Radiation Management for Breast Cancer After Neoadjuvant Therapy

Abstract Purpose of Review Neoadjuvant chemotherapy (NAC) utilization is an important part of breast cancer therapy. Recent advances call into question the optimal role of radiotherapy after NAC, as many radiation studies were performed without NAC. This review was conducted to understand the current data, outstanding questions and ongoing trials related to radiotherapy after NAC. Recent Findings Response to NAC is associated with promising clinical outcomes, particularly in triple-negative and HER2+ breast cancer. Retrospective data suggest that modification of radiotherapy based on tumor response to NAC may be appropriate, though caution is advised without prospective randomized evidence. NSABP B-51 and Alliance A011202 will investigate the management of nodal disease in this setting. Future trials will examine the optimal sequencing of treatments. Summary The personalization of adjuvant radiotherapy based on response to neoadjuvant chemotherapy is an attractive goal that is currently being evaluated in multiple clinical trials, including NSABP B-51.