Abstract
Contemporary recommendations for postmastectomy radiation have undergone a shift in thinking away from simple stage based recommendations (one size fits all) to a system that considers both tumor biology and host factors. While surgical staging has traditionally dictated indications for postmastectomy radiation therapy (PMRT), our current understanding of tumor biology, host, immunoprofiles, and tumor microenvironment may direct a more personalized approach to radiation. Understanding the interaction of these variables may permit individualization of adjuvant therapy aimed at appropriate escalation and deescalation, including recommendations for PMRT. This article summarizes the current data regarding tumor and host molecular biomarkers in vitro and in vivo that support the individualization of PMRT and discusses open questions that may alter the future of breast cancer treatment.
Highlights
Breast cancer is the most commonly diagnosed malignancy and the second most frequent cause of cancer death in women [1]
Moving into the decade of cancer care, it is imperative that personalized medicine moves beyond medical oncology and includes radiation therapy
Clinicians must synthesize our current understanding of tumor biology, stromal microenvironment, host genetic and immune factors, risk of recurrence and complications, and improved therapeutics to make up-to-date and appropriate recommendations for our patients
Summary
Breast cancer is the most commonly diagnosed malignancy and the second most frequent cause of cancer death in women [1]. Surgical staging provided risk-stratification that served as the basis for recommending PMRT; modern understanding of genetics, immunology, and molecular biology is shedding light on tumor and host biomarkers that may alter patients’ rates of response, progression, or survival [5]. To usher radiation oncology into the era of personalized medicine, we must consider individual patient and tumor parameters that influence treatment response and complications to provide appropriate treatment recommendations. Applying our understanding of molecular markers representing tumor and host biology may permit individualization of radiation therapy aimed at appropriate escalation and deescalation of PMRT based on biologic parameters. This article summarizes the current data regarding molecular markers, which support the individualization of radiation using tumor molecular profiles, stromal microenvironment data, and patient genetic and immune parameters
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