Breast Cancer Between Radiomics and Adaptive Radiotherapy

Abstract Manuscript Information The breast is a complex structure located between the chest wall and the skin. It consists mainly of glands and adipose tissue. The mammary glands, called lobules, join together to form lobes. In one breast there can be 15 to 20 such lobes. Breast cancer is a potentially serious disease caused by the uncontrolled growth of certain cells within the breast gland, which become malignant and have the potential to spread to surrounding tissues and, over time, to distant organs. In theory, all cells in the breast can give rise to a tumor. In most cases, breast cancer is caused by glandular cells (lobules) or those that form the wall of the ducts. In Italy, breast cancer is the most common neoplasm, representing 30.3% of all cancers affecting women and 14.6% of all cancers diagnosed. Although the incidence has increased, especially in younger women, mortality is decreasing, with a 6% reduction in 2020 compared to 2015. Breast cancer remains the leading cause of cancer death in women. Breast cancer treatment has undergone significant changes over time. Years ago, the standard approach was a complete mastectomy, which involved removing the entire breast gland. However, at the end of the 20th century, the surgeon U. Veronesi demonstrated the effectiveness of quadrantectomy, which involves the surgical removal of only the quadrant affected by the disease, preserving a large part of the breast tissue. This is a conservative approach linked to the use of radiotherapy to treat any microscopic residues. Continuous studies have shown that patients treated with mastectomy and those who underwent quadrantectomy had similar rates of recurrence. Today, conservative surgery is widely used and requires a personalized approach for each patient. The removal of the axillary lymph nodes occurs only in case of positivity, and mastectomy is limited to cases in which it is strictly necessary. Radiotherapy targeted to the breast affected by the lesion reduces the risk of recurrence. These advances in the diagnosis and treatment of breast cancer demonstrate how much medicine is advancing in the management of this disease