title: Critical decision-making in radiotherapy for early stage breast cancer in a neo-adjuvant treatment era.
abstract: In breast cancer management, the role of adjuvant radiation therapy (RT) has been the subject of intense controversy over the past several years, due to the improvement in neoadjuvant chemotherapy (NACT) prescription. One of the most controversial questions regarding indication for adjuvant RT is whether or not RT is essential in patients with early stage disease at diagnosis. The value of adjuvant RT remains highly debatable in those patients with clinically negative nodes at the completion of NACT. Areas covered: This review is focused on this gray area and is intended to assist with clinical decision-making. We provide a comprehensive review using PubMed and meeting proceedings of San Antonio Breast Cancer Symposium, European Society for Radiotherapy & Oncology, European Society of Medical Oncology and American Society of Clinical Oncology. Expert commentary: The identification of potential prognostic factors may lead to novel adjuvant RT indications. Phase III clinical trials are underway and their results will help guide treatment decisions.
authors.affiliation: a Department of Radiotherapy , Policlinico Umberto I, "Sapienza" University of Rome , Rome , Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: De Felice
authors.affiliation: b Department of Medicine and Surgery and Translational Medicine , Unit of Radiotherapy, S Andrea Hospital, "Sapienza" University of Rome , Rome , Italy.
authors.forename: Mattia Falchetto
authors.initials: MF
authors.lastname: Osti
authors.affiliation: b Department of Medicine and Surgery and Translational Medicine , Unit of Radiotherapy, S Andrea Hospital, "Sapienza" University of Rome , Rome , Italy.
authors.forename: Vitaliana
authors.initials: V
authors.lastname: De Sanctis
authors.affiliation: a Department of Radiotherapy , Policlinico Umberto I, "Sapienza" University of Rome , Rome , Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Musio
authors.affiliation: a Department of Radiotherapy , Policlinico Umberto I, "Sapienza" University of Rome , Rome , Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tombolini
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003657:Decision Making; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy / Q000379:methods; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000379:methods
chemical_list: D000970:Antineoplastic Agents
keywords: Breast cancer; breast conservative surgery; clinical response; mastectomy; neoadjuvant chemotherapy; radiotherapy