania, Burnie, TAS 7320, Australia
Interests: breast cancer; radiotherapy; radiation oncology; molecular genetics

Special Issue Information

Dear Colleagues,

Breast cancer is the leading cause of cancer in women and the second most common cause of cancer death. Radiotherapy is one of the pillars of breast cancer treatment. It is an exciting time in breast cancer radiotherapy, where the landscapes for diagnosis, treatment and prognosis are rapidly evolving. You are invited to contribute to this Special Issue of JCM entitled “Advances in Breast Cancer Radiotherapy: Implications for Current and Future Practice”.

Molecular biology is impacting the breast cancer treatment with the development of prognostic gene expression signatures. In early breast cancer, the eligibility criteria for the omission of post-lumpectomy radiotherapy are expanding, while hypofractionation has impacted standard practice and is being actively explored in locally advanced disease; its extension to ultrahypofractionation is revolutionizing treatment schemes. The indications for postmastectomy radiotherapy are actively evolving, while subsets of breast cancer patients with oligometastatic disease, suitable for ablative radiotherapy, are actively being sought.

We look forward to receiving your submissions to this Special Issue.

Prof. Dr. Michael J. McKay
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 short 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. Journal of Clinical Medicine 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 2600 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

breast conserving surgery
post-mastectomy radiotherapy
accelerated partial breast irradiation
radiotherapy hypofractionation
radiotherapy hypofractionation and ultrahypofractionation
metastasis-directed therapy
radiotherapy clinical trials
breast cancer
radiotherapy

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Published Papers (5 papers)

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Research

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10 pages, 874 KiB

Open AccessArticle

Impact of Varying Chest Wall Target Volume Delineation on Postmastectomy Radiation Therapy Outcomes in Breast Cancer Patients with Implant-Based Reconstruction

by Pei-Yu Hou, Chen-Hsi Hsieh, Chen-Xiong Hsu, Deng-Yu Kuo, Yueh-Feng Lu and Pei-Wei Shueng

J. Clin. Med. 2023, 12(21), 6882; https://doi.org/10.3390/jcm12216882 - 31 Oct 2023

Viewed by 1846

Abstract

Background: The target volume for post-mastectomy radiation therapy (PMRT) in breast cancer patients with reconstruction has been a subject of debate. Traditionally, the RT chest wall (CW) volume encompasses the entire implant. For patients with retropectoral implants, the deep lymphatic plexus dorsal part of the implant is no longer considered high risk and can be omitted. This study aimed to assess the radiation dose distribution and treatment outcomes associated with different CW delineation according to ESTRO ACROP guideline for patients who have undergone implant-based reconstruction. Methods: We conducted a retrospective review of breast cancer patients who underwent a mastectomy followed by two-stage implant-based breast reconstruction and adjuvant radiation therapy (RT) between 2007 and 2022. The expanders/implants were positioned retropectorally. The chest wall target volumes were categorized into two groups: the prepectoral group, which excluded the deep lymphatic plexus, and the whole expander group. Results: The study included 26 patients, with 15 in the prepectoral group and 11 in the whole expander group. No significant differences were observed in normal organ exposure between the two groups. There was a trend toward a lower ipsilateral lung mean dose in the prepectoral group (10.2 vs. 11.1 Gy, p = 0.06). Both groups exhibited limited instances of reconstruction failure and local recurrence. Conclusions: For patients undergoing two-stage expander/implant retropectoral breast reconstruction and PMRT, our data provided comparable outcomes and normal organ exposure for those omitting the deep lymphatic plexus. Full article

(This article belongs to the Special Issue Advances in Breast Cancer Radiotherapy: Implications for Current and Future Practice)

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15 pages, 712 KiB

Open AccessArticle

Objective, Clinician- and Patient-Reported Evaluation of Late Toxicity Following Adjuvant Radiation for Early Breast Cancer: Long-Term Follow-Up Results of a Randomised Series

by Cas Stefaan Dejonckheere, Alina Abramian, Kira Lindner, Anne Bachmann, Katharina Layer, Teresa Anzböck, Julian Philipp Layer, Gustavo Renato Sarria, Davide Scafa, David Koch, Christina Leitzen, Christina Kaiser, Andree Faridi and Leonard Christopher Schmeel

J. Clin. Med. 2023, 12(13), 4212; https://doi.org/10.3390/jcm12134212 - 22 Jun 2023

Cited by 4 | Viewed by 1744

Abstract

Background and Purpose: This study aimed to differentially assess the frequency and severity of late radiation-induced toxicity following adjuvant whole-breast irradiation for early breast cancer with conventional fractionation (CF) and moderate hypofractionation (mHF). Materials and Methods: Patients recruited in a previous randomised controlled trial comparing acute toxicity between CF and mHF without disease recurrence were included in a post hoc analysis. Spectrophotometric and ultrasonographic examinations were performed for an objective evaluation and subsequent comparison of long-term skin toxicity. Furthermore, patient- and clinician-reported outcomes were recorded. Results: Sixty-four patients with a median age of 58 (37–81) years were included. The median follow-up was 57 (37–73) months. A total of 55% underwent CF and 45% mHF. A total of 52% received a sequential boost to the tumour bed. A significant decrease in mean L* (p = 0.011) and an increase in a* (p = 0.040) and b* values (p < 0.001) were observed, indicating hyperpigmentation. In comparison with the non-irradiated breast, there was a significant increase in both cutis (+14%; p < 0.001) and subcutis (+17%; p = 0.011) thickness, significantly more pronounced in CF patients (p = 0.049). In CF patients only, a sequential boost significantly increased the local cutis thickness and oedema compared to non-boost regions in the same breast (p = 0.001 and p < 0.001, respectively). Conclusions: mHF objectively resulted in reduced long-term skin toxicity compared to CF. A sequential boost increased the local fibrosis rate in CF, but not in mHF. This might explain the subjectively reported better cosmetic outcomes in patients receiving mHF and reinforces the rationale for favouring mHF as the standard of care. Full article

(This article belongs to the Special Issue Advances in Breast Cancer Radiotherapy: Implications for Current and Future Practice)

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Review

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14 pages, 1081 KiB

Open AccessReview

Contemporary Issues in Postmastectomy Radiotherapy: A Brief Review

by Caroline A. Grace and Michael J. McKay

J. Clin. Med. 2024, 13(24), 7545; https://doi.org/10.3390/jcm13247545 - 11 Dec 2024

Viewed by 1077

Abstract

Breast cancer is the one of the most common cancers and causes a significant disease burden. Currently, postmastectomy radiotherapy (PMRT) is indicated for breast cancer patients with higher risk of recurrence, such as those with positive surgical margins or high-risk breast cancer (T3 with positive lymph nodes, ≥4 positive lymph nodes or T4 disease). Whether PMRT should be used in intermediate-risk breast cancer (T3 with no positive lymph nodes or T1-2 with 1-3 positive lymph nodes) is contentious. Rates of breast reconstruction postmastectomy are increasing in countries like Australia, and PMRT usage in such settings is another area of active research. Ongoing trials are also assessing the safety and efficacy of hypofractionated PMRT, a clinical scenario now widely accepted for early-stage breast cancer. This brief review is unique in that it aims to examine three current and controversial aspects of the PMRT field (PMRT in intermediate-risk breast cancer, PMRT in conjunction with breast reconstruction and its hypofractionation). To achieve this aim, we discuss available and emerging literature and guidelines to offer insights important to the PMRT field. Current literature suggests that PMRT could play a role in improving the overall survival rate and in reducing locoregional recurrence in intermediate-risk breast cancer. In terms of recommending a timing or type of breast reconstruction best suited to the setting of PMRT, we found that individual patient preferences and circumstances need to be considered alongside a multidisciplinary approach. Research into PMRT hypofractionation safety and efficacy is ongoing and its place remains to be elucidated. Full article

(This article belongs to the Special Issue Advances in Breast Cancer Radiotherapy: Implications for Current and Future Practice)

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16 pages, 275 KiB

Open AccessReview

Breast Cancer Adjuvant Radiotherapy and Chemotherapy Sequencing: Sequential, Concomitant, or What Else? A Comprehensive Review of the Adjuvant Combinations Journey

by Grazia Lazzari, Antonietta Montagna, Barbara D’Andrea, Antonella Bianculli, Giovanni Calice, Raffaele Tucciariello, Giovanni Castaldo, Vito Metallo, Giuseppina De Marco and Ilaria Benevento

J. Clin. Med. 2024, 13(20), 6251; https://doi.org/10.3390/jcm13206251 - 19 Oct 2024

Viewed by 2012

Abstract

Background: To date, in breast cancer (BC) treatment, adjuvant chemotherapy (A-CT) has preceded adjuvant radiotherapy (A-RT). In the last twenty years, the adjuvant treatment of BC has quickly evolved due to better knowledge of its molecular biology, genetic profile, and α/β ratio of 3/4 Gy for tumor and normal tissue radiosensitivity. Thus, new schedules with hypofractionated radiotherapy have been tested, and a third generation of A-CT has been introduced, raising the question of whether it is time to rethink the sequencing between these two approaches. Methods: In the last 20 years, many attempts have been made worldwide to optimize the best sequencing strategy between these two approaches in terms of sequential CT-RT and RT-CT and concomitant and sandwich modalities using drugs and schedules. This paper presents a comprehensive review of the state of the art, analyzing all the available studies to assess the sequencing between A-CT and A-RT with different generations of chemotherapy schedules. Results: More than 8000 patients from 30 studies treated with adjuvant chemotherapy and whole breast radiotherapy who were enrolled in randomized, retrospective, and prospective studies were analyzed. Sequential, concomitant, and sandwich modalities of chemotherapy with conventional or hypofractionated RT schedules from the most important studies were included. The most used sequence was adjuvant chemotherapy followed by conventional or hypofractionated radiotherapy. In the concomitant approach, i.v. CMF has been the most important adopted schedule, while the concomitant use of anthracyclines and taxanes with conventional or hypofractionated radiotherapy has been found to be more toxic. One study analyzed the benefit in terms of reducing adjuvant treatment time with upfront hypofractionated radiotherapy and third-generation chemotherapy. Conclusions: At present, the best sequencing strategy has not yet been defined. This comprehensive review is a journey among the most important randomized, retrospective, and prospective studies that highlights the past, current, and novel time sequencing proposals between A-CT and A-RT to assess the state of the art and provide useful information for future adjuvant approaches in breast cancer treatment. Full article

(This article belongs to the Special Issue Advances in Breast Cancer Radiotherapy: Implications for Current and Future Practice)

20 pages, 1588 KiB

Open AccessReview

PET Molecular Imaging in Breast Cancer: Current Applications and Future Perspectives

by Sanaz Katal, Michael J. McKay and Kim Taubman

J. Clin. Med. 2024, 13(12), 3459; https://doi.org/10.3390/jcm13123459 - 13 Jun 2024

Cited by 2 | Viewed by 3527

Abstract

Positron emission tomography (PET) plays a crucial role in breast cancer management. This review addresses the role of PET imaging in breast cancer care. We focus primarily on the utility of 18F-fluorodeoxyglucose (FDG) PET in staging, recurrence detection, and treatment response evaluation. Furthermore, we delve into the growing interest in precision therapy and the development of novel radiopharmaceuticals targeting tumor biology. This includes discussing the potential of PET/MRI and artificial intelligence in breast cancer imaging, offering insights into improved diagnostic accuracy and personalized treatment approaches. Full article

(This article belongs to the Special Issue Advances in Breast Cancer Radiotherapy: Implications for Current and Future Practice)

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