Partial Breast Irradiation Is the Preferred Standard of Care for a Majority of Women With Early‐Stage Breast Cancer
Ce dossier présente un ensemble d'articles concernant le traitement locorégional d'un cancer du sein
The meticulous work of numerous investigators has significantly advanced our understanding of the biologic diversity and molecular complexity of breast cancer. Because of this expanded insight into the natural history of this disease, surgical, radiotherapeutic, and systemic management has evolved in remarkably profound ways, leading to unequivocal improvement in patient outcomes. For example, an achievement of undeniable impact was the identification of high-risk subgroups with definably aggressive phenotypes. This observation directed trials of risk-adapted systemic and regional treatment intensification, with the gratifying consequence of improved breast cancer–specific survival.
Of equal importance to identifying those women at greatest risk of recurrence and death has been the recognition of low-risk subgroups with indolent biologic behavior or favorable pathologic anatomy for whom escalated treatment intensity presents risk with limited prospect of reward. It is perhaps the apotheosis of our enhanced understanding of the biology and natural history of breast cancer that we can now declare that we have entered the age of treatment de-escalation. The obvious benefit of de-escalation for the appropriately selected patient is that it decreases the risk of treatment-related morbidity with the result of enhanced quality of life (QOL). In addition, less intense therapy can decrease treatment time, improve convenience, and decrease the cost of therapy. Satisfying examples of de-escalation now span all treatment modalities and include such weighty advances as sentinel lymph node biopsy, omission of cytotoxic chemotherapy on the basis of genomic profile, and omission of radiation therapy in the low-risk elderly patient.
Journal of Clinical Oncology , commentaire en libre accès, 2019