How could breast cancer molecular features contribute to locoregional treatment decision making?

详细信息    查看全文

• 作者：Pelagia G. Tsoutsou^a ; ^b ; ^c ; ^{Pelagia.Tsoutsou@h-ne.ch} ; ^{Pelagia.Tsoutsou@chuv.ch} ; Marie-Catherine Vozenin^b ; ^c ; André ; -Dante Durham^b ; ^c ; Jean Bourhis^a ; ^b
• 关键词：Breast cancer ; Radiotherapy ; Genetic assays ; Subtypes ; Heterogeneity
• 刊名：Critical Reviews in Oncology/Hematology
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：110
• 期：Complete
• 页码：43-48
• 全文大小：727 K
• 卷排序：110

文摘

Systemic treatments are tailored to breast cancer (BC) heterogeneity, which is not yet taken into account for radiotherapy (RT) personalization. The primary objective of this review is to summarize existing data suggesting BC subtypes and genetic assays are prognostic and predictive biomarkers useful for RT decision-making and to provide implications for their incorporation into future translational and clinical research.The evidence suggesting that BC subtypes also exhibit distinct “locoregional recurrence (LRR)” patterns is retrospective but consistent and validated in over fifteen studies. The HER-2 positive and triple negative subtypes are the most susceptible to locoregional failure. The high risk of the HER-2 positive subtype can be reversed with trastuzumab administration. Very little is known on the subtypes’ intrinsic radiosensitivity properties.Genetic assays have assessed retrospectively signatures’ prognostic and predictive value in patients’ cohorts (several coming from prospective studies) for LRR risk and radiotherapy (RT) benefit. Further confirmation is needed before their introduction into clinical routine.Evidence on the use of molecular biomarkers for adjuvant RT tailoring is emerging but needs validation and introduction into prospective studies. The plethora of modern RT options (partial breast irradiation, hypofractionation), as well as recent evidence pointing towards more extensive radiotherapy, demand introduction of biological features into clinical trials to improve therapeutic decisions. Open questions, such as tailoring of irradiation after neo-adjuvant chemotherapy in complete responders and the understanding of the interplay between local control, systemic recurrence and survival given modern systemic treatments, need to be addressed under the prism of biology within this heterogeneous disease. Intrinsic radiobiological properties within this heterogeneity need to be highlighted in order to further improve outcomes.