Optimising adjuvant breast radiotherapy via preoperative imaging

Menée en Australie sur 443 patientes atteintes d'un cancer du sein de stade précoce (âge médian : 63 ans), cet essai multicentrique évalue la possibilité d'une IRM pré-opératoire et d'une analyse pathologique post-opératoire de la tumeur pour identifier les patientes n'ayant pas besoin d'une radiothérapie adjuvante

Résumé en anglais

Historically, even early-stage breast cancer required exceedingly aggressive locoregional treatment. Nowadays, it is among the most curable of malignancies, necessitating increasingly limited intervention. Landmark surgical trials showed that breast-conserving surgery (BCS; also known as lumpectomy) was not a suitable alternative to mastectomy unless it was bolstered by adjuvant radiotherapy. As this combined-modality approach (lumpectomy with radiotherapy) became more widely adopted, several studies revisited the requirement for adjuvant radiotherapy over the years. Many of these studies preceded our current understanding of biologically driven risk, and consequently exhibited inordinately high recurrence rates, further cementing the need for radiotherapy. More recently, trials such as CALGB 9343 and PRIME II demonstrated the feasibility of omitting radiation for older patients with small, oestrogen receptor (ER)-positive tumours, albeit with a modestly increased risk of local recurrence, thus setting the stage for a series of ongoing trials that promise to widen the conditions under which patients can reasonably forego radiotherapy.