AIRO Breast Cancer Group Best Clinical Practice 2022 Update.

Abstract

INTRODUCTION:

Breast cancer is the most common tumor in women and represents the leading cause of cancer death. Radiation therapy plays a key-role in the treatment of all breast cancer stages. Therefore, the adoption of evidence-based treatments is warranted, to ensure equity of access and standardization of care in clinical practice.

METHOD:

This national document on the highest evidence-based available data was developed and endorsed by the Italian Association of Radiation and Clinical Oncology (AIRO) Breast Cancer Group.We analyzed literature data regarding breast radiation therapy, using the SIGN (Scottish Intercollegiate Guidelines Network) methodology (www.sign.ac.uk). Updated findings from the literature were examined, including the highest levels of evidence (meta-analyses, randomized trials, and international guidelines) with a significant impact on clinical practice. The document deals with the role of radiation therapy in the treatment of primary breast cancer, local relapse, and metastatic disease, with focus on diagnosis, staging, local and systemic therapies, and follow up. Information is given on indications, techniques, total doses, and fractionations.

RESULTS:

An extensive literature review from 2013 to 2021 was performed. The work was organized according to a general index of different topics and most chapters included individual questions and, when possible, synoptic and summary tables. Indications for radiation therapy in breast cancer were examined and integrated with other oncological treatments. A total of 50 questions were analyzed and answered.Four large areas of interest were investigated: (1) general strategy (multidisciplinary approach, contraindications, preliminary assessments, staging and management of patients with electronic devices); (2) systemic therapy (primary, adjuvant, in metastatic setting); (3) clinical aspects (invasive, non-invasive and micro-invasive carcinoma; particular situations such as young and elderly patients, breast cancer in males and cancer during pregnancy; follow up with possible acute and late toxicities; loco-regional relapse and metastatic disease); (4) technical aspects (radiation after conservative surgery or mastectomy, indications for boost, lymph node radiotherapy and partial breast irradiation).Appendixes about tumor bed boost and breast and lymph nodes contouring were implemented, including a dedicated web application. The scientific work was reviewed and validated by an expert group of breast cancer key-opinion leaders.

CONCLUSIONS:

Optimal breast cancer management requires a multidisciplinary approach sharing therapeutic strategies with the other involved specialists and the patient, within a coordinated and dedicated clinical path. In recent years, the high-level quality radiation therapy has shown a significant impact on local control and survival of breast cancer patients. Therefore, it is necessary to offer and guarantee accurate treatments according to the best standards of evidence-based medicine.

• Authors: Antonella Ciabattoni, Fabiana Gregucci, Fiorenza De Rose, Sara Falivene, Alessandra Fozza, Antonio Daidone, Anna Morra, Daniela Smaniotto, Raffaele Barbara, Laura Lozza, Cristiana Vidali, Simona Borghesi, Isabella Palumbo, Alessandra Huscher, Elisabetta Perrucci, Antonella Baldissera, Giorgio Tolento, Paolo Rovea, Pierfrancesco Franco, Maria Carmen De Santis, Alfio Di Grazia, Lorenza Marino, Bruno Meduri, Francesca Cucciarelli, Cynthia Aristei, Filippo Bertoni, Marina Guenzi, Maria Cristina Leonardi, Lorenzo Livi, Luigia Nardone, Francesca De Felice, Maria Elena Rosetto, Lidia Mazzuoli, Paola Anselmo, Fabio Arcidiacono, Rosaria Barbarino, Mariateresa Martinetti, Nadia Pasinetti, Isacco Desideri, Fabio Marazzi, Giovanni Ivaldi, Elisabetta Bonzano, Monica Cavallari, Vincenzo Cerreta, Vincenzo Fusco, Laura Sarno, Alessio Bonanni, Maria Grazia Mangiacotti, Agnese Prisco, Giovanna Buonfrate, Damiana Andrulli, Antonella Fontana, Rita Bagnoli, Luca Marinelli, Chiara Reverberi, Giovanna Scalabrino, Francesca Corazzi, Daniela Doino, Milena Di Genesio-Pagliuca, Mariagrazia Lazzari, Francesca Mascioni, Maria Paola Pace, Mirko Mazza, Pasquale Vitucci, Antonio Spera, Gabriella Macchia, Mariangela Boccardi, Giovanna Evangelista, Barbara Sola, Maria Rosa La Porta, Alba Fiorentino, Niccolò Giaj Levra, Edy Ippolito, Sonia Silipigni, Mattia Falchetto Osti, Marcello Mignogna, Marina Alessandro, Lucia Anna Ursini, Marianna Nuzzo, Icro Meattini, Giuseppe D'Ermo
• Journal: Tumori (Tumori) Vol. 108 Issue 2_suppl Pg. 1-144 (Jul 2022) ISSN: 2038-2529 [Electronic] United States
• PMID: 36112842 (Publication Type: Journal Article)

Topics

• Aged
• Breast Neoplasms (pathology, radiotherapy)
• Female
• Humans
• Mastectomy
• Neoplasm Recurrence, Local (radiotherapy, surgery)
• Neoplasms, Second Primary (surgery)
• Radiation Oncology
• Radiotherapy, Adjuvant