Skip to main content

Advertisement

SpringerLink
Log in

Integrating Adjuvant Radiation with Post-Neoadjuvant Therapies in Early Breast Cancer

  • Breast Cancer (AS Zimmer, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Purpose of review

Because of the strong prognostic value of pathologic complete response (pCR) in early breast cancer (EBC), patients who fail to achieve this outcome have increasingly been eligible to a new treatment modality, namely post-neoadjuvant systemic therapy (PNT). However, adjuvant radiation therapy (RT) retains a crucial role in EBC, and also needs to be timely administered to patients. To address how modern PNT optimally integrates with adjuvant RT is therefore the purpose of this review.

Recent Findings

How PNT administration optimally integrates with adjuvant RT has varied depending on the type of systemic therapy employed. The introduction of novel “targeted” agents has created new challenges, as for many of them limited information is available on the feasibility of concurrent systemic and RT administration or their optimal sequencing.

Summary

PNT and RT are both of utmost importance to the management of EBC and need to be timely and safely administered to patients. The optimal strategy to integrate these modalities may vary according to the type of PNT agent and other factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Harbeck N, Im S-A, Barrios CH, Bonnefoi HR, Gralow J, Toi M, et al. Primary analysis of KAITLIN: A phase III study of trastuzumab emtansine (T-DM1) + pertuzumab versus trastuzumab + pertuzumab + taxane, after anthracyclines as adjuvant therapy for high-risk HER2-positive early breast cancer (EBC). J Clin Oncol. 2020;38(15_suppl):500.

    Article  Google Scholar 

  2. Romond EH, Perez EA, Bryant J, Suman VJ, Geyer CE, Davidson NE, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 2005;353(16):1673–84.

    Article  CAS  PubMed  Google Scholar 

  3. Slamon D, Eiermann W, Robert N, Pienkowski T, Martin M, Press M, et al. Adjuvant trastuzumab in HER2-positive breast cancer. N Engl J Med. 2011;365(14):1273–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Perez EA, Romond EH, Suman VJ, Jeong J-H, Sledge G, Geyer CE, et al. Trastuzumab plus adjuvant chemotherapy for human epidermal growth factor receptor 2–positive breast cancer: planned joint analysis of overall survival from NSABP B-31 and NCCTG N9831. J Clin Oncol. 2014;32(33):3744–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Cameron D, Brown J, Dent R, Jackisch C, Mackey J, Pivot X, et al. Adjuvant bevacizumab-containing therapy in triple-negative breast cancer (BEATRICE): primary results of a randomised, phase 3 trial. Lancet Oncol. 2013;14(10):933–42.

    Article  CAS  PubMed  Google Scholar 

  6. Goss PE, Ingle JN, Pritchard KI, Robert NJ, Muss H, Gralow J, et al. A randomized trial (MA.17R) of extending adjuvant letrozole for 5 years after completing an initial 5 years of aromatase inhibitor therapy alone or preceded by tamoxifen in postmenopausal women with early-stage breast cancer. J Clin Oncol. 2016;34(18_suppl):LBA1.

    Article  Google Scholar 

  7. EBCTCG (Early Breast Cancer Trialists’ Collaborative Group). Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials. Lancet. 2011;378(9804):1707–16.

    Article  Google Scholar 

  8. EBCTCG (Early Breast Cancer Trialists’ Collaborative Group). Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014;383(9935):2127–35.

    Article  Google Scholar 

  9. Dodwell D, Taylor C, McGale P, Coles C, Duane F, Gray R, et al. Abstract GS4-02: Regional lymph node irradiation in early stage breast cancer: an EBCTCG meta-analysis of 13,000 women in 14 trials. In: General session abstracts [Internet]. American Association for Cancer Research; 2019. p. GS4-02-GS4-02. Available in: http://cancerres.aacrjournals.org/lookup/doi/10.1158/1538-7445.SABCS18-GS4-02. Access in September 2020.

  10. Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164–72.

    Article  PubMed  Google Scholar 

  11. von Minckwitz G, Untch M, Blohmer J-U, Costa SD, Eidtmann H, Fasching PA, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012;30(15):1796–804.

    Article  Google Scholar 

  12. Perou CM, Sørlie T, Eisen MB, van de Rijn M, Jeffrey SS, Rees CA, et al. Molecular portraits of human breast tumours. Nature. 2000;406(6797):747–52.

    Article  CAS  PubMed  Google Scholar 

  13. Sparano JA, Gray RJ, Makower DF, Pritchard KI, Albain KS, Hayes DF, et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med. 2018;379(2):111–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Siow ZR, De Boer R, Lindeman G, Mann GB. Spotlight on the utility of the oncotype DX® breast cancer assay. Int J Women's Health. 2018;10:89–100.

    Article  CAS  Google Scholar 

  15. Masuda N, Lee S-J, Ohtani S, Im Y-H, Lee E-S, Yokota I, et al. Adjuvant capecitabine for breast cancer after preoperative chemotherapy. N Engl J Med. 2017;376(22):2147–59 This study describes the current status of post-neoadjuvant systemic therapy in TNBC.

    Article  CAS  PubMed  Google Scholar 

  16. Fyles AW, McCready DR, Manchul LA, Trudeau ME, Merante P, Pintilie M, et al. Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med. 2004;351(10):963–70.

    Article  CAS  PubMed  Google Scholar 

  17. Hughes KS, Schnaper LA, Bellon JR, Cirrincione CT, Berry DA, McCormick B, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol. 2013;31(19):2382–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Kunkler IH, Williams LJ, Jack WJL, Cameron DA, Dixon JM. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol. 2015;16(3):266–73.

    Article  PubMed  Google Scholar 

  19. Woodward WA, Barlow WE, Jagsi R, Buchholz TA, Shak S, Baehner F, et al. Association between 21-gene assay recurrence score and locoregional recurrence rates in patients with node-positive breast cancer. JAMA Oncol. 2020;6(4):505.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Joensuu H, Kellokumpu-Lehtinen P-L, Huovinen R, Jukkola-Vuorinen A, Tanner M, Kokko R, et al. Adjuvant capecitabine in combination with docetaxel, epirubicin, and cyclophosphamide for early breast cancer: the randomized clinical FinXX trial. JAMA Oncol. 2017;3(6):793.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Natori A, Ethier J-L, Amir E, Cescon DW. Capecitabine in early breast cancer: a meta-analysis of randomised controlled trials. Eur J Cancer. 2017;77:40–7.

    Article  CAS  PubMed  Google Scholar 

  22. Zhang Z-C, Xu Q-N, Lin S-L, Li X-Y. Capecitabine in combination with standard (neo)adjuvant regimens in early breast cancer: survival outcome from a meta-analysis of randomized controlled trials. Bid HK, organizador. PLoS ONE. 2016;11(10):e0164663.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Schmid P, Adams S, Rugo HS, Schneeweiss A, Barrios CH, Iwata H, et al. Atezolizumab and nab-paclitaxel in advanced triple-negative breast cancer. N Engl J Med. 2018;379(22):2108–21.

    Article  CAS  PubMed  Google Scholar 

  24. Cortes J, Cescon DW, Rugo HS, Nowecki Z, Im S-A, Yusof MM, et al. KEYNOTE-355: randomized, double-blind, phase III study of pembrolizumab + chemotherapy versus placebo + chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer. J Clin Oncol. 2020;38(15_suppl):1000.

    Article  Google Scholar 

  25. Schmid P, Cortes J, Pusztai L, McArthur H, Kümmel S, Bergh J, et al. Pembrolizumab for early triple-negative breast cancer. N Engl J Med. 2020;382(9):810–21.

    Article  CAS  PubMed  Google Scholar 

  26. Keenan TE, Tolaney SM. Role of immunotherapy in triple-negative breast cancer. J Natl Compr Cancer Netw. 2020;18(4):479–89.

    Article  CAS  Google Scholar 

  27. Mittendorf EA, Zhang H, Barrios CH, Saji S, Jung KH, Hegg R, et al. Neoadjuvant atezolizumab in combination with sequential nab-paclitaxel and anthracycline-based chemotherapy versus placebo and chemotherapy in patients with early-stage triple-negative breast cancer (IMpassion031): a randomised, double-blind, phase 3 trial. Lancet. 2020;396(10257):1090–100.

    Article  CAS  PubMed  Google Scholar 

  28. Korde LA, Somerfield MR, Carey LA, Crews JR, Denduluri N, Hwang ES, et al. Neoadjuvant chemotherapy, endocrine therapy, and targeted therapy for breast cancer: ASCO Guideline. J Clin Oncol. 2021; JCO20.03399.

  29. Diéras V, Harbeck N, Budd GT, Greenson JK, Guardino AE, Samant M, et al. Trastuzumab emtansine in human epidermal growth factor receptor 2–positive metastatic breast cancer: an integrated safety analysis. J Clin Oncol. 2014;32(25):2750–7.

    Article  PubMed  Google Scholar 

  30. Verma S, Miles D, Gianni L, Krop IE, Welslau M, Baselga J, et al. Trastuzumab emtansine for HER2-positive advanced breast cancer. N Engl J Med. 2012;367(19):1783–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Diéras V, Miles D, Verma S, Pegram M, Welslau M, Baselga J, et al. Trastuzumab emtansine versus capecitabine plus lapatinib in patients with previously treated HER2-positive advanced breast cancer (EMILIA): a descriptive analysis of final overall survival results from a randomised, open-label, phase 3 trial. Lancet Oncol. 2017;18(6):732–42.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Krop IE, Lin NU, Blackwell K, Guardino E, Huober J, Lu M, et al. Trastuzumab emtansine (T-DM1) versus lapatinib plus capecitabine in patients with HER2-positive metastatic breast cancer and central nervous system metastases: a retrospective, exploratory analysis in EMILIA. Ann Oncol. 2015;26(1):113–9.

    Article  CAS  PubMed  Google Scholar 

  33. Krop IE, Kim S-B, Martin AG, LoRusso PM, Ferrero J-M, Badovinac-Crnjevic T, et al. Trastuzumab emtansine versus treatment of physician’s choice in patients with previously treated HER2-positive metastatic breast cancer (TH3RESA): final overall survival results from a randomised open-label phase 3 trial. Lancet Oncol. 2017;18(6):743–54.

    Article  CAS  PubMed  Google Scholar 

  34. Perez EA, Barrios C, Eiermann W, Toi M, Im Y-H, Conte P, et al. Trastuzumab emtansine with or without pertuzumab versus trastuzumab plus taxane for human epidermal growth factor receptor 2–positive, advanced breast cancer: primary results from the phase III MARIANNE study. J Clin Oncol. 2017;35(2):141–8.

    Article  CAS  PubMed  Google Scholar 

  35. Perez EA, Barrios C, Eiermann W, Toi M, Im Y, Conte P, et al. Trastuzumab emtansine with or without pertuzumab versus trastuzumab with taxane for human epidermal growth factor receptor 2–positive advanced breast cancer: final results from MARIANNE. Cancer. 2019;125(22):3974–84.

    Article  CAS  PubMed  Google Scholar 

  36. von Minckwitz G, Huang C-S, Mano MS, Loibl S, Mamounas EP, Untch M, et al. Trastuzumab emtansine for residual invasive HER2-positive breast cancer. N Engl J Med. 2019;380(7):617–28 This study describes the current status of post-neoadjuvant systemic therapy in HER2+ BC with residual invasive disease.

    Article  Google Scholar 

  37. Kuhl C, Kuhn W, Braun M, Schild H. Pre-operative staging of breast cancer with breast MRI: one step forward, two steps back? Breast. 2007;16:34–44.

    Article  Google Scholar 

  38. Akissue de Camargo Teixeira P, Chala LF, Shimizu C, Filassi JR, Maesaka JY, de Barros N. Axillary lymph node sonographic features and breast tumor characteristics as predictors of malignancy: a nomogram to predict risk. Ultrasound Med Biol. 2017;43(9):1837–45.

    Article  PubMed  Google Scholar 

  39. Pillay B, Wootten AC, Crowe H, Corcoran N, Tran B, Bowden P, et al. The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: a systematic review of the literature. Cancer Treat Rev. 2016;42:56–72.

    Article  PubMed  Google Scholar 

  40. von Minckwitz G, Procter M, de Azambuja E, Zardavas D, Benyunes M, Viale G, et al. Adjuvant pertuzumab and trastuzumab in early HER2-positive breast cancer. N Engl J Med. 2017;377(2):122–31.

    Article  Google Scholar 

  41. Cardoso F, van ’t Veer L, Poncet C, Lopes Cardozo J, Delaloge S, Pierga J-Y, et al. MINDACT: long-term results of the large prospective trial testing the 70-gene signature MammaPrint as guidance for adjuvant chemotherapy in breast cancer patients. J Clin Oncol. 2020;38(15_suppl):506.

    Article  Google Scholar 

  42. Poorvu PD, Gelber SI, Rosenberg SM, Ruddy KJ, Tamimi RM, Collins LC, et al. Prognostic impact of the 21-gene recurrence score assay among young women with node-negative and node-positive ER-positive/HER2-negative breast cancer. J Clin Oncol. 2020;38(7):725–33.

    Article  CAS  PubMed  Google Scholar 

  43. Johnston SRD, Harbeck N, Hegg R, Toi M, Martin M, Shao ZM, et al. Abemaciclib combined with endocrine therapy for the adjuvant treatment of HR+, HER2−, node-positive, high-risk, early breast cancer (monarchE). J Clin Oncol. 2020;38(34):3987–98.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Mayer EL, Dueck AC, Martin M, Rubovszky G, Burstein HJ, Bellet-Ezquerra M, et al. Palbociclib with adjuvant endocrine therapy in early breast cancer (PALLAS): interim analysis of a multicentre, open-label, randomised, phase 3 study. Lancet Oncol. 2021:S1470204520306422.

  45. Loibl S, Marme F, Martin M, et al. Phase III study of palbociclib combined with endocrine therapy in patients with hormone-receptor-positive, HER2-negative primary breast cancer and high relapse risk after neoadjuvant chemotherapy: first results from PENELOPE-B. 2020 San Antonio Breast Cancer Symposium.; 2020.

  46. Recht A, Comen EA, Fine RE, Fleming GF, Hardenbergh PH, Ho AY, et al. Postmastectomy radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update. J Clin Oncol. 2016;34(36):4431–42.

    Article  PubMed  Google Scholar 

  47. Mamounas EP, Anderson SJ, Dignam JJ, Bear HD, Julian TB, Geyer CE, et al. Predictors of locoregional recurrence after neoadjuvant chemotherapy: results from combined analysis of national surgical adjuvant breast and bowel project B-18 and B-27. J Clin Oncol. 2012;30(32):3960–6.

    Article  PubMed  PubMed Central  Google Scholar 

  48. McGuire SE, Gonzalez-Angulo AM, Huang EH, Tucker SL, Kau S-WC, Yu T-K, et al. Postmastectomy radiation improves the outcome of patients with locally advanced breast cancer who achieve a pathologic complete response to neoadjuvant chemotherapy. Int J Radiat Oncol. 2007;68(4):1004–9.

    Article  Google Scholar 

  49. Boughey JC. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: The ACOSOG Z1071 (Alliance) Clinical Trial. JAMA. 2013;310(14):1455.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Arvold ND, Taghian AG, Niemierko A, Abi Raad RF, Sreedhara M, Nguyen PL, et al. Age, breast cancer subtype approximation, and local recurrence after breast-conserving therapy. J Clin Oncol. 2011;29(29):3885–91 This study demonstrates that young age remains an independent risk factor for LR, with variability in LR risk for young patients according to BC subtype.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Kao J, Conzen SD, Jaskowiak NT, Song DH, Recant W, Singh R, et al. Concomitant radiation therapy and paclitaxel for unresectable locally advanced breast cancer: results from two consecutive Phase I/II trials. Int. J Radiat Oncol. 2005;61(4):1045–53.

    Article  CAS  Google Scholar 

  52. Ismaili N, Mellas N, Masbah O, Elmajjaoui S, Arifi S, Bekkouch I, et al. Concurrent chemoradiotherapy in adjuvant treatment of breast cancer. Radiat Oncol. 2009;4(1):12.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Fernando IN, Bowden SJ, Herring K, Brookes CL, Ahmed I, Marshall A, et al. Synchronous versus sequential chemo-radiotherapy in patients with early stage breast cancer (SECRAB): A randomised, phase III, trial. Radiother Oncol. 2020;142:52–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Leonard CE, Wood ME, Zhen B, Rankin J, Waitz DA, Norton L, et al. Does administration of chemotherapy before radiotherapy in breast cancer patients treated with conservative surgery negatively impact local control? J Clin Oncol. 1995;13(12):2906–15.

    Article  CAS  PubMed  Google Scholar 

  55. Lluch A, Barrios CH, Torrecillas L, Ruiz-Borrego M, Bines J, Segalla J, et al. Phase III trial of adjuvant capecitabine after standard neo-/adjuvant chemotherapy in patients with early triple-negative breast cancer (GEICAM/2003-11_CIBOMA/2004-01). J Clin Oncol. 2020;38(3):203–13.

    Article  CAS  PubMed  Google Scholar 

  56. Sherry AD, Mayer I, Ayala-Peacock DN, Abramson V, Rexer B, Chakravarthy AB. Combining adjuvant radiotherapy with capecitabine appears to be safe and feasible for chemotherapy-resistant breast cancer. Int J Radiat Oncol. 2019;105(1):E33–4.

    Google Scholar 

  57. Woodward WA, Fang P, Arriaga L, Gao H, Cohen EN, Reuben JM, et al. A phase 2 study of preoperative capecitabine and concomitant radiation in women with advanced breast cancer. Int J Radiat Oncol. 2017;99(4):777–83.

    Article  CAS  Google Scholar 

  58. Aboudaram A, Modesto A, Chaltiel L, Gomez-Roca C, Boulinguez S, Sibaud V, et al. Concurrent radiotherapy for patients with metastatic melanoma and receiving anti-programmed-death 1 therapy: a safe and effective combination. Melanoma Res. 2017;27(5):485–91.

    Article  CAS  PubMed  Google Scholar 

  59. Luke JJ, Lemons JM, Karrison TG, Pitroda SP, Melotek JM, Zha Y, et al. Safety and clinical activity of pembrolizumab and multisite stereotactic body radiotherapy in patients with advanced solid tumors. J Clin Oncol. 2018;36(16):1611–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Loibl S, Huang C-S, Mano MS, Mamounas TP, Geyer CE, Untch M, et al. 96O Adjuvant trastuzumab emtansine (T-DM1) vs trastuzumab (T) in patients (pts) with residual invasive disease after neoadjuvant therapy for HER2+ breast cancer: subgroup analysis from KATHERINE. Ann Oncol. 2020;31:S48.

    Article  Google Scholar 

  61. Tolaney SM. A randomized phase II study of adjuvant trastuzumab emtansine (T-DM1) vs paclitaxel (T) in combination with trastuzumab (H) for stage I HER2-positive breast cancer (BC) (ATEMPT). SABCS; 2019; San Antonio, Texas.

  62. Halyard MY, Pisansky TM, Dueck AC, Suman V, Pierce L, Solin L, et al. Radiotherapy and adjuvant trastuzumab in operable breast cancer: tolerability and adverse event data from the NCCTG phase III trial N9831. J Clin Oncol. 2009;27(16):2638–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Romond EH, Jeong J-H, Rastogi P, Swain SM, Geyer CE, Ewer MS, et al. Seven-year follow-up assessment of cardiac function in NSABP B-31, a randomized trial comparing doxorubicin and cyclophosphamide followed by paclitaxel (ACP) with ACP plus trastuzumab as adjuvant therapy for patients with node-positive, human epidermal growth factor receptor 2–positive breast cancer. J Clin Oncol. 2012;30(31):3792–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. McGee SF, Mazzarello S, Caudrelier JM, Lima MAG, Hutton B, Sienkiewicz M, et al. Optimal sequence of adjuvant endocrine and radiation therapy in early-stage breast cancer – a systematic review. Cancer Treat Rev. 2018;69:132–42.

    Article  CAS  PubMed  Google Scholar 

  65. Cardoso F, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rubio IT, et al. Early breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2019;30(10):1674.

    Article  CAS  PubMed  Google Scholar 

  66. Chowdhary M, Sen N, Chowdhary A, Usha L, Cobleigh M, Wang D, et al. Safety and efficacy of palbociclib (CDK4/6 inhibitor) and radiotherapy in metastatic breast cancer patients: initial results of a novel combination. Int J Radiat Oncol. 2019;105(1):E2.

    Article  Google Scholar 

  67. Guerini AE, Pedretti S, Salah E, Simoncini EL, Maddalo M, Pegurri L, et al. A single-center retrospective safety analysis of cyclin-dependent kinase 4/6 inhibitors concurrent with radiation therapy in metastatic breast cancer patients. Sci Rep. 2020;10(1):13589.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Gonzalez-Angulo AM, Lei X, Alvarez RH, Green MC, Murray JL, Valero V, et al. Phase II randomized study of ixabepilone versus observation in patients with significant residual disease after neoadjuvant systemic therapy for HER2-negative breast cancer. Clin Breast Cancer. 2015;15(5):325–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Miller K, Tong Y, Jones DR, Walsh T, Danso MA, Ma CX, et al. Cisplatin with or without rucaparib after preoperative chemotherapy in patients with triple negative breast cancer: final efficacy results of Hoosier Oncology Group BRE09-146. J Clin Oncol. 2015;33(15_suppl):1082.

    Article  Google Scholar 

  70. von Minckwitz G, Rezai M, Tesch H, Huober J, Gerber B, Zahm DM, et al. Zoledronate for patients with invasive residual disease after anthracyclines-taxane-based chemotherapy for early breast cancer – the phase III NeoAdjuvant Trial Add-oN (NaTaN) study (GBG 36/ABCSG 29). Eur J Cancer. 2016;64:12–21.

    Article  Google Scholar 

  71. Haviland JS, Owen JR, Dewar JA, Agrawal RK, Barrett J, Barrett-Lee PJ, et al. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol. 2013;14(11):1086–94 The long-term follow-up of this study confirms that appropriately dosed hypofractionated radiotherapy is safe and effective for patients with early breast cancer.

    Article  PubMed  Google Scholar 

  72. Taylor C, Correa C, Duane FK, Aznar MC, Anderson SJ, Bergh J, et al. Estimating the risks of breast cancer radiotherapy: evidence from modern radiation doses to the lungs and heart and from previous randomized trials. J Clin Oncol. 2017;35(15):1641–9.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The authors received no specific funding for this work.

Author information

Authors and Affiliations

  1. Centro Paulista de Oncologia (CPO) – Unidade Faria Lima Endereço, Av. Brigadeiro Faria Lima, 4300 Grupo Oncoclínicas (GOC), São Paulo, SP, 04538-132, Brazil

    Max S. Mano & Leandro Jonata C. Oliveira

  2. Department of Radiation Oncology - Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, Oncology Center, São Paulo, 01308-050, Brazil

    Samir A. Hanna

Authors
  1. Max S. Mano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leandro Jonata C. Oliveira
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Samir A. Hanna
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Max S. Mano.

Ethics declarations

Conflict of interest

• Dr. Mano has provided compensated consultancy services and lectures for Roche, MSD, Astrazeneca, Novartis, Lilly-Inclone, and Pfizer though none are related to the subject of this article.

• Dr. Hanna has provided compensated lecture services for Roche.

• Dr. Oliveira has no conflicts of interest to report.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Breast Cancer

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mano, M.S., Oliveira, L.J.C. & Hanna, S.A. Integrating Adjuvant Radiation with Post-Neoadjuvant Therapies in Early Breast Cancer. Curr Oncol Rep 23, 58 (2021). https://doi.org/10.1007/s11912-021-01050-w

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11912-021-01050-w

Keywords

Search

Navigation