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Past
Standard of care for low-risk breast cancer patients is breast conserving surgery (BCS) followed by partial breast irradiation (PBI). Postoperative PBI leads to unnecessary large irradiated breast volumes due to artifacts, including seroma.1 Preoperative PBI allows more precise target volume definition as the tumor is still in situ, and more importantly carries the possibility of tumor downstaging.
Present
Recent studies have reported good to excellent clinical and oncological outcomes in patients treated with preoperative PBI followed by BCS.2 Five studies reported results on single-dose external beam preoperative PBI ranging between 15 and 21 Gy.2 Treatment with this relatively high dose led to mainly mild toxicity and good to excellent cosmetic outcomes in the majority of the patients. A remarkable result is the increased rate of pathologic complete response (pCR) after a longer interval of 6–8 months (42%) in comparison with a shorter interval of 2–8 weeks between radiotherapy and surgery (0–15%).2 Therefore, extending the interval could lead to an even higher response rate.
Future
The ultimate goal is to omit surgery in future low-risk patients with a pCR. For this purpose, it is necessary to be able to predict a pCR accurately after single-dose PBI. Even when patients do not reach a pCR after preoperative PBI, the advantage of this approach is single-dose radiotherapy instead of the standard multi-fractionated radiotherapy (i.e., 5–15 fractions).3 This could reduce the treatment burden, facilitate healthcare logistics, and reduce healthcare costs. The positive predictive value of magnetic resonance imaging (MRI) alone is 67%, which is not sufficient to predict a pCR.4 Combining MRI parameters with biomarkers, such as gene expression profiling, specific immune profiles, and circulating tumor DNA could result in more accurate prediction of pCR after preoperative single-dose PBI in low-risk breast cancer patients.5
References
Nichols EM, Dhople AA, Mohiuddin MM, Flannery TW, Yu CX, Regine WF. Comparative analysis of the post-lumpectomy target volume versus the use of pre-lumpectomy tumor volume for early-stage breast cancer: implications for the future. Int J Radiat Oncol Biol Phys. 2010;77(1):197–202. https://doi.org/10.1016/j.ijrobp.2009.04.063.
Civil YA, Jonker LW, Groot Koerkamp MPM, et al. Preoperative partial breast irradiation in low-risk breast cancer patients: a systematic review of literature. Ann Surg Oncol. 2023. https://doi.org/10.1245/s10434-023-13233-9.
Murray Brunt A, Haviland JS, Wheatley DA, et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet. 2020;395(10237):1613–26. https://doi.org/10.1016/S0140-6736(20)30932-6.
Vasmel JE, Charaghvandi RK, Houweling AC, et al. Tumor response after neoadjuvant magnetic resonance guided single ablative dose partial breast irradiation. Int J Radiat Oncol Biol Phys. 2020;106(4):821–9. https://doi.org/10.1016/j.ijrobp.2019.11.406.
Papakonstantinou A, Gonzalez NS, Pimentel I, et al. Prognostic value of ctDNA detection in patients with early breast cancer undergoing neoadjuvant therapy: a systematic review and meta-analysis. Cancer Treat Rev. 2022;104:102362. https://doi.org/10.1016/j.ctrv.2022.102362.
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Funding was provided by KWF Kankerbestrijding, 12138.
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Civil, Y.A., Jonker, L.W., Oei, A.L. et al. ASO Author Reflections: Personalized Breast Cancer Treatment Using Preoperative Partial Breast Irradiation. Ann Surg Oncol 30, 5709–5710 (2023). https://doi.org/10.1245/s10434-023-13298-6
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DOI: https://doi.org/10.1245/s10434-023-13298-6