Breast最新文献

{"title":"Reply to: \"Breast RT microcalcifications: a stress test for trainee-led magnetic-seed lumpectomy\".","authors":"Fabio Corsi","doi":"10.1016/j.breast.2026.104793","DOIUrl":"https://doi.org/10.1016/j.breast.2026.104793","url":null,"abstract":"","PeriodicalId":9093,"journal":{"name":"Breast","volume":" ","pages":"104793"},"PeriodicalIF":7.9,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast RT microcalcifications: a stress test for trainee-led magnetic-seed lumpectomy.","authors":"Xiaowei Zhang, Zheng Wang","doi":"10.1016/j.breast.2026.104794","DOIUrl":"https://doi.org/10.1016/j.breast.2026.104794","url":null,"abstract":"","PeriodicalId":9093,"journal":{"name":"Breast","volume":" ","pages":"104794"},"PeriodicalIF":7.9,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Real-world effectiveness of palbociclib in combination with an aromatase inhibitor in HR+/HER2- bone-only metastatic breast cancer\" [The Breast 86 (2026) 104744].","authors":"Adam Brufsky, Rachel M Layman, Xianchen Liu, Benjamin Li, Lynn McRoy, Aaron B Cohen, Melissa Estevez, Paul Cottu, Giuseppe Curigliano, Hope S Rugo","doi":"10.1016/j.breast.2026.104782","DOIUrl":"https://doi.org/10.1016/j.breast.2026.104782","url":null,"abstract":"","PeriodicalId":9093,"journal":{"name":"Breast","volume":" ","pages":"104782"},"PeriodicalIF":7.9,"publicationDate":"2026-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of pneumonitis in patients treated with systemic therapy and radiotherapy for localized triple negative or HER2 positive breast cancer","authors":"Hannah Bacon ,&nbsp;Xiang Y. Ye ,&nbsp;Zhihui Amy Liu ,&nbsp;Grace Lee ,&nbsp;Ezra Hahn ,&nbsp;Eitan Amir ,&nbsp;Tony Tadic ,&nbsp;Andrew Hope ,&nbsp;C. Anne Koch","doi":"10.1016/j.breast.2026.104706","DOIUrl":"10.1016/j.breast.2026.104706","url":null,"abstract":"<div><h3>Purpose</h3><div>The treatment of HER2-positive (HER2+) and triple negative (TN) breast cancer (BC) increasingly includes systemic therapies that can be associated with a risk of drug-induced pneumonitis and may overlap with the delivery of radiotherapy, which carries an independent risk of pneumonitis. The aim of this study is to characterize the interaction between trastuzumab-emtansine (T-DM1), pembrolizumab and radiotherapy in modulating the risk of pneumonitis in a real-world setting.</div></div><div><h3>Methods</h3><div>A retrospective, single institution, chart review identified patients with non-metastatic HER2+ or TN BC, who were treated with adjuvant radiotherapy between 2019 and 2024. Among this cohort the proportion with pneumonitis diagnosed within 1-year following completion of radiotherapy was evaluated. The association of grade ≥2 pneumonitis (G2P+) with clinical factors of interest was examined using univariate and multivariable logistic regression.</div></div><div><h3>Results</h3><div>Of 863 eligible patients, 528 were HER2+ and 335 were TN. Overall the rate of G2P+ was 2.8 %; 3.6 % for HER2+ and 1.5 % for TN patients. On univariate analysis, radiation treatment volume, clinical stage, and receipt of T-DM1 were associated with G2P+, however, only T-DM1 (OR = 4.16, 95 % CI = 1.59–10.92, p &lt; 0.01) and clinical stage III vs. II (OR 2.69, 95 % CI 1.03–7.02, p = 0.04) remained significant on multivariable analysis.</div></div><div><h3>Conclusion</h3><div>Overall, the probability of G2P+ in patients receiving radiotherapy for HER2+ or TN BC is low. However, concurrent T-DM1 and radiotherapy was associated with significantly higher rates of pneumonitis than previously reported, suggesting a cautionary approach when combining the two therapies.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"86 ","pages":"Article 104706"},"PeriodicalIF":7.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pleomorphic and florid lobular carcinoma in situ of the Breast: A systematic review of current evidence and knowledge gaps","authors":"Massimo Ferrucci ,&nbsp;Daniele Passeri ,&nbsp;Francesco Milardi ,&nbsp;Giacomo Montagna ,&nbsp;Anna C. Beck ,&nbsp;Riccardo Audisio ,&nbsp;Fredrick Wärnberg ,&nbsp;Gianluca Franceschini ,&nbsp;Lucio Fortunato ,&nbsp;Matteo Ghilli ,&nbsp;Valentina Guarneri ,&nbsp;Alberto Marchet ,&nbsp;Rocco Cappellesso ,&nbsp;Angelo Paolo Dei Tos ,&nbsp;Tari Ann King","doi":"10.1016/j.breast.2026.104711","DOIUrl":"10.1016/j.breast.2026.104711","url":null,"abstract":"<div><h3>Introduction</h3><div>Pleomorphic (PLCIS) and florid (FLCIS) lobular carcinoma in situ are uncommon entities, characterized by significant architectural distortion and cellular atypia. Their rarity poses three key clinical challenges: diagnostic variability, histologic upgrade and risk of local recurrence (LR). Currently, no standardized management guidelines exist. This systematic review provides the most comprehensive synthesis to date of the available evidence on clinical, radiologic, pathologic, and molecular characteristics of P/FLCIS, and evaluates outcomes associated with different treatment strategies.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted across major biomedical databases up to June 2025. Eligible studies were original case series reporting primary data on P/FLCIS.</div></div><div><h3>Results</h3><div>From 5402 screened records, 38 studies were included, comprising 629 total cases: 411 PLCIS, 98 FLCIS, and 120 categorized as LCIS with pleomorphic or non-classic features. The pooled upgrade rate was 35.3% (PLCIS 35.1%, FLCIS 33.3%; p = 0.843), predominantly to invasive carcinoma (28.8%). Among 258 pure P/FLCIS cases with available follow-up (median, 50 months) the overall LR rate was 12.4% (PLCIS 13.1%, FLCIS 9.1%; p = 0.618), with invasive recurrences representing the majority (62.5%; p = 0.04). Margin status was significantly associated with risk of LR (positive margins 38.2%, close margins (&lt;2 mm) 20.0%, negative margins 3.0%; p &lt; 0.001). Data on adjuvant treatments were inconsistent and heterogeneous.</div></div><div><h3>Conclusions</h3><div>Given the high upgrade rate and significant risk of LR for P/FLCIS, complete surgical excision with negative margins is strongly advised to ensure definitive diagnosis and reduce future breast events. The role of adjuvant therapies remains unclear, highlighting the urgent need for standardized, multicenter studies to guide optimal clinical management.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"86 ","pages":"Article 104711"},"PeriodicalIF":7.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146123840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-reported outcomes from the randomized ALICE trial evaluating the addition of atezolizumab to anthracycline-based chemotherapy in metastatic triple-negative breast cancer","authors":"K.G. Svalheim ,&nbsp;N.K. Andresen ,&nbsp;C. Bjerre ,&nbsp;B. Gilje ,&nbsp;E.H. Jakobsen ,&nbsp;R.S. Falk ,&nbsp;B. Naume ,&nbsp;S. Kaasa ,&nbsp;J.A. Kyte","doi":"10.1016/j.breast.2026.104704","DOIUrl":"10.1016/j.breast.2026.104704","url":null,"abstract":"<div><h3>Background</h3><div>The ALICE trial demonstrated that adding atezolizumab to anthracycline-based immunomodulatory chemotherapy improved progression-free survival (PFS) in patients with metastatic triple-negative breast cancer (mTNBC), including those with PD-L1–negative tumors. Here, we report the patient-reported outcome measures (PROMs).</div></div><div><h3>Methods</h3><div>Patients were randomized to receive chemotherapy plus atezolizumab (atezo-chemo) or chemotherapy plus placebo (placebo-chemo). PROMs were collected at baseline and weeks 9, 17, 25, and 49 using the EORTC QLQ-C15-PAL, Chalder Fatigue Questionnaire (CFQ), and Numeric Rating Scale (NRS) for pain.</div></div><div><h3>Results</h3><div>PROMs were available from 64 of 68 patients. At week 9, mean changes from baseline favored the atezo-chemo arm across all QLQ-C15-PAL domains, CFQ scores, and NRS pain intensity. Time-to-deterioration analyses also favored atezo-chemo, with statistically significant hazard ratios for global quality of life (QoL; HR 0.24), emotional functioning (HR 0.30), and pain (HR 0.20). Pain—a pre-specified cardinal symptom—improved in the atezo-chemo group at all time points. At 12 months, PROMs indicated sustained tolerability. Better baseline PROM scores were associated with improved PFS and overall survival, especially among patients treated with atezolizumab. Patients with &gt;median QoL score at baseline recorded improved PFS when treated with atezolizumab (HR 0.25), while patients with ≤median QoL score did not (HR 1.02).</div></div><div><h3>Conclusions</h3><div>Adding atezolizumab to the study-chemotherapy in mTNBC improves both PFS and patient-reported quality of life, emotional well-being and symptom control. These findings support continued development of this combination regimen and suggest that baseline quality of life may serve as a useful predictor of immunotherapy benefit.</div></div><div><h3>Trial registration</h3><div>NCT03164993, May 24^th 2017; <span><span>https://clinicaltrials.gov/ct2/show/record/NCT03164993</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"86 ","pages":"Article 104704"},"PeriodicalIF":7.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epigenetic and fragment-based profiling across CDK4/6 inhibitors in first-line HR+/HER2– metastatic breast cancer. An ancillary analysis of the MAGNETIC.1 study","authors":"Claudia Noto ,&nbsp;Lorenzo Foffano ,&nbsp;Fabiola Giudici ,&nbsp;Elisabetta Molteni ,&nbsp;Alessandra Franzoni ,&nbsp;Martina Tessitori ,&nbsp;Linda Cucciniello ,&nbsp;Silvia Bolzonello ,&nbsp;Lucia Da Ros ,&nbsp;Lucia Bortot ,&nbsp;Elena Scudeler ,&nbsp;Brenno Pastò ,&nbsp;Giulia Cudia ,&nbsp;Serena Della Rossa ,&nbsp;Marta Bonotto ,&nbsp;Alessandro Marco Minisini ,&nbsp;Giuseppe Damante ,&nbsp;Barbara Belletti ,&nbsp;Lorenzo Gerratana ,&nbsp;Fabio Puglisi","doi":"10.1016/j.breast.2026.104703","DOIUrl":"10.1016/j.breast.2026.104703","url":null,"abstract":"<div><h3>Background</h3><div>CDK4/6 inhibitors (CDK4/6i) in combination with endocrine therapy (ET) represent the standard of care for hormone receptor–positive, HER2-negative (HR+/HER2–) metastatic breast cancer (MBC) patients. However, no head-to-head randomized trials have directly compared palbociclib, ribociclib, and abemaciclib. Moreover, predictive biomarkers of resistance to CDK4/6i remain largely undefined. This study aimed to evaluate circulating tumor DNA (ctDNA)-based epigenetic and fragmentomic biomarkers as potential predictors of response and resistance in patients receiving CDK4/6i.</div></div><div><h3>Methods</h3><div>We conducted a biomarker-driven analysis within the prospective, multicenter MAGNETIC.1 study, enrolling 149 patients with HR+/HER2– MBC treated with first-line endocrine therapy and a CDK4/6 inhibitor. Plasma samples were collected at baseline and during treatment (3 and 6 months). Droplet digital PCR was used to assess <em>ESR1</em> promoter methylation and <em>ACTB</em> fragmentomic profiles. Progression-free survival (PFS) and overall survival (OS) were evaluated, and molecular dynamics were compared between treatment groups.</div></div><div><h3>Results</h3><div>After a median follow-up of 34.8 months, no statistically significant differences in PFS or OS were observed between ribociclib and palbociclib treated patients, although ribociclib was associated with numerically longer PFS and higher survival rates. At the molecular level, palbociclib treatment was characterized by transient increases in <em>ESR1</em> promoter methylation at the first evaluation and a rebound in <em>ACTB</em>_short fragment levels at six months relative to baseline. These dynamic patterns were not observed among patients receiving ribociclib.</div></div><div><h3>Conclusions</h3><div>ctDNA-based methylation and fragmentomic profiling revealed exploratory, treatment specific molecular dynamics, highlighting biological differences between CDK4/6 inhibitors. These findings support the feasibility of liquid biopsy–based biomarker studies in this setting, although their potential clinical relevance remains preliminary and requires validation in larger cohorts with earlier and more granular on-treatment timepoints.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"86 ","pages":"Article 104703"},"PeriodicalIF":7.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of axillary disease extent defined by baseline 18F-FDG PET/CT on the accuracy of axillary surgical staging after neoadjuvant systemic therapy in clinically node-positive breast cancer","authors":"Cornelis M. de Mooij ,&nbsp;Janine M. Simons ,&nbsp;Florien J.G. van Amstel ,&nbsp;Cristina Mitea ,&nbsp;Paul J. van Diest ,&nbsp;Patty J. Nelemans ,&nbsp;Felix M. Mottaghy ,&nbsp;Carmen C. van der Pol ,&nbsp;Ernest J.T. Luiten ,&nbsp;Linetta B. Koppert ,&nbsp;Marjolein L. Smidt ,&nbsp;Thiemo J.A. van Nijnatten","doi":"10.1016/j.breast.2026.104718","DOIUrl":"10.1016/j.breast.2026.104718","url":null,"abstract":"<div><h3>Background</h3><div>In clinically node-positive patients, sentinel lymph node biopsy (SLNB), marking axillary lymph node with radioactive iodine seed (MARI), and combined SLNB/MARI (RISAS-procedure) can replace axillary lymph node dissection (ALND) after neoadjuvant systemic therapy. Surgical staging outcome can be combined with baseline axillary disease on ¹⁸F-FDG PET/CT. This study assessed whether baseline axillary disease on ¹⁸F-FDG PET/CT affects the accuracy of staging-procedures. Second, when staging-procedures detected residual disease, it was assessed whether baseline axillary disease on ¹⁸F-FDG PET/CT affected the probability of remaining positive nodes at completion ALND (cALND).</div></div><div><h3>Method</h3><div>Included were patients with baseline ¹⁸F-FDG PET/CT within the RISAStrial (NCT02800317). Patients underwent the RISAS-procedure followed by cALND. False negative rates were stratified by limited or advanced baseline axillary disease (1-3 vs. ≥4 hypermetabolic lymph nodes). When staging-procedures detected residual disease, the probability of remaining positive nodes at cALND was stratified by baseline axillary disease.</div></div><div><h3>Results</h3><div>Of 185 patients, 116 had limited and 69 had advanced baseline axillary disease. Staging-procedures had higher accuracy in limited than advanced baseline axillary disease. When the RISAS-procedure detected residual disease, the probability of remaining positive nodes at cALND was lower in limited than advanced baseline axillary disease (44.9% vs. 91.5%,p &lt; .001). When SLNB or MARI detected residual disease, the probability of remaining positive nodes at cALND was &gt;88.4%, irrespective of baseline axillary disease.</div></div><div><h3>Conclusion</h3><div>Staging-procedures had higher accuracy in patients with limited than advanced axillary disease on baseline ¹⁸F-FDG PET/CT. When staging-procedures detected residual disease, the probability of remaining positive nodes at cALND remained high.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"86 ","pages":"Article 104718"},"PeriodicalIF":7.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for breast fibrosis and unfavorable cosmetic outcomes after breast conserving therapy in the contemporary treatment era: a systematic review","authors":"M.C.A.W. Notenboom ,&nbsp;W.D. Heemsbergen ,&nbsp;M. Franckena ,&nbsp;L.B. Koppert ,&nbsp;M.A.M. Mureau ,&nbsp;R.A. Nout ,&nbsp;M.B.E. Menke-Pluijmers ,&nbsp;F.E. Froklage","doi":"10.1016/j.breast.2026.104707","DOIUrl":"10.1016/j.breast.2026.104707","url":null,"abstract":"<div><h3>Background</h3><div>This systematic review aimed to identify risk factors for fibrosis and unfavorable cosmetic outcomes after breast conserving therapy (BCT) for breast cancer in the light of contemporary oncoplastic surgery and 3D-radiotherapy techniques.</div></div><div><h3>Methods</h3><div>The systematic literature search was carried out in Embase, Ovid Medline, Cochrane Central Register of Controlled Trials, and CINAHL. Studies published after 2005, reporting two or more risk factors for fibrosis or unfavorable cosmetic outcomes as primary outcomes were eligible for inclusion. Only prospective studies with 100 or more patients analyzed were included. The Quality In Prognosis Studies tool and Cochrane risk-of-bias tool were used to assess risk of bias. Patient, tumor, and treatment-related predictors were identified.</div></div><div><h3>Results</h3><div>Twelve papers investigating 12.118 patients were identified. Risk factors for both the development of fibrosis and unfavorable cosmetic outcomes were increasing age, larger tumor size, re-resection, poor early cosmetic outcomes before the start of radiotherapy, high boost dose, boost volume per 10 cc, homogeneity-index, dose whole breast irradiation, and adjuvant chemotherapy. No specific risk factors in the setting of BCT with complex oncoplastic surgery techniques or ultra-hypo fractionated radiotherapy were identified in this review.</div></div><div><h3>Conclusion</h3><div>The risk factors identified in this review are largely similar to those found in 2D-radiotherapy studies; dose homogeneity was additionally identified. Administering chemotherapy before radiotherapy should be considered for patients requiring both treatments. However, the lack of sufficient high-quality data regarding BCT with (complex) oncoplastic surgery techniques and ultra-hypo fractionated radiotherapy schedules address the need for large, multidisciplinary prospective studies with long-term follow-up.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"86 ","pages":"Article 104707"},"PeriodicalIF":7.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward genomic personalization of breast cancer radiotherapy: foundations, challenges, and a roadmap for clinical integration","authors":"Pierre Loap ,&nbsp;Irene Buvat ,&nbsp;Gilles Crehange ,&nbsp;Youlia Kirova","doi":"10.1016/j.breast.2026.104733","DOIUrl":"10.1016/j.breast.2026.104733","url":null,"abstract":"<div><div>Personalizing radiotherapy dose in breast cancer remains a major unmet need, as current treatment paradigms rely on uniform prescriptions that overlook interpatient variability in intrinsic radiosensitivity. Over the past decade, transcriptome-based biomarkers such as the Radiosensitivity Index (RSI) and its radiobiological extension, the Genomic-Adjusted Radiation Dose (GARD), have emerged as promising tools capable of quantifying this biological heterogeneity and linking it to expected therapeutic effectiveness. Retrospective clinical studies across diverse breast cancer cohorts have consistently demonstrated that RSI and GARD correlate with locoregional control, identify radioresistant subgroups that may benefit from dose escalation, and reveal radiosensitive tumors for which de-escalation may be safely explored. These findings challenge the assumption that radiation response is uniform within histological or molecular subtypes and highlight the opportunity for biologically tailored dosing. Yet despite early evidence, translation into clinical practice remains limited. Key barriers include the absence of prospective validation, heterogeneous analytic pipelines for RNA sequencing and RSI computation, uncertainty regarding optimal biomarker timing in the neoadjuvant era, and sensitivity of bulk transcriptomic assays to spatial and microenvironmental heterogeneity. Addressing these challenges will require standardization, consensus on clinically meaningful GARD thresholds, and coordinated international efforts to define methodological and regulatory pathways. Emerging approaches in radiomics, digital pathology, and multimodal artificial intelligence may further refine radiosensitivity assessment and reduce reliance on invasive sampling. As the field progresses, genomic personalization of radiotherapy has the potential to transform breast cancer management by replacing one-size-fits-all prescriptions with biologically informed dose adaptation aimed at maximizing tumor control while minimizing toxicity.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"86 ","pages":"Article 104733"},"PeriodicalIF":7.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146185280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}