Current Trends and Challenges in Real-World Breast Cancer Adjuvant Radiotherapy: A Practical Review. New trends in adjuvant radiotherapy in BC

Grazia Lazzari (1), Angela Pia Solazzo (2), Ilaria Benevento (3), Antonietta Montagna (4), Luciana Rago (5), Giovanni Castaldo (6), Giovanni Silvano (7)
(1) Radiation Oncology Unit, San Giuseppe Moscati Hospital, Taranto, Italy, Italy,
(2) Radiation Oncology Unit, IRCCS-CROB, Rionero in Vulture (PZ), Italy , Italy,
(3) Radiation Oncology Unit, IRCCS-CROB, Rionero in Vulture (PZ), Italy, Italy,
(4) Radiation Oncology Unit -IRCCS CROB Rionero in Vulture, Italy,
(5) Radiation Oncology Unit -IRCCS CROB Rionero in Vulture, Italy, Italy,
(6) Radiation Oncology Unit -IRCCS CROB Rionero in Vulture, Italy,
(7) Emicenter Casoria -Napoli, Italy


Background: The treatment of breast cancer (BC) remains a constant and rapidly evolving issue for multidisciplinary breast cancer teams. Considering the emerging understanding and advances in the biological course of this disease, new trends in radiotherapy fractionation, systemic therapies, and oncoplastic surgical techniques are revolutionizing adjuvant treatment approaches to BC. Novel challenges are questioning the integration of adjuvant radiotherapy (ART) into the real-world clinical setting.

Methods: PubMed literature search was conducted in order to extract data supporting the role of new trends in breast cancer adjuvant approach according to rising issues in the multidisciplinary team discussion such as sequencing with chemotherapy (CT) plus whole breast hypofractionated radiotherapy (HF-WBRT); the role of ART after neoadjuvant CT (NACT) followed by breast conservative surgery (BCS) in early BC achieving pathological complete remission (pCR); and the integration of ART in immediate autologous breast oncoplastic reconstruction after mastectomy (a-IBR). Furthermore, there are still several concerns about toxicity with adjuvant trastuzumab emtansine (T-DM1) or breast re-irradiation after BCS relapse in long-term survivors refusing mastectomy.

Results:  Among 40 hits, only 12 studies answered to these issues. Many of them were retrospective studies. Less than 500 patients met the criteria for these issues and several conclusions were found exhaustive.

Conclusion:  Few issues seem to have literature solutions, while there are still open questions in regard to these new trends. Novel strategies through prospective or randomized studies and new consensus guidelines are required.

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Grazia Lazzari (Primary Contact)
Angela Pia Solazzo
Ilaria Benevento
Antonietta Montagna
Luciana Rago
Giovanni Castaldo
Giovanni Silvano
Author Biographies

Angela Pia Solazzo, Radiation Oncology Unit, IRCCS-CROB, Rionero in Vulture (PZ), Italy

MD Radiation Oncologist 

Ilaria Benevento, Radiation Oncology Unit, IRCCS-CROB, Rionero in Vulture (PZ), Italy

MD Radiation Oncologist

Antonietta Montagna, Radiation Oncology Unit -IRCCS CROB Rionero in Vulture

MD Radiation Oncologist

Luciana Rago, Radiation Oncology Unit -IRCCS CROB Rionero in Vulture, Italy

MD Radiation Oncologist

Giovanni Castaldo, Radiation Oncology Unit -IRCCS CROB Rionero in Vulture

MD Radiation Oncologist

Giovanni Silvano, Emicenter Casoria -Napoli

MD Radiation Oncologist -Radiotherapy Unit 

Lazzari G, Solazzo AP, Benevento I, Montagna A, Rago L, Castaldo G, Silvano G. Current Trends and Challenges in Real-World Breast Cancer Adjuvant Radiotherapy: A Practical Review. : New trends in adjuvant radiotherapy in BC. Arch Breast Cancer [Internet]. 2022 Dec. 27 [cited 2024 Apr. 14];10(1):6-14. Available from:

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