David Krug

Radiotherapy of Ductal Carcinoma In Situ

Ductal carcinoma in situ (DCIS) is a heterogeneous disease in both its biology and clinical course. In the past, recurrence rates after breast-conserving surgery have been as high as 30% after 10 years. The introduction of mammography screening and advances in imaging have led to an increase in the detection of DCIS. The focus of this review is on the role of radiotherapy in the multidisciplinary treatment, including current developments in hypofractionation and boost delivery, and attempts to define low-risk subsets of DCIS for which the need for adjuvant radiation is repeatedly questioned.

Current controversies in radiotherapy for breast cancer

Multimodal treatment approaches have substantially improved the outcome of breast cancer patients in the last decades. Radiotherapy is an integral component of multimodal treatment concepts used in curative and palliative intention in numerous clinical situations from precursor lesions such as ductal carcinoma in situ (DCIS) to advanced breast cancer. This review addresses current controversial topics in radiotherapy with special consideration of DCIS, accelerated partial breast irradiation (APBI) and regional nodal irradiation (RNI) and provides an update on the clinical practice guidelines of the Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO).

Neoadjuvant chemotherapy for breast cancer—background for the indication of locoregional treatment

Neoadjuvant chemotherapy (NACT) has been widely adopted into the multidisciplinary management of breast cancer. The prognostic impact of treatment response has been clearly demonstrated. However, the impact of treatment response on the indication for adjuvant radiotherapy is unclear. This review summarizes important implications of NACT and treatment response on the risk of recurrence and locoregional multidisciplinary management from the standpoint of radiation oncology.ZusammenfassungDie neoadjuvante Chemotherapie (NACT) hat mittlerweile einen festen Stellenwert in der interdisziplinären Behandlung des Mammakarzinoms. Der prognostische Einfluss des Therapieansprechens konnte mehrfach klar gezeigt werden. Jedoch ist der Einfluss des Therapieansprechens auf die Indikation für die adjuvante Strahlentherapie noch weitgehend unklar. Diese Übersichtsarbeit fasst die wichtigen Auswirkungen der NACT und des Therapieansprechens auf das Rezidivrisiko und die lokoregionäre interdisziplinäre Behandlung aus der Sichtweise der Radioonkologie zusammen.