Breast cancer radiotherapy: Is it time to rethink the indication?

Based on our recent published paper [ [1] Overgaard M. Nielsen H.M. Tramm T. Højris I. Grantzau T.L. Alsner J. et al. Postmastectomy radiotherapy in high-risk breast cancer patients given adjuvant systemic therapy. A 30-year long-term report from the Danish breast cancer cooperative group DBCG 82bc trial. Radiother Oncol. 2022; 170: 4-13https://doi.org/10.1016/j.radonc.2022.03.008 Google Scholar ] Lazzari et al. [ [2] Lazzari G. Rago L. Solazzo A.P. Benevento I. Montagna A. Castaldo G. et al. Adjuvant chemotherapy and hypofractionated whole breast cancer radiotherapy: is it time to rethink the sequencing?. Radiother Oncol. 2002; (current issue) Google Scholar ] raise the general question of whether we should rethink the sequencing of radiotherapy and systemic treatment in early breast cancer (BC), as recently discussed elsewhere [ [3] Alcorn S.R. Wright J.L. Toxicity and timing of breast radiation therapy with overlapping systemic therapies. Int J Radiat Oncol Biol Phys. 2022; 114: 377-381https://doi.org/10.1016/j.ijrobp.2022.05.024 Google Scholar ]. The complexity in treating patients with BC has increased considerably since the accrual of patients in the DBCG 82b&c trial. There are several important results from the trial, that are still valid today, but also pivotal differences making extrapolation of the DBCG 82b&c results up to 2020’s difficult.