Partial Breast Irradiation for Early-Stage Breast Cancer: Advances, Challenges, and Future Directions-A Narrative Review.

IF 2.2 4区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Ayyaz Qadir, Nabita Singh, Anelyn Chui, Michael Chao, Sergio Uribe, Farshad Foroudi
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引用次数: 0

Abstract

Advances in breast cancer treatment have shifted the focus from maximizing local control to balancing oncologic efficacy with treatment de-escalation and toxicity reduction. Whole-breast irradiation (WBI) following breast-conserving surgery remains the standard of care, but with up to 90% of recurrences occurring near the tumor bed, partial breast irradiation (PBI) has emerged as a viable alternative. Large randomized controlled trials (such as IMPORT LOW, Florence, and GEC-ESTRO) have demonstrated comparable ipsilateral breast tumor recurrence (IBTR) rates between PBI and WBI, reinforcing its oncologic safety in well-selected patients. However, challenges remain in optimizing fractionation schedules, refining patient selection, and minimizing late toxicity. Recent innovations, including MRI-guided radiotherapy (MRgRT) and neoadjuvant PBI, offer improved tumor targeting, real-time plan adaptation, and enhanced normal tissue sparing. These advancements hold promise for further reducing radiation-related morbidity and improving cosmetic outcomes. As PBI progresses, integrating novel imaging modalities and hypofractionated regimens will be crucial to refining protocols. This review synthesizes the latest evidence on PBI techniques, clinical outcomes, and emerging technologies to guide future research and clinical decision-making in precision breast radiotherapy.

早期乳腺癌部分乳房照射:进展、挑战和未来方向。
乳腺癌治疗的进展已将重点从最大化局部控制转移到平衡肿瘤疗效与治疗降级和毒性降低。保乳手术后的全乳照射(WBI)仍然是标准的治疗方法,但由于高达90%的复发发生在肿瘤床附近,部分乳房照射(PBI)已成为一种可行的替代方法。大型随机对照试验(如IMPORT LOW、Florence和GEC-ESTRO)已经证明PBI和WBI的同侧乳房肿瘤复发率(IBTR)相当,在精心挑选的患者中加强了其肿瘤安全性。然而,在优化分馏计划、优化患者选择和最小化晚期毒性方面仍然存在挑战。最近的创新,包括mri引导放射治疗(MRgRT)和新辅助PBI,提供了更好的肿瘤靶向,实时计划适应和增强正常组织保留。这些进步有望进一步减少与辐射有关的发病率和改善美容效果。随着PBI的发展,整合新的成像模式和低分割治疗方案将是完善治疗方案的关键。这篇综述综合了PBI技术、临床结果和新兴技术的最新证据,以指导未来精确乳房放疗的研究和临床决策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Tomography
Tomography Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
2.70
自引率
10.50%
发文量
222
期刊介绍: TomographyTM publishes basic (technical and pre-clinical) and clinical scientific articles which involve the advancement of imaging technologies. Tomography encompasses studies that use single or multiple imaging modalities including for example CT, US, PET, SPECT, MR and hyperpolarization technologies, as well as optical modalities (i.e. bioluminescence, photoacoustic, endomicroscopy, fiber optic imaging and optical computed tomography) in basic sciences, engineering, preclinical and clinical medicine. Tomography also welcomes studies involving exploration and refinement of contrast mechanisms and image-derived metrics within and across modalities toward the development of novel imaging probes for image-based feedback and intervention. The use of imaging in biology and medicine provides unparalleled opportunities to noninvasively interrogate tissues to obtain real-time dynamic and quantitative information required for diagnosis and response to interventions and to follow evolving pathological conditions. As multi-modal studies and the complexities of imaging technologies themselves are ever increasing to provide advanced information to scientists and clinicians. Tomography provides a unique publication venue allowing investigators the opportunity to more precisely communicate integrated findings related to the diverse and heterogeneous features associated with underlying anatomical, physiological, functional, metabolic and molecular genetic activities of normal and diseased tissue. Thus Tomography publishes peer-reviewed articles which involve the broad use of imaging of any tissue and disease type including both preclinical and clinical investigations. In addition, hardware/software along with chemical and molecular probe advances are welcome as they are deemed to significantly contribute towards the long-term goal of improving the overall impact of imaging on scientific and clinical discovery.
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