Abstract
Current research in radiotherapy (RT) for breast cancer is evaluating neoadjuvant as opposed to adjuvant partial breast irradiation (PBI) with the aim of reducing the volume of breast tissue irradiated and therefore the risk of late treatment-related toxicity. The development of magnetic resonance (MR)–guided RT, including dedicated MR-guided RT systems [hybrid machines combining an MR scanner with a linear accelerator (MR-linac) or 60Co sources], could potentially reduce the irradiated volume even further by improving tumour visibility before and during each RT treatment. In this position paper, we discuss MR guidance in relation to each step of the breast RT planning and treatment pathway, focusing on the application of MR-guided RT to neoadjuvant PBI.
Highlights
The combination of a worldwide rising incidence of breast cancer together with decreasing mortality following breast cancer treatment has resulted in increasing numbers of breast cancer survivors living with late treatment-related toxicity [1,2,3]
The use of T1-weighted fatsuppressed contrast-enhanced magnetic resonance imaging (MRI) is recommended for optimal tumour and tumour spiculae visualization, because differences in contrast uptake provide a clear distinction between tumour and glandular breast tissue (Figure 3) [35,36,37,38]
Guidelines for the delineation of primary breast tumours on MRI for use in neoadjuvant partial breast irradiation (PBI) setting have recently been developed by the Breast Tumor Site Group of the International magnetic resonance (MR)-Linac Atlantic Consortium [36]
Summary
The development of magnetic resonance (MR)–guided RT, including dedicated MR-guided RT systems [hybrid machines combining an MR scanner with a linear accelerator (MR-linac) or 60Co sources], could potentially reduce the irradiated volume even further by improving tumour visibility before and during each RT treatment. In this position paper, we discuss MR guidance in relation to each step of the breast RT planning and treatment pathway, focusing on the application of MR-guided RT to neoadjuvant PBI
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