Abstract
IntroductionThe use of neo-adjuvant radiotherapy (NRT) has been proven effective at improving cancer related outcome measures, including overall-survival (OS) in the management of solid cancers. However, its utilisation in breast cancer has not been explored to the extent of neo-adjuvant chemotherapy (NAC). The evidence for the application of NRT in breast cancer is evaluated.MethodsPubMed, Embase and the Cochrane Library databases were searched systematically in August 2020 for studies that addressed the role of NRT in the treatment of breast cancer. Studies were deemed eligible if they reported on objective outcome measurements of OS, disease free-survival (DFS) or pathological complete response (pCR) and attained a satisfactory quality assessment.FindingsA total of 23 studies reported upon 3,766 patients who had received NRT of which 3,233 also received NAC concurrently (neo-adjuvant chemo-radiotherapy (NCRT)). The pCR values ranged from 14% to 42%, 5-year DFS 61.4% to 81% and 5-year OS 71.6% to 84.2%. Complications were confined to radiation dermatitis with no cases of implant loss reported during breast reconstruction. The application of NRCT alone showed no significant difference in OS or DFS compared to NCRT followed by surgery.InterpretationNumbers of patients receiving exclusively NRT is small. However, NCRT is oncologically safe with a low side-effect profile including preceding breast reconstruction. Potential benefits include precise cancer volume targeting, chemosensitisation, elimination of delays in adjuvant therapies and alternatives to chemotherapy in oestrogen receptor positive patients. These factors warrant further exploration within randomised controlled-trials.
Highlights
The use of neo-adjuvant radiotherapy (NRT) has been proven effective at improving cancer related outcome measures, including overall-survival (OS) in the management of solid cancers
The studies reported upon 3,766 patients who received NRT, of these only 533 received it alone in three studies [12, 21, 23] with the remaining 18 studies involving patients being treated sequentially with neo-adjuvant chemotherapy (NAC) followed by RT
The authors identified that the pathological complete response (pCR) rate was 35% and 28% in the neoadjuvant chemotherapy and radiotherapy (NCRT) and NRT groups, respectively
Summary
The use of neo-adjuvant radiotherapy (NRT) has been proven effective at improving cancer related outcome measures, including overall-survival (OS) in the management of solid cancers. The tumouricidal effects of combining neo-adjuvant radiotherapy and chemotherapy in rectal cancer have led to a decrease in tumour size, stage of nodal disease and less adverse histological features (lymphovascular invasion and tumour differentiation) [3]. These findings have supported combining neo-adjuvant radiotherapy and chemotherapy in rectal cancer [4]. The current evidence for the use of NRT as an alternative approach to the management of breast cancer is appraised within this systematic review
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