title: Radiotherapy Issues After Neoadjuvant Chemotherapy.
abstract: Radiotherapy (RT) is standard following neoadjuvant chemotherapy (NCT) and breast-conserving surgery. NCT leads to pathologic down-staging, allowing some patients to undergo breast-conserving therapy (BCT) instead of mastectomy. BCT can also be considered in select stage III patients who respond well to NCT. Clearly-negative surgical margins should be obtained in all patients undergoing BCT. RT is used selectively following NCT and mastectomy. Indications for RT have not been fully established; retrospective data and results from National Surgical Adjuvant Breast and Bowel Project B-18 and B-27 currently form the basis for recommending RT. Patients with locally advanced breast cancer should receive postmastectomy RT (PMRT). Patients with residual nodal involvement require PMRT. Stage I-II patients with a pathologic complete response do not require PMRT. Patients without residual nodal involvement, but with residual breast involvement represent an intermediate-risk group. NCT also provides down-staging in the axilla. The role of axillary RT in the setting of NCT is under investigation in ongoing randomized trials.
authors.affiliation: Harvard Radiation Oncology Program, Boston, MA (KSM); Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA (JRH).
authors.forename: Kimberley S
authors.initials: KS
authors.lastname: Mak
authors.affiliation: Harvard Radiation Oncology Program, Boston, MA (KSM); Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA (JRH) jharris@lroc.harvard.edu.
authors.forename: Jay R
authors.initials: JR
authors.lastname: Harris
mesh_terms: D001943:Breast Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant / Q000379:methods; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods; D020360:Neoadjuvant Therapy / Q000379:methods*; D011184:Postoperative Period; D017410:Practice Guidelines as Topic; D018714:Radiotherapy, Adjuvant / Q000379:methods