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Modern radiation techniques in early stage breast cancer for the breast radiologist

  • Brianna M. Jones
    Correspondence
    Corresponding author at: Radiation Oncology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, NY 10029, United States of America.
    Affiliations
    Icahn School of Medicine at Mount Sinai, United States of America
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  • Author Footnotes
    1 Radiation Oncology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, First Floor, New York, NY 10029, United States of America.
    Sheryl Green
    Footnotes
    1 Radiation Oncology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, First Floor, New York, NY 10029, United States of America.
    Affiliations
    Icahn School of Medicine at Mount Sinai, United States of America
    Search for articles by this author
  • Author Footnotes
    1 Radiation Oncology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, First Floor, New York, NY 10029, United States of America.

      Highlights

      • Age ≥ 18 years old, invasive ductal or lobular carcinoma, pTis/T1/T2, node negative, lumpectomy or mastectomy.
      • Partial breast radiation is safe and effective for suitable patients.
      • Age >40-50, Stage I (node negative) invasive ductal carcinoma, ER+PR+, grade 1-2 and low risk pure DCIS.
      • Lobular carcinoma may also benefit, but proceed with caution.
      • Globally, these shorter course regimens are becoming routine practice due to increased randomized evidence.
      • Mammogram or DBT should be obtained 6-12 months after completion of RT and yearly thereafter.

      Abstract

      Partial breast irradiation (PBI) and ultra-hypofractionated whole breast irradiation (uWBI) are contemporary alternatives to conventional and standard hypofractionated whole breast irradiation (WBI), which shorten treatment from 3 to 6 weeks to 1–2 weeks for select patients. PBI and accelerated PBI (APBI) can be delivered with external beam radiation (3D conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT)), intraoperative radiation (IORT), or brachytherapy. These new radiation techniques offer the advantage of convenience and lower cost, which ultimately improves access to care. Globally, the COVID 19 pandemic has accelerated APBI/PBI and ultra-hypofractionated regimens into routine practice for carefully selected patients. Recent long-term data from randomized controlled trials (RCTs) have demonstrated these techniques are safe and effective in suitable patients demonstrating equivalent or improved local recurrence, acute/late toxicity, and cosmesis. PBI and APBI should be limited to low risk unifocal invasive ductal carcinoma and ductal carcinoma in situ with tumor size < 2 cm, clear margins (≥2 mm), ER+, and negative nodes. Based on the results from UK Fast-Forward and UK FAST ultra-hypofractionated breast radiation can be safely employed for early stage node negative patients, but is not yet considered an international standard of care. In this review, authors will appraise recent data for these shorter course radiation treatment regimens, as well as, considerations for breast radiologists including surveillance imaging and radiographic findings.

      Keywords

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