ADVANCES IN BREAST CANCER DIAGNOSIS AND TREATMENT: ESSENTIALS

Advances in breast cancer diagnosis and treatment Essentials_kapak

RADIOTHERAPY

Özüm Atasoy

Giresun Training and Research Hospital, Department of Radiation Oncology, Giresun, Türkiye

Atasoy Ö. Radiotherapy. In: Citgez B editor. Advances in Breast Cancer Diagnosis and Treatment Essentials. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.101-116.

ABSTRACT

Radiotherapy (RT) is a cornerstone of multidisciplinary breast cancer treatment. It improves locoregional control, reduces recurrence, and contributes to survival, especially when integrated with surgery and systemic therapies. This chapter provides a comprehensive review of current radiotherapy approaches across early-stage, locally advanced, and selected metastatic breast cancer settings. In early-stage disease, whole-breast irradiation following breast-conserving surgery remains the standard of care, with hypofractionation now preferred based on strong evidence from trials such as OCOG, START, and FAST-Forward. Partial breast irradiation is selectively used in low-risk patients, while the use of boost radiation is guided by patient age, margin status, and tumor biology. In locally advanced breast cancer, postmastectomy radiotherapy and regional nodal irradiation are essential, particularly in patients with T3-T4 tumors, ≥4 positive lymph nodes, or high-risk features such as lymphovascular invasion and triple-negative subtype. Contemporary evidence supports chest wall and nodal field irradiation, guided by anatomical and biological criteria. In the neoadjuvant setting, radiotherapy decisions should be based on clinical stage at diagnosis and residual disease, with emerging data from trials such as NSABP B-51 and ALLIANCE A011202 shaping future guidelines. Acute and late toxicities of RT-such as skin reactions, fibrosis, lymphedema, cardiopulmonary effects-are also discussed, along with mitigation strategies. Modern techniques including IMRT, VMAT, and deep inspiration breath hold (DIBH) have significantly reduced treatment-related morbidity. Overall, radiotherapy in breast cancer has evolved into a highly personalized and evidence-based discipline. While current practices are rooted in large randomized trials and international consensus guidelines, future directions include biologically guided RT, integration with immunotherapy, and adaptive techniques. Continued research is essential to refine indications, minimize toxicity, and improve long-term outcomes.

Keywords: Breast Neoplasms; Radiotherapy; Radiotherapy, Adjuvant; Radiation dose Hypofractionation; Lymphatic irradiation

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