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 keyopinionleaders. 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.

AIRO breast caner group "Best Clinical Practice" 2022 update / Ciabattoni, Antonella; Gregucci, Fabiana; De Rose, Fiorenza; Falivene, Sara; Fozza, Alessandra; Daidone, Antonio; Morra, Anna; Smaniotto, Daniela; Barbara, Raffaele; Lozza, Laura; Vidali, Cristiana; Borghesi, Simona; Palumbo, Isabella; Huscher, Alessandra; Perrucci, Elisabetta; Baldissera, Antonella; Tolento, Giorgio; Rovea, Paolo; Franco, Pierfrancesco; Carmen De Santis, Maria; Di Grazia, Alfio; Marino, Lorenza; Meduri, Bruno; Cucciarelli, Francesca; Aristei, Cynthia; Bertoni, Filippo; Guenzi, Marina; Cristina Leonardi, Maria; Livi, Lorenzo; Nardone, Luigia; De Felice, Francesca; Elena Rosetto, Maria; Mazzuoli, Lidia; Anselmo, Paola; Arcidiacono, Fabio; Barbarino, Rosaria; Martinetti, Mariateresa; Pasinetti, Nadia; Desideri, Isacco; Marazzi, Fabio; Ivaldi, Giovanni; Bonzano, Elisabetta; Cavallari, Monica; Cerreta, Vincenzo; Fusco, Vincenzo; Sarno, Laura; Bonanni, Alessio; Mangiacotti, Mariagrazia; Prisco, Agnese; Bonfrate, Giovanna; Andrulli, Damiana; Fontana, Antonella; Bagnoli, Rita; Marinelli, Luca; Reverberi, Chiara; Scalabrino, Giovanna; Corazzi, Francesca; Doino, Daniela; Di Genesio Pagliuca, Milena; Lazzari, Mariagrazia; Mascioni, Francesca; Paola Pace, Maria; Mazza, Mirko; Vitucci, Pasquale; Spera, Antonio; Macchia, Gabriella; Boccardi, Mariangela; Evangelista, Giovanna; Sola, Barbara; Rosa La Porta, Maria; Fiorentino, Alba; Giay Levra, Niccolo; Ippolito, Edy; Silipigni, Sonia; Osti, Mattia Falchetto; Mignona, Marcello; Alessandro, Marina; Anna Ursini, Lucia; Nuzzo, Marianna; Meattini, Icro; D'Ermo, Giuseppe. - In: TUMORI. - ISSN 0300-8916. - (2022), pp. 1-144.

AIRO breast cancer group Best Clinical Practice 2022 update

Francesca De Felice;Mattia Falchetto Osti;Giuseppe D'Ermo
Ultimo
Membro del Collaboration Group
2022

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 keyopinionleaders. 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.
File allegati a questo prodotto
File Dimensione Formato  
Ciabattoni_postprint_AIRO brest cancer_2022.pdf

accesso aperto

Tipologia: Documento in Post-print (versione successiva alla peer review e accettata per la pubblicazione)
Licenza: Tutti i diritti riservati (All rights reserved)
Dimensione 3.46 MB
Formato Adobe PDF
3.46 MB Adobe PDF Visualizza/Apri PDF

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1635563
Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 1
  • ???jsp.display-item.citation.isi??? 3
social impact